PIPP Score Research Articles

Comparison of pain during heel prick in preterm neonates receiving only expressed breast milk and expressed breast milk with kangaroo mother care

Background: Newborns' heels are sampled for blood, which is crucial in the identification of genetic and metabolic illnesses. Repeated painful stimulation impairs the future development of their normal motor and cognitive functions. Hence it is necessary to find out suitable remedy to alleviate the pain. The aim of this study was to observe the premature newborns' response to pain (Heel prick) by giving either single (EBM) or combined (EBM and KMC). Methods: The analytical cross-sectional study was conducted in NICU of SMIMER. hospital, Surat from March 2022 to February 2023. The study included 56 premature newborns, divided into three groups. Group A received only EBM, Group B received EBM and KMC (15 minutes), and Group C received EBM and KMC (30 minutes) before the heal prick. The pain was assessed by PIPP score in all three groups at the end of 30,60 and 120 seconds after the procedure. Data were analyzed using SPSS 24 and a one-way ANOVA test was applied. Results: The PIPP score after 60 seconds between Group A with B and A with C was statistically significant (p<0.05) whereas Group B with C was insignificant (p>0.05). The score after 60 seconds between Group A with B and A with C was statistically significant (p<0.05) whereas Group B with C was insignificant (p>0.05). Conclusions: EBM with KMC (15 minutes) duration had an effective impact on pain relief as compared to EBM with KMC (30 minutes) duration at the interval of 60 seconds.

Intranasal dexmedetomidine reduces pain scores in preterm infants during retinopathy of prematurity screening.

This study aimed to investigate the effectiveness of intranasal dexmedetomidine in reducing pain scores during retinopathy of prematurity (ROP) screening examinations in preterm infants. Infants born at ≤32 weeks of gestational age, undergoing routine ROP examinations in the neonatal intensive care unit, were included in the study and divided into two groups: the standard protocol group (n = 43) and the dexmedetomidine group (n = 56), over a 1-year period. Both groups received standard procedural preparation including swaddling, oral dextrose, and topical anesthesia with proparacaine. The dexmedetomidine group additionally received intranasal dexmedetomidine at a dose of 1 mcg/kg before the procedure. Pain scores (PIPP score), heart rate, respiratory rate, blood pressure, and oxygen saturation were compared at baseline, 1-min, and 5-min during the procedure. There were no significant differences between the groups regarding descriptive and pre-procedure characteristics. In the dexmedetomidine group, the median (25-75p) PIPP score, heart rate, systolic blood pressure and mean (±SD) respiratory rate measured at the 1st minute of the procedure were significantly lower than those in the standard group [PIPP score 10 (8-13) vs. 14 (10-16), p < 0.001; heart rate 165 (153-176) beats/min vs. 182 (17-190) beats/min, p < 0.001; respiratory rate 60 (±7) breaths/min vs. 65(±9) breaths/min, p = 0.002; systolic blood pressure 78 (70-92) mmHg vs. 87 (78-96) mmHg, p = 0.024; respectively] whereas the saturation value was significantly higher (88% (81-95) vs. 84% (70-92), p = 0.036; respectively). By the 5th minute of the procedure, the median (25-75p) PIPP score [4 (2-6) vs. 6 (4-10), p < 0.001], heart rate [148 (143-166) beats/min vs. 162 (152-180) beats/min, p = 0.001] and respiratory rate [56 (54-58) breaths/min vs. 58 (54-62) breaths/min, p = 0.034] were significantly lower, and the saturation level was significantly higher [96% (94-97) vs. 93% (91-96), p = 0.003] in the dexmedetomidine group. Additionally, the frequency of adverse effects was significantly lower in the dexmedetomidine group compared to the standard protocol group (11% vs. 47%, p = 0.001). Administering intranasal dexmedetomidine before ROP screening examinations was associated with a decrease in pain scores among preterm infants. This suggests its potential as an effective and well-tolerated method for pain management during ROP screenings.

Kangaroo mother care verses oral sucrose for pain control in premature neonates on heel prick: a randomized control trial

Background: Preterm Neonates receiving intensive care are subjected to multiple painful procedures as part of their intensive care management. Pain leads to abnormal neurodevelopment, so it is extremely important to treat and reduce pain. Multiple studies have shown to be beneficial in pain control. Objective was to compare the efficacy of Kangaroo Mother Care with oral sucrose for pain management in premature neonates on heel prick. Methods: A total of 100 preterm neonates (28-36 weeks) who fulfill the inclusion and exclusion criteria were recruited for the study. Randomization was done and fifty participants per study arm were randomly assigned to the KMC and oral sucrose group. Preterm babies in the KMC group were given KMC for 15 minutes uninterrupted prior to heel prick. In oral sucrose group, two minutes prior to the procedure, baby received 0.5ml of 24% oral sucrose solution by syringe onto the tongue. The remainder of the total recommended dose was given as needed in small increments during the procedure. Assessment of pain done using PIPP. The post-procedural PIPP score was compared between KMC and oral sucrose groups. Results: Analysis of 100 preterm neonates (50 KMC and 50 oral sucrose) were done. Baseline variables were mean±SD gestational age 34.25±1.42 weeks, age 7.15±4.9 days, birth weight 1.72±0.32 kg. Post procedural PIPP score was less in KMC 5.16±1.58 group compared to oral sucrose 5.48±1.81 group but could not achieve statistical significance p=0.35, 95% CI=−0.99,0.35. Conclusions: KMC and oral sucrose are equally effective for pain management in premature neonates on heel prick but KMC is considered better compared to oral sucrose.

ANALGESIC EFFICACY OF EXPRESSED BREAST MILK, 10% DEXTROSE AND STERILE WATER IN PREVENTION OF PAIN DURING SCREENING OF RETINOPATHY OF PREMATURITY- A THREE LIMBED DOUBLE BLINDED RANDOMIZED CONTROL TRIAL

Introduction : Retinopathy of prematurity is a potentially blinding eye disorder that primarily affects premature infants weighing about 1750 gm or less or born before 34 weeks of gestation. It occurs when abnormal blood vessel grows and spread throughout retina. Aim: To compare efcacy of analgesia during screening of Rtinopathy of Prematurity by EBM, 10% Dextrose and Sterile Water in preterm neonates as measured by prematurity infant pain prole (PIPP) score. Material and Methods: The present study was a three-limbed randomized controlled double-blinded study. This Study was conducted over 2 years at Dept. of Paediatrics (NICU) and RIO, IGIMS, Patna. A total of 75 patients were included in this study who were eligible for ROP screening as per NNF 2020 guidelines. Result: Data of our study showed that almost all patients had Oxygenation [74 (98.7%)] and Respiratory Distress [73 (97.3%)]. Apnea was observed to be absent in more than half of the cases [42 (56%)]. In this study ROP staging was applicable for 39 cases and out of them most common stage identied was ROP Stage 2; the distribution of pain palliative method was observed to be 10% Dextrose in 26 cases (34.7%), EBM in 24 cases (32%) and sterile water in 25 cases (33.3%). The distribution of PIPP score inference elucidated that a signicantly higher number of patients had moderate pain (6-12 score) [53 (70.7%)]. In our study, higher number of patients had moderate pain (6-12) as per PIPP Score with Expressed Breast Milk [21 (91.3%)] compared to Sterile Water [17 (59.3%)] and 10% Dextrose [16 (61.5%)] and this was statistically signicant (p=0.0444). In our study Total PIPP score was highest in Sterile Water [11.4615± 1.3633] compared to 10% Dextrose [9.4231± 2.5640] and Expressed Breast Milk [9.0000± 2.3741] and this nding was statistically signicant (p=0.0002). Conclusion: EBM was found to be signicantly better in pain palliation during ROP screening as compared to 10 % Dextrose and Sterile water

The Physiologic Status of Low-Birth-Weight Infants Before and After Kangaroo Mother Care Sessions: A Retrospective Study

Objective. To compare the physiologic status of infants before and after receiving kangaroo mother care (KMC) through assessment of their heart rate (HR), respiratory rate (RR), temperature, oxygen saturation, and pain scores.&#x0D; Methods. We conducted a retrospective study by chart review of all low-birth weight (LBW) infants enrolled in the KMC program of a tertiary medical center. Significance is defined by lower HR, RR, PIPP score and FLACC scale, and significant increase in temperature and oxygen saturation (within normal range) after 4 hours after each KMC session.&#x0D; Results. Out of the 46 LBW weight infants enrolled in the KMC program, only 23 infants had complete chart entries. A total of 99 KMC sessions were analyzed. There was no significant difference in the HR (p = 0.331), RR (p = 0.453), oxygen saturation (p = 0.839), and PIPP (p = 0.387)/FLACC (p = 0.13) scores among the LBW infants before and after the KMC session. However, there was a significantly higher axillary temperature (within normal range) four hours after KMC (p = 0.044).&#x0D; Conclusions. KMC is associated with better thermoregulation even at four hours after the KMC session compared to four hours before. Other physiologic parameters such as heart rate, respiratory rate, oxygen saturation and pain scores were similar four hours before and after the KMC session.

Paracetamol (acetaminophen) for prevention or treatment of pain in newborns.

Newborn infants have the ability to experience pain. Hospitalised infants are exposed to numerous painful procedures. Healthy newborns are exposed to pain if the birth process consists of assisted vaginal birth by vacuum extraction or by forceps and during blood sampling for newborn screening tests. To determine the efficacy and safety of paracetamol for the prevention or treatment of procedural/postoperative pain or pain associated with clinical conditions in neonates. To review the effects of various doses and routes of administration (enteral, intravenous or rectal) of paracetamol for the prevention or treatment of pain in neonates. We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 4), MEDLINE via PubMed (1966 to 9 May 2016), Embase (1980 to 9 May 2016), and CINAHL (1982 to 9 May 2016). We searched clinical trials' databases, Google Scholar, conference proceedings, and the reference lists of retrieved articles. We included randomised and quasi-randomised controlled trials of paracetamol for the prevention/treatment of pain in neonates (≤ 28 days of age). Two review authors independently extracted data from the articles using pre-designed forms. We used this form to decide trial inclusion/exclusion, to extract data from eligible trials and to request additional published information from authors of the original reports. We entered and cross-checked data using RevMan 5 software. When noted, we resolved differences by mutual discussion and consensus. We used the GRADE approach to assess the quality of evidence. We included nine trials with low risk of bias, which assessed paracetamol for the treatment of pain in 728 infants. Painful procedures studied included heel lance, assisted vaginal birth, eye examination for retinopathy of prematurity assessment and postoperative care. Results of individual studies could not be combined in meta-analyses as the painful conditions, the use of paracetamol and comparison interventions and the outcome measures differed. Paracetamol compared with water, cherry elixir or EMLA cream (eutectic mixture of lidocaine and prilocaine) did not significantly reduce pain following heel lance. The Premature Infant Pain Profile score (PIPP) within three minutes following lancing was higher in the paracetamol group than in the oral glucose group (mean difference (MD) 2.21, 95% confidence interval (CI) 0.72 to 3.70; one study, 38 infants). Paracetamol did not reduce "modified facies scores" after assisted vaginal birth (one study, 119 infants). In another study (n = 123), the Échelle de Douleur et d'Inconfort du Nouveau-Né score at two hours of age was significantly higher in the group that received paracetamol suppositories than in the placebo suppositories group (MD 1.00, 95% CI 0.60 to 1.40). In that study, when infants were subjected to a heel lance at two to three days of age, Bernese Pain Scale for Neonates scores were higher in the paracetamol group than in the placebo group, and infants spent a longer time crying (MD 19 seconds, 95% CI 14 to 24). For eye examinations, no significant reduction in PIPP scores in the first or last 45 seconds of eye examination was reported, nor at five minutes after the eye examination. In one study (n = 81), the PIPP score was significantly higher in the paracetamol group than in the 24% sucrose group (MD 3.90, 95% CI 2.92 to 4.88). In one study (n = 114) the PIPP score during eye examination was significantly lower in the paracetamol group than in the water group (MD -2.70, 95% CI -3.55 to 1.85). For postoperative care following major surgery, the total amount of morphine (µg/kg) administered over 48 hours was significantly less among infants assigned to the paracetamol group than to the morphine group (MD -157 µg/kg, 95% CI -27 to -288). No adverse events were noted in any study. The quality of evidence according to GRADE was low. The paucity and low quality of existing data do not provide sufficient evidence to establish the role of paracetamol in reducing the effects of painful procedures in neonates. Paracetamol given after assisted vaginal birth may increase the response to later painful exposures. Paracetamol may reduce the total need for morphine following major surgery, and for this aspect of paracetamol use, further research is needed.

Applicability of Neonatal Pain Scores depending on Level of Education and Work Experience in Child Care

In management of pain the nursing staff plays a major role in measuring, preventing and treating pain. The influence of general work experience and experience with newborns was investigated by comparing PIPP and NRS measurements in groups with work experience and student nurses. 44 students of the nursing school and 35 members of the staff of 2 university hospitals scored the Premature Infant Pain Profile PIPP - a 7 dimensional measurement tool - for 10 videos of painful procedures on preterm and newborn. The subjective impression of the patients' pain was obtained by a NRS. In contrast to the application of one dimensional measurement tools there were no differences between the groups with different experience levels. Also the work experience with newborn did not seem to influence the total PIPP score. Certainly both groups showed a moderate dispersion of the total values (e. g. Video 1: 10,5 [9-12] vs. 10 [3-11]). In NRS students rated the pain lower than experienced nurses. These results were not significant. The application of PIPP by students was equal to the application by experienced nurses. The work experience with newborn did not seem to influence the rating. Certainly both groups showed a moderate dispersion of total values (e. g. Video 1: 10,5 [9-12] vs. 10 [3-11]).

A Pilot Study of Responses to Suctioning Among Neonates on Bubble Nasal Continuous Positive Airway Pressure.

Maintenance of a patent airway while the neonate is on nasal continuous positive airway pressure (nasal CPAP) requires vigilant monitoring and oral/nasopharyngeal suctioning. Currently, no evidence-based guidelines for safe suctioning in neonates while on bubble nasal CPAP have been published. (1) To characterize the clinical and behavioral responses of neonates on bubble nasal CPAP in a level III neonatal intensive care unit following routine oral and nasopharyngeal suctioning. This pilot study has a 1-sample within-subject repeated-measures design in which neonates (N = 16) served as their own control. Data on a neonate's physiological and behavior measures (heart rate, respiratory rate, oxygen saturation [SaO2], and Premature Infant Pain Profile [PIPP] score) were collected before, during, and after the completion of suctioning sequence. A total of 16 neonates with a mean gestational age of 29.76 weeks and an average day of life of 3.4 were enrolled. The infant's heart rates did not differ significantly (P = .51) across the suctioning sequence. There were no statistical significant changes in the average respiratory rate across the suctioning sequences (P = .79). SaO2 demonstrated a drop between baseline and after each suctioning (P < .001). The PIPP score demonstrated a precipitous increase throughout the procedure (P < .001). On average, it took 9.5 seconds (SD = 4.9) to complete the suctioning sequences. Our results suggest that the guideline tested is safe and tolerated by infants. This guideline should be tested in a larger sample and with neonates on other nasal CPAP systems.

Paracetamol (acetaminophen) for prevention or treatment of pain in newborns.

Newborn infants have the ability to experience pain. Hospitalised infants are exposed to numerous painful procedures. Healthy newborns are exposed to pain if the birth process consists of assisted vaginal birth by vacuum extraction or by forceps and during blood sampling for newborn screening tests. To determine the efficacy and safety of paracetamol for the prevention or treatment of procedural/postoperative pain or pain associated with clinical conditions in neonates. To review the effects of various doses and routes of administration (enteral, intravenous or rectal) of paracetamol for the prevention or treatment of pain in neonates. We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 4), MEDLINE via PubMed (1966 to 9 May 2016), Embase (1980 to 9 May 2016), and CINAHL (1982 to 9 May 2016). We searched clinical trials' databases, Google Scholar, conference proceedings, and the reference lists of retrieved articles. We included randomised and quasi-randomised controlled trials of paracetamol for the prevention/treatment of pain in neonates (≤ 28 days of age). Two review authors independently extracted data from the articles using pre-designed forms. We used this form to decide trial inclusion/exclusion, to extract data from eligible trials and to request additional published information from authors of the original reports. We entered and cross-checked data using RevMan 5 software. When noted, we resolved differences by mutual discussion and consensus. We used the GRADE approach to assess the quality of evidence. We included nine trials with low risk of bias, which assessed paracetamol for the treatment of pain in 728 infants. Painful procedures studied included heel lance, assisted vaginal birth, eye examination for retinopathy of prematurity assessment and postoperative care. Results of individual studies could not be combined in meta-analyses as the painful conditions, the use of paracetamol and comparison interventions and the outcome measures differed. Paracetamol compared with water, cherry elixir or EMLA cream (eutectic mixture of lidocaine and prilocaine) did not significantly reduce pain following heel lance. The Premature Infant Pain Profile score (PIPP) within three minutes following lancing was higher in the paracetamol group than in the oral glucose group (mean difference (MD) 2.21, 95% confidence interval (CI) 0.72 to 3.70; one study, 38 infants). Paracetamol did not reduce "modified facies scores" after assisted vaginal birth (one study, 119 infants). In another study (n = 123), the Échelle de Douleur et d'Inconfort du Nouveau-Né score at two hours of age was significantly higher in the group that received paracetamol suppositories than in the placebo suppositories group (MD 1.00, 95% CI 0.60 to 1.40). In that study, when infants were subjected to a heel lance at two to three days of age, Bernese Pain Scale for Neonates scores were higher in the paracetamol group than in the placebo group, and infants spent a longer time crying (MD 19 seconds, 95% CI 14 to 24). For eye examinations, no significant reduction in PIPP scores in the first or last 45 seconds of eye examination was reported, nor at five minutes after the eye examination. In one study (n = 81), the PIPP score was significantly higher in the paracetamol group than in the 24% sucrose group (MD 3.90, 95% CI 2.92 to 4.88). In one study (n = 114) the PIPP score during eye examination was significantly lower in the paracetamol group than in the water group (MD -2.70, 95% CI -3.55 to 1.85). For postoperative care following major surgery, the total amount of morphine (µg/kg) administered over 48 hours was significantly less among infants assigned to the paracetamol group than to the morphine group (MD -157 µg/kg, 95% CI -27 to -288). No adverse events were noted in any study. The quality of evidence according to GRADE was low. The paucity and low quality of existing data do not provide sufficient evidence to establish the role of paracetamol in reducing the effects of painful procedures in neonates. Paracetamol given after assisted vaginal birth may increase the response to later painful exposures. Paracetamol may reduce the total need for morphine following major surgery, and for this aspect of paracetamol use, further research is needed.

Paracetamol (acetaminophen) for prevention or treatment of pain in newborns.

Paracetamol (acetaminophen) for prevention or treatment of pain in newborns.

Contrasting paired signals arising from the same physiological process

using CRISP-TDMn and STDMn0. Plasma and effect site concentrations (Cp/Ce) were simulated by the PKPD modeling module of the Artemis platform. Encinas' PKPD8 model for fentanyl was used in this retrospective analysis. HRV and RRV were analyzed using the estimated Cp/Ce at the specific point in time. Data from the periods of the infant's NICU hospital course were used for the analysis of the relationship between drug concentration, HRV, RRV, and PIPP score. Results: A fentanyl Ce of 0.02 μg/mL was correlated with a low HRV, statistical significance P = .01 (P b .05), and a PIPP score of 6. The infant's PIPP score was 9 before the increased fentanyl drug dose. There was no detectable effect on RRV for this infant whose respiratory failure was managed with high-frequency jet ventilation at 240 breaths per minute. Conclusions: This case study demonstrates that a high concentration of fentanyl in this critically ill premature infant is associated with a reduction in PIPP score and correlates with decreased HRV. The estimated effect site concentration correlations with low HRV suggests that high-fidelity cardiorespiratory physiological data could serve as an indicator for fentanyl's pharmacodynamics as well as controller variable for a novel pain profile index.

Comparing the Efficacy of Oral Sucrose and Acetaminophen in Pain Relief for Ophthalmologic Screening of Retinopathy of Prematurity

Retinopathy of prematurity (ROP) is a potential cause for visual impairment in preterm newborn infants with gestation age 32 weeks or less and birth weight less than1500 gram. There are several studies that reported physiologic and behavioral responses to painful and stressing screening examination. This study was conducted to compare the efficacy of sucrose and acetaminophen in pain control during eye examination in premature infants. A prospective randomized clinical trial was carried out in a tertiary level NICU. One hundred twenty preterm infants were randomly allocated in to 3 groups. Group A received oral acetaminophen 15mg/kg 30 minutes before eye examination and 0.2ml sterile water, given by mouth using a syringe, during examination; group B 0.2ml sucrose 25% and group C 0.2ml sterile water given by mouth using a syringe during examination. Ophthalmologic examinations were recorded by videotape. Pain score was determined by using PIPP during first 45 seconds and at last 45 seconds of eye examination. There was no significant difference between groups regarding gestation age, birth weight and age at examination. The mean PIPP score at first 45 sec were 12.9±2.4, 9±2.1 and 13.7±1.6 for groups A, B, and C respectively (p<0.001). It was 12.3±2.4, 11.2±3 and 12.1±2.6 at last 45 sec of examination in groups A, B, and C respectively P=0.12.Two patients had apnea during first 12 hours after examination and both of them were in group C. In our study, using sucrose was associated with reduced pain score in neonates undergoing screening for ROP at beginning of eye examination but not at the last seconds of examination.

Pain and stress assessment after retinopathy of prematurity screening examination: Indirect ophthalmoscopy versus digital retinal imaging

BackgroundIncreasingly, neonatal clinics seek to minimize painful experiences and stress for premature infants. Fundoscopy performed with a binocular indirect ophthalmoscope is the reference examination technique for screening of retinopathy of prematurity (ROP), and it is associated with pain and stress. Wide-field digital retinal imaging is a recent technique that should be evaluated for minimizing infant pain and stress.MethodsThe purpose of the study was to assess and compare the impact of using a binocular indirect ophthalmoscope (BIO), or wide-field digital retinal imaging (WFDRI) on pain and stress in infants undergoing ROP screening examination. This was a comparative evaluation study of two screening procedures. Ophthalmologic examinations (N = 70) were performed on 24 infants with both BIO and WFDRI. Pain assessments were performed with two specific neonatal scales (Crying, requires oxygen, increased vital signs, expression and sleeplessness, CRIES and, Premature infant pain profile, PIPP) just prior to the examination, and 30 seconds, 1 hour, and 24 hours later after ending the examination.ResultsChanges over time were significantly different between BIO and WFDRI with both scales (PIPP score, p = .007, and CRIES score, p = .001). Median PIPP score (interquartile interval) at baseline was 4 (3–5). At 30 seconds the score was 8 (6–9) for BIO and 6 (5–7) for WFDRI, respectively. The increase in PIPP score between baseline and 30 seconds was significantly lower with WFDRI (p = .006). The median increase in CRIES score from baseline to 30 seconds was 1 point lower for WFDRI than for BIO (p < .001). No significant difference in response remained at 1 hour or 24 hour assessments.ConclusionsA transient short-term pain and stress response occurs with both BIO and WFDRI. Infants examined for screening of ROP with digital retinal imaging present less pain and stress at 30 seconds following completion of the exam when compared with binocular indirect ophthalmoscopy.

Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial

SummaryBackgroundMany infants admitted to hospital undergo repeated invasive procedures. Oral sucrose is frequently given to relieve procedural pain in neonates on the basis of its effect on behavioural and physiological pain scores. We assessed whether sucrose administration reduces pain-specific brain and spinal cord activity after an acute noxious procedure in newborn infants.MethodsIn this double-blind, randomised controlled trial, 59 newborn infants at University College Hospital (London, UK) were randomly assigned to receive 0·5 mL 24% sucrose solution or 0·5 mL sterile water 2 min before undergoing a clinically required heel lance. Randomisation was by a computer-generated randomisation code, and researchers, clinicians, participants, and parents were masked to the identity of the solutions. The primary outcome was pain-specific brain activity evoked by one time-locked heel lance, recorded with electroencephalography and identified by principal component analysis. Secondary measures were baseline behavioural and physiological measures, observational pain scores (PIPP), and spinal nociceptive reflex withdrawal activity. Data were analysed per protocol. This study is registered, number ISRCTN78390996.Findings29 infants were assigned to receive sucrose and 30 to sterilised water; 20 and 24 infants, respectively, were included in the analysis of the primary outcome measure. Nociceptive brain activity after the noxious heel lance did not differ significantly between infants who received sucrose and those who received sterile water (sucrose: mean 0·10, 95% CI 0·04–0·16; sterile water: mean 0·08, 0·04–0·12; p=0·46). No significant difference was recorded between the sucrose and sterile water groups in the magnitude or latency of the spinal nociceptive reflex withdrawal recorded from the biceps femoris of the stimulated leg. The PIPP score was significantly lower in infants given sucrose than in those given sterile water (mean 5·8, 95% CI 3·7–7·8 vs 8·5, 7·3–9·8; p=0·02) and significantly more infants had no change in facial expression after sucrose administration (seven of 20 [35%] vs none of 24; p<0·0001).InterpretationOur data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug. The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.FundingMedical Research Council.

How effective is tetracaine 4% gel, before a venipuncture, in reducing procedural pain in infants: A randomized double-blind placebo controlled trial

Procedural pain relief is sub-optimal in neonates. Topical tetracaine provides pain relief in children. Evidence of its efficacy and safety in neonates is limited. The objective of this study was to assess the efficacy and safety of topical tetracaine on the pain response of neonates during a venipuncture. Medically stable infants greater than or equal to 24 weeks gestation, requiring a venipuncture, were included. Following randomization and double blinding, 1.1 g of tetracaine or placebo was applied to the skin for 30 minutes. Participants received oral sucrose if they met local eligibility criteria. The venipuncture was performed according to a standard protocol. A medium effect size in the pain score (corresponding to about 2 point difference in the PIPP score) was considered clinically significant, leading to a sample size of 142 infants, with 80% statistical power. Local skin reactions and immediate adverse cardiorespiratory events were noted. The primary outcome, PIPP score at 1 minute, was analysed using an independent Student's t-test. One hundred and forty two infants were included, 33 +/- 4 weeks gestation, 2100 +/- 900 grams and 6 +/- 3 days of age. There was almost no difference in PIPP scores at 1 minute between groups (mean difference -0.09; 95% confidence interval [CI]: -1.68 to 1.50; P = . 91). Similarly, there were no differences in PIPP scores during the 2nd, 3rd and 4th minute. Duration of cry did not differ between the groups (median difference, 0; 95% CI, -3 to 0; P = . 84). The majority of infants in both groups received sucrose 24%. Sucrose had a significant effect on the PIPP score, as assessed by an ANOVA model (p = 0.0026). Local skin erythema was observed transiently in 11 infants (7 in the tetracaine and 4 in the placebo group). No serious side effect was observed. Tetracaine did not significantly decrease procedural pain in infants undergoing a venipuncture, when used in combination with routine sucrose administration.

How effective is tetracaine 4% gel, before a venipuncture, in reducing procedural pain in infants: a randomized double-blind placebo controlled trial

BackgroundProcedural pain relief is sub-optimal in neonates. Topical tetracaine provides pain relief in children. Evidence of its efficacy and safety in neonates is limited. The objective of this study was to assess the efficacy and safety of topical tetracaine on the pain response of neonates during a venipuncture.MethodsMedically stable infants greater than or equal to 24 weeks gestation, requiring a venipuncture, were included. Following randomization and double blinding, 1.1 g of tetracaine or placebo was applied to the skin for 30 minutes. Participants received oral sucrose if they met local eligibility criteria. The venipuncture was performed according to a standard protocol. A medium effect size in the pain score (corresponding to about 2 point difference in the PIPP score) was considered clinically significant, leading to a sample size of 142 infants, with 80% statistical power. Local skin reactions and immediate adverse cardiorespiratory events were noted. The primary outcome, PIPP score at 1 minute, was analysed using an independent Student's t-test.ResultsOne hundred and forty two infants were included, 33 +/- 4 weeks gestation, 2100 +/- 900 grams and 6 +/- 3 days of age. There was almost no difference in PIPP scores at 1 minute between groups (mean difference -0.09; 95% confidence interval [CI]: -1.68 to 1.50; P = . 91). Similarly, there were no differences in PIPP scores during the 2nd, 3rd and 4th minute. Duration of cry did not differ between the groups (median difference, 0; 95% CI, -3 to 0; P = . 84). The majority of infants in both groups received sucrose 24%. Sucrose had a significant effect on the PIPP score, as assessed by an ANOVA model (p = 0.0026). Local skin erythema was observed transiently in 11 infants (7 in the tetracaine and 4 in the placebo group). No serious side effect was observed.ConclusionTetracaine did not significantly decrease procedural pain in infants undergoing a venipuncture, when used in combination with routine sucrose administration.

Sucrose and non-nutritive sucking for the relief of pain in screening for retinopathy of prematurity: A randomised controlled trial

Background: Screening is necessary for infants at risk of retinopathy of prematurity. Despite local anaesthetic drops, infants find eye examinations distressing, displaying behavioural and physiological changes indicating acute pain. Oral sucrose and non-nutritive sucking reduce pain responses associated with invasive procedures. Objective: To evaluate the use of oral sucrose and/or pacifier for reducing pain responses during eye examinations. Methods: Forty infants Results: The groups were similar in gestation, birth weight, and age at examination. Mean PIPP scores were 15.3, 14.3, 12.3, and 12.1 for groups 1, 2, 3, and 4 respectively. Analysis of variance showed a significant difference in PIPP score between groups (p = 0.023). Infants randomised to pacifiers scored lower than those without pacifiers (p = 0.003). There was no difference between groups receiving sucrose and those receiving water (p = 0.321). Conclusions: Non-nutritive sucking reduced distress responses in infants undergoing screening for retinopathy of prematurity. The difference in response was large enough to be detected by a validated assessment tool. No synergistic effect of sucrose and pacifier was apparent in this group.