Abstract
Multisensory stimulation (MSS) effectively alleviates procedural pain in neonates during blood sample collection. However, quantitative evidence on the comparative effectiveness of different sensory stimulation types remains limited. This network meta-analysis (NMA) systematically evaluated the efficacy of MSS interventions in reducing neonatal pain during blood sampling. The results aim to provide an evidence-based foundation for selecting optimal clinical pain-management protocols. A NMA of randomized controlled trials (RCTs) was conducted according to the PRISMA guidelines. Studies using MSS interventions were included. A systematic search was performed in the Cochrane Library, PubMed, Web of Science, Embase, CINAHL, CNKI, CBM, Wanfang, and VIP databases from inception to May 14, 2025. Pain scores served as the primary outcome measure and were analyzed as continuous variables. The effect size was calculated using standardized mean differences (SMD) with 95% confidence intervals (Crl). Bayesian NMA was performed using Stata 18.0 software. A total of 46 RCTs involving 5836 neonates were included. Among these, 11 studies focused on arteriovenous blood collection, examining 7 different MSS types, and 35 studies focused on heel blood collection, examining 8 MSS types. For arteriovenous blood sampling, three interventions showed significantly better pain relief compared to the routine method, with the tactile-taste-kinesthetic intervention demonstrating the greatest effect (SMD = -3.29; 95% credible interval [Crl], -5.47 to -1.12). For heel blood sampling, five interventions were more effective than the routine method, with the tactile-taste-auditory intervention exhibiting the best analgesic effect (SMD = -5.45; 95% credible interval [Crl], -7.44 to -3.47). MSS significantly reduces procedural pain during neonatal blood sampling. Future research should investigate the impact of intervention duration, frequency, timing, and choice of pain-assessment tools to further optimize pain-management strategies in neonates. What is Known: • Blood sampling is a common, painful procedure in neonatal intensive care units. • MSS is effective in alleviating neonatal procedural pain during blood collection. What is New: • The study focused on blood sampling pain to evaluate the most effective interventions for pain relief during arteriovenous and heel blood collections, and to rank various sensory stimuli. • MSS was the primary intervention method examined to determine the optimal approaches.