Preemies in Pain Get Relief with Micro-Pacifier

preemies, nicu, pacifiers — Nurse Harriet Miller shows the pacifier she developed specifically for preemies. Miller was bothered by the fact that most preemies in her care couldn't have pacifiers due to tubes in their mouths that help them breathe and eat. So, she developed a specialized "preemie pacifier" and showed its effectiveness through a study at Winnie Palmer Hospital for Women and Babies.

(Image credit: Winnie Palmer Hospital for Women & Babies)

Harriet Miller, CPN, a nurse scientist at the Center for Nursing Research at Winnie Palmer Hospital for Women & Babies at Orlando Health, contributed this article to Live Science's Expert Voices: Op-Ed & Insights.

The problem was their endotracheal tube. This tube is necessary to provide these newborns with oxygen, but because it passes between their vocal cords, it prevents them from making audible sounds when they cry — something that newborns need to do quite frequently. It's estimated that in the first two weeks after admission, the average baby will undergo 16 painful or stressful situations each day.

Amber Eady, a mother prematures twins, says both of her babies respond almost immediately to the soothing power of pacifiers. One of her babies went home earlier than the other and was able to use a traditional pacifier. Her other child, however, had to spend weeks in the hospital and needed tubes in her throat to help her breath and eat. Those tubes normally prevent babies from being able to use a pacifier, but thanks to a special preemie pacifier developed by a nurse at Winnie Palmer Hospital for Women & Babies in Orlando, both babies are now happier and healthier.

Another option for providing comfort and managing pain in babies is the use of a pacifier. The sucking reflex is vital to newborns. Not only does it allow them to feed instinctively, but non-nutritive sucking (the use of a pacifier) is a powerful coping mechanism. It's hypothesized that the mere act of sucking on a pacifier may actually block the body's ability to transmit the sensation of a painful impulse back to the brain.

In an effort to help comfort the babies in my care and better manage their pain, I would give them pacifiers. But this rarely helped. I noticed that either their mouths were too small to accommodate both the endotracheal tube and the larger nipple of a standard-size pacifier, or the pacifier's flange would press against the tube and force the nipple out of the mouth. That only led to more stress and frustration.

So, I decided to create my own pacifier, one specifically designed for intubated babies. I cut a notch in one side of the pacifier's flange to make room for the endotracheal tube. The design allows for the tube and the pacifier to sit side by side in the baby's mouth — and I noticed a difference immediately. The babies were calmer and quieter, and appeared much more content, even in painful or stressful situations.

Every baby who was given a modified pacifier during heel sticks had heart rates considerably lower than the babies who did not get the modified pacifier. And the oxygen-saturation levels of the babies with pacifiers were significantly higher. Those who got the modified pacifier also scored better on the Neonatal Infant Pain Scale (NIPS), which tracked crying, breathing patterns, facial expressions, limb movement and arousal. Simply put, the preemie pacifiers worked.

This month, I wrote a letter to the American Academy of Neonatal Nursing urging them to support my efforts to make these pacifiers more readily available. Hospitals have done a great job incorporating the pacifiers into NICUs, but the devices should also be available anywhere an infant might be intubated, including in emergency departments and in medical transport vehicles like ambulances and helicopters.

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