Babies born before the thirty-seventh gestational week are called preterm or premature. Most preterm newborns require Neonatal Intensive Care Unit (NICU) care depending on their gestational age and clinical condition. Although many painful invasive procedures are usually performed on newborns in the NICU, the most common procedure is heel prick. Heel prick is a painful and stressful procedure for the newborn. Neonates do not respond to pain verbally; they respond physiologically, behaviorally and hormonally. Physiologic responses of preterm infants to pain include increased heart and respiratory rate, increased blood pressure and intracranial pressure, decreased oxygenation, and sweating of palms. Among the hormonal symptoms caused by stress in newborns, the most commonly used biochemical method is the measurement of cortisol level. It is reported that there is a significant correlation between salivary and plasma cortisol levels and salivary cortisol level reflects plasma cortisol level. This method is particularly preferred because saliva sampling is much less stressful.
Mother 18 years of age or older
Mother is literate
Whether the mother gives birth naturally or by caesarean section
Uncomplicated pregnancy and birth history in mother
The baby has a fever
The baby receiving oxygen therapy,
The baby receiving antibiotic treatment
The baby has a congenital anomaly
Parallel
pacifier with breast milk
Other interventionswaddling in the mother\'s lap together with giving a pacifier dipped in breast milk
heel heating
Other interventionswaddling in the mother\'s lap together with local dry heat application
interventions combined
Other interventionswaddling in the mother\'s lap together with giving a pacifier dipped in breast milk and heel heating
Control
Other interventionswaddling the baby in the mother\'s lap
Cardiac apex beat (HRV)
HRV will be evaluated before, during and after the heel blood collection. Each baby will be video recorded for 7-10 minutes before, during and after the procedure by the researcher.
Oxygen saturation (SpO2)
SpO2 will be evaluated before, during and after the heel blood collection. Each baby will be video recorded for 7-10 minutes before, during and after the procedure by the researcher. SpO2 will be recorded from this video recording.
Crying time
The baby crying time will be monitored and recorded 5 minutes before the heel prick and 5 minutes during the heel prick
Premature Infant Pain Profile Scale (PIPP-R)
The PIPP-R scale includes 3 behavioral (frowning, squeezing eyes, nasolabial groove), 2 physiological (heart rate and oxygen saturation) and 2 contextual (behavioral state and gestational age) items. In the scoring of the scale, items related to physiological and behavioral items are scored as 0,1,2,3 in each variable, reflecting the difference between baseline and treatment values. Items related to contextual items are scored as 3,2,1,0 before touching the baby. The babys pain is evaluated on a total score. Accordingly, the maximum score for newborns is 21. If the premature infant pain profile is between 0-6 points, the pain level in the infant is mild, between 7-12 points is moderate, and between 13-21 points is severe pain. Each baby will be video monitored and recorded for 7-10 minutes before, during and after the procedure. This video recording will be evaluated and recorded according to the Premature Infant Pain Profile Scale.
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