Year: 2026 | Month: July-September | Volume: 11 | Issue: 3 | Pages: 120-127
DOI: https://doi.org/10.52403/ijshr.20260315
Gestational Age-Based Comparison of Pain Response to Heel Prick and Different Gauge IV Cannulation Using Premature Infant Pain Profile (PIPP) in Preterm Neonates
Krishna H Mori1, Nilamben Chavda2, Radhikaba N. Vaghela3, Kamleshkumar G Rathod4*, Bharat Muliya5
1,2,3Assistant Professor, 4Professor, 5Professor and HOD,
1,2,3,4,5Department of Pediatrics, C. U. Shah Medical College and SRSH Hospital, Surendranagar
Corresponding Author: Dr. Kamleshkumar G Rathod
ABSTRACT
Background: Procedural pain is frequently experienced by preterm neonates admitted to neonatal intensive care units. Heel prick and intravenous (IV) cannulation are commonly performed procedures, yet their relative pain burden across gestational age groups remains inadequately studied.
Methods: This hospital-based observational analytical study, conducted between September 2025 and May 2026, included 90 neonates of 28–37 weeks’ gestation (30 per group) admitted to a tertiary care neonatal unit. Neonates were categorized into three gestational age groups: 28–30 weeks, 31–34 weeks, and 35–37 weeks. Pain was assessed using the PIPP score during heel prick and IV cannulation procedures. Each neonate was observed during both procedures. Mean PIPP scores were compared between procedures using paired t-test and across gestational age groups using one-way ANOVA.
Results: Mean PIPP scores during heel prick ranged from 3.22 ± 1.09 to 3.67 ± 1.71 across gestational age groups, indicating mild pain. IV cannulation was associated with significantly higher PIPP scores, ranging from 7.93 ± 2.60 to 8.00 ± 2.35. Paired analysis demonstrated significantly higher pain scores during IV cannulation compared to heel prick (p < 0.001). One-way ANOVA showed no statistically significant difference in PIPP scores across gestational age groups for either procedure (p > 0.05). PIPP scores were significantly higher for 24G (yellow) IV cannula than for 26G (purple) cannula, indicating that using the smallest gauge cannula possible may decrease procedural pain when clinically appropriate.
Conclusion: IV cannulation causes significantly greater pain than heel prick in preterm neonates. Gestational age between 28 and 37 weeks does not significantly influence procedural pain responses. These findings highlight the need for routine pain assessment and implementation of pain-relief strategies during invasive neonatal procedures.
Keywords: Neonatal pain, PIPP score, heel prick, intravenous cannulation, preterm neonates