Abstract
Background: Infants may also experience pain during procedures like simple physical examination, bladder catheterization, phlebotomy, intravenous line placement, central venous line, chest tube placement and circumcision. Data on managing pain in infants in low and middle-income countries is scarce. In view of the high incidence of procedural pain and less available data, the current study was taken up to check for better management options. Our objective is to compare the efficacy of oral sucrose versus breastmilk in reducing procedural pain among infants.
Materials and Methods: This interventional comparative study was done at a tertiary care centre among 200 infants who underwent certain minor procedures in the department of paediatrics at Indira Gandhi Institute of Medical Sciences, Patna, from December 2021 to may 2022. Infants with perinatal asphyxia, congenital malformations, neurological problems and who need repeated pricks for blood collection were excluded. 100 infants belonged to the breastmilk group and 100 infants belonged to the oral sucrose group. Age, gender, level of pain etc were assessed and compared between both groups.
Results: There is no significant difference in the mean age of infants in both groups. There is no significant difference in the type of painful procedure, and duration of procedure between both groups. There is a significant reduction in pain in the sucrose group compared to the breastmilk group. Duration of crying is significantly more in the breastmilk group. There were no side effects seen in both groups.
Conclusion: Oral sucrose provided effective pain relief among infants who underwent minor procedures. We recommend using oral sucrose for all infants 10 min before the scheduled painful procedure.
Keywords: Breast milk, Oral sucrose, Procedural pain, Infants, Non-pharmacological interventions.
References
- Grunau R. Early pain in preterm infants. A model of long-term effects. ClinPerinatol: 2002; 29: 373-394.
- Anand KJS, Bergqvist L, Whit Hall R, et al. Acute pain management in newborn infants. Pain: Clin Updates.2011; 19: 1-6.
- Dilen B, Elseviers M. Oral glucose as pain relief in newborns: Results of a clinical trial. Birth.2010. 37: 98-105.
- Walters CB, Kynes JM, Sobey J, Chimhundu-Sithole T, McQueen KAK. Chronic Pediatric Pain in Low- and Middle-Income Countries. Children (Basel). 2018;5(9).
- King S, Chambers CT, Huguet A, MacNevin RC, McGrath PJ, Parker L et al. The epidemiology of chronic pain in children and adolescents revisited: a systematic review. Pain. 2011;152(12): 2729-2738.
- Perquin CW, Hazebroek-Kampschreur AA, Hunfeld JA, van Suijlekom-Smit LW, Passchier J, van der Wouden JC. Chronic pain among children and adolescents: physician consultation and medication use. Clin J Pain. 2000;16(3):229-235.
- Huguet A, Miro J. The severity of chronic pediatric pain: an epidemiological study. J Pain. 2008;9(3):226-236.
- Stanford EA, Chambers CT, Biesanz JC, Chen E. The frequency, trajectories and predictors of adolescent recurrent pain: a population based approach. Pain. 2008;138(1):11-21
- Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA [Internet]. 2008;300(1):60–70. Available from: http://dx.doi.org/10.1001/jama.300.1.60
- Lawrence J., Alcock D., Kay J., McGrath P. J. The development of a tool to assess neonatal pain. Journal of Pain and Symptom Management. 1991;6(3):p. 194. doi: 10.1016/0885-3924(91)91127-U. [CrossRef] [Google Scholar]
- Lan, H.-Y.; Yang, L.; Lin, C.-H.; Hsieh, K.-H.; Chang, Y.-C.; Yin, T. Breastmilk as a Multisensory Intervention for Relieving Pain during Newborn Screening Procedures: A Randomized Control Trial. Int. J. Environ. Res. Public Health 2021, 18, 13023. https://doi.org/ 10.3390/ijerph182413023
- Abinaya, Vinoth, & Ramesh. Use of expressed breast milk for pain relief during venepuncture in neonates. International Journal of Contemporary Pediatrics.2018: 5(5), 1832. https://doi.org/10.18203/2349-3291.ijcp20183516
- Goswami G, Upadhyay A, Gupta NK, Chaudhry R, Chawla D, Sreenivas V. Comparison of analgesic effect of direct breastfeeding, oral 25% dextrose solution and placebo during 1st DPT vaccination in healthy term infants: a randomized, placebo controlled trial. Indian Pediatr. 2013 Jul;50(7):649-53. doi: 10.1007/s13312-013-0196-8. Epub 2012 Dec 5. PMID: 23502661.
- De Bernardo G, Riccitelli M, Sordino D, Giordano M, Piccolo S, Buonocore G, Perrone S. Oral 24% sucrose associated with nonnutritive sucking for pain control in healthy term newborns receiving venipuncture beyond the first week of life. J Pain Res. 2019 Jan 8; 12:299-305. doi: 10.2147/JPR.S184504. PMID: 30662283; PMCID: PMC6329346.
- Sahoo JP, Rao S, Nesargi S, Ranjit T, Ashok C, Bhat S. Expressed breast milk vs 25% dextrose in procedural pain in neonates, a double blind randomized controlled trial. Indian Pediatr. 2013 Feb;50(2):203-7. doi: 10.1007/s13312-013-0067-3. Epub 2012 Jul 5. PMID: 23024098.
- Lalitha Rosali, Saudamini Nesargi, Shiny Mathew, Usha Vasu, Suman PN Rao, Swarnarekha Bhat, Efficacy of Expressed Breast Milk in Reducing Pain During ROP Screening—a Randomized Controlled Trial, Journal of Tropical Pediatrics, Volume 61, Issue 2, April 2015, Pages 135–138,https://doi.org/10.1093/tropej/fmu073
- Varghese, T. C., Paul, A. S., &Soans, S. Oral dextrose v/s breast milk for the pain relief of newborn infants. Clin. Invest. 2020: 10(3), 90-94 Openaccessjournals.com
- American Academy of Pediatrics. The assessment and management of acute pain in infants, children, and adolescents. Pediatrics 2001;108(3):793–7. [PubMed]
- American Academy of Pediatrics. Committee on Fetus and Newborn. Committee on Drugs. Section on Anesthesiology. Section on Surgery. Canadian Paediatric Society. Fetus and Newborn Committee. Prevention and management of pain and stress in the neonate. Pediatrics 2000;105(2):454–61. [PubMed] [Google Scholar]
- Royal College of Paediatrics and Child Health. Recognition and assessment of acute pain in children. London: Royal College of Paediatrics and Child Health, 2001. [Google Scholar]
- Royal Australasian College of Physicians. Guideline statement: Management of procedure-related pain in children and adolescents. J Paed Child Health 2006;42(Suppl 1):S2–S30. [Google Scholar]
- Royal Australasian College of Physicians. Guideline statement: Management of procedure-related pain in neonates. J Paed Child Health 2006;42(Suppl 1):S31–S39. [PubMed]
Corresponding Author
Dr Pooja Mishra
Senior Resident, Department of Paediatrics, Indira Gandhi Institute of Medical Sciences (IGIMS) Patna