Analgesic Efficacy of Oral Dextrose and Breast Milk during Nasopharyngeal Suctioning of Preterm Infants on CPAP: A Blinded Randomized Controlled Trial

Abstract

Continuous positive airway pressure (CPAP) requires nasopharyngeal suctioning for airway patency, which is painful. Other procedures have used breast milk and 25% dextrose as analgesics. We aimed to compare their analgesic efficacy during nasopharyngeal suctioning in preterm neonates on CPAP. In this blinded randomized controlled trial, babies received 25% dextrose or breast milk orally. Pain before, during and after was assessed using the Premature Infant Pain Profile (PIPP) score. Analysis was done for 40 babies. The mean PIPP score in the 25% dextrose group during the procedure was 11.25 ± 2.73 and 13.2 ± 2.55 (p = 0.02) with the intervention and without. In the breast milk group the PIPP score during the procedure was 11.35 ± 3.05 and 13.45 ± 3.27 (p = 0.04); this difference persisted even after the procedure. There was no significant difference between the interventions. Both interventions significantly reduce pain. The analgesic effect of breast milk was sustained.

Efficacy and safety of non‐pharmacological interventions for endotracheal suctioning pain in preterm infants: A systematic review

“…The sample size of the studies ranged from 20 to 108, the weight of participants was more than 560 grams, and the gestational age ranged from 23 and 37 weeks. In addition, the types of respiratory support were different, including non‐invasive ventilation (Axelin et al, 2009; Rodrigues et al, 2017; Vezyroglou et al, 2015), invasive mechanical ventilation (Alinejad‐Naeini et al, 2014; Fatollahzade et al, 2020; Taplak & Bayat, 2021; Ward‐Larson et al, 2004) and both of them (Axelin et al, 2006; Desai et al, 2017; Mitchell et al, 2013).…”

“…Table 3 summarizes the characteristics of the interventions in each study. A total of nine non‐pharmacological interventions were reported: gentle human touch (GHT) (Fatollahzade et al, 2020), FT (Alinejad‐Naeini et al, 2014; Axelin et al, 2006, 2009; Taplak & Bayat, 2021; Ward‐Larson et al, 2004), swaddling (Desai et al, 2017), oral sucrose (Desai et al, 2017), oral glucose (OG) (Axelin et al, 2009; Rodrigues et al, 2017; Vezyroglou et al, 2015), EBM (Desai et al, 2017; Rodrigues et al, 2017), KC (Mitchell et al, 2013), breast milk smell (BMS) (Taplak & Bayat, 2021) and white noise (WN) (Taplak & Bayat, 2021). The timing of the assessment varied from 5 min before the pain procedure to 5 min after the procedure.…”

“…Figure 2 reported the risk of bias. Five studies (Axelin et al, 2009; Mitchell et al, 2013; Rodrigues et al, 2017; Taplak & Bayat, 2021; Vezyroglou et al, 2015) had a low risk of bias, and four studies were judged to raise some concerns (Alinejad‐Naeini et al, 2014; Axelin et al, 2006; Desai et al, 2017; Fatollahzade et al, 2020), and one study (Ward‐Larson et al, 2004) was assessed to have some concerns in two domains (randomization process and measurement of the outcome). However, given that participants included were premature infants and the intervention process was strictly required, we still believed in the reliability of the result.…”

“…Oral sweet solutions and breast milk have been shown to relieve pain in a single tissue injury procedure. One study (Rodrigues et al, 2017) reported the effects of EBM and dextrose in relieving pain and found that EBM (11.35 ± 3.05 vs 13.45 ± 3.27, p = .04) and 25% dextrose (11.25 ± 2.73 vs 13.20 ± 2.55, p = .02) both can significantly relieve pain during the procedure. In addition, the analgesic effect of EBM remained statistically significant compared to the control group 1 min ( p = .02) and 5 min ( p = .01) after the procedure.…”

“…Rodrigues. et al also analysed the effectiveness of EBM for the preterm infant (Rodrigues et al, 2017). The results showed that there was no statistical difference between EBM and glucose during and 1 min and 5 min after the suctioning ( p > .05), but the effectiveness of EBM was more durable.…”