Top

Published in:

01-07-2015 | Original Article

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

Authors: Katharina Vezyroglou, Katrin Mehler, Angela Kribs, Ingrid Becker, Kristina Langhammer, Bernhard Roth, Christoph Hünseler

Published in: European Journal of Pediatrics | Issue 7/2015

Abstract

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.

Conclusion: 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.

Alinejad-Naeini M, Mohagheghi P, Peyrovi H, Mehran A (2014) The effect of facilitated tucking during endotracheal suctioning on procedural pain in preterm neonates: a randomized controlled crossover study. Global J Health Sci 6(4):34774. doi:10.5539/gjhs.v6n4p278 CrossRef

Allegaert K, Veyckemans F, Tibboel D (2009) Clinical practice: analgesia in neonates. Eur J Pediatr 168(7):765–770. doi:10.1007/s00431-009-0932-1 PubMedCrossRef

Anand KJ, International Evidence-Based Group for Neonatal P (2001) Consensus statement for the prevention and management of pain in the newborn, vol 155. Arch Pediatr Adolesc Med 2

Axelin A, Salantera S, Kirjavainen J, Lehtonen L (2009) Oral glucose and parental holding preferable to opioid in pain management in preterm infants. Clin J Pain 25(2):138–145. doi:10.1097/AJP.0b013e318181ad81 PubMedCrossRef

Axelin A, Salantera S, Lehtonen L (2006) Facilitated tucking by parents' in pain management of preterm infants—a randomized crossover trial. Early Hum Dev 82(4):241–247. doi:10.1016/j.earlhumdev.2005.09.012 PubMedCrossRef

Ballantyne M, Stevens B, McAllister M, Dionne K, Jack A (1999) Validation of the premature infant pain profile in the clinical setting. Clin J Pain 15(4):297–303PubMedCrossRef

Blass EM, Shah A (1995) Pain-reducing properties of sucrose in human newborns. Chem Senses 20(1):29–35PubMedCrossRef

Bueno M, Yamada J, Harrison D, Khan S, Ohlsson A, Adams-Webber T, Beyene J, Stevens B (2013) A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manage J Can Pain Soc J de la societe canadienne pour le traitement de la douleur 18(3):153–161

Cignacco E, Hamers JP, Stoffel L, van Lingen RA, Gessler P, McDougall J, Nelle M (2007) The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain 11(2):139–152. doi:10.1016/j.ejpain.2006.02.010 PubMedCrossRef

10.

Cignacco E, Hamers JP, Stoffel L, van Lingen RA, Schutz N, Muller R, Zimmermann LJ, Nelle M (2008) Routine procedures in NICUs: factors influencing pain assessment and ranking by pain intensity. Swiss Med Wkly 138(33–34):484–491PubMed

11.

Cignacco E, Hamers JP, van Lingen RA, Zimmermann LJ, Muller R, Gessler P, Nelle M (2008) Pain relief in ventilated preterms during endotracheal suctioning: a randomized controlled trial. Swiss Med Wkly 138(43–44):635–645PubMed

12.

Fitzgerald M (2005) The development of nociceptive circuits. Nat Rev Neurosci 6(7):507–520. doi:10.1038/nrn1701 PubMedCrossRef

13.

Fitzgerald M, Millard C, McIntosh N (1989) Cutaneous hypersensitivity following peripheral tissue damage in newborn infants and its reversal with topical anaesthesia. Pain 39(1):31–36PubMedCrossRef

14.

Gibbins S, Stevens B (2003) The influence of gestational age on the efficacy and short-term safety of sucrose for procedural pain relief. Adv Neonatal Care 3(5):241–249PubMedCrossRef

15.

Gibbins S, Stevens B, Hodnett E, Pinelli J, Ohlsson A, Darlington G (2002) Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nurs Res 51(6):375–382PubMedCrossRef

16.

Gitto E, Pellegrino S, Manfrida M, Aversa S, Trimarchi G, Barberi I, Reiter RJ (2012) Stress response and procedural pain in the preterm newborn: the role of pharmacological and non-pharmacological treatments. Eur J Pediatr 171(6):927–933. doi:10.1007/s00431-011-1655-7 PubMedCrossRef

17.

Grunau RV, Whitfield MF, Petrie JH, Fryer EL (1994) Early pain experience, child and family factors, as precursors of somatization: a prospective study of extremely premature and fullterm children. Pain 56(3):353–359PubMedCrossRef

18.

Gupta NK, Upadhyay A, Agarwal A, Goswami G, Kumar J, Sreenivas V (2013) Randomized controlled trial of topical EMLA and breastfeeding for reducing pain during wDPT vaccination. Eur J Pediatr 172(11):1527–1533. doi:10.1007/s00431-013-2076-6 PubMedCrossRef

19.

Harrison D, Bueno M, Yamada J, Adams-Webber T, Stevens B (2010) Analgesic effects of sweet-tasting solutions for infants: current state of equipoise. Pediatrics 126(5):894–902. doi:10.1542/peds. 2010-1593 PubMedCrossRef

20.

Hermann C, Hohmeister J, Demirakca S, Zohsel K, Flor H (2006) Long-term alteration of pain sensitivity in school-aged children with early pain experiences. Pain 125(3):278–285. doi:10.1016/j.pain.2006.08.026 PubMedCrossRef

21.

Holsti L, Grunau RE (2010) Considerations for using sucrose to reduce procedural pain in preterm infants. Pediatrics 125(5):1042–1047. doi:10.1542/peds. 2009-2445 PubMedCentralPubMedCrossRef

22.

Ivars K, Nelson N, Finnstrom O, Morelius E (2012) Nasopharyngeal suctioning does not produce a salivary cortisol reaction in preterm infants. Acta Paediatr 101(12):1206–1210. doi:10.1111/apa.12001 PubMedCrossRef

23.

Johnston CC, Stremler R, Horton L, Friedman A (1999) Effect of repeated doses of sucrose during heel stick procedure in preterm neonates. Biol Neonate 75(3):160–166PubMedCrossRef

24.

Kenward MG JB (2003) Design and analysis of cross-over trials. Chapman and Hall

25.

Mitchell A, Boss BJ (2002) Adverse effects of pain on the nervous systems of newborns and young children: a review of the literature. J Neurosci Nurs J Am Assoc Neurosci Nurses 34(5):228–236CrossRef

26.

Okan F, Coban A, Ince Z, Yapici Z, Can G (2007) Analgesia in preterm newborns: the comparative effects of sucrose and glucose. Eur J Pediatr 166(10):1017–1024. doi:10.1007/s00431-006-0373-z PubMedCrossRef

27.

Rommel N, van Wijk M, Boets B, Hebbard G, Haslam R, Davidson G, Omari T (2011) Development of pharyngo-esophageal physiology during swallowing in the preterm infant. Neurogastroenterol Motil Off J Eur Gastrointest Motil Soc 23(10):e401–e408. doi:10.1111/j.1365-2982.2011.01763.x CrossRef

28.

Silverman WA, Andersen DH (1956) A controlled clinical trial of effects of water mist on obstructive respiratory signs, death rate and necropsy findings among premature infants. Pediatrics 17(1):1–10PubMed

29.

Simons SH, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D (2003) Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med 157(11):1058–1064. doi:10.1001/archpedi.157.11.1058 PubMedCrossRef

30.

Simons SH, van Dijk M, van Lingen RA, Roofthooft D, Duivenvoorden HJ, Jongeneel N, Bunkers C, Smink E, Anand KJ, van den Anker JN, Tibboel D (2003) Routine morphine infusion in preterm newborns who received ventilatory support: a randomized controlled trial. JAMA 290(18):2419–2427. doi:10.1001/jama.290.18.2419 PubMedCrossRef

31.

Stevens B, Johnston C, Petryshen P, Taddio A (1996) Premature Infant Pain Profile: development and initial validation. Clin J Pain 12(1):13–22PubMedCrossRef

32.

Stevens B, Johnston C, Taddio A, Gibbins S, Yamada J (2010) The premature infant pain profile: evaluation 13 years after development. Clin J Pain 26(9):813–830. doi:10.1097/AJP.0b013e3181ed1070 PubMedCrossRef

33.

Stevens B, Yamada J, Lee GY, Ohlsson A (2013) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 1:CD001069. doi:10.1002/14651858.CD001069.pub4 PubMed

34.

Taddio A, Katz J, Ilersich AL, Koren G (1997) Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 349(9052):599–603. doi:10.1016/S0140-6736(96)10316-0 PubMedCrossRef

35.

Vanhatalo S, van Nieuwenhuizen O (2000) Fetal pain? Brain Dev 22(3):145–150PubMedCrossRef

36.

Ward-Larson C, Horn RA, Gosnell F (2004) The efficacy of facilitated tucking for relieving procedural pain of endotracheal suctioning in very low birthweight infants. MCN Am J Matern Child Nurs 29(3):151–156, quiz 157–158PubMedCrossRef

37.

Wellmann S, Buhrer C (2012) Who plays the strings in newborn analgesia at birth, vasopressin or oxytocin? Front Neurosci 6:78. doi:10.3389/fnins.2012.00078 PubMedCentralPubMedCrossRef

Title: Oral glucose in preterm neonates during oropharyngeal suctioning: a randomized controlled cross-over trial
Authors: Katharina Vezyroglou
Katrin Mehler
Angela Kribs
Ingrid Becker
Kristina Langhammer
Bernhard Roth
Christoph Hünseler
Publication date: 01-07-2015
Publisher: Springer Berlin Heidelberg
Published in: European Journal of Pediatrics / Issue 7/2015
Print ISSN: 0340-6199
Electronic ISSN: 1432-1076
DOI: https://doi.org/10.1007/s00431-014-2472-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

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

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 7/2015

Effect of glucocorticoids on growth and bone mineral density in children with nephrotic syndrome

An insight into the relationships between prohepcidin, iron deficiency anemia, and interleukin-6 values in pediatric Helicobacter pylori gastritis

Periodic limb movements during sleep are associated with a lower quality of life in children with monosymptomatic nocturnal enuresis

Monitoring aspirin therapy in children after interventional cardiac catheterization: laboratory measures, dose response, and clinical outcomes

Long-term follow-up of re-sting reactions in children with moderate to severe venom hypersensitivity

Letter to the editor: Appropriate use of common accepted methodologies