The effects of manual and automatic lancet use on pain, stress, physiological parameters and crying duration during capillary heel blood collection in term neonates: a randomized controlled trial

Objective: This study aimed to investigate the effects of lancet types (manual and automatic) on pain, stress, physiological parameters and crying time during heel prick blood collection, an invasive procedure in neonates. Methods: This randomized clinical trial was conducted in a hospital located in Turkey. This study included neonates (N = 66) with a gestational age of ≥ 37 weeks and a postnatal age of < 24 h. Heel blood samples were collected from the neonates in the control group according to the procedures followed by the hospital. Unlike the control group, an automatic lancet was used instead of a manual lancet for the experimental group. The Newborn Information Form and the ALPS-Neo Neonatal Pain and Stress Assessment Scale (ALPS-Neo) were used for data collection. ALPS-Neo was scored at three time points (pre-procedure, during, and post-procedure). The chi-square test, independent samples t-test, Friedman test, and Mann–Whitney U test were used for data analysis. A p-value < 0.05 was considered statistically significant. Results: The study included 66 term neonates with a gestational age of ≥ 37 weeks. During the procedure, the experimental group had significantly lower ALPS-Neo scores (4.43 ± 1.92) compared with the control group (5.73 ± 1.70; p < 0.05). After the procedure, scores remained lower in the experimental group (1.33 ± 1.93 vs. 2.76 ± 2.14; p < 0.05). Crying duration was also significantly shorter in the experimental group (median 7.0 s, interquartile range [IQR] 5.0–10.0) than in the control group (median 14.0 s, IQR 10.0–20.0; p < 0.001). The changes in physiological parameters of the experimental group after the procedure were more stable than the control group. Conclusions: The use of automatic lancets for heel blood collection in neonates significantly reduced pain and stress, shortened crying time, and supported physiological stability, underscoring their clinical value in neonatal care. Contributions to practice: It is recommended to adopt and increase the use of automatic lancets rather than manual lancets in neonates. Clinical trial registration: This study was prospectively registered at ClinicalTrials.gov, registration ID: NCT05448508.