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Oral glucose in preterm neonates during oropharyngeal suctioning: a randomized controlled cross-over trial

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Abstract

To investigate whether orally applied glucose reduces pain response during oropharyngeal suctioning in preterm infants with a birth weight >1500 g, we conducted a randomized, double-blind, placebo-controlled cross-over trial on 32 preterm infants undergoing oropharyngeal suctioning while on nasal continuous positive airway pressure (CPAP). The Premature Infant Pain Profile (PIPP) score was assessed and compared in a cross-over design to investigate whether there was a significant difference in the patients’ pain response. The mean PIPP score during oropharyngeal suctioning after placebo was 8.6 (KI 7.8–9.4). After glucose administration, the mean PIPP score was 8.0 (KI 7.1–8.9). Comparison of the treatment effects reached no statistic significance (p = 0.23). During the oral study drug administration during nasal CPAP, we observed 47 adverse events, but none necessitated therapeutic intervention and none was classified as serious.

Conclusion: In our study, late preterm infants in the first days of life did not benefit significantly from analgesia with glucose during oropharyngeal suctioning. The oral administration of glucose under nasal CPAP led to no serious adverse events.

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Abbreviations

AE:

Adverse event

CPAP:

Continuous positive airway pressure

PIPP:

Premature Infant Pain Profile

SAE:

Serious adverse event

References

  1. Alinejad-Naeini M, Mohagheghi P, Peyrovi H, Mehran A (2014) The effect of facilitated tucking during endotracheal suctioning on procedural pain in preterm neonates: a randomized controlled crossover study. Global J Health Sci 6(4):34774. doi:10.5539/gjhs.v6n4p278

    Article  Google Scholar 

  2. Allegaert K, Veyckemans F, Tibboel D (2009) Clinical practice: analgesia in neonates. Eur J Pediatr 168(7):765–770. doi:10.1007/s00431-009-0932-1

    Article  PubMed  Google Scholar 

  3. Anand KJ, International Evidence-Based Group for Neonatal P (2001) Consensus statement for the prevention and management of pain in the newborn, vol 155. Arch Pediatr Adolesc Med 2

  4. Axelin A, Salantera S, Kirjavainen J, Lehtonen L (2009) Oral glucose and parental holding preferable to opioid in pain management in preterm infants. Clin J Pain 25(2):138–145. doi:10.1097/AJP.0b013e318181ad81

    Article  PubMed  Google Scholar 

  5. Axelin A, Salantera S, Lehtonen L (2006) Facilitated tucking by parents' in pain management of preterm infants—a randomized crossover trial. Early Hum Dev 82(4):241–247. doi:10.1016/j.earlhumdev.2005.09.012

    Article  PubMed  Google Scholar 

  6. Ballantyne M, Stevens B, McAllister M, Dionne K, Jack A (1999) Validation of the premature infant pain profile in the clinical setting. Clin J Pain 15(4):297–303

    Article  CAS  PubMed  Google Scholar 

  7. Blass EM, Shah A (1995) Pain-reducing properties of sucrose in human newborns. Chem Senses 20(1):29–35

    Article  CAS  PubMed  Google Scholar 

  8. Bueno M, Yamada J, Harrison D, Khan S, Ohlsson A, Adams-Webber T, Beyene J, Stevens B (2013) A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manage J Can Pain Soc J de la societe canadienne pour le traitement de la douleur 18(3):153–161

  9. Cignacco E, Hamers JP, Stoffel L, van Lingen RA, Gessler P, McDougall J, Nelle M (2007) The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain 11(2):139–152. doi:10.1016/j.ejpain.2006.02.010

    Article  PubMed  Google Scholar 

  10. Cignacco E, Hamers JP, Stoffel L, van Lingen RA, Schutz N, Muller R, Zimmermann LJ, Nelle M (2008) Routine procedures in NICUs: factors influencing pain assessment and ranking by pain intensity. Swiss Med Wkly 138(33–34):484–491

    PubMed  Google Scholar 

  11. Cignacco E, Hamers JP, van Lingen RA, Zimmermann LJ, Muller R, Gessler P, Nelle M (2008) Pain relief in ventilated preterms during endotracheal suctioning: a randomized controlled trial. Swiss Med Wkly 138(43–44):635–645

    PubMed  Google Scholar 

  12. Fitzgerald M (2005) The development of nociceptive circuits. Nat Rev Neurosci 6(7):507–520. doi:10.1038/nrn1701

    Article  CAS  PubMed  Google Scholar 

  13. Fitzgerald M, Millard C, McIntosh N (1989) Cutaneous hypersensitivity following peripheral tissue damage in newborn infants and its reversal with topical anaesthesia. Pain 39(1):31–36

    Article  CAS  PubMed  Google Scholar 

  14. Gibbins S, Stevens B (2003) The influence of gestational age on the efficacy and short-term safety of sucrose for procedural pain relief. Adv Neonatal Care 3(5):241–249

    Article  PubMed  Google Scholar 

  15. Gibbins S, Stevens B, Hodnett E, Pinelli J, Ohlsson A, Darlington G (2002) Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nurs Res 51(6):375–382

    Article  PubMed  Google Scholar 

  16. Gitto E, Pellegrino S, Manfrida M, Aversa S, Trimarchi G, Barberi I, Reiter RJ (2012) Stress response and procedural pain in the preterm newborn: the role of pharmacological and non-pharmacological treatments. Eur J Pediatr 171(6):927–933. doi:10.1007/s00431-011-1655-7

    Article  CAS  PubMed  Google Scholar 

  17. Grunau RV, Whitfield MF, Petrie JH, Fryer EL (1994) Early pain experience, child and family factors, as precursors of somatization: a prospective study of extremely premature and fullterm children. Pain 56(3):353–359

    Article  CAS  PubMed  Google Scholar 

  18. Gupta NK, Upadhyay A, Agarwal A, Goswami G, Kumar J, Sreenivas V (2013) Randomized controlled trial of topical EMLA and breastfeeding for reducing pain during wDPT vaccination. Eur J Pediatr 172(11):1527–1533. doi:10.1007/s00431-013-2076-6

    Article  CAS  PubMed  Google Scholar 

  19. Harrison D, Bueno M, Yamada J, Adams-Webber T, Stevens B (2010) Analgesic effects of sweet-tasting solutions for infants: current state of equipoise. Pediatrics 126(5):894–902. doi:10.1542/peds. 2010-1593

    Article  PubMed  Google Scholar 

  20. Hermann C, Hohmeister J, Demirakca S, Zohsel K, Flor H (2006) Long-term alteration of pain sensitivity in school-aged children with early pain experiences. Pain 125(3):278–285. doi:10.1016/j.pain.2006.08.026

    Article  PubMed  Google Scholar 

  21. Holsti L, Grunau RE (2010) Considerations for using sucrose to reduce procedural pain in preterm infants. Pediatrics 125(5):1042–1047. doi:10.1542/peds. 2009-2445

    Article  PubMed Central  PubMed  Google Scholar 

  22. Ivars K, Nelson N, Finnstrom O, Morelius E (2012) Nasopharyngeal suctioning does not produce a salivary cortisol reaction in preterm infants. Acta Paediatr 101(12):1206–1210. doi:10.1111/apa.12001

    Article  CAS  PubMed  Google Scholar 

  23. Johnston CC, Stremler R, Horton L, Friedman A (1999) Effect of repeated doses of sucrose during heel stick procedure in preterm neonates. Biol Neonate 75(3):160–166

    Article  CAS  PubMed  Google Scholar 

  24. Kenward MG JB (2003) Design and analysis of cross-over trials. Chapman and Hall

  25. Mitchell A, Boss BJ (2002) Adverse effects of pain on the nervous systems of newborns and young children: a review of the literature. J Neurosci Nurs J Am Assoc Neurosci Nurses 34(5):228–236

    Article  Google Scholar 

  26. Okan F, Coban A, Ince Z, Yapici Z, Can G (2007) Analgesia in preterm newborns: the comparative effects of sucrose and glucose. Eur J Pediatr 166(10):1017–1024. doi:10.1007/s00431-006-0373-z

    Article  CAS  PubMed  Google Scholar 

  27. Rommel N, van Wijk M, Boets B, Hebbard G, Haslam R, Davidson G, Omari T (2011) Development of pharyngo-esophageal physiology during swallowing in the preterm infant. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc 23(10):e401–e408. doi:10.1111/j.1365-2982.2011.01763.x

    Article  CAS  Google Scholar 

  28. Silverman WA, Andersen DH (1956) A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants. Pediatrics 17(1):1–10

    CAS  PubMed  Google Scholar 

  29. Simons SH, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D (2003) Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med 157(11):1058–1064. doi:10.1001/archpedi.157.11.1058

    Article  PubMed  Google Scholar 

  30. Simons SH, van Dijk M, van Lingen RA, Roofthooft D, Duivenvoorden HJ, Jongeneel N, Bunkers C, Smink E, Anand KJ, van den Anker JN, Tibboel D (2003) Routine morphine infusion in preterm newborns who received ventilatory support: a randomized controlled trial. JAMA 290(18):2419–2427. doi:10.1001/jama.290.18.2419

    Article  CAS  PubMed  Google Scholar 

  31. Stevens B, Johnston C, Petryshen P, Taddio A (1996) Premature Infant Pain Profile: development and initial validation. Clin J Pain 12(1):13–22

    Article  CAS  PubMed  Google Scholar 

  32. Stevens B, Johnston C, Taddio A, Gibbins S, Yamada J (2010) The premature infant pain profile: evaluation 13 years after development. Clin J Pain 26(9):813–830. doi:10.1097/AJP.0b013e3181ed1070

    Article  PubMed  Google Scholar 

  33. Stevens B, Yamada J, Lee GY, Ohlsson A (2013) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 1:CD001069. doi:10.1002/14651858.CD001069.pub4

    PubMed  Google Scholar 

  34. Taddio A, Katz J, Ilersich AL, Koren G (1997) Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 349(9052):599–603. doi:10.1016/S0140-6736(96)10316-0

    Article  CAS  PubMed  Google Scholar 

  35. Vanhatalo S, van Nieuwenhuizen O (2000) Fetal pain? Brain Dev 22(3):145–150

    Article  CAS  PubMed  Google Scholar 

  36. Ward-Larson C, Horn RA, Gosnell F (2004) The efficacy of facilitated tucking for relieving procedural pain of endotracheal suctioning in very low birthweight infants. MCN Am J Matern Child Nurs 29(3):151–156, quiz 157–158

    Article  PubMed  Google Scholar 

  37. Wellmann S, Buhrer C (2012) Who plays the strings in newborn analgesia at birth, vasopressin or oxytocin? Front Neurosci 6:78. doi:10.3389/fnins.2012.00078

    Article  PubMed Central  PubMed  Google Scholar 

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Funding source

The study was financially supported by the B. Braun-Stiftung.

Financial disclosure

The authors have no financial relationships relevant to this article to disclose.

Conflict of interest

The authors have no conflicts of interest to disclose.

Clinical trial registration

This trial has been registered at www.clinicaltrials.gov (identifier NCT00761059).

Author information

Authors and Affiliations

  1. Department of Neonatology and Pediatric Intensive Care Medicine, Children’s Hospital, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany

    Katharina Vezyroglou, Katrin Mehler, Angela Kribs, Kristina Langhammer, Bernhard Roth & Christoph Hünseler

  2. Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Cologne, Germany

    Ingrid Becker

Authors
  1. Katharina Vezyroglou
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  2. Katrin Mehler
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  3. Angela Kribs
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  4. Ingrid Becker
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  5. Kristina Langhammer
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  6. Bernhard Roth
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  7. Christoph Hünseler
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Corresponding author

Correspondence to Katharina Vezyroglou.

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Communicated by Patrick Van Reempts

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Vezyroglou, K., Mehler, K., Kribs, A. et al. Oral glucose in preterm neonates during oropharyngeal suctioning: a randomized controlled cross-over trial. Eur J Pediatr 174, 867–874 (2015). https://doi.org/10.1007/s00431-014-2472-6

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  • DOI: https://doi.org/10.1007/s00431-014-2472-6

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