The Effect of Modulating Environmental Stimuli on Pain Experience in Premature Infants During Peripherally Inserted Central Catheter-port Implantation

Premature infants in neonatal intensive care units are exposed to painful experiences due to various procedures, and effectively and safely pain relief is the responsibility of nurses. Due to their harmful effects on the neural development of premature infants, reducing environmental stimuli such as light and sound is one of the essential pillars of caring for these infants. 

This study aimed to determine the effectiveness of modulation of environmental stimuli on pain caused by peripherally inserted central catheter (PICC) placement in preterm infants.

This controlled trial study was conducted on 60 infants receiving PICC-port implantation. The infants who met the inclusion criteria were selected by random sampling. Then, they were randomly placed in an intervention or control group (30 in each group). The sound and light were reduced in the intervention group using earmuffs and eye shields. When implanting a central venous catheter, the pain amount was measured using the premature infant pain profile (PIPP) instrument. The control group measured neonatal pain without light and sound reduction. The data were recorded for statistical tests using the independent t-test, chi-squared test, and Fisher exact test.

Most of the studied neonates were female (56.6%) and analysis of covarianse. The total number of newborns who were candidates to receive a PICC-port was 80, of whom 60 were included in the study. The neonates have no surgery and congenital anomalies. Both genders were included in this study; 24.6% of them suffer from respiratory distress syndrome and prematurity simultaneously. The Mean±SD scores of pain were 9.37±3.15 in the intervention group and 12.63±2.19 in the control group. The independent t-test showed no significant difference between the two groups regarding demographic characteristics before the intervention. The mean score of PIPP after the intervention was significantly less in the intervention group than in the control group (P=0.001). According to the results of the analysis of covariance, adjusting the environmental stimuli of light and sound was effective on the pain level of the neonate during PICC implantation with an effect size of 0.917.

Environment modifications are effective, inexpensive, accessible, and safe methods during PICC placement for premature infants in the neonatal intensive care unit and should be used to promote neonatal outcomes in terms of the neural development of the infant.