{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:57:11Z","timestamp":1788865031678,"version":"build-2803163510"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T00:00:00Z","timestamp":1747872000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Newborns are particularly vulnerable to pain, and non-pharmacological methods are frequently employed for pain management due to their lack of side effects. However, there is a lack of comprehensive comparison and ranking of the effectiveness of various non-pharmacological interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objective<\/jats:title><jats:p>To evaluate the effectiveness of non-pharmacological interventions and to determine whether differences exist in the efficacy of various interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Systematic review and network meta-analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data source<\/jats:title><jats:p>RCTs studies in MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials from inception to November 1, 2024.<\/jats:p><\/jats:sec><jats:sec><jats:title>Review methods<\/jats:title><jats:p>Up to November 1, 2024, we conducted a comprehensive search across four databases to identify studies meeting our inclusion criteria. A Bayesian model was employed for the analysis, and heterogeneity was quantified using random-effects standard deviation (RESD), <jats:italic>\u03c4<\/jats:italic>\u00b2, and I\u00b2 statistics. The certainty of the synthesized evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. This study protocol has been registered with PROSPERO.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Initially, we identified 20 citations and included 59 trials involving 2,028 participants for network meta-analysis. Due to many interventions being supported by only one or two original studies, we excluded interventions with fewer than three studies. Ultimately, we identified 13 citations, including 31 trials with a total of 1,141 participants. Regarding efficacy, several interventions were found to be effective. Breast milk (BM), sweet taste (ST), Yakson touch (YT), swaddling, and heel warming (HW) demonstrated significant effectiveness, with mean differences (MDs) in NIPS scores as follows: BM vs. control, \u22121.71 [95% credible interval (CrI): \u22122.29, \u22121.17]; ST vs. control, \u22121.35 (CrI: \u22122.13, \u22120.52); YT vs. control, \u22121.41 (CrI: \u22122.09, \u22120.74); swaddling vs. control, \u22120.65 (CrI: \u22121.23, \u22120.13); and HW vs. control, \u22120.53 (CrI: \u22120.89, \u22120.01). In pairwise comparisons between interventions, significant efficacy differences were observed: BM vs. HW, \u22121.89 (CrI: \u22122.70, \u22121.05); BM vs. non-nutritive sucking (NNS), \u22121.89 (CrI: \u22122.70, \u22121.05); BM vs. ST, \u22120.88 (CrI: \u22121.61, \u22120.11); BM vs. YT, \u22120.82 (CrI: \u22121.56, \u22120.03); BM vs. swaddling, \u22121.59 (CrI: \u22122.20, \u22120.78); NNS vs. ST, 0.98 (CrI: 0.11, 1.89); NNS vs. YT, 1.06 (CrI: 0.12, 2.03); and HW vs. YT, 0.89 (CrI: 0.23, 1.69). Notably, NNS was not found to be effective. The Surface Under the Cumulative Ranking Curve (SUCRA) analysis suggested that BM may be the most effective non-pharmacological intervention for neonatal pain management. SUCRA rankings for the interventions were as follows: BM\u2009&amp;gt;\u2009ST\u2009&amp;gt;\u2009YT\u2009&amp;gt;\u2009swaddling\u2009&amp;gt;\u2009HW\u2009&amp;gt;\u2009NNS\u2009&amp;gt;\u2009control. However, the certainty of the evidence ranged from moderate to very low. Heterogeneity assessments indicated a random-effects standard deviation (RESD) of 0.28 (CrI: 0.04, 0.73) in the consistent model and 0.36 (CrI: 0.01, 1.36) in the inconsistent model, with <jats:italic>I<\/jats:italic>\u00b2\u2009=\u2009100% and <jats:italic>\u03c4<\/jats:italic>\u00b2\u2009=\u20092.22.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Given the limitation of high heterogeneity, this study should be regarded as a clinical effectiveness comparison. Among the included interventions, breast milk (BM), sweet taste (ST), Yakson touch (YT), heel warming (HW), and swaddling were found to be efficacious, while non-nutritive sucking (NNS) was not effective. The top three interventions, based on ranking, were BM, YT, and ST. However, some effects should be interpreted with caution, as they are derived from small sample sizes. Future research should focus on identifying factors associated with individual responses through large, multicenter studies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications for Nursing Management<\/jats:title><jats:p>Findings will inform nurse managers of an ideal environment for the non-pharmacological pain management for newborn.<\/jats:p><\/jats:sec><jats:sec><jats:title>Systematic Review Registration<\/jats:title><jats:p><jats:uri>https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD42023399924<\/jats:uri>, PROSPERO CRD42024567338.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1547308","type":"journal-article","created":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T04:13:47Z","timestamp":1747887227000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["A Bayesian network meta-analysis of non-pharmacological interventions for neonatal pain management: a clinical effectiveness comparison"],"prefix":"10.3389","volume":"13","author":[{"given":"Lingxue","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lali","family":"Xiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihui","family":"Pan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peipei","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yurong","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongyan","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuwei","family":"Hu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Zheng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1007\/s11096-015-0090-7","article-title":"Reducing pain from heel lances in neonates following education on oral sucrose","volume":"37","author":"Shen M","year":"2015","journal-title":"Int J Clin Pharm"},{"key":"B2","doi-asserted-by":"publisher","first-page":"178","DOI":"10.1097\/JPN.0000000000000258","article-title":"Neuro biological consequences of early painful experience: basic science findings and implications for evidence-based practice","volume":"31","author":"Young","year":"2017","journal-title":"J Perinat Neonatal Nurs"},{"key":"B3","doi-asserted-by":"publisher","first-page":"S65","DOI":"10.1016\/j.pain.2010.10.008","article-title":"Pain in neonates is different","volume":"152","author":"Johnston","year":"2011","journal-title":"Pain"},{"key":"B4","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.ejpain.2006.02.010","article-title":"The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates.: a systematic literature review","volume":"11","author":"Cignacco","year":"2007","journal-title":"Eur J Pain"},{"key":"B5","doi-asserted-by":"publisher","first-page":"1701","DOI":"10.1016\/j.clinthera.2019.07.014","article-title":"Managing procedural pain in the neonate using an opioid-sparing approach","volume":"41","author":"Squillaro","year":"2019","journal-title":"Clin Ther"},{"key":"B6","doi-asserted-by":"publisher","first-page":"13023","DOI":"10.3390\/ijerph182413023","article-title":"Breastmilk as a multisensory intervention for relieving pain during newborn screening procedures: a randomized control trial","volume":"18","author":"Lan","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"B7","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1089\/bfm.2020.0116","article-title":"The calming effect of maternal breast milk odor on term infant: a randomized controlled trial","volume":"15","author":"Tasci","year":"2020","journal-title":"Breastfeed Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1089\/bfm.2015.0174","article-title":"Comparative effect of the smells of amniotic fluid, breast milk, and lavender on newborns' pain during heel lance","volume":"11","author":"Akcan","year":"2016","journal-title":"Breastfeed Med"},{"key":"B9","doi-asserted-by":"publisher","first-page":"6741","DOI":"10.19082\/6741","article-title":"Comparison the effectiveness of breastfeeding, oral 25% dextrose, kangaroo-mother care method, and EMLA cream on pain score level following heal pick sampling in newborns: a randomized clinical trial","volume":"10","author":"Soltani","year":"2018","journal-title":"Electron Physician"},{"key":"B10","doi-asserted-by":"publisher","first-page":"4384","DOI":"10.21037\/apm-21-329","article-title":"Effect analysis of embracing breast milk sucking to relieve pain of neonatal heel blood sampling: a randomized controlled trial","volume":"10","author":"Wu","year":"2021","journal-title":"Ann Palliat Med"},{"key":"B11","doi-asserted-by":"publisher","first-page":"992","DOI":"10.4040\/jkan.2006.36.6.992","article-title":"The effect of oral glucose on pain relief in newborns","volume":"36","author":"Ahn","year":"2006","journal-title":"Taehan Kanho Hakhoe chi"},{"key":"B12","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1186\/s12887-024-04604-6","article-title":"The effect of the simulated intrauterine sound on behavioral and physiological indices of pain during capillary blood sampling for screening preterm infants: a randomized clinical trial study","volume":"24","author":"Yarahmadi","year":"2024","journal-title":"BMC Pediatr"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.pedn.2023.01.005","article-title":"The effect of using maternal voice, white noise, and holding combination interventions on the heel stick sampling","volume":"70","author":"Apaydin Cirik","year":"2023","journal-title":"J Pediatr Nurs"},{"key":"B14","doi-asserted-by":"publisher","first-page":"E43","DOI":"10.1097\/ANC.0000000000000918","article-title":"The effect of vibration on pain during heel lance procedures in newborns: a randomized controlled trial","volume":"22","author":"Avan Antepli","year":"2022","journal-title":"Adv Neonatal Care"},{"key":"B15","doi-asserted-by":"publisher","first-page":"2066","DOI":"10.1080\/03004430.2021.1979536","article-title":"The effectiveness of swaddling and maternal holding applied during heel blood collection on pain level of healthy term newborns; randomized controlled trial","volume":"192","author":"Inal","year":"2022","journal-title":"Early Child Dev Care"},{"key":"B16","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/j.ctim.2019.08.004","article-title":"The effects of acupressure and foot massage on pain during heel lancing in neonates: a randomized controlled trial","volume":"46","author":"Ko\u00e7 \u00d6zkan","year":"2019","journal-title":"Complement Ther Med"},{"key":"B17","doi-asserted-by":"publisher","first-page":"e12734","DOI":"10.1111\/ijn.12734","article-title":"Effects of breastfeeding and heel warming on pain levels during heel stick in neonates","volume":"25","author":"Aydin","year":"2019","journal-title":"Int J Nurs Pract"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e12338","DOI":"10.1111\/jjns.12338","article-title":"Effects of three different methods used during heel lance procedures on pain level in term neonates","volume":"17","author":"Yilmaz","year":"2020","journal-title":"Jpn J Nurs Sci"},{"key":"B19","doi-asserted-by":"publisher","first-page":"43","DOI":"10.4274\/jpr.galenos.2022.67799","article-title":"Effects of white noise and facilitated tucking during heel stick sampling on the pain response of healthy term newborns: a randomized controlled study","volume":"10","author":"Pekyi\u011fit","year":"2023","journal-title":"J Pediatr Res"},{"key":"B20","doi-asserted-by":"publisher","first-page":"49","DOI":"10.22038\/ebcj.2018.28347.1686","article-title":"Effects of yakson therapeutic touch and heel warming on pain caused by heel stick procedure, vital signs, and cry duration in full-term neonates","volume":"8","author":"Mir","year":"2018","journal-title":"J Evid-Based care"},{"key":"B21","doi-asserted-by":"publisher","first-page":"48","DOI":"10.3126\/jnps.v41i1.30786","article-title":"Efficacy of heel warming on pain response to heel stick in neonates","volume":"41","author":"Sapkota","year":"2021","journal-title":"J Nepal Paediatr Soc"},{"key":"B22","doi-asserted-by":"publisher","first-page":"3107","DOI":"10.1111\/jocn.12549","article-title":"Efficacy of swaddling and heel warming on pain response to heel stick in neonates: a randomised control trial","volume":"23","author":"Shu","year":"2014","journal-title":"J Clin Nurs"},{"key":"B23","doi-asserted-by":"publisher","first-page":"870","DOI":"10.3390\/ijerph19020870","article-title":"Evaluation of methods to minimize pain in newborns during capillary blood sampling for screening: a randomized clinical trial","volume":"19","author":"Napi\u00f3rkowska-Orkisz","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"B24","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1038\/s41390-023-02746-4","article-title":"Music for pain relief of minor procedures in term neonates","volume":"95","author":"Anbalagan","year":"2024","journal-title":"Pediatr Res"},{"key":"B25","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1093\/tropej\/fmm083","article-title":"Pain reduction of heel stick in neonates: Yakson compared to non-nutritive sucking","volume":"54","author":"Im","year":"2008","journal-title":"J Trop Pediatr"},{"key":"B26","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1016\/j.midw.2014.11.001","article-title":"Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: a randomized controlled trial","volume":"31","author":"Zhu","year":"2015","journal-title":"Midwifery"},{"key":"B27","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1159\/000014105","article-title":"Pain-relieving effect of sucrose in newborns during heel prick","volume":"75","author":"Overgaard","year":"1999","journal-title":"Biol Neonate"},{"key":"B28","first-page":"28","article-title":"Effect of Yakson touch and white noise on pain in neonatal heel blood collection: a randomized controlled study","volume":"30","author":"Kadiroglu","year":"2024","journal-title":"Altern Ther Health Med"},{"key":"B29","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1136\/acupmed-2015-010765","article-title":"Laser acupuncture before heel lancing for pain management in healthy term newborns: a randomised controlled trial","volume":"33","author":"Abbasoglu","year":"2015","journal-title":"Acupunct Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"F499","DOI":"10.1136\/archdischild-2012-302921","article-title":"Analgesia with breastfeeding in addition to skin-to-skin contact during heel prick","volume":"98","author":"Gabriel","year":"2013","journal-title":"Arch Dis Child Fetal Neonatal Ed"},{"key":"B31","doi-asserted-by":"publisher","first-page":"2313","DOI":"10.1002\/sim.1201","article-title":"Network meta-analysis for indirect intervention comparisons","volume":"21","author":"Lumley","year":"2002","journal-title":"Stat Med"},{"key":"B32","doi-asserted-by":"publisher","first-page":"e99682","DOI":"10.1371\/journal.pone.0099682","article-title":"Evaluating the quality of evidence from a network meta-analysis","volume":"9","author":"Salanti G","year":"2014","journal-title":"PLoS One"},{"key":"B33","doi-asserted-by":"publisher","first-page":"145","DOI":"10.1097\/JPN.0000000000000253","article-title":"Breast-feeding analgesia in infants","volume":"31","author":"Benoit","year":"2017","journal-title":"J Perinat Neonatal Nurs"}],"container-title":["Frontiers in Pediatrics"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1547308\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,22]],"date-time":"2025-05-22T04:13:50Z","timestamp":1747887230000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fped.2025.1547308\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,22]]},"references-count":33,"alternative-id":["10.3389\/fped.2025.1547308"],"URL":"https:\/\/doi.org\/10.3389\/fped.2025.1547308","relation":{},"ISSN":["2296-2360"],"issn-type":[{"value":"2296-2360","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,22]]},"article-number":"1547308"}}