Premature Infant Pain Profile Scores Research Articles

Effects of Kangaroo Care on Neonatal Pain in South Korea.

Blood sampling for a newborn screening test is necessary for all neonates in South Korea. During the heel stick, an appropriate intervention should be implemented to reduce neonatal pain. This study was conducted to identify the effectiveness of kangaroo care (KC), skin contact with the mother, on pain relief during the neonatal heel stick. Twenty-six neonates undergoing KC and 30 control neonates at a university hospital participated in this study. Physiological responses of neonates, including heart rate, oxygen saturation, duration of crying and Premature Infant Pain Profile (PIPP) scores were measured and compared before, during and 1 min and 2 min after heel sticks. The heart rate of KC neonates was lower at both 1 and 2 min after sampling than those of the control group. Also, PIPP scores of KC neonates were significantly lower both during and after sampling. The duration of crying for KC neonates was around 10% of the duration of the control group. In conclusion, KC might be an effective intervention in a full-term nursery for neonatal pain management.

A feasibility and efficacy randomised controlled trial of swaddling for controlling procedural pain in preterm infants.

This study aimed to investigate the feasibility and efficacy of swaddling to control procedural pain among preterm infants. Swaddling has been recommended for controlling neonatal pain. However, the feasibility for use is uncertain and insufficient evidence is available among preterm infants. A two-arm randomised controlled trial with repeated measures. The study was conducted in a 21-bed neonatal intensive care unit of a regional hospital in Hong Kong. Preterm infants who required heelstick procedure were eligible. Fifty-four preterm infants between 30-37 gestational weeks were randomly assigned to swaddling (n=27) and control (standard care, n=27) groups. Pain assessment was performed pre, during, immediate, two, four, six and eight minutes after heelstick procedure using the Premature Infant Pain Profile. The mean Premature Infant Pain Profile scores were significantly reduced in the intervention group compared to the control group during, immediate, two, four, and six minutes after the heelstick procedure. The mean changes of heart rate and oxygen saturation in the intervention group were significantly lower than that of the control group at all measured time points. Notably, the swaddled infants quickly resumed to the baseline level at two minutes whereas the control group reached the stable state at an extended period of six minutes. The findings show that swaddling is feasible and efficacious in controlling pain for heelstick procedure among preterm infants. No adverse effects were observed. This article presents the feasibility and efficacy of swaddling as a non-pharmacological and non-invasive intervention to relieve pain during the heelstick procedures among preterm infants. Swaddling can contribute to control minor procedural pain in neonates as one of the simple, safe, cost effective, humanistic and natural analgesia alternatives.

Effects of Sucrose and Kangaroo Care on Pain Alleviation Among Preterm Neonates Undergoing Invasive Procedures

Background: Persistent neonatal pain due to numerous painful procedures can result in serious consequences of the newborn. Effective pain management is required to promote physiologic stability and positive developmental outcomes in preterm infants. Aims of this study were to examine the effect of sucrose and kangaroo care on pain alleviation among preterm neonates undergoing invasive procedures and compare between sucrose versus kangaroo care on pain alleviation among preterm neonates undergoing invasive procedures. It hypothesized that sucrose and kangaroo care would be effective measures to alleviate procedural pain. The Design of this study was quasi-experimental research design. A sample of 60 neonates was selected to carry out this study then they were randomized to receive (a) sucrose (n =20), (b) kangaroo care (n =20), or (c) routine care (n =20). Setting of this study was health care center for neonates. Tool of this study was Premature Infant Pain Profile (PIPP) (Stevens et al., 1996). Results showed that there was significant difference in PIPP score among preterm neonates within the three groups at 30 seconds and 1 minute (P < 0.001**). Mean PIPP scores for sucrose, kangaroo care and routine care were 8.1 ±3.22, 9.76 ±3.04 and 10.15 ±2.64 respectively. Conclusion: sucrose is the most effective intervention for alleviation of procedural pain in neonates. Therefore, sucrose is a recommended analgesic for premature neonates.

To evaluate and compare the efficacy of combined sucrose and non-nutritive sucking for analgesia in newborns undergoing minor painful procedure: a randomized controlled trial.

The objective of this study was to evaluate and compare the efficacy of combined sucrose and non-nutritive sucking (NNS) for analgesia in newborn infants undergoing heel-stick procedures. This randomized control trial was conducted in the neonatal intensive care unit of a tertiary care hospital over a period of 1 year. One hundred and eighty full-term neonates with birth weight >2200 g and age >24 h were randomized to one of four interventions administered 2 min before the procedure: 2 ml of 30% sucrose (group I, n=45) or NNS (group II, n=45) or both (group III, n=45) or none (group IV, n=45). Primary outcome was composite score based on Premature Infant Pain Profile (PIPP) score. Baseline variables were comparable among the groups. Median (interquartile range) PIPP score was 3 (2 to 4) in group III as compared with 7 (6.5 to 8) in group I, 9 (7 to 11) in group II and 13 (10.5 to 15) in group IV. Group III had significant decrease in the median PIPP score compared with other groups (P=0.000). Median PIPP score also decreased significantly with any intervention as compared with no intervention (P=0.000). Sucrose and/or NNS are effective in providing analgesia in full-term neonates undergoing heel-stick procedures, with the combined intervention being more effective compared with any single intervention.

Acupressure at BL60 and K3 Points Before Heel Lancing in Preterm Infants

Acupressure is an ancient Chinese healing art. In this pain-relieving method, the fingers are used to press key acupuncture points on the skin surface that stimulates the body׳s regulatory processes. The aim of this study was to investigate the effect of acupressure at Kun Lun (UB60) and Taixi (K3) points for pain management in preterm infants prior to heel lancing for blood collection. This was a prospective, randomized controlled study. The study setting was the neonatal intensive care unit at Baskent University Hospital in Turkey. A total of 32 preterm infants between 28 and 36 weeks׳ gestational age were randomly assigned to one of two groups: an acupressure group (n = 16) or a control group (n = 16). In the acupressure group, immediately before the heel prick, acupressure was applied for three minutes at UB60 and K3 points. A behavioral pain score was determined using the Premature Infant Pain Profile (PIPP) scale. There were no significant differences between the groups with respect to gestational age, birth weight, sex, mode of delivery, age at time of procedure, weight at time of procedure, or PIPP score. Mean duration of procedure and mean duration of crying were both shorter in the acupressure group (both P = .001). Applying acupressure at the BL60 and K3 points before heel lancing was associated with shorter procedural time and shorter duration of crying in preterm infants.

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

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

Oral Sucrose for Pain in Neonates During Echocardiography: A Randomized Controlled Trial.

To test the efficacy of oral sucrose in reducing pain/stress during echocardiography as estimated by Premature Infant Pain Profile score. Double-blind, parallel-group, randomized control trial. Tertiary-care neonatal care unit located in Western India. Neonates with established enteral feeding, not on any respiratory support and with gestational age between 32 and 42 weeks requiring echocardiography. Neonates in intervention group received oral sucrose prior to echocardiography. Assessment was done using Premature Infant Pain Profile score. There were 104 examinations; 52 in each group. Baseline characteristics like mean gestational age (37.6 vs. 37.1), birth weight (2.20 vs. 2.08), and feeding status (Breastfeeding- 59.6% vs. 44.2%, paladai feeding- 13.5% vs. 13.5%, and gavage feeding- 26.9% vs. 42.3%) were comparable. The mean (SD) premature infant pain profile score was significantly higher in control group [(7.4 (3.78) vs. 5.2 (1.92), P <0.001]. Oral sucrose significantly reduces pain, and is safe to administer to neonates.

Efficacy of Single Dose Oral Paracetamol in Reducing Pain During Examination for Retinopathy of Prematurity: A Blinded Randomized Controlled Trial.

To investigate the efficacy of paracetamol in reducing pain during examination for retinopathy of prematurity (ROP) in preterm infants. A total of 114 infants undergoing eye examination for retinopathy of prematurity screening were prospectively randomized. Topical anesthetic (Proparacaine; Alcaine® drop 0.5%) was applied 30 s before the eye examination in all the infants. The infants in the intervention group (Group 1, n = 58) received 15 mg/kg of oral paracetamol, 60 min before the examination. The control group (Group 2, n = 56) received the same volume of sterile water per oral with an opaque syringe. Primary outcome measurement was pain assessed by Premature Infant Pain Profile (PIPP) score. Secondary outcome measurements were tachycardia (>180 bpm)/bradycardia (<100 bpm), desaturations (<85% for >10 s), and crying time. The groups were similar for gestational age, birthweight or postnatal age at examination. The intervention group had a significantly lower mean PIPP score during eye examination, following insertion of the speculum [Group 1:12 (9-13) vs. Group 2:14 (13-15), p 0.001]. There were no significant differences between the groups with regard to crying time and the number of the patients with tachycardia/bradycardia and desaturation. Oral paracetamol modestly reduces pain scores during eye examinations. Further cross-over trials on dose and frequency of paracetamol and combination of pharmacological with non-pharmacological approaches and paracetamol alone as a single agent in significant pain reduction are needed.

Oral Dextrose for Pain Management during Laser Treatment of Retinopathy of Prematurity under Topical Anesthesia.

To evaluate efficacy of oral dextrose, in addition to topical anesthesia in providing pain relief during laser ablation therapy of retinopathy of prematurity (ROP). In this randomized controlled trial, neonates with type 1 ROP undergoing laser ablation of peripheral retina were randomized to receive or not to receive 2ml of 25% dextrose orally just before the laser therapy. In both the groups, topical anesthesia was provided by instilling paracaine eye drops twice at 10min interval just before the laser treatment. Main outcome was Premature Infant Pain Profile (PIPP) recorded before and 30s after starting the laser treatment. Birth weight, gestation, stage and extent of ROP and other baseline variables were comparable among neonates randomized to dextrose (n = 12) or control (n = 12) groups. Both groups required comparable number of laser spots. PIPP scores was comparable in neonates randomized to dextrose or control groups and indicated significant amount of pain felt during laser ablation despite local anesthesia with or without oral dextrose. Single dose of oral dextrose did not significantly reduce pain during laser treatment in premature neonates. Further studies with multiple doses of dextrose and its combination with other non-pharmacological (e.g., behavioral, physical) interventions may be needed.

Effect of Mozart music on heel prick pain in preterm infants: a pilot randomized controlled trial

Objective: The aim of this pilot study was to determine the effect of music by Mozart on heel prick procedural pain in premature infants.Background: Painful procedures are routinely performed in the setting of neonatal intensive care unit (NICU). Pain may exert short- and long-term deleterious effects on premature babies. Many non-pharmacological interventions have been proven efficacious for blunting neonatal pain.Study design: Randomized, controlled trial.Methods: The study was carried out in the NICU of the “G. Rummo” Hospital in Benevento, Italy. The sample consisted of 42 preterm infants, with no hearing loss or significant cerebral lesions on cranial ultrasound. They were randomized to receive heel lance during a music condition or a no-music control condition. We set strict criteria for selecting and delivering the music. Baseline and postprocedural heart rate and transcutaneous oxygen saturation were manually recorded. The Premature Infant Pain Profile (PIPP) score was used to measure the behavioral response to prick. An unpaired t-test was performed for the intergroup comparisons.Results: There were significant differences between groups on heart rate increase, oxygen saturation reduction and PIPP score following the procedure.Conclusions: Listening to Mozart music during heel prick is a simple and inexpensive tool for pain alleviating in preterm stable neonates.

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

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. 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.

Topical anesthesia or oral dextrose for the relief of pain in screening for retinopathy of prematurity: a randomized controlled double-blinded trial.

Compare efficacy of 0.5% proparacaine eye drops and oral 25% dextrose in reducing pain during screening for retinopathy of prematurity (ROP). Double-blinded randomized controlled trial. Twenty eligible babies were randomized. Group I received 0.5% proparacaine eye drops at first ROP screening, while Group II received 25% dextrose orally. At second examination, babies received no intervention. Pain was assessed using Premature Infant Pain Profile (PIPP) score. The mean ( ± SD) PIPP during procedure in Group I were 15.5 ± 2.06 and 14 ± 2.4 at first and second screening (p = 0.259). The mean ( ± SD) PIPP in Group II were 14.2 ± 1. 8 and 14.9 ± 2.5 at the first and second screening (p = 0.428). Differences were not statistically significant. The PIPP scores of Group I and Group II at the first screening were also not significantly different (p = 0.165). ROP screening causes moderate to severe pain and neither proparacaine nor dextrose is an effective analgesic.

PO-0666 Acupressure For Preterm Infants In Pain Relief

Background and aims Recent studies have shown that newborns remember and perceive the pain, and they have been shown to feel pain from intrauterine life. To avoid adverse effects of pharmacologic analgesic agents, non pharmacologic strategies to minimise neonatal procedural pain have been proposed. Acupressure is a complementary treatment that uses fingers and applies pressure to stimulate acupoints of the human body. We studied the analgesic effect of acupressure in preterm infants during heel prick blood draw. Methods This study was carried out in a tertiary care neonatal unit at the Baskent University in Turkey. 32 infants born before the age of 37 weeks, and who did not have sepsis, any metabolic or genetic disease, and did not receive any medication for sedation or analgesia were included. The experimental group was given both routine care and acupressure. The control group only underwent routine care. Kunlun point (EX-HN3) and Taixi point (K3) was kneaded for 3 min before the procedure. All babies were scored according to the Premature Infant Pain Profile (PIPP) by a second researcher. Results In both groups of infants enrolled in the study; gestational age, birth weight, postnatal day, the actual weights were similar (p > 0.05). The procedure time and crying time in the acupressure group was significantly lower than other group (p = 0.00). PIPP scores were not found different (p = 0,046). Conclusions In this study, applying acupressure did not change the PIPP score in preterm infants. More research should be done in different acupressure points for analgesic effect for preterm infants.

Music and 25% glucose pain relief for the premature infant: a randomized clinical trial.

OBJECTIVE: to analyze the total Premature Infant Pain Profile scores of premature infants undergoing arterial puncture during music and 25% glucose interventions, and to assess their association with neonatal and therapeutic variables. METHOD: a randomized clinical trial with 80 premature infants; 24 in the Experimental Group 1 (music), 33 in the Experimental Group 2 (music and 25% glucose), 23 in the Positive Control Group (25% glucose). All premature infants were videotaped and a lullaby was played for ten minutes before puncture in Experimental Groups 1 and 2; 25% glucose administered in Experimental Group 2 and the Positive Control Group two minutes before puncture. RESULTS: 60.0% of premature infants had moderate or maximum pain; pain scores and intervention groups were not statistically significant. Statistically significant variables: Experimental Group 1: head and chest circumference, Apgar scores, corrected gestational age; Experimental Group 2: chest circumference, Apgar scores, oxygen therapy; Positive Control group: birth weight, head circumference. CONCLUSION: neonatal variables are associated with pain in premature infants. Brazilian Registry of Clinical Trials: UTN: U1111-1123-4821.

PS-194 The Efficacy Of Non-nutritive Sucking And Sucrose For The Relief Of Pain During Eye Examinations For Retinopathy Of Prematurity: A Randomised Controlled Trial

<h3>Background and aims</h3> Screening of eyes is necessary in infants at risk of retinopathy of prematurity (ROP). Although local anaesthetic drops are administered before eye examination, most infants are highly scored on validated pain scores such as the Premature Infant Pain Profile (PIPP) during examination. We aimed to determine the efficacy of oral sucrose combined with non-nutritive sucking (NNS) for reducing pain during eye examination. <h3>Methods</h3> This was a randomised, controlled study of infants for ROP screening. All infants enrolled in the study met the criteria for ROP screening on the basis of birth weight and/ or gestational age. Only the first screening examination for each baby was considered. Premature babies, were randomised to one of three interventions before their screening examination: group 1 (n = 27) received 24% sucrose oral, group 2 (n = 27) received 24% sucrose with pacifier, group 3 (n = 27) received sterile water with pacifier.Pain responses were scored by using the PIPP. <h3>Results</h3> A total of 81 infants (42 males and 39 females) were enrolled in the study. The mean birth weight was 1280 ± 316 g, gestational age was 28.7 ± 2.1 weeks and corrected gestational age at examination was 34.2 ± 2.9 weeks. The mean PIPP scores in group 1, 2, and 3 were 16.7, 11.4 and 15.1, respectively. Sucrose with pacifier (group 2) had a significantly lower mean PIPP score than group 1 and 3 (p 0.014; 0.021, respectively). <h3>Conclusions</h3> Sucrose combined with NNS and NNS itself reduce pain scores during screening examinations for ROP.

Analgesic effect of non-pharmacological interventions in healthy newborns: A randomised controlled study

Objectives: To assess if breastfeeding and skin-to-skin contact have an analgesic effect in newborns undergoing venepuncture and to evaluate if skin-to-skin contact together with breast feeding provides additional analgesic effect compared to skin-to-skin contact alone. Method: We conducted a prospective randomised controlled study in three maternity units in Colombo South Teaching Hospital. Sixty infants who were undergoing routine venepuncture to assess serum bilirubin levels and who fulfilled the inclusion criteria were enrolled. They were randomly assigned to 1 of 3 study groups. In group I, infants were breastfed while being held in skin-to-skin contact. In group II, babies were given skin-to-skin contact by the mother. Control group infants (Group III) were kept on a table similar to the procedure table during venepuncture, which is the standard ward procedure. Two trained observers independently measured the pain score, using Premature Infant Pain Profile (PIPP). Results: Pain scores of 20 neonates from each group were analyzed. There were no significant differences between the 3 groups in terms of demographic characteristics. Median PIPP scores of the 2 study groups were statistically significant when compared to the control group. There was no significant difference of pain score between the breast feeding with skin to skin contact and skin to skin contact groups. Conclusions: Skin-to-skin contact and breast feeding were effective in reducing the pain during venepuncture. However, breastfeeding with skin-to-skin contact did not provide additional analgesic effect compared to skin-to-skin contact alone. (Key words: pain; newborn infant; skin to skin contact) Sri Lanka Journal of Child health , 2014; 43 (3): 142-146 DOI: http://dx.doi.org/10.4038/sljch.v43i3.7373

The Effect of Vanilla Odor on Response to Venipuncture Pain in Preterm Newborns: a Randomized Control Clinical Trial

Background: Studies have shown that use of olfactory stimuli during painful medical procedures reduces infants’ response to pain. Aim: The main purpose of this study was investigating the effect of vanilla on pain response in preterm infants during and after venipuncture. Methods: This study is a randomized clinical trial. Ninety preterm infants, who were randomly selected and divided into two groups of control and vanilla odor, were classified into 45 people. Infants in the vanilla group were exposed to vanilla odor from 5 minutes before and up to 30 seconds after sampling, and infants of control group were exposed to smell of distilled water. The pain score was measured using premature infant pain profile (PIPP) score 30 seconds prior, during and 30 seconds after sampling. Statistical analyses were done using SPSS 16 software. Analyses were done by t-test, chi-square and repeated measure analyses. Results: Despite the differences between the pain scores of two groups during and after sampling, statistical analyses showed no significant differences between them (p=0.36). Conclusion: Results of the present study showed that use of vanilla odor has no significant effect on premature infants’ pain during blood sampling.

A Comparative Study of Two Remifentanil Doses for Procedural Pain in Ventilated Preterm Infants

Remifentanil is an ultrashort-acting synthetic opioid, and the metabolism of which is not influenced by hepatic or renal function. This study aims to compare the efficacy of two remifentanil doses during procedures in ventilated preterm infants. Prospective, randomized, double-blind, noninferiority trial. Neonatal ICU. Preterm infants who were supported by a mechanical ventilator with tracheal tube and requiring central venous access. Two remifentanil dosages were administered in mechanically ventilated preterm infants during peripherally inserted central catheter insertion. Fourteen preterm infants were randomly assigned to low-dose (0.1 μg/kg/min) or high-dose (0.25 μg/kg/min) remifentanil infusion. The Premature Infant Pain Profile was used to score pain during the procedure, and changes in the Premature Infant Pain Profile score between needle puncture and baseline were analyzed to investigate the noninferiority of low-dose to high-dose remifentanil. Occurrence of cardiorespiratory complications was also recorded. The median gestational age (minimum, maximum) was 26 weeks (24, 31), and the median birth weight was 825 g (610, 1,280). Changes in Premature Infant Pain Profile in the high-dose and low-dose groups were 1.43 ± 3.10 and -0.60 ± 5.32, respectively. The difference in changes in the Premature Infant Pain Profile score between the high-dose and low-dose groups was -2.03 ± 4.13. The corresponding lower limit of one-tailed 97.5% CI was -7.24, below the noninferiority margin. Apneic events and bradycardia did not occur in the low-dose group; however, there were three episodes of apnea (42.9%) and one of bradycardia (14.3%) in the high-dose group (p = 0.683 and 0.366, respectively). For mechanically ventilated preterm infants, the use of remifentanil at 0.25 μg/kg/min as an analgesic for short procedures represents a therapeutic option. Our pilot study suggests the need for larger randomized trials.

Remifentanil analgesia during laser treatment for retinopathy of prematurity: a practical approach in neonatal intensive care unit.

Retinopathy of prematurity (ROP) is a significant cause of childhood blindness. The aim of this study is to determine the feasibility of remifentanil analgesia during laser treatment of ROP performed in the neonatal intensive care unit (NICU). Remifentanil was infused continuously during the procedure starting with a dose of 0.2 µg/kg/min and increased gradually to 0.6 µg/kg/min to provide an adequate level of analgesia. We enrolled 64 infants. Remifentanil was infused continuously at a mean rate of 0.4 ± 0.1 μg/kg/min. No major adverse effects were observed except in two patients with reversible bradycardia and hypotension. Premature infant pain profile (PIPP) scores revealed no pain. Patients with bronchopulmonary dysplasia had similar remifentanil dosage, intubation duration, and extubation time. Remifentanil analgesia for ROP treatment performed in the NICU by pediatricians is a safe and effective modality. This modality offers a practical solution in hospitals without readily available pediatric anesthetists.

Cobedding of Twin Premature Infants: Calming Effects on Pain Responses

The purpose of this trial was to determine whether cobedding of preterm twins has analgesic effects during heel lancing or not. One hundred premature twins (50 sets) born between 26 weeks' and 34 weeks' gestation undergoing heel blood sampling were randomly assigned into two groups: the cobedding group (receiving care in the same incubator) and the standard care group (receiving care in separate incubators). Pain was assessed using the premature infant pain profile score. Duration of crying was measured after heel blood sampling, and salivary cortisol was measured prior to and after heel blood sampling. Infants in the standard care group cried for a longer time during heel lancing than those in the cobedding group (42.6 ± 19.8 seconds vs. 36.4 ± 21.7 seconds, p = 0.03). The mean premature infant pain profile score after heel lancing was significantly higher in the standard care group (9.8 ± 2.6 vs. 8.06 ± 2.8, p = 0.002). The mean salivary cortisol after heel lancing was also significantly higher in the standard care group (24.3 ± 7.4 nmol/L vs. 20.8 ± 7.4 nmol/L, p = 0.02). No significant adverse effects were seen with cobedding. Cobedding is a comforting measure for twin premature infants during heel lancing, which can be performed without any significant adverse effects.