Oral sucrose and a pacifier for pain relief during simple procedures in preterm infants: a randomized controlled trial

Previous randomized trials of the analgesic effects of sucrose, glucose, and a pacifier in term neonates have shown that the pacifier resulted in lower pain scores than glucose or sucrose, but the pacifier with and without sucrose did not differ. The current study was designed to assess the analgesic effect of pharmacologic [sucrose, water] and a non-pharmacologic measures [pacifier] in preterm infants and to find whether there is any synergism between these intervention in relieving pain during painful procedures. In this double-blind, randomized, controlled study, 36 preterm infants [mean 31 weeks gestational age, range 27 to 36 weeks] were randomly allocated to six different regimens [0.5 mL sterile water with pacifier, 0.5 mL sterile water without pacifier, 0.5 mL sucrose 24% with pacifier, 0.5 mL sucrose 24% without pacifier, pacifier alone and control group] during a stay in intensive care of up to 15 days. Pain scores were measured with the Premature Infant Pain Profile [PIPP], a validated behavioral acute pain scale. Of all the regimens, the lowest pain scores occurred with the use of 24% sucrose solution combined with pacifier. The mean pain score for the combination of sucrose with pacifier was 0.7 as compared to 1.4 for the sterile water with pacifier group [P < .05]. The synergistic effect of the combination of sucrose and non-nutritive sucking was clinically effective and safe in relieving the pain of simple procedures such as venipuncture or heel stick in preterm and term infants, but further research is needed on these interventions alone and in combination with other behav-ioral interventions in neonates

Survival of 2 extreme pretrem neonates with cardiac tamponade as a complication of percutaneous central venous catheterization

We report 2 extreme preterm neonates who developed cardiac tamponade secondary to perforation of the myocardium by the percutaneous silastic central venous catheters, which were inserted for parental nutrition. Percutaneous pericardiocentesis was performed and pericardial effusion was aspirated, later proved by analysis to be total parental nutrition. The lines were removed and the patients successfully resuscitated and survived, both were sent home in good condition

Once daily gentamicin dosing in full term neonates

There is no uniformity in the current recommendations of dosing regimen of gentamicin for neonates. We conducted this study to compare once-daily dosing regimen to the twice-daily dosing regimen for neonates with birth weight of >/= 2500 g during the first 7 days of life. Fifty full term infants with birth weight of >/= 2500 gm admitted to the neonatal intensive care unit of King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia between November 1999 to October 2000 and received gentamicin at a dose of 2.5 mg/kg every 12 hours [control group] were compared with 50 term infants who received gentamicin at dose of 4 mg/kg every 24 hours during the period of November 2000 until October 2002 [protocol group]. Trough and peak serum gentamicin levels [SDL] were measured on all infants. Peak SDL was 8.4 +/- 1.8 mg/ml in the protocol group, compared to 6.7 +/- 2 mg/ml in the control group [p=0.001]. Ninety-eight% [n=49] of the protocol group, compared to 86% [n=43] of the control group, had peak SDL in therapeutic range. Fifty-eight% [n=29] of infants in the protocol group, compared to 24% [n=12] of infants in the control group, had peak SDL in higher therapeutic range of 8-12 mg/ml. Six% [n=3] of the protocol infants, compared to 26% [n=13] of the control infants, had trough SDL >2 mg/ml. Six infants [12%] in the protocol group, versus 20 infants [40%] of the control group, required a dosing adjustment. Gentamicin dose of 4 mg/kg given at 24-hour interval achieved significantly higher peak and safe trough serum concentrations in term infants, compared to the twice-daily regimen of 2.5 mg/kg. We suggest that measurement of gentamicin concentration may be not required when once-daily regimen is prescribed for 72 hours to term infants with suspected sepsis

Rebound hyperbilirubinemia in term infants after phototherapy

To determine whether a rebound in serum bilirubin level occurs within 24 hours after discontinuation of phototherapy in term infants with hyperbilirubinemia. A retrospective medical record review of term infants with hyperbilirubinemia requiring phototherapy who were admitted over 24 months, June 1999 to December 2001, at King Abdul-Aziz University Hospital, Jeddah, Kingdom of Saudi Arabia was completed. Total serum bilirubin levels [TSB] at and up to 24 hours after termination of phototherapy [follow-up levels] were recorded. The difference between mean TSB level at termination of phototherapy and at follow-up was calculated using the paired t test. Three hundred and one infants, 53% [n=161] were boys, mean +/- standard deviation [SD] for gestational age was 39.4 +/- 1.4 weeks, mean birth weight was 3200 +/- 600g, mean TSB +/- SD at termination of phototherapy was 193 +/- 46 micromole/ liter [mmol/l] and at follow-up was 188 +/- 45 mmol/l for all infants with either positive or negative direct coombs' test results. The difference in mean TSB level at discontinuation of phototherapy and at follow-up was statistically significant, [t=3.12, P= 0.002]. The mean TSB level at termination of phototherapy was 179 +/- 47 mmol/l and at follow-up was 177 +/- 47 mmol/l for 65 infants with positive direct coombs' test results. This difference was statistically insignificant [t=0.725, P=0.47]. The mean time interval between the termination of phototherapy and the measurement of follow-up TSB level was 8.3 +/- 5.3 hour. The rebound of bilirubin level after termination of phototherapy in otherwise healthy term infants is minimal; thus measurement of serum bilirubin is not required after termination of phototherapy and adds unnecessary expense, prolongs hospitalization, or both