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Vibhuti Shah, MD, MRCP(UK); Anna Taddio, BScPhm, MSc, PhD; Karthik Kulasekaran, MD; Lisa O'Brien, BSc; Esther Perkins, CNE; Edmond Kelly, FRCPC

Arch Pediatr Adolesc Med. 2003;157:1075-1078.

Objective  To evaluate 2 heel lancet devices in terms of pain response and success of the procedure in neonates undergoing the newborn screening test.

Design  Randomized trial.

Setting  Tenth level, mother-and-baby unit of a university-affiliated hospital.

Patients  Eighty term neonates.

Interventions  Heel lance using either the BD Safety-Flow lancet (SF) or the BD QuikHeel lancet (QH).

Main Outcome Measures  Facial grimacing score (brow bulge, eye squeezed shut, and nasolabial furrow [range, 0%-100%]), cry duration, duration of the procedure, and number of punctures required to collect the blood.

Results  Forty neonates were enrolled in each group. There were no differences in the demographic characteristics between groups. During the first skin puncture, the median score (25th-75th percentile) for facial grimacing was 100% (76%-100%) for the SF compared with 73% (42%-100%) for the QH (P = .02). For cry duration, it was 6 seconds (0-9 seconds) vs 0 seconds (0-6 seconds), respectively (P = .01). Pain scores during blood collection (ie, squeezing) did not differ between groups (P = .09). The procedure took less time to perform in the QH group (140 seconds [90-236 seconds]) than in the SF group (215 seconds [137-314 seconds]) (P = .02). The total crying time was shorter in the QH group (90 seconds [66-196 seconds] vs 148 seconds [92-267 seconds]; P = .03). Thirty-six (90%) of the neonates in the QH group received 1 puncture for blood collection compared with 21 (53%) in the SF group (P<.001).

Conclusion  The BD QuikHeel lancet is superior to the BD Safety-Flow lancet for blood collection in term neonates undergoing the newborn screening test.

From the Departments of Paediatrics (Drs Shah and Kelly) and Nursing (Ms Perkins), Mount Sinai Hospital, Toronto, Ontario; Faculty of Medicine (Drs Shah and Kelly) and Graduate Department of Pharmaceutical Sciences, Faculty of Pharmacy (Ms O'Brien), University of Toronto; Research Institute and Neonatal Intensive Care, Department of Pharmacy, The Hospital for Sick Children, Toronto (Dr Taddio); and Department of Neonatology, The Hospital for Sick Children (Dr Kulasekaran).

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