Premature Infant Pain Profile Research Articles

Effectiveness of Hammock Positioning in Reducing Pain and Improving Sleep-Wakefulness State in Preterm Infants.

Hammock positioning is now frequently used with preterm infants admitted to ICUs. However, few studies have investigated the extent to which hammock positioning reduces pain and improves the sleep-wakefulness state compared with traditional positioning. Twenty-six clinically stable newborns with gestational ages from 30 to 37 weeks who were breathing spontaneously were randomly assigned to 2 groups: a hammock-positioning group (n = 13), in which newborns were placed in hammocks in the lateral position, and a traditional-positioning group (n = 13), in which they were kept nested, also in the lateral position. The following variables were evaluated at the beginning and the end of the treatment: pain (with the Premature Infant Pain Profile, and Neonatal Facial Coding System), sleep-wakefulness state (with the Brazelton Neonatal Behavioral Assessment Scale), heart rate, breathing frequency, and peripheral SpO2 . The subjects in the hammock-positioning group showed an improvement in pain compared with the traditional-positioning group(Premature Infant Pain Profile score, 2.62 ± 1.89 vs 2.31 ± 1.97, ΔP = .008) and sleep-wakefulness state score (2.08 ± 0.64 vs 1.23 ± 0.44, Δ P < .001), reduced heart rate (151.69 ± 5.44 vs 142.77 ± 5.18 beats/min, Δ P < .001), breathing frequency (52.31 ± 4.05 vs 50.23 ± 2.55 beats/min, Δ P = .024), and increased peripheral SpO2 (94.69 ± 2.14 vs 98.00 ± 1.22%, Δ P < .001). Hammock positioning was an effective treatment option to reduce pain and improve sleep-wakefulness state. It also helped to reduce heart rate and breathing frequency, and to increase peripheral SpO2 , which made it a treatment option for preterm infants.

Effect of Eye Shield versus Massage on Preterm Infants’ Pain Response during Venipuncture

Background: Evidence demonstrates that controlling pain in the preterm infants during the neonatal periods is improving physiological, behavioral and hormonal outcomes. Eye shield and massage may play an important role as a non-pharmacological pain management during venipuncture. Aim: Is to investigate effect of eye shield and massage on preterm infants’ pain response during venipuncture. Patients and Methods: Time seriesquasi experimental research design was carried out on a randomized sample of 100 newborn infants attending the Neonatal Intensive Care Unit (NICU) of El Manial University Hospital (Kasr Al Ainy), (30control group,30 eye shield group and 30 massage group). Neonatal assessment tool and Preterm Infant Pain Profile (PIPP) were utilized for data collection. Results: There was a significant mean difference between control, eye shield and massage groups regarding PIPP pain assessment scores in three time frames (before venipuncture T0, during T1 and after T2) at P? 0.00 but there wasn’t a significant mean differences after 5 min (T3). Massage group had the fewest mean PIPP score during four time frames (3.50±0.97 before venipuncture, 8.16±1.91 during venipuncture, 4.30±4.30 after venipuncture and 3.22±0.81 after 5 minutes of venipuncture). Conclusion: ANOVA indicated that massage and eye shield groups showed a significant reduction in preterm infant’s pain response than control group during venipuncture but massage was more effective than eye shield. Recommendations: Further studies needed to evaluate the effect of massage in combination with eye shield on preterm infant pain response.

Clinical and Economic Analysis of Morphine Versus Fentanyl in Managing Ventilated Neonates With Respiratory Distress Syndrome in the Intensive Care Setting

PurposeMorphine and fentanyl opioids are common analgesic agents for consideration in the neonatal intensive care unit (NICU) for neonates with respiratory distress syndrome (RDS) and undergoing mechanical ventilation (MV). The aim of this study was to evaluate the clinical and economic impact of morphine versus fentanyl in neonates with RDS undergoing MV. MethodsRetrospective cost-effectiveness analysis of critically ill neonates with RDS receiving standard doses of morphine versus fentanyl at Women's Wellness and Research Center, Qatar. Clinical data of neonates were extracted from medical records of patients from 2014 to 2016. A decision analytic model based on the hospital's perspective was constructed to follow possible consequences of the initial dosing of analgesia, before potential titration. Primary end points were successful pain relief rate based on the Premature Infant Pain Profile scale and overall direct medical cost of therapy. Study population of 126 neonates was used to achieve results with 80% power and 0.05 significance. Sensitivity analysis was conducted to enhance robustness of conclusions against input uncertainties and to increase generalizability of results. FindingsMorphine achieved a success of 68% versus 43% with fentanyl (risk ratio = 1.72; 95% CI, 1.16–2.56; P = 0.0075). Morphine was associated with a minimal incremental cost-effectiveness ratio of USD 135 per additional case of successful pain relief over fentanyl. Higher morphine cost was reported in 2% of cases. Sensitivity analysis found model insensitivity to input uncertainties except NICU stay and cost of MV. ImplicationsThis is the first cost-effectiveness evaluation of morphine versus fentanyl in the NICU. Morphine significantly improved the relieve of pain over fentanyl. It had 98% probability of dominance over fentanyl. Results in this study support the use of morphine over fentanyl as first-line monotherapy with MV in NICU settings.

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]).

Role of sucrose, pacifier and their combination as pain reliever among preterm neonates during painful procedures

Background/Objective: The role of sucrose and/or non-nutritive sucking (NNS) has been evaluated for relieving procedural pain in newborn infants with satisfactory results however there was a controversy regarding the synergestic effect of their combination.}Methods: This quasi-experimental study was conducted in the neonatal intensive care unit in Assiut University Children Hospital including 120 preterm neonates who were divided into 4 groups (20 neonates each). Control group received routine hospital care; sucrose group received oral sucrose solution (OS); pacifier group received pacifier; and last group received oral sucrose solution and pacifier during painful procedures. All were assessed regarding socio-demographic and clinical data in addition to application of Premature Infant Pain Profile (PIPP) scale to assess the levels of pain and mean pain scores pre and post-intervention.Results: The 4 groups were similar regarding soci-demographic and clinical data. The application of the OS and/or pacifier, led to significant improvement of the levels of pain and reduction of the mean score of pain among preterm neonates during painful procedures. In addition, combined pacifier and OS was superior to OS alone and comparable to pacifier alone regarding their effect on the reduction of pain level and mean score of pain.Conclusions: OS and pacifier are effective as pain reliever during painful procedures among preterm neonates. Combined OS and pacifier is superior to OS and pacifier alone.

Skin-to-skin contact during eye examination did not reduce pain compared to standard care with parental support in preterm infants.

We compared the pain relieving effect of skin-to-skin contact versus standard care in the incubator during screening for retinopathy of prematurity. This randomised crossover study included 35 preterm infants of less than 32weeks of gestational age admitted to St Olavs University Hospital, Trondheim, Norway, between January 2014 and June 2016. Randomisation was for skin-to-skin with one of the parents or standard care with supportive positioning by parents for the first of two consecutive eye examinations. The pain score was measured twice using the Premature Infant Pain Profile (PIPP) during and after the eye examination. The infants' movement activity was video recorded after the examination. There was no difference in mean pain scores with skin-to-skin contact versus standard care during (10.2 vs. 10.3, p=0.91) or after (7.0 vs. 6.8, p=0.76) the procedure. Independent of the randomisation group, PIPP scores were lower than previous comparable studies have found. Bouts of movement activity were also the same whether the examination was conducted in skin-to-skin position or in the incubator (p=0.91). Skin-to-skin contact during the eye examination did not provide additional pain relief compared to standard care where the parents were already a part of the multidimensional approach.

Effectiveness of oral glucose as analgesic for neonates undergoing retinopathy of prematurity screening – A randomized pilot study for a parallel randomized control trial

Background: Eye examination is a painful procedure. Neonates exposed to painful stimuli have short- and long-term behavioral and sensory problems. To determine an analgesic for alleviating pain during this mandatory painful, medical procedure is of utmost importance, to have optimal outcomes in these vulnerable preterm babies. We analyzed the effectiveness of 25% dextrose solution as analgesic for retinopathy of prematurity (ROP) screening. Objective: The objective was to study the feasibility of conducting a Phase III randomized controlled trial, for oral analgesic during ROP screening in neonates and to utilize this pilot data for calculating sample size for Phase III trial. Place of the Study: The study was conducted in a tertiary care neonatal unit, Southern India. Type of Study: This was a randomized parallel group masked Phase I/2 external pilot study. Methods: Feasibility was defined a priori; the study population was inpatient babies undergoing ROP screening procedure for the first time as per unit protocol. All subsequent babies, after a written consent from parents/legal guardian, were randomized to oral glucose (25% dextrose solution) or placebo group (distilled water). Premature infant pain profile (PIPP) scores were assessed at basal and post procedure. Babies were observed for 24 h for predefined adverse events. Statistical analysis was done using Stata 11.2. Continuous data were expressed as median based on the skewness, and Mann–Whitney U-test was used for hypothesis testing. Results: Twenty-six inpatient neonates were randomized. The median pain scores (PIPP) at 1 min post procedure for the placebo group were 7 IQ (6, 8), and median pain scores of the oral glucose group were 4 IQ (3–5). Eighty-six percent of the eligible babies were randomized for the study. Eighty-five percent of the randomized babies where available for total observation period of 24 h. Inter-rater variability was assessed by interclass correlation (ICC) coefficient. No adverse events (predefined) were recorded in both groups. Conclusion: This randomized pilot trial is feasible to deliver. Oral glucose (25% dextrose) solution has a significant pain alleviation compared to placebo, in our pilot population. Pain scores assessed were validated by independent reviewer with high ICC of 0.89.

Comparison of pain response to vein puncture versus heel lance among preterm infants undergoing blood sampling

Background Pain in neonates is largely underestimated and neglected. Accurate pain assessment is the first step toward effective pain management. Skin-breaking procedures such as heel lances, vein punctures, and arterial punctures are the most frequently performed painful procedures in neonatal ICUs. Few studies have been done to compare preterm infants’ pain response to heel lance vs venipuncture. Aim The aim was to compare pain response to venipuncture vs heel lance among preterm infants undergoing blood sampling. Materials and methods A comparative descriptive research design was used on a convenient sample of 60 preterm infants less than 37 weeks of gestation who were undergoing blood sampling for complete blood count, blood chemistry, or glucose estimation. Neonatal assessment sheet, blood sampling assessment sheet, and premature infant pain profile scale were used to collect data from two neonatal ICUs of both Cairo University Children Hospital (El Monira) and El Manial University Hospital (Kaser El Aini). After a written consent from parents, the same preterm infant pain response was continuously monitored 30 s before procedure and up to 6 min during the procedure over 2 days (one for venipuncture and one for heel lance). Results The total mean premature infant pain profile score significantly increased during venipuncture than heel lance. Behavioral state was significantly more unstable during vein puncture than heel lance. Venipuncture procedure significantly increased heart rate and decreased oxygen saturation more than heel lance. Conclusion Preterm infants perceive pain as demonstrated by premature infant pain profile scale and vein puncture is the more painful procedure than heel lancing for blood sampling in preterm infants. Recommendations Premature infant pain profile scale should be included in the routine assessment for preterm infants.

A Comprehensive analysis of Neonatal pain and measures to reduce pain

Pain management of neonates is much debated topic in the medical field. Pain and particularly chronic pain may affect the development of the brain and cause permanent injuries. Neonates being non-verbal are unable to express their pain and thus are exposed to various painful procedures without adequate pain relief. This lack of self-report, inadequate pain assessment tool, lack of awareness and concern amongst the care providers and non-availability of standard protocols lead to inadequate pain relief in neonates. The communication of infant pain is identified through validated tools such as: Premature Infant Pain Profile (PIPP), Neonatal Facial Coding System (NFCS), and the Neonatal Infant Pain Scale (NIPS). The most popular means of reducing minor procedural pain is oral glucose solution, music therapy, cuddling the neonates, breast feeding and use of topical anaesthetic agents. Topical anaesthetic agents that are commonly used like EMLA are not far from side effects. EMLA is known to cause methemoglobinemia in preterm babies. Recently a study has been conducted using 4% Liposomal Lidocaine at a tertiary care centre in India by Kaur et al which has found this agent to be useful to relieve minor procedural pain like Venepuncture and found it to be free from side effects of methaemoglobinaemia.[18] In nutshell, effective management of pain is an ethicals well as a scientific issue. Is it not humane to think about providing adequate pain relief to such tiny non-verbal human beings? Effective pain assessment and management in infants correlates with the quality of healthcare provided and the professionalism shown by healthcare providers. As part of comprehensive pain prevention program, each neonatal unit should develop strategies to provide effective pain relief for all procedures.

Erratum: Effect of music (Brahms lullaby) and non-nutritive sucking on heel lance in preterm infants: A randomized controlled crossover trial.

[This corrects the article DOI: 10.1093/pch/pxy072.].

Oral Glucose and Listening to Lullaby to Decrease Pain in Preterm Infants Supported with NCPAP: A Randomized Controlled Trial

BackgroundPreterm infants spend the early days of their lives in neonatal intensive care units, where they undergo many minor painful procedures. There are many nonpharmacologic methods that can effectively reduce the pain response of neonates who undergo routine procedures. AimsThis study aimed to investigate whether oral glucose and listening to lullabies could bring pain relief during the removal and reinsertion of the tracheal tube and also oronasopharyngeal suctioning in premature infants to whom nasal continuous positive airway pressure was applied. DesignA double-blind, randomized controlled trial. SettingThis study was conducted in the neonatal intensive care unit in the tertiary setting between November 2012 and September 2013. Participants/SubjectsA total of 106 preterm infants were divided into three groups, including 37 infants in the control group, 35 infants in the lullaby group, and 34 infants in the glucose group. MethodsAll preterm infants were randomly assigned to either the intervention groups or the control group. Pain responses were assessed using the Neonatal Infant Pain Scale and the Premature Infant Pain Profile. ResultsAn assessment of the pain severity of the preterm infants after the intervention indicated that the preterm infants in the lullaby and glucose groups had lower pain, whereas the preterm infants in the control group experienced more pain (p < .05). ConclusionThe findings suggest that pain could be reduced significantly in preterm infants after the suggested intervention, although further studies are required to identify the benefits of lullabies or glucose in infants during other painful procedures.

Large Spot Laser for Treatment of Retinopathy of Prematurity.

To compare large spot versus standard spot laser for treatment of retinopathy of prematurity (ROP). Eighty eyes of 40 infants with bilateral type 1 ROP were randomized for laser photocoagulation using laser indirect ophthalmoscope with either standard spot or large spot size laser. During the procedure, total time taken and Premature Infant Pain Profile (PIPP) scores were noted. Regression of disease and refractive error were noted on follow-up. The infants were randomized into two groups. All infants in both groups had regression of ROP. Large spot laser significantly reduced total treatment duration in zone I by 32% (P = .005) and zone II by 63.4% (P = .0006). Moderate-to-severe pain occurred in PIPP scores in both groups throughout the procedure (under topical anesthesia) and was comparable between the groups. Mean change in refractive error (myopia) from pre-laser (2.090 diopters [D] ± 1.345 D) to 3 months' post-laser (2.465 D ± 1.399 D) was not statistically significant between the groups. Large spot laser significantly reduced total duration of laser treatment in zone I/II ROP. Large spot laser is a useful alternative for treatment of ROP in terms of faster procedure, lesser total duration of pain, and similar regression profile. It does not cause additional myopia and can be performed without additional training. [Ophthalmic Surg Lasers Imaging Retina. 2018;49:e233-e239.].

Early father-infant skin-to-skin contact and its effect on the neurodevelopmental outcomes of moderately preterm infants in China: study protocol for a randomized controlled trial

BackgroundSkin-to-skin contact (SSC) is an evidence-based intervention that benefits low birth weight /preterm infants. However, China’s health institutional policy inhibits parents from visiting their baby in the neonatal intensive care unit (NICU). In addition, the Chinese traditional postpartum behavioral practice of confining women to home raises barriers to mother-infant contact. Thus, to shorten the duration of parent-infant separation, father-infant SSC is considered a possible alternative. This study determines whether it is safe to perform father-infant SSC in the NICU and investigates how paternal SSC affects outcomes compared with traditional care (TC) for moderately preterm infants.Methods/designA randomized controlled trial will be used to investigate the effects of paternal-infant SSC in NICU wards in China. Preterm infants born at a gestational age in the range of 320–346 weeks with a birth weight > 1500 g will be eligible. A simple random sampling method will be used to allocate infants to the SSC group (n = 25) or the TC group (n = 25). After medical stability, infants in the SSC group will be provided SSC by fathers for one hour every day until discharged from hospital. The primary outcome is neurodevelopmental measures, specifically salivary cortisol and Premature Infant Pain Profile (PIPP) during hospitalization. At 40 weeks of corrected age, infants will be assessed using the Infant Neurological International Battery (INFANIB) and neuroimaging. Secondary outcomes include infants’ physiological stability during SSC and throughout hospitalization and state observation at discharge. The fathers’ mental health will be assessed with the State-Trait Anxiety Inventory (STAI) 1 day to 3 days after the infant’s admission to the NICU and at discharge. Father-infant attachment will be evaluated at 4 and 6 months after the infants’ discharge, measured by the Paternal Postnatal Attachment Scale (PPAS). Statistical analyses will be conducted using a two-sided significance level of 0.05.DiscussionThe effects of paternal-infant SSC on moderately preterm infants will be assessed. The data gathered in this study may have important implications for medical practice and policy in the NICU regarding the care methods of premature infants in China.Trial registrationChinese Clinical Trial Registry, ChiCTR-IOR-1701274. Registered on 20 September 2017. Retrospectively registered.

Analgesic efficacy and safety of morphine in the Procedural Pain in Premature Infants (Poppi) study: randomised placebo-controlled trial

SummaryBackgroundInfant pain has immediate and long-term effects but is undertreated because of a paucity of evidence-based analgesics. Although morphine is often used to sedate ventilated infants, its analgesic efficacy is unclear. We aimed to establish whether oral morphine could provide effective and safe analgesia in non-ventilated premature infants for acute procedural pain.MethodsIn this single-centre masked trial, 31 infants at the John Radcliffe Hospital, Oxford, UK, were randomly allocated using a web-based facility with a minimisation algorithm to either 100 μg/kg oral morphine sulphate or placebo 1 h before a clinically required heel lance and retinopathy of prematurity screening examination, on the same occasion. Eligible infants were born prematurely at less than 32 weeks' gestation or with a birthweight lower than 1501 g and had a gestational age of 34–42 weeks at the time of the study. The co-primary outcome measures were the Premature Infant Pain Profile–Revised (PIPP-R) score after retinopathy of prematurity screening and the magnitude of noxious-evoked brain activity after heel lancing. Secondary outcome measures assessed physiological stability and safety. This trial is registered with the European Clinical Trials Database (number 2014-003237-25).FindingsBetween Oct 30, 2016, and Nov 17, 2017, 15 infants were randomly allocated to morphine and 16 to placebo; one infant assigned placebo was withdrawn from the study before monitoring began. The predefined stopping boundary was crossed, and trial recruitment stopped because of profound respiratory adverse effects of morphine without suggestion of analgesic efficacy. None of the co-primary outcome measures differed significantly between groups. PIPP-R score after retinopathy of prematurity screening was mean 11·1 (SD 3·2) with morphine and 10·5 (3·4) with placebo (mean difference 0·5, 95% CI −2·0 to 3·0; p=0·66). Noxious-evoked brain activity after heel lancing was median 0·99 (IQR 0·40–1·56) with morphine and 0·75 (0·33–1·22) with placebo (median difference 0·25, 95% CI −0·16 to 0·80; p=0·25).InterpretationAdministration of oral morphine (100 μg/kg) to non-ventilated premature infants has the potential for harm without analgesic efficacy. We do not recommend oral morphine for retinopathy of prematurity screening and strongly advise caution if considering its use for other acute painful procedures in non-ventilated premature infants.FundingWellcome Trust and National Institute for Health Research.

EEG, behavioural and physiological recordings following a painful procedure in human neonates

We present a dataset of cortical, behavioural, and physiological responses following a single, clinically required noxious stimulus in a neonatal sample. Cortical activity was recorded from 112 neonates (29–47 weeks gestational age at study) using a 20-channel electroencephalogram (EEG), which was time-locked to a heel lance. This data is linked to pain-related behaviour (facial expression), physiology (heart rate, oxygenation) and a composite clinical score (Premature Infant Pain Profile, PIPP). The dataset includes responses to non-noxious sham and auditory controls. The infants’ relevant medical and pain history was collected up to the day of the study and recorded in an extensive database of variables including clinical condition at birth, diagnoses, medications, previous painful procedures, injuries, and selected maternal information. This dataset can be used to investigate the cortical, physiological, and behavioural pain-related processing in human infants and to evaluate the impact of medical conditions and experiences upon the infant response to noxious stimuli. Furthermore, it provides information on the formation of individual pain phenotypes.

Cultural adaptation and harmonization of four Nordic translations of the revised Premature Infant Pain Profile (PIPP-R)

BackgroundPreterm infants are especially vulnerable to pain. The intensive treatment often necessary for their survival unfortunately includes many painful interventions and procedures. Untreated pain can lead to both short- and long-term negative effects. The challenge of accurately detecting pain has been cited as a major reason for lack of pain management in these non-verbal patients. The Premature Infant Pain Profile (PIPP) is one of the most extensively validated measures for assessing procedural pain in premature infants. A revised version, PIPP-R, was recently published and is reported to be more user-friendly and precise than the original version. The aims of the study were to develop translated versions of the PIPP-R in Finnish, Icelandic, Norwegian, and Swedish languages, and to establish their content validity through a cultural adaptation process using cognitive interviews.MethodsPIPP-R was translated using the recommendations from the International Society for Pharmacoeconomics and Outcomes Research and enhanced with cognitive interviews. The respondent nurse was given a copy of the translated, national version of the measure and used this together with a text describing the infant in the film to assess the pain of an infant in a short film. During the assessment the nurse was asked to verbalize her thought process (thinking aloud) and upon completion the interviewer administered probing questions (verbal probing) from a structured interview guide. The interviews were recorded, transcribed, and analyzed using a structured matrix approach.ResultsThe systematic approach resulted in translated and culturally adapted versions of PIPP-R in the Finnish, Icelandic, Norwegian and Swedish languages. During the cultural adaptation process several problems were discovered regarding how the respondent understood and utilized the measure. The problems were either measure problems or other problems. Measure problems were solved by a change in the translated versions of the measure, while for other problems different solutions such as education or training were suggested.ConclusionsThis study have resulted in translations of the PIPP-R that have content validity, high degree of clinical utility and displayed beginning equivalence with each other and the original version of the measure.

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

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 &lt; .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 &lt; .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.

Use of expressed breast milk for pain relief during venepuncture in neonates

Background: It is now known that repeated pain in neonatal period influences neurodevelopmental outcome. It is necessary to assess and manage neonatal pain with appropriate interventions. The objective is to study whether expressed breast milk effectively reduces neonatal pain after venepuncture in comparison to placebo using sterile water.Methods: In this randomised controlled trial, neonates were randomised into two groups-expressed breast milk group and placebo group with 40 neonates in each group. Two minutes before venepuncture, 2 ml of test solution was administered. Mean Premature Infant Pain Profile (PIPP) score and mean cry time were recorded in neonates of both groups after venepuncture and compared.Results: At 0-30 second, 1-1 ½ minute, 3-3 ½ minute, 5-5 ½ minute after venepuncture, neonates in placebo group had mean PIPP score of 11.475, 10.125, 9.125, 7.575 respectively. At the same time intervals, mean PIPP score was 9.375, 7.825, 6.475, 5.05 in neonates of expressed breast milk group. Mean cry time after venepuncture was 105.65 seconds and 75.825 seconds in the placebo group and expressed breast milk group respectively.Conclusions: Compared to placebo, expressed breast milk significantly reduced mean PIPP score and cry time in neonates.

Sucrose vs. skin to skin care for preterm neonatal pain control-a randomized control trial.

To compare the efficacy of SSC with oral Sucrose for pain management in preterm neonates. Parallel-group, assessor-blinded randomized control trial conducted from February-June 2017 at a level 3B-NICU. Hundred preterm neonates (29-0/7 to 36-6/7 weeks gestational age) requiring heel-stick were randomly assigned (1:1), to SSC (50, Group-A) and Sucrose (50, Group-B). In Group-A, SSC was provided at least 10 min before the procedure. In Group-B, 0.2 ml of oral Sucrose was provided 2 min before the procedure. Blinded assessment of Premature Infant Pain Profile (PIPP) score was done 30 s post-procedure using recorded videos. Baseline variables were [Mean(SD)] gestational age [32.79(2.34) weeks], age [14.04(11.10) days] and birth weight [1.62(0.35) kilograms]. PIPP score was less in group- A vs. B but could not achieve statistical significance [Mean(SD): 7.74(2.43) vs. 8.1(2.82), p = 0.50 CI of the difference: (-1.40,0.68)]. SSC and Sucrose have comparable efficacy in managing pain in premature neonates.

Assisted Physical Exercise and Stress in Preterm Neonates

To evaluate the markers of stress before and after a session of assisted physical exercise in infants born before 35 weeks' gestation. 25 infants born at 280/7 to 346/7 weeks were subjected to assisted physical exercise daily for about 10-15 min at one week of postnatal age or 33 weeks of post menstrual age, whichever was later. Primary outcome was salivary cortisol and secondary outcome was Premature infant pain profile (PIPP) score. Outcomes were measured, on day 5 (±1) of exercise. There was no difference in salivary cortisol between baseline and immediately after (P=0.16), at 90 min (P=0.6) or 120 min (P=0.7) after exercise. Salivary cortisol was lower at 30 min after exercise as compared to baseline (mean difference -0.08 µg/dL; 95% CI -0.16 to -0.002; P=0.04). The median (IQR) PIPP score was significantly higher at 5 min into exercise (4 (3-6) vs 4 (3-5); P=0.04) and at completion of exercise 6 (4-8) vs 4 (3-5); P<0.01), as compared to baseline. Assisted physical exercise does not seem to result in stress in premature infants.