Effects of a less invasive suction protocol on pain and physiological stability in preterm infants receiving non-ınvasive ventilation: a randomized controlled trial

BACKGROUND: Non-invasive ventilation (NIV) is widely used in preterm infants to reduce ventilator-associated lung injury. However, nasopharyngeal suctioning during NIV is an invasive procedure that may cause pain, stress and physiological instability in preterm infants. This study aimed to compare the effects of less invasive suction protocol and conventional nasopharyngeal suctioning on pain and physiological stability in preterm infants receiving non-invasive ventilation. METHODS: weeks who required NIV were eligible. A total of 100 infants were randomly assigned to either the less invasive suction protocol group (n = 50) or the conventional suction group (n = 50). Pain was assessed using the Neonatal Pain, Agitation and Sedation Scale (N-PASS). Heart rate (HR), respiratory rate (RR), oxygen saturation (SpO₂), and skin color were recorded before suctioning, during the procedure, and 10 min after completion. Between-group comparisons were performed using appropriate parametric or non-parametric statistical tests, with p < 0.05 considered statistically significant. RESULTS: Baseline demographic and clinical characteristics were comparable between groups. During suctioning, infants in the less invasive suction protocol group had significantly lower HR and higher SpO₂ levels compared to the conventional group (p < 0.05). The proportion of infants with pink skin color was significantly higher in the less invasive suction protocol group. N-PASS pain scores during the procedure were significantly lower in the less invasive suction protocol group (p < 0.05). No significant differences were observed between groups in RR measurements at any time point. CONCLUSIONS: The less invasive suction protocol reduced procedural pain and supported physiological stability in preterm infants receiving NIV. Minimizing airway manipulation may contribute to safer and more developmentally supportive care in neonatal intensive care units. TRIAL REGISTRATION: ClinicalTrials.gov (NCT07111611), registered on 08 August 2025 (retrospectively registered).