Pain and Comfort Levels During Heel Stick Blood Sampling in Newborns

The study was designed as a randomised controlled trial to determine the effect of Buzzy® and Shotbloker® application on pain and comfort levels in newborns during heel prick blood sampling.

Materials and Methods Setting After obtaining ethical committee approval, the study will be conducted with babies admitted to the Neonatal Unit of Samandağ State Hospital between March and December 2025.

Sample According to the power analysis performed for the sample size, the power of the sample was calculated using the G*Power 3.1 programme in line with the literature. With a Type I error rate of 0.05 and a test power of 0.80 (α = 0.05, 1-β = 0.80), the minimum sample size (with 53 newborns in each group) was calculated to be 159.

Data Collection In the study, babies brought to the Neonatal Unit for heel prick blood sampling will first be evaluated according to the sampling criteria, and those who do not meet the criteria will be excluded from the study. The nurse researcher herself will collect the data, evaluate it using the NIPS pain scale and the Neonatal Comfort Behaviour Scale, collect the heel blood, and administer the Buzzy® and Shotbloker® applications. To ensure consistency in the application, heel blood will be collected from the left lateral foot of all infants included in the study by the same nurse.

Application Before the heel prick procedure, the room will be well lit and warm to ensure that the babies are comfortable. Babies in the Buzzy, Shotbloker, and control groups who meet the sample criteria will first be examined by a paediatrician, and if there are no contraindications for heel pricking, their parents will be informed about the study and their verbal and written consent will be obtained, after which the data collection form will be completed. The 'Baby Information Form' will be completed by the researcher before the heel pricking procedure. Immediately afterwards, the infant's physiological parameters (pulse, SpO2) will be measured, and the infant's pain and comfort will be assessed by the researcher using the NIPS Scale and YDKÖ. All infants participating in the study will be held in their mothers' arms during the heel prick procedure.

Before taking blood, the nurse will clean the skin with 70% isopropyl alcohol and wait for it to dry. Blood will be taken from each baby using a single sterile lancet, and the first drop of blood will be wiped away. Then, a blood sample will be taken from one side of the Guthrie card, covering the entire marked area. The blood sample will be taken so that bloodstains of equal size are visible on both sides of the blood collection paper. In this way, each of the five marked areas will be filled. During blood collection, the blood collection paper will not be pressed, and the heel will not be squeezed excessively to prevent haemolysis or dilution (thinning) of the blood with tissue fluid. All heel blood samples will be collected on standard blood sample paper containing five circles. After heel blood collection, the researcher will measure the physiological parameters of the babies in the Buzzy group, Shotbloker group, or control group a second time and record their pain and comfort assessments.

STATISTICAL ANALYSIS The data obtained within the scope of the research will be evaluated using the Statistical Package For Social Science (SPSS) 22.0 software package. The Chi-square Fisher's exact test will be used to determine the homogeneity between groups, the Independent Groups t-test will be used to determine whether the difference between groups is statistically significant, and the One-Way Analysis of Variance will be used to determine which group the difference originates from using the Bonferroni test.

One-Way Analysis of Variance will be used to determine whether the difference is statistically significant between groups, and the Bonferroni test will be used to determine which group the difference originates from. A significance level of 0.05 will be used, and if p<0.05, a significant difference will be determined, and if p>0.05, no significant difference will be determined.

Inclusion criteria

• The baby must be full-term (38-42 weeks),
• No analgesic administration up to 8 hours prior to the procedure,
• No pain prior to the procedure,
• No chronic or metabolic disease,
• Born at least 24 hours prior,
• Being in the hospital during the study period

Exclusion criteria

• The baby is not full-term,
• Analgesic medication has been administered within 8 hours prior to the procedure,
• The baby has a chronic or metabolic disease,
• The baby requires oxygen support,
• The baby cannot be fed orally,
• The baby is not in the hospital on the dates the study will be conducted and the parents do not agree to participate in the study.