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doi:10.1111/jpc.12392
ORIGINAL ARTICLE
Oral dextrose for analgesia in neonates during nasogastric tube insertion: A randomised controlled trial Arjun Ravishankar, Rajat Thawani, Pooja Dewan, Saurabhi Das, Archana Kashyap, Prerna Batra and Moonis Mohammed Akbar Faridi Department of Paediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Dilshad Garden, Delhi, India
Aim: This study aims to determine if oral dextrose solution can mitigate the pain response to nasogastric tube (NGT) insertion in neonates. Methods: The study was a double-blinded, placebo-controlled, randomised controlled trial. One hundred and fifty consecutive neonates were randomised into three groups to receive 25% dextrose (D25), or 10% dextrose (D10) or placebo (distilled water). An NGT was inserted after giving 2 mL of one of the solutions orally. Pain response was assessed using the Premature Infant Pain Profile (PIPP), and the duration of cry was noted within 60 s of the intervention. Total PIPP score, duration of cry, change in heart rate and oxygen saturation (SpO2) were compared among the three groups. Results: Neonates who received D25 had significantly lesser pain response to NGT insertion in terms of lower PIPP score (P < 0.05) and duration of cry (P = 0.001) compared to D10. There was a significantly smaller increase in heart rate and decrease in SpO2 (P < 0.05). In comparison with placebo, D10 significantly decreased duration of cry (P < 0.05) but not PIPP score. Conclusion: Oral D25 was effective in reducing the pain response during NGT insertion in neonates when compared with oral D10 and placebo. Oral D10 was not found to have a potent analgesic effect for the same. Key words:
analgesia; dextrose; infant; newborn; pain.
What is already known on this topic
What this paper adds
1 Neonates experience pain. 2 Painful experiences in the newborn period may have long term adverse effects. 3 Oral 24% sucrose is a potent analgesic for neonates.
1 Oral 25% dextrose is a potent analgesic in neonates and may be offered as a substitute for oral sucrose solution especially in developing countries. 2 Nasogastric tube insertion in neonates is a painful procedure. 3 Oral D10 is not an effective analgesic in neonates.
Repeated exposure to pain in the neonatal period has been shown to cause functional changes in pain processing systems,1 which may lead to permanent behavioural changes in pain perception during childhood and adulthood.2–4 Hence, it is no longer acceptable to indiscriminately carry out painful procedures on neonates under the assumption that they will not remember it. Various methods have been evaluated for management of neonatal pain such as sucrose, breastfeeding, kangaroo mother care, non-nutritive sucking and swaddling.5–10 Although invasive procedures like heel lance are regarded as noxious and procedural analgesia is often offered,11,12 a simple procedure like nasogastric tube (NGT) insertion, although a routine procedure in most neonatal intensive care units (NICUs), is not perceived to cause pain, and hence, analgesia is not offered routinely. Correspondence: Dr Pooja Dewan, 20B Pocket A, SFS Flats, Mayur Vihar3, Delhi-110096, India. Fax: +91 11 22590495; email: poojadewan@ hotmail.com Conflict of interest: None. Accepted for publication 21 July 2013.
There have been multiple studies showing the efficacy of oral sucrose as an analgesic in neonates.13 One such study has evaluated its role in mitigation of pain during NGT insertion.14 Oral 25% dextrose (D25) has been shown to be as effective as 24% sucrose in neonates in a few studies, and as it is more readily available than 24% sucrose in resource poor settings, it can be tried as its substitute. Hence, we aimed to determine the efficacy of different concentrations of oral dextrose (10% and 25%) in decreasing the pain response in neonates during NGT insertion.
Materials and Methods This randomised, double-blind, placebo-controlled study was conducted in the NICU of University College of Medical Sciences and Guru Tegh Bahadur Hospital, a tertiary care hospital in Delhi, India, between March 2012 and October 2012. Neonates at 24–72 h of age who were haemodynamically stable were included in this study. Neonates with gross congenital anomalies, central nervous system malformations, sepsis, severe/ moderate asphyxia, gestational age
doi:10.1111/jpc.12392
ORIGINAL ARTICLE
Oral dextrose for analgesia in neonates during nasogastric tube insertion: A randomised controlled trial Arjun Ravishankar, Rajat Thawani, Pooja Dewan, Saurabhi Das, Archana Kashyap, Prerna Batra and Moonis Mohammed Akbar Faridi Department of Paediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Dilshad Garden, Delhi, India
Aim: This study aims to determine if oral dextrose solution can mitigate the pain response to nasogastric tube (NGT) insertion in neonates. Methods: The study was a double-blinded, placebo-controlled, randomised controlled trial. One hundred and fifty consecutive neonates were randomised into three groups to receive 25% dextrose (D25), or 10% dextrose (D10) or placebo (distilled water). An NGT was inserted after giving 2 mL of one of the solutions orally. Pain response was assessed using the Premature Infant Pain Profile (PIPP), and the duration of cry was noted within 60 s of the intervention. Total PIPP score, duration of cry, change in heart rate and oxygen saturation (SpO2) were compared among the three groups. Results: Neonates who received D25 had significantly lesser pain response to NGT insertion in terms of lower PIPP score (P < 0.05) and duration of cry (P = 0.001) compared to D10. There was a significantly smaller increase in heart rate and decrease in SpO2 (P < 0.05). In comparison with placebo, D10 significantly decreased duration of cry (P < 0.05) but not PIPP score. Conclusion: Oral D25 was effective in reducing the pain response during NGT insertion in neonates when compared with oral D10 and placebo. Oral D10 was not found to have a potent analgesic effect for the same. Key words:
analgesia; dextrose; infant; newborn; pain.
What is already known on this topic
What this paper adds
1 Neonates experience pain. 2 Painful experiences in the newborn period may have long term adverse effects. 3 Oral 24% sucrose is a potent analgesic for neonates.
1 Oral 25% dextrose is a potent analgesic in neonates and may be offered as a substitute for oral sucrose solution especially in developing countries. 2 Nasogastric tube insertion in neonates is a painful procedure. 3 Oral D10 is not an effective analgesic in neonates.
Repeated exposure to pain in the neonatal period has been shown to cause functional changes in pain processing systems,1 which may lead to permanent behavioural changes in pain perception during childhood and adulthood.2–4 Hence, it is no longer acceptable to indiscriminately carry out painful procedures on neonates under the assumption that they will not remember it. Various methods have been evaluated for management of neonatal pain such as sucrose, breastfeeding, kangaroo mother care, non-nutritive sucking and swaddling.5–10 Although invasive procedures like heel lance are regarded as noxious and procedural analgesia is often offered,11,12 a simple procedure like nasogastric tube (NGT) insertion, although a routine procedure in most neonatal intensive care units (NICUs), is not perceived to cause pain, and hence, analgesia is not offered routinely. Correspondence: Dr Pooja Dewan, 20B Pocket A, SFS Flats, Mayur Vihar3, Delhi-110096, India. Fax: +91 11 22590495; email: poojadewan@ hotmail.com Conflict of interest: None. Accepted for publication 21 July 2013.
There have been multiple studies showing the efficacy of oral sucrose as an analgesic in neonates.13 One such study has evaluated its role in mitigation of pain during NGT insertion.14 Oral 25% dextrose (D25) has been shown to be as effective as 24% sucrose in neonates in a few studies, and as it is more readily available than 24% sucrose in resource poor settings, it can be tried as its substitute. Hence, we aimed to determine the efficacy of different concentrations of oral dextrose (10% and 25%) in decreasing the pain response in neonates during NGT insertion.
Materials and Methods This randomised, double-blind, placebo-controlled study was conducted in the NICU of University College of Medical Sciences and Guru Tegh Bahadur Hospital, a tertiary care hospital in Delhi, India, between March 2012 and October 2012. Neonates at 24–72 h of age who were haemodynamically stable were included in this study. Neonates with gross congenital anomalies, central nervous system malformations, sepsis, severe/ moderate asphyxia, gestational age
