Twenty-Five Percent Dextrose and EBM in Pain Relief During Heel Lance in Late Preterm Babies Using the PIPP Score: A Randomized Controlled Trial

Abstract

Objective: To compare the analgesic effect of 25% dextrose and expressed breast milk (EBM) in pain relief during heel lance in late preterm babies using the premature infant pain profile (PIPP) score. Study Design: Prospective, double blind, randomized controlled trial. Setting: The neonatal intensive care unit of Jaipur Golden Hospital, Rohini, Delhi. Participants: One-hundred eleven late preterm babies who required heel lancing for glycemic control and who were on oral feeds and were hemodynamically stable. Methodology: The babies were randomized into 2 intervention groups (25% dextrose and EBM) and control group (sterile water). The test solution of 2mL was given to baby 2 minutes before heel lancing. The facial response to pain (brow bulge, eye squeeze, and nasolabial furrow) was analyzed from the video. Maximum heart rate (HR) and minimum blood oxygen saturation (SpO2) were also recorded at 30 seconds, 1 minute, 1.5 minutes, and 2.5 minutes after heel lancing by another camera. Outcome Variable: PIPP score, HR, SpO2 at 30 seconds, 1 minute, 1.5 minutes, and 2.5 minutes after heel lancing. Results: A total of 63 babies were considered for final analysis with 21 each in the 25% dextrose, EBM, and sterile water groups. The mean PIPP score in the 25% dextrose, EBM, and control groups at 30 seconds were 4.52, 6.86, and 10.14, respectively ( P < .001). At 1 minute, the PIPP scores were 3.24, 5.14, and 8.24, respectively, for the 25% dextrose, EBM, and control groups ( P < .001). Twenty-five percent dextrose gave better pain relief than EBM. Mean difference between the PIPP score in the 25% dextrose and EBM groups was –2.34 and –1.9 at 30 seconds and 1 minute, respectively, after the painful procedure ( P = .001). Babies in intervention groups had less increase in HR and less decrease in SpO2. Conclusions: Twenty-five percent dextrose and EBM significantly reduced procedural pain in neonates, though pain relief was better in the 25% dextrose group as compared to the EBM group.