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Aspects of prevention and assessment of neonatal pain
Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Faculty of Health Sciences.
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Improvements in neonatal care have led to improved mortality and morbidity rates. An increased number of infants that are born more prematurely are being treated for prolonged time periods in the neonatal care units. The care includes many procedures that might inflict pain on the newborn infants. Pain is a protective mechanism, but it can have negative short- and long-term consequences on vulnerable infants. In order to prevent and treat pain, reliable pain assessment is needed. The aim of this research was to improve pain relief at blood sampling in the neonatal period, by non-pharmacological methods, and to investigate skin conductance as a pain assessment tool in newborn infants.

Study I was a randomised trial with 120 infants divided into four groups, who received 1 ml 10% glucose, 30% glucose, breast milk or no solution, orally, two minutes prior to the heel-stick. In the group given 30% glucose the crying time was significantly shorter than in the control group. Significantly fewer infants in the 30% glucose group did not cry at all, and the heart rate increased less in that group than in the control group.

Study II was a randomised trial with 120 infants divided into four groups, undergoing blood sampling with either heel-stick or veneplmcture and receiving 1 ml 30% glucose orally, or no fluid, prior to the painful event. The crying time was significantly shorter and PIPP pain score lower in the venepuncture group than in the heel-stick group when no glucose was given. When glucose was given, PIPP score was lower in both glucose groups than in the groups without glucose, but no difference was seen between the two glucose groups. Crying time in the glucose group was shorter than ill the group without glucose when heel-stick was performed.

In study III we used a randomised controlled double-blind design. Two hundred and one infants were randomly allocated to one of two groups receiving either 0.5 g EMLA® on the dorsum ofthehandfor 60 minutes followed by a recovery period of 15 min, and 1 ml sterile water in the mouth 2 min prior to venepuncture, or 0.5 ml placebo cream on the hand and 1 ml 30% glucose orally. PIPP scores were lower in the glucose group and fewer infants were scored as having pain (PIPP > 6). Crying time during the first 3 ruin was shorter in the glucose group.

Study IV was designed in a randomised, controlled double-blind way, where 57 infants were divided into two groups, receiving either 1 ml sterile water or 30% glucose three times daily for 3-5 days. Before undergoing routine blood sampling all infants had 1 ml 30% glucose instilled in the mouth. There was no difference in PIPP score, crying time or heart rate increase between the groups.

In study V galvanic skin response and other pain assessment methods were investigated in 32 infants during three procedures performed in a randomised order: 1) gently touching an ann or a leg (no stress or pain), 2) putting a alcohol-soaked cloth on the tnmk skin (stress) and 3) performing heel-stick for routine blood sampling (pain). GSR conductance level increased more in the painful than in the stressing situation. Number of waves and amplitude of the waves increased more during pain than during touching. Crying time was higher dming the painful situation than during the stressful intervention and PIPP was higher during pain than during touching and stress.

In conclusion, we found that 1 ml 30% glucose reduces pain signs from heel-stick and from venepuncture in neonates. Glucose does this better than EMLA ® cream and the effect is better than that of changing from heel-stick to venepuncture. Repeated administration of 1 ml 30% glucose for 3-5 days does not decrease the pain relieving effect.

GSR can contribute to differentiate pain from stress but more research is needed to achieve a clinically useful application.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet , 2003. , 67 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 829
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-22082Local ID: 1162ISBN: 91-7373-519-1 (print)OAI: oai:DiVA.org:liu-22082DiVA: diva2:242395
Public defence
2004-01-16, Wilandersalen, Universitetssjukhuset, Linköping, 09:15 (Swedish)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-05Bibliographically approved
List of papers
1. Analgesia in newborns given oral glucose
Open this publication in new window or tab >>Analgesia in newborns given oral glucose
1997 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 86, no 2, 217-220 p.Article in journal (Refereed) Published
Abstract [en]

There is evidence that newborn babies feel pain even at the lowest gestational ages when they can survive. Because sweet solutions such as sucrose, given orally, may relieve pain in neonates, we decided to compare the effects of two concentrations of glucose (normally used for intravenous infusions) and of breast milk in a randomized controlled trial in 120 babies requiring heel-prick tests. Glucose solutions and breast milk are readily available in the neonatal department. No other treatment was given. Our results strongly suggest that 1 ml of a 30% glucose solution given orally alleviates mild pain significantly and can be used for this purpose in newborns. Breast milk and 10% glucose did not have a similar effect.

Keyword
Breast milk, glucose, newborns, pain
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84394 (URN)10.1111/j.1651-2227.1997.tb08872.x (DOI)
Available from: 2012-10-05 Created: 2012-10-05 Last updated: 2017-12-07Bibliographically approved
2. Oral glucose and venepuncture reduce blood sampling pain in newborns
Open this publication in new window or tab >>Oral glucose and venepuncture reduce blood sampling pain in newborns
1999 (English)In: Early Human Development, ISSN 0378-3782, E-ISSN 1872-6232, Vol. 55, no 3, 211-218 p.Article in journal (Refereed) Published
Abstract [en]

The objectives of this study were to measure pain symptoms in healthy fullterm newborns undergoing routine blood sampling with different methods. The 120 study subjects were randomly allocated to one of four groups with 30 babies in each, namely venepuncture or heel stick, with or without oral glucose administration. Pain was assessed from the duration of crying within the first 3 min, the Premature Infant Pain Profile (PIPP) and changes in heart rate. When the babies received 1 ml 30% glucose prior to skin puncture there was no significant difference between the heel stick and venepuncture group either in mean crying time (12.9 and 11.6 s, respectively) or in PIPP score (3.9 and 3.3). When no glucose was given crying time was 57.3 s in the heel stick group and 26.8 s in the venepuncture group (P=0.0041) and the mean PIPP scores were 8.4 and 6.0, respectively (P=0.0458). This study suggests that if oral glucose is given prior to skin puncture the choice of blood sampling method has no impact on the pain symptoms.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25891 (URN)10.1016/S0378-3782(99)00018-3 (DOI)10332 (Local ID)10332 (Archive number)10332 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
3. Pain reduction at venipuncture in newborns: oral glucose compared with local anesthetic cream
Open this publication in new window or tab >>Pain reduction at venipuncture in newborns: oral glucose compared with local anesthetic cream
Show others...
2002 (English)In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 110, no 6, 1053-1057 p.Article in journal (Refereed) Published
Abstract [en]

Objective. A number of studies have shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. The local anesthetic cream EMLA has recently been shown to be safe for use in neonates. This study compared the pain-reducing effect of orally administered glucose with that of EMLA cream during venipuncture in newborns.

Methods. Randomized, controlled, double-blind study including 201 newborns undergoing venipuncture for clinical purposes. Ninety-nine of the newborns received EMLA on the skin and orally administered placebo (sterile water), and 102 received glucose 30% orally and placebo (Unguentum Merck) on the skin. Symptoms associated with pain at venipuncture were measured with the Premature Infant Pain Profile (PIPP) scale (also validated for full-term infants). Heart rate and crying time were recorded.

Results. There were no differences in background variables between the 2 groups.

The results shows that the PIPP scores were significantly lower in the glucose group (mean: 4.6) compared with the EMLA group (mean: 5.7). The duration of crying in the first 3 minutes was significantly lower in the glucose group (median: 1 second) than in the EMLA group (median: 18 seconds). There were significantly fewer patients in the glucose group who were scored having pain (defined as PIPP score above 6); 19.3% compared with 41.7% in the EMLA group. The changes in heart rate were similar in both groups.

Conclusions. We found that glucose is effective in reducing symptoms associated with pain from venipuncture in newborns and seems to be better than the local anesthetic cream EMLA.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26432 (URN)10.1542/peds.110.6.1053 (DOI)10974 (Local ID)10974 (Archive number)10974 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
4. Can daily repeated doses of orally administered glucose induce tolerance when given for neonatal pain relief?
Open this publication in new window or tab >>Can daily repeated doses of orally administered glucose induce tolerance when given for neonatal pain relief?
2004 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 93, no 2, 246-249 p.Article in journal (Refereed) Published
Abstract [en]

Aim: Orally administered sweet solutions have a pain-relieving effect during painful procedures in newborn infants. The underlying mechanism is not fully understood, but, from the results of animal research, an opioid-like mechanism is often suggested. The aim of this study was to determine whether repeated doses of orally administered glucose would cause tolerance to glucose.

Methods: Fifty-seven healthy, full-term infants were recruited on the day of birth to receive three daily doses of either 1 ml 30% glucose or sterile water for 3–5 d, after which routine blood samples were collected by heel-lance. All infants received 1 ml 30% glucose before the heel-lance was carried out. Crying time, Premature Infant Pain Profile scores and changes in heart rate were used as pain measures.

Results: No differences were found between the groups, either in demographic data or in the outcome variables.

Conclusion: No tolerance was observed under the conditions prevailing in this study. However, we cannot rule out an endogenous opioid mechanism. What is clinically important is that repeated doses of glucose do not decrease the pain-relieving effect.

Keyword
glucose, neonatal pain, tolerance
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22026 (URN)10.1080/08035250310008041 (DOI)1060 (Local ID)1060 (Archive number)1060 (OAI)
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2017-12-13Bibliographically approved
5. Skin conductance compared to a combined behavioural and physiological pain measure in newborn infants
Open this publication in new window or tab >>Skin conductance compared to a combined behavioural and physiological pain measure in newborn infants
2008 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 1, 27-30 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To assess the ability of galvanic skin response (GSR) to differentiate between tactile and painful stimulation in newborn infants, and to compare this with the ability of the premature infant pain profile (PIPP).

Methods: Thirty-two healthy full-term infants undergoing routine blood sampling were recruited. In a randomized order they were subjected to tactile and painful stimulation. The three GSR variables conductance baseline level, number of waves per second and mean amplitude of the waves were recorded together with the behavioural and physiological variables of PIPP.

Results: The GSR variables number of waves and amplitude of the waves increased more during painful stimulation than during tactile stimulation, as did also the PIPP score. Receiver operating characteristic curves analysis revealed no significant differences between the studied methods.

Conclusion: GSR can differentiate painful from tactile stimulation, but more research is needed to achieve a clinically useful application.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84396 (URN)10.1111/j.1651-2227.2007.00586.x (DOI)
Available from: 2012-10-05 Created: 2012-10-05 Last updated: 2017-12-07Bibliographically approved

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