Systematic ReviewResearchPatient Education

Venepuncture probably reduced pain and repeat punctures versus heel lance in term newborns without sweet solutions

The Cochrane database of systematic reviews (PubMed)Jul 17, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

An updated Cochrane review of eight randomized or quasi-randomized studies involving 826 term neonates found moderate-certainty evidence that venepuncture probably reduced procedural pain and repeat punctures versus heel lance when no sweet-tasting analgesic solution was used.

What NurseJet pulled from the source

This Cochrane review update compared venepuncture with heel lance for blood sampling in term neonates. Eight randomized or quasi-randomized studies with 826 infants were included, and overall risk of bias was judged high. Without a sweet-tasting solution, venepuncture probably reduced pain and the need for more than one puncture, based on moderate-certainty evidence. With a sweet-tasting solution, venepuncture may reduce pain, but evidence was low certainty, and the effect on repeat punctures was very uncertain. The findings depend on the analgesia context and do not replace neonatal sampling competency or pain-management protocols.

Why this matters for nurses

Pediatric and newborn nurses perform or support frequent blood sampling and assess procedural pain. This review distinguishes the evidence by sampling method and whether a sweet-tasting analgesic solution is used.

Bedside takeaway

Venepuncture probably reduced pain and repeat punctures without sweet solutions, but the evidence changes when analgesic solutions are used.

How This Applies in Practice

Use this when: Preparing to obtain a provider-ordered blood sample from a term neonate.

On your shift

Confirm the approved collection method and pain-management plan and ensure the clinician performing the procedure has the required competency.
Assess procedural pain, record the number of punctures, and escalate repeated unsuccessful attempts through the unit pathway.

Keep in mind: Do not choose a sampling or analgesia method from this review alone. Follow the neonatal protocol, facility policy, and patient-specific provider orders.

Key takeaways

The updated Cochrane review included eight studies and 826 term neonates.
Without a sweet-tasting solution, venepuncture probably reduced pain and repeat punctures versus heel lance.
With a sweet-tasting solution, pain evidence was low certainty and repeat-puncture evidence was very uncertain.
All eight studies had an overall high risk of bias, particularly around blinding and allocation concealment.

Practice implications

Before collecting a term newborn's sample, confirm the ordered test, approved collection method, staff competency, and neonatal pain-management plan. Use a validated pain assessment and document the number of punctures; escalate repeated unsuccessful attempts according to the unit pathway.

Limitations & cautions

The eight included studies had an overall high risk of bias and substantial pain-score heterogeneity. Evidence with sweet-tasting solutions was low or very low certainty, and the repeat-puncture estimate in that context was based on only 110 infants with a very wide confidence interval.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

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The Cochrane database of systematic reviews (PubMed)

The Cochrane database of systematic reviews (PubMed). Venepuncture versus heel lance for blood sampling in term neonates.

Open original source

https://pubmed.ncbi.nlm.nih.gov/42466545/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Pediatrics (PubMed)Oct 20, 2026Research Article

A randomized crossover simulation trial of 123 emergency clinicians found that real-time device feedback dramatically improved pediatric bag-valve-mask ventilation quality, increasing guideline-adherent tidal volumes from 16.2% to 87.0%.

Peds EmergencyAI summaryReview source

Research ArticleResearchQuality ImprovementPatient EducationAI summary · original source linked below

Manual bag-mask ventilation is a critical, lifesaving intervention for children suffering acute respiratory arrest, but delivery of appropriate pediatric tidal volumes without barotrauma or gastric insufflation remains challenging. In a single-anonymized, randomized crossover trial across five emergency medical services agencies in three US metropolitan areas, 123 emergency clinicians ventilated a high-fidelity manikin simulating a 3-year-old child in respiratory arrest. Participants completed two sequential 2-minute ventilation trials—one with real-time visual feedback using the EOLifeX ventilation feedback device (VFD) and one without feedback—separated by a 10-minute washout period. Real-time feedback increased adherence to age-recommended tidal volumes from 16.2% to 87.0%. Ventilation rate adherence improved from 65.0% to 88.6%, and minimal mask leak (<30%) was maintained in 88.4% of breaths with feedback compared to 80.0% without feedback.

Key takeaways

Randomized crossover simulation study evaluated 123 emergency clinicians ventilating a simulated 3-year-old toddler.
Unassisted baseline ventilation rarely met pediatric standards, with only 16.2% of breaths delivering guideline-recommended tidal volumes.
Real-time visual feedback increased guideline-compliant tidal volume delivery to 87.0% and rate adherence from 65.0% to 88.6%.
Mask seal with less than 30% leak improved from 80.0% to 88.4% when feedback was active.

Why this matters on shift

Pediatric emergency nurses and rapid response teams frequently provide manual ventilation during arrests and severe respiratory compromise. Because children have high chest wall compliance and low functional residual capacity, unguided manual bagging frequently leads to severe hyperventilation or dangerous overdistention. Objective feedback devices provide immediate visual cues that safeguard against excessive tidal volumes and erratic rates.

Bedside takeaway

In a randomized crossover study of 123 emergency clinicians ventilating a 3-year-old child manikin, real-time feedback increased guideline-adherent tidal volume delivery from 16.2% to 87.0% and rate adherence from 65.0% to 88.6%.

Nursing implications

When delivering bag-mask ventilation to pediatric patients, use two-person technique when possible to optimize mask seal, utilize volume-limiting and feedback-guided adjuncts per unit protocol, and maintain deliberate, age-appropriate ventilation rates.

Limitations & cautions

Simulation manikin model evaluating simulated respiratory arrest rather than live clinical patient outcomes; short 2-minute testing intervals may not reflect clinician physical fatigue during prolonged resuscitations.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatrics (PubMed). Prehospital Pediatric Ventilation Quality Following Use of a Feedback Device: A Randomized Study.

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Pediatrics (PubMed)Oct 1, 2026Clinical Guideline

The American Academy of Pediatrics updated its clinical practice guideline for diagnosing and managing urinary tract infections in infants and children aged 8 days to 5 years with low medical complexity.

Peds EmergencyAI summaryReview source

Clinical GuidelineGuidelineQuality ImprovementPatient EducationAI summary · original source linked below

Urinary tract infections (UTIs) occur in approximately 7% of febrile infants and represent one of the most common bacterial infections in pediatric practice. Replacing the 2011 guidance, the American Academy of Pediatrics issued an updated clinical practice guideline with three companion technical reports for children 8 days to 5 years of age with low medical complexity. Developed using the GRADE framework with evidence-to-decision panels, the update provides eight Key Action Statements (two strong and six conditional recommendations ranging from low to very low certainty of evidence) and four Good Practice Statements. Core guidance spans the diagnostic evaluation of suspected UTI, targeted antimicrobial selection and treatment duration, indications for renal and bladder ultrasound and voiding cystourethrography, prevention of structural sequelae including vesicoureteral reflux, and structured screening and treatment for bowel and bladder dysfunction.

Key takeaways

AAP updated its pediatric UTI guideline for children aged 8 days to 5 years with low medical complexity.
Formulates 8 Key Action Statements (2 strong, 6 conditional) and 4 Good Practice Statements using GRADE methodology.
Refines diagnostic sampling criteria, acute antibiotic selection, and targeted duration to minimize antimicrobial resistance.
Updates indications for renal imaging, vesicoureteral reflux evaluation, and systematic management of bowel and bladder dysfunction.

Why this matters on shift

Pediatric and emergency nurses are central to identifying febrile infants at risk for UTI, executing proper catheterized or clean-catch urine specimen collection, and guiding families through antibiotic completion and scheduled follow-up imaging. Standardizing diagnostic thresholds prevents both delayed pyelonephritis treatment and unnecessary antibiotic exposure in young children.

Bedside takeaway

AAP updated its pediatric UTI guideline for children 8 days to 5 years, delivering 8 Key Action Statements on diagnostic sampling, targeted antibiotic therapy, imaging indications, and bowel-bladder dysfunction.

Nursing implications

Collect clean catheterized urine specimens rather than bag samples for culture in non-toilet-trained febrile infants, reinforce completing prescribed antibiotic courses with parents, and assess older toddlers for withholding and bowel/bladder dysfunction during discharge education.

Limitations & cautions

Guideline applies specifically to children with low medical complexity and excludes those with neurogenic bladder, known high-grade anatomical urological anomalies, or immunodeficiency; evidence certainty for several recommendations remains low to very low.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Pediatrics (PubMed). Clinical Practice Guideline for the Diagnosis and Treatment of Urinary Tract Infection in Children From 8 Days to 5 Years of Age.

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JAMA (PubMed)Oct 13, 2026Research Article

A phase 3 double-blind randomized clinical trial of 271 pediatric and young adult sickle cell patients halted early for futility found that intravenous arginine did not shorten time to pain crisis resolution or decrease total parenteral opioid requirements compared with placebo.

Emergency PedsAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

Vaso-occlusive pain episodes represent the primary driver of emergency department visits and acute inpatient admissions in sickle cell disease (SCD). Patients frequently exhibit acute arginine deficiency during pain crises, and earlier phase 2 single-center trials suggested supplemental arginine might reduce hospital stay and opioid requirements. The multicenter phase 3 STArT trial, conducted across 10 US children's hospitals, evaluated whether intravenous arginine (200 mg/kg loading dose followed by 100 mg/kg every 8 hours) improved clinical outcomes compared to saline placebo in patients aged 3 to 21 years presenting to the ED with SCD pain requiring parenteral opioids. Among 274 randomized patients (271 received study drug; mean age 14.3 years; 51% male; 92% Black), the trial was halted early for futility. Time to crisis resolution—defined as time from initial infusion to final parenteral opioid dose—did not differ between arginine and placebo (median 60.8 hours [IQR 34.8–109.0] vs 65.8 hours [IQR 31.1–111.1]; absolute difference 7.2 hours; 95% CI -21.6 to 35.9). Secondary endpoints including cumulative parenteral opioid consumption, numeric pain scores, and safety profiles showed no significant differences.

Key takeaways

Multicenter double-blind phase 3 trial across 10 US children's hospitals enrolled 271 patients aged 3 to 21 years with severe sickle cell pain episodes.
Trial was terminated early by the data and safety monitoring board due to clinical futility.
Intravenous arginine did not shorten median time to pain crisis resolution compared with placebo (60.8 vs 65.8 hours; absolute difference 7.2 hours).
Arginine did not decrease cumulative parenteral opioid consumption or improve patient-reported pain intensity scores.

Why this matters on shift

Emergency and pediatric nurses are on the front lines of administering rapid parenteral analgesia and titrating scheduled opioids during severe sickle cell vaso-occlusive crises. Demonstrating that IV arginine confers no opioid-sparing or crisis-shortening benefit clarifies that nurses should continue prioritizing prompt evidence-based opioid titration, aggressive hydration, and individualized pain protocols.

Bedside takeaway

In a 271-patient multicenter pediatric trial halted early for futility, IV arginine did not shorten time to sickle cell pain crisis resolution (median 60.8 vs 65.8 hrs) or reduce total opioid requirements compared to placebo.

Nursing implications

Do not delay or alter standard guideline-directed parenteral opioid delivery for sickle cell pain crises in anticipation of arginine therapy, and maintain rigorous pain assessments and adverse-effect monitoring on shift.

Limitations & cautions

Trial halted prematurely for futility; enrolled cohort limited to pediatric and transitional young adult patients aged 3 to 21 years; findings may not generalize to older adult sickle cell populations.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

JAMA (PubMed). Arginine Therapy for Sickle Cell Disease Acute Pain Episodes: The STArT Randomized Clinical Trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

How This Applies in Practice

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Randomized simulation trial of 123 emergency clinicians finds real-time feedback increases pediatric bag-mask ventilation volume compliance from 16% to 87%

AAP updates pediatric UTI clinical practice guideline with 8 key action statements for children 8 days to 5 years

Phase 3 STArT trial in 271 patients finds intravenous arginine does not shorten sickle cell acute pain crises or reduce opioid requirements