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Heel lancing is the most used method to obtain a blood sample in newborn and pre-term infants. The effectiveness on pain reduction of a new lancet, Tenderfoot was compared against the traditional Lancetta, randomizing 40 preterm newborns to have the heel lanced with one of the two instruments and observing overall 76 blood sampling episodes. Newborns were observed at baseline, when disinfected, during and at the end of the blood sampling procedure. Statistically different behavioural responses to the pain of the puncture were observed during the blood sampling, in the 'recovery time' after the procedure and in the number of pricks performed. When the Tenderfoot was used, less children cried during the first 5 seconds after the prick. The Tenderfoot is effective in reducing the heel prick pain, allows an easier collection of the blood, a reduction of the time necessary and of the need of squeezing the heel, therefore reducing the bruises and pain related to the squeezing itself. According to our data, its use is recommended for the obtainment of large quantities of blood, and in the severely ill newborns, that need frequent blood monitoring and several pricks. These characteristics render its use debatable because of the costs and of the bleeding for blood exams that require limited amount of blood (blood glucose, blood gas analysis) until its effects on the scarring time and outcome will be documented.

The aim of this study is the evaluation of the effect of different oral glucose solutions on the pain response after heelstick in newborns. Four groups of healthy newborns (gestational age 38-41 weeks, weight over 2500 g) were randomly allocated to receive 2 ml of water (19 cases) or glucose 5% solution (17 cases) or glucose 33% solution (15 cases) or nothing (control group, 14 cases) immediately before heelstick procedure. The cardiac rate of each newborn was registered before, during and 3 minutes after the procedure. Glucose 33% solution reduces the pain response (p < 0.01).

Fetal risk related to cordocentesis has been analyzed on a series of 222 ultrasound-guided fetal blood samplings for prenatal diagnosis of fetal diseases during the second trimester of pregnancy. Affected and malformed fetuses were excluded. Seven intrauterine deaths (3.2%) and 2 spontaneous abortions (0.9%) were observed. These figures proved higher than those observed in non-homogeneous series which consider the second and third trimester altogether. The fetal risk was significantly correlated with gestational age (less than 18 weeks 7.6% vs greater than 18 weeks 0.7% p = .02) and duration of the procedure (greater than 10'11.4% vs = less than 10'0.9% p = .0029). The number of abdominal insertions resulted in different death rates (greater than 1 ins. = 6.5% vs 1 ins. = 1.4%). It is likely that different developmental, anatomical and neurovegetative mechanism play a significant role in the risk rate found in the second trimester cordocentesis. These findings and the specific risk factors observed within the different technical conditions reported, must be taken into consideration for prenatal counseling.