Comparison of Two Different Doses of Sucrose in Pain Relief by Using Bernese Pain Scale for Neonates

Presenter: B. Tanyeri-Bayraktar (e-mail: [e-mail])

Introduction: Procedural pain is one of utmost importance in neonates especially in premature babies, and harmless, effective pain relief strategies in newborns should be always pursued and applied. Although sucrose is the mostly used agent in this area, there is still uncertainty on which are the proper efficacious dosages and concentrations. In this study, we aimed at comparing the efficacy of two different doses of sucrose administered to neonates in NICU when performing a venipuncture.

Materials and Methods: This was a prospective, randomized, double-blind study, enrolling premature babies <37 weeks of gestational age. Neonates with perinatal asphyxia, congenital malformations, intraventricular hemorrhage grade III–IV were excluded. The study was done during the venous sampling. All babies were fed before the procedure and kept quiet until sampling. A pulse oximeter (Masimo, Irvine, CA) probe was placed to the right hand to detect heart rate and oxygen saturation. Oral 24% sucrose (Tool sweet) was given by sterile syringe on to the anterior part of the tongue. The pacifier was not used in both groups. The patients were randomly allocated to one of the two groups by using a computer-generated table of random numbers. Group 1 infants received 0.2 mL/kg 24% sucrose, and Group 2 infants received 0.5 mL/kg 24% sucrose. Sucrose was given by a nurse who was not involved in the study. After 3 minutes the blood sampling was done by a skilled, trained nurse to equalize the severity of pain. If the sampling was not successful at the first time the baby was excluded from the study. Bernese Pain Scale for Neonates was used to assess the pain scores before, during and after the procedure. Scoring was done and the study data were collected by one doctor and one nurse who were blinded to the treatment groups. Another doctor videorecorded the infants with a cell phone camera during the procedure, and the camera recordings were assessed by another neonatologist in a different time period who was also blinded to the groups. The study was approved by the local ethical boards of Bezmialem Vakif University (02.07.2014 No: 71306642/050–01–04/171) and written informed consents were obtained from the parents.

Results: 129 infants were enrolled in the study (Group 1 [n = 65] and Group 2 [n = 64]). Enrolled infants were 67 girls (51.9%) and 62 boys (48.1%) aged 1- 24 days (8.34 ± 6.25). Ten patients were excluded from the study, one of them had spontaneous intestinal perforation and underwent surgery on his 2nd day of life, two of them died on the first days of life. Four of them had severe intraventricular hemorrhage and three of them had unsuccessful interventions and poor camera recording. No statistically significant difference was found between Group 1 and Group 2 regarding birth weight, gestational age, delivery mode and postnatal age. The results show that there was no statistically significant difference between the groups in the Bernese Pain Scale for Neonates. There was also no statistically difference between groups in the subscales (subjective and objective parameters) of Bernese Pain Scale for Neonates (p > 0.05).

Conclusion: 24% sucrose 0.2 mL/kg is sufficient to relief pain during the venipuncture procedures in premature babies.

Keywords: pain, neonate, bernese pain scale, sucrose