Subject Areas: Internal Medicine
1. Introduction
Health is a whole state of physical, psychological and social well-being. In newborn care, supporting the mother and her baby by the ancient healing knowledge can be combined with modern medical care. In this regard, the mostly studied and practiced method is the kangaroo care. The other few subjects recently studied are massage therapy, therapeutic touch, acupuncture, and acupressure.
Healthy term newborns during routine follow-up visits commonly undergo painful procedures whereas preterm infants having the same during their neonatal intensive care unit stay. Some research suggests that painful experiences can alter clinical outcome and brain development in these infants [1] [2] .
Nonpharmacological strategies are important for managing neonatal pain because pharmacologic analgesic agents tend to have low efficacy and have potential side effects in this age group [3] - [5] .
The two most widely studied non-pharmacological methods are sucrose administration and non-nutritive- sucking [3] . The American Academy of Pediatrics and the Canadian Paediatric Society recommend oral administration of 0.05 to 0.5 mL of 24% sucrose 1 to 2 minutes before the procedure to decrease neonatal pain [3] .
Acupressure is a pain-relieving method; the fingers are used to press key acupuncture points on the skin surface that stimulates the body’s regulatory processes [6] .
Acupuncture is an ancient technique is based on the theories of Traditional Chinese Medicine which involves stimulating “acupoints” via insertion of thin needles or via laser [7] .
Light needle acupuncture has been used to show the effect on feeding, stooling and sleeping in infants with infantile colic and to show analgesic effects on procedural pain in preterm infants [8] . The efficacy and safety of pediatric light needle acupuncture has been investigated, and reviews to date have concluded that acupuncture use should be limited to clinical trials [9] [10] .
To date acupressure and acupuncture, including needle and laser acupuncture have been used for pain, skin perfusion, weight gain, neonatal abstience syndrome, agitation and hypoxic ischemic encephalopathy. We studied needle acupuncture, laser acupuncture and acupressure for minor painful procedures.
2. Materials and Methods
Ecevit et al. [11] studied 10 preterm infants who required a heel prick for blood gas analysis. In this study, needle acupuncture was performed at Yintang point before heel prick. They observed shorter crying duration and lower (better) neonatal infant pain scores in their needle acupuncture group compared to untreated controls. It has been reported that the levels of enkephalin, endomorphin-1, beta-endorphin, and serotonin increase in plasma and brain tissue after acupuncture or electroacupuncture application. When an acupuncture needle is inserted, it stimulates pain receptors (nevre endings) and causes the secretion of endogenous opioids, which play a role in pain control [12] .
Abbasoglu et al. [13] found that applying acupressure at the BL60 and K3 points before heel lancing was safe and associated with shorter procedural time and shorter duration of crying in preterm infants. Acupressure stimulates peripheral sensory nerve endings and causes the release of vasoactive neuropeptides, such as calcitonin gene-related peptide and substance P. [14] . These mediators induce local vasodilation, thus increasing skin blood flow. Distinct from seratonin effects, increased blood supply around the malleolus as a result of acupressure might also have contributed to the shorter procedure time we observed in the acupressure group.
Abbasoglu et al. [15] indicated that laser acupuncture (LA) with 1.125 microjoules of energy at the Yintang point two minutes prior to heel lancing is less effective than oral sucrose for reducing the discomfort of this procedure. We found shorter procedure time in the LA group compared to the oral sucrose group, but longer crying time and worse NIPS scores in the LA group. We observed shorter heel-lancing procedure time in healthy term infants who received LA compared to their counterparts who received oral sucrose. Part of the explanation for this may be the vasomodulatory effect of LA on endothelium and vascular smooth muscle [16] .
Tugcu et al. [17] showed the impact of acupressure application on the Yintang point on neonatal skin perfusion, oxygen saturation and pulse rate. In this study, it was found that after acupressure application on the Yintang point, the pulse rate value in newborns decreased significantly. In our opinion, this decrease occurs also as a result of the fact that acupressure application on the Yintang point decreases sympathetic activity. The study done by Arai YC et al. also demonstrated that acupressure application on the Yintang point significantly decreases sympathetic activity [18] .
3. Conclusion
Acupressure and acupuncture has the potential to decrease neonatal exposure to potentially neurotoxic analgesic and sedative agents during their early life. In newborn care, traditional and complementary medicine could be combined with modern medical care. The results of our studies suggest using acupressure and acupuncture for minor painful procedures in newborn infants could be a simple, quick and safe way. Further studies would be helpful for practice of new points and modes to use in acupressure an acupuncture for pain control in newborns.