Abstract
Objective
To compare the effect of expressed breast milk (EBM), 25% dextrose (25 D) and sterile water (SW) on procedural pain in neonates as assessed by the premature infant pain profile (PIPP), changes in heart rate (HR), oxygen saturation (SpO2) and duration of crying.
Design
Prospective, double blind, randomized controlled trial.
Setting
Postnatal ward of a tertiary-care hospital.
Participants
210 babies who required venipuncture for blood sampling and who were on oral feeds were recruited into the study after parental informed consent.
Methods
The enrolled babies were randomized into intervention groups (EBM, 25% dextrose) and control group (sterile water). Two ml of test solution was given to baby by paladay (a traditional cup with a spout) 2 min before venipuncture. The face and crying of baby were video graphed by an independent, blinded observer. The facial response to pain (brow bulge, eye squeeze, nasolabial furrow) was analysed from the video. Maximum HR and minimum SpO2 were recorded during, and 1, 3 and 5 min after venipuncture by another blinded observer.
Outcome variable
PIPP score, HR, SpO2 and crying time at 0/1/3/5 min after sampling.
Results
160 babies were considered for final analysis with 50 in 25 D, 62 in EBM and 48 in SW group. The mean PIPP score in the 3 groups were 5.22, 6.84 and 11.22 at 0–30 sec after venipuncture; 4.52, 6.34, and 10.88 at 1–1 ½ min; 3.96, 6.15 and 9.35 at 3–3 ½ min; and 3.12, 4.68 and 7.83 at 5–5 ½ min; respectively (P< 0.001). The median crying time was 10,37.5 and 162 seconds in 25 D, EBM and SW groups, respectively (P< 0.001).
Conclusions
EBM significantly reduces procedural pain in neonates though to a lesser extent as compared to 25% dextrose.
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References
Anand K J, Carr DB. The neuroanatomy, neurophysiology and neurochemistry of pain, stress and analgesia in newborns and children. Pediatr Clin North Am. 1989; 36: 795–822.
Carbajal R, Chauvet X, Couderc S, Olivier-Martin M. Randomized trial of analgesic effects of sucrose, glucose and pacifiers in term neonates. BMJ. 1999; 319: 1393–1397.
Gray L, Watt L, Blass EM. Skin-to-skin contact is analgesic in healthy newborns. Pediatrics. 2000; 105: e14.
Corbo MG, Mansi G, Stagni A, Romano A, van den Heuvel J, Capasso L, et al. Non-nutritive sucking during heel stick procedures decreases behavioural distress in the newborn infant. Biol Neonate. 2000; 77:162–167.
Carabajal R, Veerapen S, Couderc S, Jugie M, Ville Y. Analgesic effect of breast feeding in term neonates: a randomized controlled trial. BMJ. 2003; 326:13–17.
Upadhyay A, Aggarwal R, Narayan S, Joshi M, Paul VK, Deorari AK. Analgesic effect of expressed breast milk in procedural pain in term neonates: a randomized, placebo-controlled double blind trial. Acta Pediatr. 2004; 93:518–522.
Ors R, Ozek E, Baysoy G, Cebeci D, Bilgen H, Türküner M, et al. Comparison of sucrose and human milk in pain response in neonates. Eur J Pediatr. 1999; 158:63–66.
Taddio A, Shah V, Hancock R, Smith RW, Stephens D, Atenafu E, et al. Effectiveness of sucrose analgesia in newborns undergoing painful medical procedures. CMAJ. 2008; 179:37–43.
Skogsdal Y, Eriksson M, Shollin J. Analgesia in newborns given oral glucose. Acta Pediatr. 1997; 86:217–220.
Desmukh LS, Udani RH. Analgesic effect of oral glucose in preterm infants during venipuncture — a double blind randomised controlled trial. J Trop Pediatr. 2002; 48:138–141.
Stevens B, Johnson C, Petryshen P, Taddio A. Premature Infant Pain Profile: development and initial validation. Clin J Pain. 1996; 12:13–22.
Blass E, Fitzgerald E, Kehoe P. Interactions between sucrose, pain and isolation distress. Pharmacol Biochem Behav. 1987; 26:483–489.
Gibbins S, Stevens B. Mechanisms of sucrose and nonnutritive sucking in procedural pain management in infants. Pain Res Manag. 2001; 6:21–28.
Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2010 Jan 20; 1:CD001069.
Matrindale W. The Extra Pharmacoepia. 29th edn, London: Pharmaceutical press; 1989: 1275.
Blass EM. Milk-induced hypoalgesia in human newborns. Pediatrics. 1997; 99: 825–829.
Barrett T, Kent S, Voudouris N. Does melatonin modulate beta-endorphin, corticosterone and pain threshold? Life Sci. 2000; 66:467–476.
Buenno M, Stevens B, Camargo P, Toma E, Krebs V, Kimura A. Breast milk and glucose in pain relief in preterm infants: A noninferiority randomized controlled trial. Pediatrics. 2012; 129: 2011–2024.
Stevens B, Johnson C, Taddio A, Gibbins S, Yamada J. The premature infant pain profile: evaluation 13 years after development. Clin J Pain. 2010; 26:813–830.
Ballanntyne M, Stevens B, McAllister M, Dionne K, Jack A. Validation of the premature infant pain profile in the clinical setting. Clin J Pain. 1999;15: 297–303.
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Sahoo, J.P., Rao, S., Nesargi, S. et al. Expressed breast milk vs 25% Dextrose in procedural pain in neonates: A double blind randomized controlled trial . Indian Pediatr 50, 203–207 (2013). https://doi.org/10.1007/s13312-013-0067-3
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DOI: https://doi.org/10.1007/s13312-013-0067-3