The effect of pacifier use on stress and bilirubin levels during phototherapy in newborns with hyperbilirubinemia

Introduction: Newborns receiving phototherapy for hyperbilirubinemia may experience stress due to hospitalization, exposure to invasive procedures during treatment, and the need to stay in separate phototherapy beds from their mothers, except for feeding, to avoid interruptions in phototherapy. Pacifiers offer numerous benefits for newborns, including reducing stress, calming, stimulating oromotor movements, and facilitating the secretion of enzymes and hormones responsible for digestion. Aim: Given that pacifiers reduce stress in newborns, calm them, and facilitate the secretion of digestive enzymes and hormones that facilitate defecation, this study aimed to investigate the effects of pacifier use on stress, physiological symptoms (HR, SpO2, bowel sounds, bowel frequency), and bilirubin levels during phototherapy in newborns with hyperbilirubinemia. Method: The study, conducted with a randomized-controlled design, consisted of 60 term newborns diagnosed with hyperbilirubinemia (experimental group=30 infants; control group=30 infants). Data were collected at the Neonatal Intensive Care Unit of Ankara University Faculty of Medicine between June 2023 and September 2024. Babies who received 18 hours of phototherapy were given a pacifier every 3 hours for 5 minutes to assess their stress levels, HR and SpO2 levels, bowel sounds, number of bowel movements, and bilirubin levels. The babies' stress levels were assessed using the Neonatal Stress Scale (NSS), HR and SpO2 levels were assessed using a pulse oximeter, and bowel sounds were assessed using a stethoscope by an observing nurse. The number of bowel movements was observed and recorded by the researcher each time the mother changed the baby's diaper. The babies' bilirubin levels were measured and recorded by intravenous blood samples taken before the babies received phototherapy and after the babies completed their phototherapy procedures, as per the clinician's routine instructions. Results: The study found that pacifier given infants had lower stress and HR levels, and had higher bowel sounds and bowel movements than pacifier infants (p<0.05). The decreases in SpO2 and bilirubin levels were similar in newborns given pacifiers and those not given pacifiers (p>0.05). Conclusion: It was determined that pacifiers reduced infants' stress during phototherapy, increased bowel sounds and bowel movements, and had no effect on SpO2 or bilirubin levels