Scientific studies show that even very premature newborns may experience sensation of distress which could unfavourably influence many clinical and behavioural parameters of their present and future 1. Pain control in newborns is so primary importance, also stressed by the American Academy of Paediatrics 2. The purpose of our study was comparing the analgesic effects of sucking own mother milk, versus alternative chances like caressing and/or pacifier, during routine invasive procedures in full-term newborns. The most painful routine invasive procedures in full-term newborns include venous blood sample and capillary heel stick blood sampling 3. The analgesic effect of oral glucose 24% solution 4, pacifiers 5 and skin-to-skin contact 6 have already been demonstrated. The use of sucrose and/or pacifier for analgesia may interfere with a correct beginning of breastfeeding 7, so it may be an interesting alternative to test the analgesic effect of breastfeeding during painful procedures. In a recent review by Shah PS et al 8 breastfeeding is associated with changes in heart rate, duration of cry, percentage of crying time and a decrease of measured pain. Breastfeeding instead, does not seem to be favourable, if compared with higher glucose concentrations, with regards for crying duration, PIPP score and DAN score 91011. This suggests that neonates undergoing painful procedures may be breastfed or given expressed breast milk to obtain analgesic effect. This special power of breast-sucking may be linked to relational factors (skin-to-skin contact, nearness to mother, entertainment) 1213 and to specific components of human milk like sugar 14 and triptophane 15 a melatonine precursor that enhances in neonates the production of beta endorphins 16, or the endogenous opioids like galattorphins 17. This practice may be useful for driving on breastfeeding by frequent sucking and using mother's breast for comfort.

We enlisted 200 full term healthy neonates (100 cases and 100 controls). We suggested to all mothers of completely or partial breastfed neonates the execution of metabolic screening from heel puncture during breast sucking, explaining to mothers the advantages of this practice.

The magnitude of pain in neonates was measured by DAN scale (Douleur Aigue Nouveau-nè scale – Figure 1), reckoning suffering in full-term healthy neonates by observing facial changes, limb movements and vocal expression 18. This evaluation regarded both newborns undergoing capillary heel stick for screening while breastfed and control ones, i.e. children refusing breast during puncture, or formula fed ones, or babies who's mother had refused the procedure. In control cases, analgesia was provided by caressing and/or pacifier.

Every child was taken to his own mother and the puncture was performed after minimum two minutes of effective sucking. Capillary puncture was made on the postero-lateral area of the heel, using sterile click prick lancet (the kind of lancets we used were AMES MINILET LANCETS by Bayer). Every heel puncture was performed by dedicated nurses of Neonatology Division. Every nurse was trained about enlistment of neonates, about information of mothers, and especially about evaluation of pain according the standards of Dan Scale and attended a course of pain evaluation of newborn. For every enroled newborn, was filled a form including his/her name, date of birth, gestational age, Apgar score and way of punture (while breastfeeding or pacifier) (Figure 1).

A score from 0 (no pain) to 10 (highest pain) was attributed to each child, according to the intensity of pain 319. After discharge, mothers were called to verify the outcome in breastfeeding at one month of life in the two groups. Scores obtained in the two groups were statistically analysed by χ2 test. Dates confirming homogeneity of groups were statistically compared with t-Student test. We used test for relating two proportions in feed evaluation of one month aged children.

We did not collect differences between caressing and pacifier in the control group.

Statistics data give signs of homogeneity of champions, in fact there are not elements influencing mothers in the choice of way of puncture, except for formula-fed neonates.

Our results strengthen the already well-known analgesic effect of breastfeeding. This analgesic effect may be successfully exploited for minor distressing procedures in full term healthy neonates. The choice of this easy and effective method, is useful in reducing all external interferences with a beginning of breastfeeding, while other analgesic systems such as pacifiers or sucrose might disrupt a good start at breastfeeding. Moreover, stressing the curative effects of human milk, may be an important confidence boost for mothers, hopefully rendering breastfeeding easier to pursue (regarding this point, we need a longer follow-up). In our study, doing a heel lance without sucking, does not seem to influence the kind of feeding at one month of age. In our next collection of data, we would include a further group of newborns – the ones pacified with sucrose.

In our opinion, this analgesic system may easily become a routine way of performing heel lance in maternity wards. This procedure may be suggested to available mothers of newborns who are sucking effectively, and possibly also extended to other painful minor procedures like intramuscular injection or venous puncture. Further studies might consider this method in older children, for instance during vaccination.

The authors declare that they have no competing interests.

EU and SP conceived of the study and participated in its design and coordination. AP, VA, GA, MT, AMZ, MBR, DZ, CT and MA participated in the collection of data. MV and LG carried out the analyses. MC participated in the design of the study and performed the statistical analysis. All authors read and approved the final manuscript.