Iranian Journal of Neonatology

Iranian Journal of Neonatology

Comparing the Effectiveness of Local Heat and Foot Massage in Reducing the Pain Caused by Heel Blood Sampling in Neonates

Document Type : Original Article

Authors
Reyhaneh Barzegari 1
Seyed Hamid Seyed Bagheri 2
Hassan Khodadadi 3
Tabandeh Sadeghi 2
1 Student Research Committee, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2 Department of Pediatric Nursing, School of Nursing and Midwifery; Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
3 Department of Pediatric Nursing, School of Nursing and Midwifery; Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
10.22038/ijn.2025.80268.2547
Abstract
Background: Given the inevitability of heel blood sampling for thyroid testing in neonates, this study aimed to compare the effectiveness of local heat and foot massage in reducing pain caused by the procedure.
Methods: This experimental study was conducted on neonates admitted to a healthcare center for thyroid testing in Rafsanjan, southeast Iran. Neonates were selected through convenience sampling and randomly assigned to one of three groups: foot massage, local heat, or control. In the foot massage group, the outer part of the neonates' heel was massaged for three minutes before blood collection. In the local heat group, the neonates’ heel was heated to 40 °C for 3 minutes using a hair dryer before blood sampling. No specific intervention was performed in the control group. The Neonatal Infant Pain Scale (NIPS) was used to measure pain intensity. Data were analyzed using SPSS software.
Results: Data analysis revealed a statistically significant difference between the mean pain scores in the local heat group and the control group (P<0.001), as well as between the massage group and the control group (P<0.001). However, there was no significant difference in mean pain scores between the massage and local heat groups (P=0.83).
Conclusion: The findings suggest that both local heat and foot massage interventions are effective in reducing pain caused by heel blood sampling. Therefore, either method can be used for pain reduction depending on the neonates’ condition.
Keywords
Heel blood sampling
Local heat
Foot massage
Neonates
Pain
  1. Ameen SK, Alalaf SK, Shabila NP. Pattern of congenital anomalies at birth and their correlations with maternal characteristics in the maternity teaching hospital, Erbil city, Iraq. BMC Pregnancy Childbirth. 2018;18(1):8.
  2. Bowden S, Goldis M. Congenital Hypothyroidism. StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/books/NBK279022/.
  3. Yarahmadi S, Azhang N. National screening program for hypothyroidism in newborns; Special instructions for the health care provider. 2016.
  4. Peikani S, Nasiri N, Yaghoobi H, Bastam D, Doost Mohammadi F, Vahedian Shahroodi M. The prevalence of congenital hypothyroidism in newborns referred to Shahid-Ghodsi Health Center, Mashhad, Iran. Sci J School Public Health Inst Public Health Res. 2019;16(4):363–372.
  5. Antonovsky A. The sense of coherence: An historical and future perspective. Stress, Coping Health Fam. 2020;25(10):3–20.
  6. Yarahmadi S, Ajang N, Sayari A, Koosha A. National screening program for neonatal hypothyroidism. 1st ed. Tehran: Mojasameh; 2017.
  7. Yilmaz D, Yilmaz Kurt F. The effect of foot reflexology on procedural pain before heel lancing in neonates. Arch Pediatr. 2021;28:278–284.
  8. Haukkala A, Konttinen H, Lehto E, Uutela A, Kawachi I, Laatikainen T. Sense of coherence, depressive symptoms, cardiovascular diseases, and all-cause mortality. Psychosom Med. 2013;75(4):429–435.
  9. Van Dam NT, Sheppard SC, Forsyth JP, Earleywine M. Self-compassion is a better predictor than mindfulness of symptom severity and quality of life in mixed anxiety and depression. J Anxiety Disord. 2011;25(1):123–130.
  10. Rafati S, Rejeh N, Tadrisi S, Karimi M, Molodi A. Effect of massage on physiological pain responses of blood sampling in neonates. Nurs Res. 2015;11(2):45–53.
  11. Koc T, Gozen D. The effect of foot reflexology on acute pain in neonates: A randomized controlled trial. Worldviews Evid Based Nurs. 2015;12(5):289–96.
  12. Wiklund Gustin L, Wagner L. The butterfly effect of caring–clinical nursing teachers’ understanding of self‐compassion as a source to compassionate care. Scand J Caring Sci. 2013;27(1):175–183.
  13. Sajjadi M, Basirimoghaddam M, Tatari M, Shadmehri A. The effect of non-nutritive sucking on physiological and behavioral pain responses caused by first turn hepatitis B vaccine in term neonates. J Birjand Univ Med Sci. 2017;24(1):1–9.
  14. Breines JG, Chen S. Self-compassion increases self-improvement motivation. Pers Soc Psychol Bull. 2012;38(9):1133–1143.
  15. Jamshidi B, Pelarek F. Investigating the effect of baby skin-mother skin contact on infant pain: A systematic review. Student Congress; Dezful; 2020. Available from: https://civilicacom/doc/1145730.
  16. Takeuchi T, Yamazaki Y. Relationship between work–family conflict and a sense of coherence among Japanese registered nurses. Jpn J Nurs Sci. 2010;7(2):158–168.
  17. Astuti I, Wijayanti K, Nuraini L, Khasanah N, Susanto H. Effects of cold compress on the heguous point of meridian large intestine on pain before giving immunization in neonates. J Ners. 2020;14:358.
  18. Yarnell LM, Neff KD. Self-compassion, interpersonal conflict resolutions, and well-being. J Self Identity. 2013;12(2):146–159.
  19. Saeeidi KS, Abolghasemi A, Akbari B. The role of sense of coherence, alexithymia and self-compassion in predicting psychological well-being in girl with primary dysmenorrhea. Razi J Med Sci. 2018;25(8):33–42.
  20. Ghaffari M, Esmali A, Atashgir A, Hokmabadi S. Evaluation of the relationship between the sense of coherence and compassion towards the lives of others with nurses' attitudes to patient education: The mediating role of personal intelligence. Sci J Nurs Midwifery Paramedical Fac. 2018;4(2):27–38.
  21. Hosseinpour M, Samiei L, Nematolahei M. The relationship between sense of coherence and anxiety in coronary artery disease in Tabriz. J Nurs Dev Health. 2016;7(2):59–67.
  22. Ajam AA, Farzanfar J, Shokohi Fard H. The role of self-compassion in the general health and academic achievement of the nursing and midwifery students in Mashhad university of medical sciences in 2014. JNE. 2017;5(5):9–16.
  23. Mrljak R, Arnsteg Danielsson A, Hedov G, Garmy P. Effects of Infant Massage: A Systematic Review. Int J Environ Res Public Health. 2022;19:6378.
  24. Mantri S, Lawson JM, Wang Z, Koenig HG. Identifying moral injury in healthcare professionals: The moral injury symptom scale-HP. J Relig Health. 2020; 59(5):2323-2340.
  25. Malakoutikhah A, Zakeri MA, Koenig HG, Dehghan M. The psychometric properties of the Persian version of the moral injury symptoms scale-health care professionals version. Front Psychol. 2022;13:978572.
  26. Taylor C, Lynn P, Bartlett J. Fundamentals of nursing: The art and science of person-centered care. Philadelphia: Lippincott Williams & Wilkins; 2018.
  27. Malekshahi F, Aryamanesh F, Fallahi S. The effects of massage therapy on sleep quality of patients with end-stage renal disease undergoing hemodialysis. Sleep Hypn. 2018;20(2):91-95.
  28. Çelebioğlu A, Gürol A, Yildirim Z, Büyükavci M. Effects of massage therapy on pain and anxiety arising from intrathecal therapy or bone marrow aspiration in children with cancer. Int J Nurs Pract. 2015;21(6):797-804.
  29. Ghobadi Mohebi R, Baloochi Baidikhti T, Basiri Moghadam M, Delshad Noghabi A. Effect of local heat on pain intensity of heel blood sampling in term newborns. Horizon Med Sci. 2017;23(4):251-6.
  30. Sarhangi F, Mollahadi M, Ebadi A, Matinzadeh ZK, Tadrisi SD. Validity and reliability of neonatal infant pain scale in neonatal intensive care units in Iran. Pak J Med Sci. 2011;27(5):1087-1091.
  31. Mohammadpour A, Mohammadian B, Basiri Moghadam M, Nematollahi M. The effects of topical heat therapy on chest pain in patients with acute coronary syndrome: A randomised double-blind placebo-controlled clinical trial. J Clin Nurs. 2014;23(23-24):3460-3467.
  32. Dağ YS, Yayan EH, Özdemir R. The effect of massage, wipe bathing and tub bathing on physiological measurements of late premature newborns: A randomized controlled trial. J Neonatal Nurs. 2022;28(3):164-169.
  33. Özkan T, Küçükkelepçe D, Özkan S. The effects of acupressure and foot massage on pain during heel lancing in neonates: A randomized controlled trial. Complement Ther Med. 2019;46:103-108.
  34. Shu S, Lee Y, Hayter M, Wang R. Efficacy of swaddling and heel warming on pain response to heel stick in neonates: A randomised control trial. J Clin Nurs. 2014;23(21-22):3107-3114.
  35. Nurbayanti S. The effects of breastfeeding and massage on neonatus pain during intravenous blood sampling procedures. J Neonatal Nurs. 2020; 27(2):129-134.
  36. Zahed Pasha Y, Gholami S, Aziznejad Roshan P, Ashrafpour M, Akbarian Rad Z, Ahmadpour-kacho M, et al. Effect of the local heat on the pain of vitamin K injection in the neonates. Int J Pediatr. 2016;4(12):4081-4088.
  37. Sapkota P, Bhandari S, Karn B, Yadhav U. Efficacy of heel warming on pain response to heel stick in neonates. J Nepal Paediatr Soc. 2021;41(1):48-53.
  38. Herrington C, Chiodo L. Human touch effectively and safely reduces pain in the newborn intensive care unit. Pain Manag Nurs. 2014;15(1):107-115.
  39. Karamisefat M, Cheraghi F, Soltanian AR, Tehrani TH. The effect of foot massage on pain of preschoolers undergoing venipuncture: A clinical trial. Evid Based Care J. 2021;10(4):49-58.
  40. Chik YM, Ip WY, Choi KC. The effect of upper limb massage on neonates’ venipuncture pain. Pain Manag Nurs. 2017;18(1):50-57.
  41. Zardosht R, Shah Farhat A, Saeidi R, Parvin F. Assessment efficacy and complication of the distance between phototherapy lamps and neonate’s body level on serum bilirubin decrease and phototherapy complications in neonatal hyperbilirubinemia. Iran J Neonatol. 2019;10(4).

 

 

 

Iranian Journal of Neonatology
Volume 16, Issue 3
Summer 2025
Pages 68-74