The effect of two different methods used during peripheral venous blood collection on pain reduction in neonates

Bu çalışmanın amacı yenidoğanlarda vene girme sırasında meydana gelen ağrıyı azaltmada emzirme ve sukroz solüsyonunun analjezik etkilerini incelemek ve karşılaştırmaktır. Fenilketonüri (n=26) rutin taraması ve hiperbilirubinemi (n=76) için venöz kan örneği gereken, emzirilen (gestasyon yaşı 38-42 hafta ve doğum kilosu 2500-4500 g) 102 term yenidoğan çalışmaya alındı. Katılımcılar sukroz, emzirme ve kontrol gruplarına ayrıldı. Yenidoğanların sukroz ve emzirme gruplarına ayrılması annelerin isteklerine göre yapıldı. Oysa ki, kontrol grubundaki yenidoğanlara hastanenin rutin uygulaması yapıldı. Yenidoğanların vene girme işlemi öncesi, sırası ve sonrasında ağrıya cevaplarını belirlemek için Yenidoğan Ağrı Skalası (NIPS) kullanıldı ve kalp hızları, oksijen saturasyon düzeyleri ve ağlama süreleri kaydedildi. Ağlama süresi (saniye) kontrol grubuna (103.50±63.69) göre, sukroz (9.56±12.96) ve emzirme (28.62±33.71) gruplarında daha kısa idi. NIPS ile değerlendirildiği zaman, sukroz ile karşılaştırılan emzirmenin analjezik etkisinde bir farklılık olmadığı bulundu. Ortalama kalp hızında, işlem öncesi, sırası ve sonrası 3 grup arasında anlamlı bir farklılık yok idi. İşlem sırasında, sukroz grubunun ortalama oksijen saturasyon düzeyinin kontrol grubuna göre anlamlı derecede daha yüksek olduğu, fakat sukroz ve emzirme grupları arasında farklılık olmadığı gözlendi. Bu çalışma emzirme ve oral sukroz solüsyonunun vene girme sırasında yenidoğanlarda ağrıyı azaltmada etkin olduğu bilgisini desteklemektedir.

Anahtar Kelimeler:

Süt çocuğu, yenidoğan, Anne sütüyle beslenme, Ağrı, Sukroz

Yenidoğanlarda periferik venöz kan örneklemesi sırasında oluşan ağrıyı azaltmada iki farklı yöntemin etkinliği

The purpose of the present study was to examine and compare the analgesic effects of breast feeding and sucrose solutions in reducing pain due to venipuncture in term neonates. 102 term infants requiring a venous blood sample for routine screening of phenylketonuria (n=26) and hyperbilirubinemia (n= 76) were included in the study. The participants were allocated into one of the sucrose, breast feeding, and control groups. Allocation of the infants into groups was performed due to mothers’ wishes whereas the control group included the infants on whom routine procedures of the hospital were performed. In order to assess the pain response of the neonates before, during and after venipuncture, Neonatal Infant Pain Scale (NIPS) was used and their heart rates, oxygen saturation levels and length of crying were noted. The crying time (seconds) was shorter both sucrose (9.56±12.96) and breast feeding (28.62±33.71) than the control group (103.50±63.69). No difference was found in the analgesic effect of breast feeding compared with sucrose, when assessed with the NIPS. The mean heart rate did not significantly differ among three groups before, during and after procedure. During procedure, the mean oxygen saturation levels of sucrose group were found significantly higher than the control group, but no difference was observed between sucrose and breast feeding groups. This study has confirmed some well known information that breast feeding and oral sucrose solution have pain reducing effects in infants undergoing venipuncture.

Keywords:

Infant, Newborn, Breast Feeding, Pain, Sucrose,

PDF

___

Abad F, Diaz-Gomez NM, Domenech E, Gonzalez D, Robayna M,Ferida M: Oral sucrose compares favourably with lidocaineprilocaine cream for pain relief during venipuncture in neonates. Acta Paediatr 2001; 90: 160-165.
Akdovan T: Sağlıklı yenidoğanlarda ağrının değerlendirilmesi,emzik verme ve kucağa alma yöntemlerinin etkisinin incelenmesi. Master Thesis, T.C. Marmara Üniversitesi Sağlık Bilimleri Enstitüsü, Istanbul, Turkey (in Turkish) 1999.
Anand K: Consensus statement for the prevention and management of pain in the newborn. Archives of Pediatric Adolescent Medicine 2001; 155: 173-180.
Bauer K, Versmold H: Oral sugar solutions in pain therapy of neonates and premature infants. Geburtshilfe Neonatal 2001; 205: 80-85.
Bellieni C, Bagnoli F, Perrone S, Nencı A, Cordelli DM, Fusı M,Ceccarelli S, Buonocore G: Effect of multisensory stimulation on analgesia in term neonates: a randomized controlled trial. Pediatric Research 2002; 51: 460-463.
Bilgen H, Özek E, Cebeci D, Örs R: Comparison of sucrose,expressed breast milk, and breast feeding on the neonatal response to heel prick. The Journal of Pain 2001; 2: 301-305.
Blass EM, Fitzgerald E: Milk induced analgesia and comforting in 10-day-old rats: Opioid mediation. Pharmacol. Biochem. Behav. 1988; 29: 9-13.
Blass EM and Shide DJ: Endogenous cholecystokinin reduces vocalization in isolated 10-day-old rats. Behav. Neurosci 1993; 107: 488-492.
Blass E, Watt LB: Suckling- and sucrose- induced analgesia in human newborns. Pain 1999; 83: 611-623.
Blass EM: Behavioural and physiological consequences of suckling in rat and human newborn. Acta Paediatr. Suppl 1994; 397: 71-76.
Blass EM: Milk- induced hypoalgesia in human newborns.Pediatrics 1997; 99: 825-829.
Blass EM, Fitzgerald E, Kehoe P: Interactions between sucrose, pain and isolation distress. Pharmacol. Biochem. Behav. 1987; 26: 483-489.0
Blass EM: Infant formula quiets crying human newborns. J Dev Behav Pediatr 1997; 18: 162-165.
Bucher H, Bucher-Schmid A: Treating pain in the neonate. In: T.N.Hansen, N. Macintosh, Editors, Current Topics of Neonatology,WB. Saunders Company, London, 1996; s. 85-110.
Bucher H, Moser T, Von Siebenthal K, Keel M, Wolf M, Duc G:Sucrose reduces pain reaction to heel lancing in preterm infants: A placebo-controlled, randomized and masked study. Pediatric Research 1995; 38: 332-335.
Campos RG: Rocking and pacifiers: two comforting interventions for heel stick pain. Res. Nurs Health 1994; 17: 321-331.
Carbajal R, Chauvet X, Couderc S, Martin MO: Randomized trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates. British Medical Journal 1999 ; 319: 1393-1396.
Carbajal R, Veerapen S, Couderc S, Jugie M, Ville Y: Analgesic effect of breast feeding in term neonates: randomized controlled trial.British Medical Journal 2003 ; 326: 13.
Franck LS & Lawhan G: Environmental and behavioural strategies to prevent and manage neonatal pain. Semin Perinatol 1998; 22:434-443.
Gibbins S, Stevens B, Hodnett E, Pinelli J, Ohlsson A, Darlington G:Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nursing Research 2002; 51: 375-382.
Gormally S, Barr RG, Wertheim L, Alkawaf R, Calinoiu N, Young SN:Contact and nutrient caregiving effects on newborn infant pain responses. Developmental Medicine and Child Neurology 2001;43: 28-38.
Gradin M, Eriksson M, Holmqvist G, Hastein A, Schollin J: Pain reduction at venipuncture in newborns: oral glucose compared with local anesthetic cream. Pediatrics 2002; 110: 1053-1057.
Gray L, Miller LW, Philipp BL, Blass EM: Breast feeding is analgesic in healthy newborns. Pediatrics 2002; 109: 590-593.
Gray L, Watt L, Blass EM: Skin-to-skin contact is analgesic in healthy newborns. Pediatrics 2000; 105: E14.
Greenberg C: A sugar-coated pacifier reduces procedural pain in newborn. Pediatric Nursing 2002; 28: 271-277.
Gunnar M, Fisch RO, Malone S: The effects of a pacifying stimulus on behavioral and adrenocortical responses to circumcision in the newborn. Journal of the American Academy of Child & Adolescent Psychiatry 1984; 23: 34-38.
Gunnar MR, Connors J, Isensee J, Wall L: Adrenocortical activity and behavioural distress in human newborns. Dev Psychobiol 1988;21: 297-310.
Haouari N, Wood C, Griffiths G, Levene M: The analgesic effect of sucrose in full term infants: a randomized trial. British Medical Journal 1995; 310: 1498-1500.
Horwitz N: Does oral sucrose reduce the pain of neonatal procedures?Archives of Disease in Childhood 2002; 87: 80.
Johnston C, Strada ME: Acute pain response in infancy: a multidimensional description. Pain 1986; 24: 373-382.
Johnston C, Stremler RL, Stevens BJ, Horton LJ: Effectiveness of oral sucrose and stimulated rocking on pain response in preterm neonates. Pain 1997; 72: 193-199.
Kaufman G, Cimo S, Miller LW, Blass EM: An evaluation of the effects of sucrose on neonatal pain with 2 commonly used circumcision methods. American Journal of Obstetrics and Gynecology 2002; 186: 564-568.
Lawrence J, Alcock D, Mcgrath P, Kay J, MacMurray SB, Dulberg CS:The development of a tool to assess neonatal pain. Neonatal Network 1993; 12: 59-66.
Lewindon PJ, Harkness L, Lewindon N: Randomized controlled trial of sucrose by mouth for the relief of infant crying after immunization. Arch Dis Child 1998; 78: 453-456.
Logan P: Venipuncture versus heel prick for the collection of the newborn screening test. J Adv Nurs 1999; 17: 30-36.
Masters-Harte L, Abdel-Rahman SM: Sucrose analgesia for minor procedures in newborn infants. Ann Pharmacother 2001; 35:947-952.
Mitchell A, Brooks S, Roane D: The premature infant and painful procedures. Pain Manag Nurs 2000; 1: 58-65.
Ors R, Ozek E, Baysoy G et al: Comparison of sucrose and human milk on pain response in newborns. Eur J Pediatr 1999; 158: 63-66
Overgaard C, Knudsen A: Pain-relieving effect of sucrose in newborns during heel prick. Biol Neonate 1999; 75: 279 - 284.
Ramenghi L, Griffith GC, Wood CM, Levene MI: Effect of nonsucrose sweet tasting solution on neonatal heel prick responses. Archives of Disease in Childhood 1996; 74: 129-131.
Ramenghi LA, Evans DJ, Levene MI: “Sucrose analgesia”: absorptive mechanism or taste perception? Arch Dis Child Fetal Neonatal 1999; 80: F146-147.
Shah V, Ohlsson A: Venepuncture versus heel lance for blood sampling in term neonates Cochrane Review. The Cochrane Library, Issue 2, Oxford: update Software Ltd. 2002.
Skogsdal Y, Eriksson M, Schollin J: Analgesia in newborns given oral glucose. Acta Paediatr 1997; 86: 217-220
Stevens B, Taddio A, Ohlsson A, Einarson T: The efficacy of sucrose for relieving procedural pain in neonates, a systematic review and meta analysis. Acta Paediatr 1997; 86: 837-842.
Stevens B, Yamada J, Ohlsson A: Sucrose for analgesia in newborns undergoing painful procedures. Cochrane Review on CD-ROM.In: The Cochrane Library, Issue 4, Oxford, England: Update Software. 2001.
Taddio A, Goldbach M, Ipp M, Stevens B, Koren G: Effect of neonatal circumcision on pain response during vaccination in boys.Lancet 1994; 344: 291-292.
Weller A & Blass EM: Behavioural evidence for cholecystokinin-opiate interactions in neonatal rats. Am J Physiol 1988; 255: 901-907.
Wong D, Eaton MH, Winkelstein ML, Wilson D, Ahman E, Thomas PAD: Nursing care of infants and children: St. Louis: Mosby Company 1999.