Background and Aims: Neonatal pain has been under diagnosed and undertreated since forever and misconceptions regarding neonatal pain is the main reason behind it. Healthy neonates usually experience pain during the first week of life due to several medical procedures such as procedures such as blood sampling, immunization, vitamin K injection, or circumcision. Vaccination is one of the most painful procedures in infants and is the most common source of pain in childhood.

Methods: We observed 400 neonates receiving routine dose of BCG and Hepatitis B vaccine given at birth. Pain was assessed on NIPS scale 30 second after first injection and 30 seconds after second injection. The two injections were given 2 minutes apart. 

Results: On comparing the combined score for Hepatitis B and BCG in neonates with age < 24 hours was 12.35±5.07 and in neonates of >24hours mean score after vaccination was 12.84±4.63. The p value was 0.189, which was not significant. The combined mean nips score after Hepatitis B plus BCG injection in neontes residing at altitudes of <999m, 1000-1999m, >2000m was 12.35±4.78, 12.58±4.74, 12.61±5.18 respectively, with a p value of 0.968.Pain during the intramuscular route of injection was significantly higher than intradermal with a mean NIPS score of 8.47±3.09 vs 3.8±2.45 (table 4) and   P value of <0.0001, indicating that intramuscular route of vaccination is more painful than intradermal route.

Conclusion: there was no significant effect age in hours and altitude on pain perceived due to vaccination given at birth in the neontes. Pain perceived was more on intermuscular route of vaccination than on intradermal route.

Keywords: Vaccination, Neonatal Infant Pain Scale Score, Neonate, Pain, BCG Vaccine, Hepatitis B Vaccine, altitude, age, route of administration.

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Dr Pratima Thakur

Senior Resident, Department of paediatrics SLBSGMCH, Nerchowk, Mandi, HP., India