Nonpharmacological Interventions on Intramuscular Vaccination Pain among Infants: A Systematic Review and Meta-Analysis of Randomized Control Trials.

Introduction: Vaccination pain is the most common distress for young children and their parents. Non-pharmacological interventions significant impact on vaccination pain in infants. This systematic review and meta-analysis aimed to appraises the evidence concerning the non-pharmacological interventions on vaccine related pain in infants. Methods: This study was followed Preferred Reporting Items for Systematic review and Meta-Analysis (PRISMA) statement and recommendation of Cochrane guidelines. Electronic databases, including PubMed, Cumulative Index to Nursing & Allied Health Literature (CINAHL), EMBASE, Web of Science, and Clinical Key, were searched for original trails. Pooled data were analyzed using a random-effects model with 95% confidence intervals (CIs). The subgroup analysis including breastfeeding, sucrose, kangaroo mother care, massage, heat-cold applications, and pain scales were presented in forest plots using RevMan software 5 version 4.1. Results: A total of 1,739 infants were included from 19 trials. Of these, 1,055 infants received interventions, while 684 infants given usual care. Eight trails used breastfeeding as an intervention, standard mean difference (SMD): -3.28. 95% (CI): -4.16 to -2.4, P=0.0, I2=95%. Similarly, six trials employed sucrose [SMD -2.22, CI: -3.68 to -0.75, P=0.0, I2=97%]. Three studies utilized kangaroo mother care (KMC), SMD: -1.1 CI: -2.18 to -0.02, P=0.0, I2=89%) and hot and cold applications [SMD: -1.14, CI: -2.86 to 0.58, P=0.0, I2=95%]. Conclusion: Noninvasive therapies such as breastfeeding, massage, sucrose, KMC, and hot and cold applications were effective interventions in reducing vaccination pain in infants. Studies have proved that nonpharmacological interventions were ideal and acted as analgesics among children with fewer side effects.