Approximately 8% of all infants are born preterm. The majority of these infants are hospitalized in Neonatal Intensive Care Units (NICU)s where they undergo frequent painful therapeutic and diagnostic procedures. Infants who are the most preterm and/or sick are usually subjected to the greatest number of procedures and are the most vulnerable to their consequences. Minimal attention has been paid to the pain produced by therapeutic procedures or its consequences. However, frequent episodes of physiologic instability and behavioral disorganization in vulnerable infants have been associated with heightened pain sensitivity, increased neonatal morbidity and delays in healing and growth. The overall objective of this randomized crossover study is to compare the efficacy of three treatment, (positioning and non-nutritive sucking [with water and sucrose]) and one control intervention in relieving procedural pain and promoting behavioral state organization in premature infants. It is hypothesized that the treatment interventions will support the infants' own adaptive behaviors and minimize pain and stress. A secondary objective is to determine the moderating influence of gestational age, days of life, severity of illness and the frequency of therapeutic procedures on pain responses and behavioral state. The findings of this study will be significant in extending the substantive knowledge undergirding nursing practice with preterm neonates and specifically in testing the relative efficacy of safe, non-invasive, inexpensive, nonpharmacological means of relieving pain.
