Does Noninvasive Electrical Stimulation of Acupuncture Points (NESAP) Reduce Heelstick Pain in Infants?

A collaborative prospective, double-blind, randomized trial will be performed at the
University of Arkansas for Medical Sciences Hospital (Little Rock, AR), and Lucille Packard
Children's Hospital (Palo Alto, CA). After obtaining IRB approval at both sites and parental
consent, newborn infants less than 3 days of age who require heelsticks for clinical blood
sampling will be randomized in a 2 × 2 factorial trial design to four groups: standard pain
management with pacifier and water, Non−invasive Electrical Stimulation of Acupuncture
Points (NESAP) with pacifier and water, 24% oral sucrose solution with pacifier, or NESAP
plus oral sucrose solution and pacifier prior to their heelstick.

We will study the pain response to the heelstick routinely used to obtain blood for term
neonatal infants by enrolling up to 192 infants, 96 from University of Arkansas for Medical
Sciences and 96 from Lucille Packard Children's Hospital. This number will allow for screen
failures and withdrawals. A minimum of 164 infants collectively from both sites is required
to complete the study. Infants will be divided into 4 experimental groups:

1. Group A: Sham (fake electrical stimulation) plus sugar water with pacifier before
heelstick.

2. Group B: Electrical stimulation plus water with pacifier before heelstick.

3. Group C: Electrical stimulation plus sugar water with pacifier before heelstick.

4. Group D: Sham (fake electrical stimulation) plus water with pacifier before heelstick.

Electrical stimulation will be applied at appropriate acupuncture points using a very low
current for 10 minutes, routine for procedural pain. The response to pain will be assessed
using a pain scale, heart rate, heart rate variability and oxygen saturation changes,
duration of crying, and changes in salivary cortisol levels.

Inclusion Criteria:

- Newborn infants born at 37-42 weeks gestational age

- Less than 3 days of age

- Requiring a heelstick for clinically indicated blood sampling

- Written, informed consent from their parents.

Exclusion Criteria:

- Newborns who have received any analgesic treatment

- Exposed to chronic opiates in utero (excluding opiates given only at the time of
delivery) or with a positive drug screen based on review of medical records.

- Current maternal cigarette smoking.

- Infants exposed to birth asphyxia (5-minute Apgar scores of <5 or cord pH <7.0).

- Infants on mechanical ventilation.

- Newborns with suspected or confirmed neuromuscular diseases, congenital anomalies, or
sepsis.

- Infants with birth trauma to the lower extremities (bruising or other) or those
exposed multiple heelsticks in the previous 24 hours (e.g. requiring frequent glucose
or bilirubin measurements).

- Infants born from mothers with drug addiction, diabetes, pre-eclampsia, or systemic
inflammatory conditions.

- Abnormal neurological exam

- Congenital heart defects

- Enrollment or participation in other studies

- Dermatologic condition in the area of electrode placement or elsewhere

- Local or systemic infection documented or suspected

- Reasonable known allergy to the gel/adhesive

- Bleeding abnormality

- Connection to other medical equipment or devices that might interfere with the
workings or functioning of the transcutaneous electrical nerve stimulation (TENS)
unit

- Any condition the investigator determines will put the subject at risk if
participating in the study.