Stefano Bembich1, Gabriele Cont1, Sergio Demarini1
1) Italy
Breastfeeding analgesia is associated with a widespread neonatal cortical activation. However, the differential contribution of breastfeeding components, such as breast milk or holding, to cortical activation is not clear. We aimed to assess the differential effects of breast milk and maternal holding on neonatal cortical activation during a painful procedure.
We enrolled 60 healthy term newborns undergoing a routinely required heel-prick. Cortical activation was assessed by multichannel near-infrared spectroscopy (NIRS), which detects changes in cortical oxy-haemoglobin (HbO2). Parietal, temporal and frontal lobes were monitored. Participants were randomly assigned to three different non-pharmacologic analgesic conditions (N=20): a) 2 ml of oral breast milk were given two minutes before heel-prick, performed on a changing table; b) newborns were held in mother’s lap since two minutes before heel-prick and throughout the procedure; c) newborns were held in mother’s lap and breastfed since two minutes before heel-prick and throughout the procedure. NIRS data was analyzed by t-test and HbO2 increase during heel-prick was considered an estimate of cortical activation. Pain expression was also assessed.
Oral breast milk was associated with activations localized, bilaterally, in the somatosensory and motor cortex (p<0.01). Maternal holding was associated with an activation of left posterior parietal cortex and right posterior-inferior frontal cortex (p<0.01). Breastfeeding was associated with an extended bilateral activation of the somatosensory and right posterior parietal cortex (p<0.01). By U Mann-Whitney test, breastfeeding showed to be more analgesic than oral breast milk (p=0.026).
Breast milk and maternal holding analgesia showed a less extended neonatal cortical activation than breastfeeding. However, breast milk and maternal holding exhibited a different cortical response pattern to pain. As analgesic, breastfeeding showed to be more effective than breast milk. Thus, maternal holding seems an important component of breastfeeding analgesic effect, and it also possibly relates to the widespread cortical activation observed during breastfeeding.
