Background: Heelstick is the traditional method for blood sampling in neonates. Studies indicate that neonates suffer pain from heel stick. However, there is no data comparing pain response from an alternative method of blood sampling such as venepuncture.Objective: To compare pain response, adverse effects in neonates, and maternal anxiety for different methods of blood sampling.Methods: 27 term neonates were enrolled and randomised to receive venepuncture(n=13) or heelstick (n=14). Pain assessments were made using a validated scale, Neonatal Infant Pain Scale (NIPS), at baseline, during and after the procedure. Mothers rated infant's pain using a 3-point scale. The number of pricks required, reason for multiple attempts, and adverse effects if any at the site of the puncture were noted. NIPS scores were compared between groups using Student's t-test. Demographic characteristics were evaluated using the Fisher's exact test or Student's t-test. Results: No difference was noted in the demographic characteristics and NIPS score before and after the procedure. During the procedure, NIPS score was higher in the heel-stick(5.2±1.48) compared to the venepuncture group(2.8±1.57), p<0.001.Mother's anxiety before the procedure was higher for the venepuncture (2.2±0.7) compared to heelstick group(1.4±0.5), p<0.001. However, mothers of infants who received venepuncture rated their infants' pain lower(1.6±0.5) than those in the heelstick group (2.4±0.5), p<0.001. 4 neonates in heelstick and 1 in venepuncture group had a repeat sample for insufficient volume or haemolysis. Bruising was noted on the heel in 1 neonate. Table Conclusion: Venepuncture was associated with less pain than heelstick as assessed by the NIPS score and as perceived by mothers. We recommend that venepuncture should be used more frequently for blood sampling in term infants.

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