Venepuncture Outperforms Heel Lance for Newborn Comfort
Drawing blood directly from a vein is likely less painful for newborns than the traditional heel lance method. A 2026 Cochrane systematic review indicates that venepuncture also lowers the probability that an infant will endure more than one skin puncture to secure a sufficient sample, provided no sweet-tasting solution is used for pain management.
Measuring Distress in the Neonatal Ward
Medical professionals have long relied on heel lances to collect blood, particularly for smaller volumes. The process—puncturing the heel and squeezing the foot—causes significant discomfort.
The Cochrane review, which analyzed eight studies involving 826 full-term infants, determined that venepuncture resulted in lower pain scores for babies who did not receive pain relief. Researchers used validated measures, including the Neonatal Infant Pain Scale (NIPS) and the Neonatal Facial Action Coding System (NFCS), to track distress. Infants subjected to venepuncture showed fewer signs of agitation, including reduced crying and more stable heart rates.
Efficiency and the Risk of Repeat Punctures
A primary goal in neonatal care is minimizing the number of punctures, as repeated attempts increase pain and the risk of complications like local skin infections. The review found venepuncture to be the more efficient choice. When no sugar solution was administered, venepuncture significantly reduced the likelihood that a second puncture would be necessary to collect enough blood.
Data from four studies involving 254 infants showed the number needed to treat (NNT) to avoid one repeat skin puncture was three. This confirms a clear clinical advantage in reducing the total number of invasive steps for the infant.
The Variable Impact of Sucrose Solutions
Clinicians often provide sucrose or other sweet-tasting solutions to newborns to mitigate pain during sampling. The impact of these solutions on the comparison between venepuncture and heel lance remains an area of study.
While evidence suggests venepuncture still results in less pain than heel lance when a sweet solution is used, the certainty of this evidence is lower. Researchers reported uncertainty regarding whether venepuncture reduces the need for repeat punctures when sugar water is provided. Because the number of infants studied under these conditions was small, the authors could not draw definitive conclusions regarding the efficacy of venepuncture versus heel lance in the presence of sweet-tasting analgesia.
Shifting Standards in Neonatal Practice
These findings highlight a potential shift in standard practice. While heel lance remains a common, low-expertise method for minor blood collection, venepuncture appears to offer a more humane approach that prioritizes infant comfort and procedural success.
The review authors emphasize that current evidence is limited by variations in study design and small sample sizes. Future, larger-scale trials are required to establish best practices, particularly where pain-relieving solutions are routinely administered. As of July 2025, the medical community continues to evaluate these methods to ensure that routine screening tests and diagnostic procedures are performed with the least possible distress to the newborn.