Comparative Effectiveness of Non-Pharmacological Pain Management Interventions in Neonates: A Cross- Sectional Observational Study

Background: Neonates in intensive care units undergo numerous painful procedures. Non-pharmacological interventions offer safe approaches to reduce procedural pain, but comparative studies evaluating their relative effectiveness are limited, particularly in low-resource settings. Methods: We enrolled 240 neonates requiring heel lancing for blood glucose monitoring. Neonates were allocated to three intervention groups: breastfeeding, kangaroo mother care (KMC), and oral dextrose. Pain was assessed using the Neonatal Infant Pain Scale (NIPS) at baseline and at 2, 10, and 120 seconds post-procedure. Results: All three interventions effectively reduced procedural pain. Mean NIPS scores at 2 seconds were 2.17±1.76 for breastfeeding, 2.29±1.69 for KMC, and 2.61±1.72 for oral dextrose group (p=0.25). Complete pain relief (NIPS=0 at 10 seconds) differed significantly across groups: 83.8% for breastfeeding, 78.8% for KMC, and 65.0% for oral dextrose (p=0.016). However, after adjusting for age and birth weight, KMC showed lower pain scores than breastfeeding, though the difference was not significant. Conclusion: All three non-pharmacological methods were effective in reducing procedural pain. Between-group differences in mean pain scores were not statistically significant. These methods offer safe, accessible options for procedural pain management in neonates.