The effect of white noise and swaddling methods on preterm newborns pain perception related to orogastric tube insertion

Preterm newborns are subjected to various interventions that are medically necessary but are known to cause a pain response during their time under medical treatment and care. Since they are known to be more vulnerable to pain and stress, interventions to control pain developing due to invasive procedures on preterm newborns are important. This study was conducted to evaluate the effectiveness of using both white noise and swaddling methods alone or in combination in reducing the pain associated with orogastric tube (OGT) insertion, a procedure frequently performed in preterm newborns. This double-blinded randomized controlled trial design study was carried out with a total of 132 preterm newborns, receiving treatment and care in the neonatal intensive care unit (NICU) of a private hospital in Uşak, between 01/01/2021 and 01/05/2022. In this study, which consisted of 4 groups, three of which were intervention and one control group, preterms who had the interventions of white noise, swaddling, and white noise+swaddling created the intervention groups whereas those who did not have any intervention formed the control group. Preterm Newborn Information Form, Preterm Newborn Follow-up Form, and Premature Infant Pain Profile-Revised (PIPP-R) were used as the data collection tools in the study. Analysis of the study data was completed by using the SPSS version 22.0 (Armonk, NY: IBM Corp) package program. While the mean duration of stay in the NICU of the preterm newborns included in the study was 8.77±5.35 days, the mean postnatal age was 8.11±5.30 days, and the mean duration of feeding with OGT was 7.65±5.25 days, the preterms in the intervention and control groups were determined to have similar descriptive characteristics, and there was no significant difference between the groups (p>0.05). The group effect (p=0.376; p=0.465, respectively) and the group-by-time interaction (p=0.581; p=0.313, respectively) were found not to be statistically significant in terms of maximum heart rate and minimum oxygen saturation values measured at 7 different times including before the OGT insertion procedure (5th min., 3rd min., 1st min.), during the procedure and after the procedure (1st min., 3rd min., 5th min.). However, the main effect of time on the maximum heart rate and minimum oxygen saturation values was statistically significant (p<0.001). While a statistically significant difference was found between the groups for the mean pain scores of preterm newborns obtained at 7 different times with the PIPP-R scale (p=0.001), the mean total PIPP-R scores of the preterms in the swaddling group and the white noise + swaddling group were significantly lower than the control group. Furthermore, for the PIPP-R values measured at 7 different times, the main effect of time was found to be statistically significant (p<0.001), while the mean PIPP-R scores obtained during and after the procedure were determined to be significantly higher than the pre-procedure scores. According to the findings of the multiple logistic regression model created by using the generalized estimating equation method in order to determine the predictors of pain due to insertion of the OGT, gender, gestational age, and postnatal age did not have a significant effect on pain (p>0.05). In regards to the effect of intervention methods on pain, when the control group was taken as reference, the swaddling was determined to be associated with 0.587 times less pain, and the white noise + swaddling was associated with 0.473 times less pain, however, the white noise alone did not have a significant effect on pain (p=0.326). Moreover, white noise intervention was determined not to have a significant effect on pain, while preterm newborns were found to experience 348,183 times more pain during the procedure. As a result of this study, it was concluded that insertion of OGT is a procedure causing pain in preterm newborns and that the swaddling intervention alone and the combination of white noise and swaddling can help to control the pain associated with the insertion of OGT whereas the effects of white noise on pain control associated with the insertion of OGT need further investigation. Keywords: Pain, White Noise, Orogastric Tube, Preterm, Swaddling.