Abstract
BackgroundWith the increase in hospitalization of premature infants in emergency departments and the painful procedure in these sectors, appropriate methods of pain relief are required. This study aimed to compare the effect of oral dextrose and facilitated tucking in the reduction of pain during heel sticks in premature infants and assess their effectiveness and feasibility for use in emergency settings.MethodsThis study was a randomized controlled clinical trial with cross-over design. Sixty infants were recruited from a Neonatal Intensive Care Unit (NICU) at Valiasr hospital in Tehran, Iran from March 2015 to September 2016. They were randomly allocated into three groups (no pain relief method, oral dextrose and facilitated tucking). Six blood samples were collected by heel stick for each infant. Oral dextrose and facilitated tucking were compared with the routine method of blood sampling and pain was measured two times for each method. The pain scores was measured by the Premature Infant Pain Profile (PIPP). Repeated Measure ANOVA, ANOVA and Scheffe post-hoc test were used with SPSS 16.ResultsThe pain score’s increase during heel stick was significantly lower after using oral dextrose (3.58 ± 0.34) and facilitated tucking (5.58 ± 0.53) in comparison to the routine method (8.91 ± 0.18) of blood sampling (P < 0.001, η2 = 0.971). Oral dextrose was more effective than facilitated tucking (P < 0.001, Cohen’s d = 4.49). The emergency nurses rated oral dextrose as easier (t = 2.20, df = 118, p = 0.02, Cohen’s d = 0.39) and more applicable method (t = 2.99, df = 118, p = 0.003, Cohen’s d = 0.54) for the emergency department.ConclusionsFacilitated tucking is an effective method of pain reduction which can be used in the absence of oral dextrose, in a situation in which it is contraindicated or in combination with oral dextrose. Based on the increase of infant’s admission in emergency department future studies are needed to identify the best method of pain reduction for procedures in this setting.Trial registrationCurrent Controlled Trials IRCT201408029568N9, 2014-09-08.
Highlights
With the increase in hospitalization of premature infants in emergency departments and the painful procedure in these sectors, appropriate methods of pain relief are required
The results of the current study showed that facilitated tucking and oral dextrose are both effective in reducing the pain of blood sampling in infants
Gradin and Schollin [20] argued orally administered dextrose has more significant effect because it reduces the pain of painful procedures by stimulating the secretion of endorphins, Cohen, Blount, Chorney, Zempsky, Rodrigues and Cousins indicated that oral dextrose has a more significant impact on pain reduction [21]
Summary
With the increase in hospitalization of premature infants in emergency departments and the painful procedure in these sectors, appropriate methods of pain relief are required. Pain relief methods are less likely to be used in the emergency departments [5]. Nurses in these settings usually do not have special skills or enough time to apply sophisticated methods of pain reduction. The result of a study showed that the rate of readmission of preterm neonates was 15.2%, which was significantly higher than term neonates (7.9%) who were hospitalized after birth [7]. The result of a review showed that the rate of emergency department visit of preterm neonates was higher than term ones [8].
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