Oral sucrose for heel lance enhances adenosine triphosphate use in preterm neonates with respiratory distress

Abstract

Objective:To examine the effects of oral sucrose on procedural pain, and on biochemical markers of adenosine triphosphate utilization and oxidative stress in preterm neonates with mild to moderate respiratory distress.Study design:Preterm neonates with a clinically required heel lance that met study criteria (n = 49) were randomized into three groups: (1) control (n = 24), (2) heel lance treated with placebo and non-nutritive sucking (n = 15) and (3) heel lance treated with sucrose and non-nutritive sucking (n = 10). Plasma markers of adenosine triphosphate degradation (hypoxanthine, xanthine and uric acid) and oxidative stress (allantoin) were measured before and after the heel lance. Pain was measured using the Premature Infant Pain Profile. Data were analyzed using repeated measures analysis of variance, chi-square and one-way analysis of variance.Results:We found that in preterm neonates who were intubated and/or were receiving ⩾30% FiO2, a single dose of oral sucrose given before a heel lance significantly increased markers of adenosine triphosphate use.Conclusion:We found that oral sucrose enhanced adenosine triphosphate use in neonates who were intubated and/or were receiving ⩾30% FiO2. Although oral sucrose decreased pain scores, our data suggest that it also increased energy use as evidenced by increased plasma markers of adenosine triphosphate utilization. These effects of sucrose, specifically the fructose component, on adenosine triphosphate metabolism warrant further investigation.

Oral dextrose reduced procedural pain without altering cellular ATP metabolism in preterm neonates: a prospective randomized trial

“…Figure 1 describes the study inclusion and exclusion criteria and the flowchart of subject enrollment. Subjects were premature infants born at >24 weeks gestational age (GA) who had an arterial or central catheter in place and clinically required heel lancing at 27-36 weeks corrected GA. Exclusion criteria included (1) requirement for surgery, (2) intraventricular hemorrhage (IVH) ≥ grade 3, (3) neonates on medications such as morphine, fentanyl, midazolam, muscle relaxants, phenobarbital, or phenytoin, (4) renal injury (plasma creatinine >1 mg/dl), (5) cyanotic heart lesions requiring inotropic support, (6) respiratory distress (increased work of breathing as evidenced by tachypnea, nasal flaring, chest retractions and grunting [13], (7) chromosomal anomalies, and (8) facial anomalies. To minimize the risk for hypovolemia, potential subjects were excluded if study sampling (along with clinically-related blood sampling) could potentially result in blood volume loss of more than 10%.…”

“…Purine metabolites (hypoxanthine and uric acid) were measured as previously published by our laboratory [2,5,6]. Specifically, plasma was removed, transferred to separate Eppendorf tubes, and immediately centrifuged in Eppendorf 5702R (Pittsburgh, Pennsylvania) centrifuge, for 30 min at 18,000 × g. The supernatant was transferred to Microcon centrifugal filter devices (Millipore Corp, Bedford, Massachusetts), 200 μL per device, and spun for 90 min at 14,000 × g, 4°C.…”

“…Allantoin was measured in plasma as previously published by our laboratory [2,5,6] using an adaptation of the methods developed by Gruber et al [19] and Pavitt et al [20]. Plasma (50 μL) was transferred to an Eppendorf tube containing 5 × 10 −10 mol internal standard (50 μL 10 μM [ 15 N]-labeled allantoin).…”

“…Moreover, this effect was enhanced in neonates that were intubated or were receiving more than 30% FiO 2 [6]. It, therefore, became necessary to look for an intervention, or a combination of interventions, which would decrease both behavioral and physiological markers of procedural pain, and not increase the biochemical markers of ATP utilization and oxidative stress.…”

The Association of Kangaroo Mother Care, Energy Conservation, and Bonding in Preterm Neonates

“…For the mother, evidence of bonding was measured with MIBS self-scale instrument. For the infant, reduction in energy utilization was quantified by examining urinary biochemical markers of ATP degradation (hypoxanthine, xanthine, and uric acid) and further measure of oxidative stress (Allantoin) (Angeles et al, 2015;Plank, Calderon, Asmerom, Boskovic, & Angeles, 2011). See figure 1 and 2.…”