In term infants sucrose given by mouth has been reported to reduce duration of crying after a hcel prick. This study was designed primarily to investigate the cffect of sucrose administered orally immediately before heel lancing on the nociceptive reaction in pretcrm infants as assessed by change in heart rate and duration of crying. A secondary objective was to document changes in cerebral blood volume during acute pain. We used a randomized, masked, placebo-controlled, crossover trial in a neonatal intermediate care unit in a level 3 perinatal center. The patients studied were 16 preterm infants; birth weight, 900-1900 g; gestational wk, 27-34; corrected postmenstrual age at time of investigation, 33-36 wk. Each infant was assessed twice receiving 2 m L of sucrose 50% or 2 mL of distilled water in random order immediately before heel lance. Heart rate, thoracic movcPreterm infants usually endure many heel pricks and other stressful events during their first hospital stay, even if they do not need intensive care. There was a general belief that preterm infants are lcss sensitive to pain than more mature infants; as a result, analgesics and anesthetic agents were rarely used in preterm babies. There has been growing evidence in the last decade that preterm infants are anatomically and physiologically capable of feeling pain. This evidence has led to a change in clinical practice (1-3).Pain involves subjective and emotional associations that are difficult to define in neonates. Nociception (response of the pain-reception neurones), although less often used, would be a better definition as it is a purely physiologic term (4). W e use "pain" in this restricted sense of "nociception."Reaction to pain can be assessed in three ways: 1) watching behavior, including facial expression, body movements, and cry; 2) monitoring physiologic variables, such as heart rate, blood pressure, transcutaneous blood gases; and 3) measuring the release of stress hormones, such as catecholamines and ments, and transcutaneous blood gases were monitored continuously. Crying during the procedure was documented by a videocamera. A change in cerebral blood volume was assessed by near-infrared spectroscopy. We found the heart rate increased by a mean of 35 beatslmin (bpm) after sucrose and 51 bpm aftcr placebo (median difference 16 bpm, interquartile range 1-30 bpm, p = 0.005). Infants cried 67% of time after sucrose and 88% after placebo (median difference lo%, interquartile range 3-33%, 17 = 0.002). Cerebral blood volume decreased in 5 of 14 infants after sucrose and in 6 of 14 infants after placebo (difference not significant). We concluded that sucrose administered orally before a heel lance reduces the pain reaction in preterm infants. Response of cerebral blood volume to pain does not seem to be altered by sucrose. (Pediatr Res 38: 332-335, 1995) cortisol (5-7). For the present study monitoring of physiologic variables was chosen because they can be continuously recorded and easily quantified, and, therefore, are best suited to ...

ABSTRACT. Estimations of cerebral blood flow were performed by both near infrared spectroscopy and 133xenon clearance on 12 occasions in nine critically ill premature infants (26-29 gestational wk) who required mechanical ventilation and supplemental oxygen. For each study, one determination of cerebral blood flow by '33xenon was compared with the mean of two to five measurements by near infrared done within 1-19 (median 5) h. 133Xenon measurements ranged from 9.6-16.9 mL/100 g/min, and mean near infrared measurements ranged from 8.6-25.0 mL/100 g/ min. There was a significant correlation between the two sets of measurements (r = 0.80, p < 0.001). The mean difference between the methods was 1.6 mL/100 g/min, and the 95% limits of agreement were -0.5-3.8 mL/100 g/min. This study showed that cerebral blood flow can be measured noninvasively in critically ill premature infants at the cotside by near infrared spectroscopy and by the '33xenon clearance technique. Hypoxic-ischemic brain injury is a major cause of long-term neurodevelopmental disability in newborn infants-especially in very immature ones-who survive after intensive care. Impaired CBF may be an important factor in the pathogenesis of this type of cerebral injury. However, the exact mechanism is still unknown. Noninvasive quantitative techniques are therefore required to investigate the role of CBF in the pathogenesis of this condition.There are several methods that could be used to quantify CBF in the neonate: venous occlusion plethysmography (I), positron emission tomography (2), XeC, and NIRS. XeC and NIRS can both be applied at the cotside with minimal interference with care and were selected for comparison in this study. The purpose

In contrast to earlier years, in-hospital death in our clinic is nowadays usually preceded by structured and documented medical end-of-life decisions.

This new method has the potential for monitoring continuously, noninvasively, and simultaneously cerebral arterial and venous oxygen saturation and oxygen extraction in mechanically ventilated preterm infants.

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