liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Oral glucose and venepuncture reduce blood sampling pain in newborns
Department of Paediatrics, Örebro Medical Centre Hospital, Örebro, Sweden.
Department of Paediatrics, Örebro Medical Centre Hospital, Örebro, Sweden.
Department of Paediatrics, Örebro Medical Centre Hospital, Örebro, Sweden.
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.

Place, publisher, year, edition, pages
1999. Vol. 55, no 3, 211-218 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-25891DOI: 10.1016/S0378-3782(99)00018-3Local ID: 10332OAI: oai:DiVA.org:liu-25891DiVA: diva2:246439
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Aspects of prevention and assessment of neonatal pain
Open this publication in new window or tab >>Aspects of prevention and assessment of neonatal pain
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:nbn:se:liu:diva-22082 (URN)1162 (Local ID)91-7373-519-1 (ISBN)1162 (Archive number)1162 (OAI)
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
2. Procedural pain reducing methods and pain assessment in newborns
Open this publication in new window or tab >>Procedural pain reducing methods and pain assessment in newborns
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Our knowledge of pain in neonates has increased significantly during the last fifteen years.We now have an improved understanding of the pain system and of the negative effects of untreated pain. Advances in neonatal care have increased the nwnber of preterm and severely ill infants who are treated in neonatal intensive care units (NICU). These infants are subjected to a variety of painful procedures as part of their management. Sufficient pain relief is needed and for this, valid pain assessment is one prerequisite.

The aim of this research was to improve the management of procedural pain and to examine the assessment of neonatal pain in clinical practice.

In an earlier study, oral glucose was found to reduce pain during blood sampling. To further evaluate the pain-reducing effect of oral glucose and to compare this effect with different blood sampling techniques, a trial was performed. The pain score was lower and crying time shorter in the venipuncture group than in the heel stick group when no glucose was given. When glucose was administered, the pain score was lower in both glucose groups than in the groups not receiving glucose (paper I).

In a randomized, controlled study, the effect of oral glucose was compared with that of a topical local anaesthetic, EMLA, during venipuncture. The pain scores were found to be lower in the glucose group and fewer infants were scored as having pain. Crying time was also shorter in the glucose group (paper II).

To compare the pain-reducing effect of oral glucose with that of breast-feeding shortly before venipuncture, a new trial was performed. The pain score was significantly lower in the infants receiving glucose than in those not given glucose. There was no significant difference in pain score between the infants who were fed and the fasting infants (paper III).

In a previous study we found an increase in heart rate in newboms when they received glucose as pain relief. We therefore investigated whether oral glucose in itself could cause an increase in heart rate in healthy infants. In a trial, infants were randomized to receive oral glucose or placebo without undergoing any painful procedure. The heart rate was significantly higher in the glucose than in the placebo group (paper IV).

Activation of endogenous opioids is suggested as one possible mechanism underlying the pain-reducing effect of oral glucose. We therefore investigated whether administration of an opioid antagonist would reduce the effect of oral glucose at heel stick in full-term newboms. There were no significant differences in pain score or crying between the group receiving an opioid antagonist before oral glucose and the group receiving placebo before oral glucose during heel stick (paper V).

To document whether pain is assessed in Swedish neonatal units and by what methods, a questionnaire was distributed to all neonatal wards in Sweden in 1993, and again in 1998. Only a small proportion of neonatal units in Sweden attempted to assess pain. There was a minor increase in the nwnber of wards that used a structured method for pain scoring. Docwnentation of pain is still inadequate and needs to be improved (paper VI). We compared parental assessment during blood sampling with measurement of the pain score with a multidimensional tool and crying. There was low agreement between these variables during the procedure (paper III).

In conclusion, we found that oral glucose reduces signs of pain from both heel stick and venipuncture blood sampling. Oral glucose reduces pain better than does EMLA cream and better than if the infant is breast-fed shortly before the procedure. Oral glucose increases the heart rate in infants and the pain-reducing effect of oral glucose in newboms was not diminished by injection of an opioid antagonist. Parental assessment of an infant's pain cannot replace measurement by pain scores. The pain assessment at neonatal units in Sweden needs to be improved.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2004. 64 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 868
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-22319 (URN)1516 (Local ID)91-7373-840-9 (ISBN)1516 (Archive number)1516 (OAI)
Public defence
2004-11-19, Wilandersalen, Universitetssjukhuset, Örebro, 13:00 (Swedish)
Opponent
Available from: 2009-10-07 Created: 2009-10-07 Last updated: 2012-10-25Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Authority records BETA

Eriksson, Mats

Search in DiVA

By author/editor
Eriksson, Mats
In the same journal
Early Human Development
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 75 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf