A Study Comparing the Efficacy of Different Non-pharmacological Methods to Reduce Pain in Neonates Admitted in A Tertiary Care Hospital

Aim : To compare the efficacy of different non-pharmacological methods for reducing pain in Neonates. Methodology : During the study period of one year from July, 2019 to July, 2020, a total of 70 infants were consecutively recruited and divided into two groups. One group received 2ml of EBM and other group 2ml of 25% D is administered which was given 1 minute before Venepuncture. The outcome variables are the duration of cry after Venepuncture & NIPS score for both group. Result : The duration of cry was found to be higher in the group receiving EBM. The neonates in 25%D groups had lower Neonatal Infant Pain Scale (NIPS) score than EBM group (chi-sqr-10.34 & p-0.0057). Conclusion : In our study we found 25% Dextrose to be a better non-pharmacological Analgesic as compared to EBM during painful procedure in newborn.

Sodium and Saturated Fat Levels in Meat Products in the Netherlands: An Evaluation Based on Label Information

Aim: To collate and analyse label information on nutrients for meat products (used as sandwich fillings) in the Netherlands, using a standardised methodology established by the Global Food Monitoring Group. The objective was to compare levels of saturated fat (in g/100 grams) and sodium (in mg/100 grams) from 2011-2015 and to evaluate reformulation targets for sodium and saturated fat levels that were due to be met by January 1, 2015. Study Design: Data collection study. Place and Duration: Data collection in two supermarkets in the Netherlands for one month. Methodology: Data were collected by photographing the Nutrition Information Panels (NIPs), front-of-pack communications (Guideline Daily Amounts, health logos) and other back-of-pack information from product labels of processed foods in-store using smartphone technology. Photos were uploaded to a central database where data were entered and checked and cleaned manually. Levels of sodium and saturated fat were calculated and compared with data available from reformulation monitoring reports and with the reformulation targets of the meat sector. Results: Data were collected for 911 processed meat products, with data available for 863 meat products after data cleaning, and 86% (n=745) displaying a NIP. Sodium levels in 2015 were similar compared to concentrations observed in previous years for all subcategories of meat products. For saturated fat, combined heated meat products' saturated fat content was 8 g/100g (SD=3) based on label information in 2015 compared with 10 g/100g (SD=3) based on the label and chemical analyses information of 2014: P<0.001. The percentages of products (2015) which complied with the reformulation targets ranged per product category from 14%-93% for sodium levels and 25%-88% for saturated fat levels. Only a small percentage of meats displayed a health logo (2%) or Guideline Daily Amounts (15%) on the label. Conclusion: Based on the comparison we observed no progress with sodium reductions and little progress with saturated fat reductions in the Netherlands between 2011 and 2015 in processed meat products. In light of the Netherlands’ reformulation covenant of 2014, focus on nutrient levels of meat products could contribute to help meet the national commitment to reduce sodium and saturated fat levels. This method of evaluation could also be used for other product categories to monitor progress and to ultimately decrease the burden of nutrition-associated diseases in the country.

Oral glucose for pain relief during examination for retinopathy of prematurity: a masked randomized clinical trial

OBJECTIVE: Ophthalmologic examination for retinopathy of prematurity is a painful procedure. Pharmacological and non-pharmacological interventions have been proposed to reduce pain during eye examinations. This study aims to evaluate the analgesic effect of 25% glucose using a validated pain scale during the first eye examination for retinopathy of prematurity in preterm infants with birth weight <1,500 g and/or gestational age <32 weeks. METHODS: A masked, randomized clinical trial for one dose of 1 ml of oral 25% glucose solution 2 minutes before the first ophthalmologic examination for retinopathy of prematurity was conducted between March 2008 and April 2010. The results were compared to those of a control group that did not receive oral glucose solution. Pain was evaluated using a Neonatal Infant Pain Scale immediately before and immediately after the ophthalmologic examination in both groups. Clinicaltrials.gov: NCT00648687 RESULTS: One hundred and twenty-four patients who were examined for the first time for retinopathy of prematurity were included. Seventy were included in the intervention group and 54 in the control group. The number of patients with pain immediately before the procedure was similar in both groups. The number of patients with pain after ophthalmologic examination was 15.7% in the intervention group and 68.5% in the control group (p<0.001). CONCLUSIONS: One ml of oral 25% glucose solution given 2 minutes before an ophthalmologic examination for retinopathy of prematurity was an effective measure for pain relief.

Comparison of Pain Response to Venepuncture Versus Heel Lance Blood Sampling in Term Neonates.

Introduction: Pain in neonates is largely underestimated and neglected. Pain experience can alter clinical outcome, brain development and subsequent behavior in newborns. Numerous newborns undergo blood sampling routinely in nurseries/NICUs and these procedures are often done without pain relieving measures. Heel lancing and venepuncture are two common procedures for blood sampling in neonates. The objective of this study was to compare pain response to venepuncture versus heel lance in full term neonates. Materials and Methods: A comparative observational study was conducted among 200 term neonates who were undergoing blood sampling for bilirubin or glucose estimation. Neonates were randomly assigned to heel lance (HL) and venepuncture (VP) groups with 100 babies in each group. During the procedure, pain was assessed by Neonatal/Infant pain Scale (NIPS). Heart rate (HR) and oxygen saturation (SpO2) were continuously monitored 5 minutes prior to procedure and upto 5 minutes after the procedure. Results: The median NIPS score in HL and VP were 7 and 3.5 respectively which showed statistically significant (p= 0.0001) higher level of pain experience in HL than in VP. During the procedure, both the groups (HL and VP) showed significant changes in heart rate and oxygen saturation i.e., increase in HR (p= 0.0001) and decrease in SpO2 (p= 0.0001), however the increase in heart rate and decrease in oxygen saturation were significantly more in HL than in VP (p= 0.0001). Conclusion: Neonates perceive pain as demonstrated by Neonatal Pain Scale and venepuncture is the less painful procedure than heel lancing for blood sampling in neonates.

The Effect of Oral Glucose on Pain Relief in Newborns / 간호학회지

PURPOSE: This study was done to provide data for a nursing intervention to alleviate newborn pain clinically by investigating the effect of oral glucose. METHODS: Subjects were newborns hospitalized in the nursery. Informed consent was obtained from parents of 60 newborns. A heel stick was carried out for a test on 3 groups; the experimental, placebo, and control group. The Neonatal infant pain scale(NIPS), respiration rate, heart rate, peripheral oxygen partial pressure(SpO2), and crying duration were measured to assess pain reaction. All neonatal behaviors were recorded on videotape. RESULTS: There were significant differences in pain behavior during stimulus(F=4.195, p=.020), pain behavior immediately after blood-sampling (F=4.114, p=.021), and pain behavior 3 minutes after that (F=3.630, p=.033). However, there were no significant differences in heart rate, respiration rate, peripheral oxygen partial pressure or crying duration after the heel stick among the groups. CONCLUSIONS: Oral administration of glucose before a heel stick caused the reduction of neonatal pain behavior, which means that it has an effect of pain relief.

Valoración y manejo del dolor en neonatos

Durante las últimas 2 décadas ha aumentado el interés hacia el dolor que perciben los neonatos. Los niños hospitalizados en unidades de cuidados intensivos están expuestos a múltiples procedimientos dolorosos y, desafortunadamente, aún no se ha establecido un tratamiento adecuado para su manejo. Los objetivos de este estudio son: 1) aumentar la sensibilidad del médico ante el sufrimiento del neonato; 2) presentar las escalas más comunes para valorar el dolor en los neonatos (PIPP: Premature Infant Pain Profile; CRIES: Crying, Requires Oxygen to maintain saturation > 95%, Increased vital signs, Expression, Sleeplessness; NIPS: Neonatal Infants Pain Scale); y 3) proponer un manejo terapéutico para el dolor en los neonatos.

During the last 2 decades, awareness of neonatal pain is being increased. Pain has short and long term adverse effects. Babies hospitalized in neonatal intensive care units are exposed to many painful procedures; unfortunately, there is no general consensus in the approach and management of pain in newborns. The objectives of this report are: 1) Increase the awareness of neonatal pain among care givers; 2) present most common neonatal pain assessment scales (PIPP: Premature Infant Pain Profile; CRIES: Crying, Requires Oxygen to maintain saturation > 95 %, Increased vital signs, Expression, Sleeplessness; NIPS: Neonatal Infants Pain Scale); 3) discuss therapeutic approach to management of pain in newborns.