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Glucose Water Reduces Neonates' Pain Better Than Skin Cream

Gradin M, Eriksson M, Holmqvist G, Holstein A, Schollin J. Pain reduction at venipuncture in newborns: Oral glucose compared with local anesthetic cream. Pediatrics. 2002;110:1053-1057.


Researchers in Sweden compared the effectiveness of the use of EMLA(R) local anesthetic cream to oral glucose for the prevention of pain in neonates. The sample included 201 newborns (>36 weeks gestational age and older than 24 hours) who were randomly assigned to one of two groups:


1. those who had EMLA(R) cream applied to the skin 60 minutes before a venipuncture was performed plus 1 cc of sterile water placebo orally (EMLA(R) Group)


2. those who received 1 cc of 30% glucose water orally plus a placebo cream applied to the skin (Glucose Group) before the venipuncture.



Because the applications were double-blind, none of the researchers knew whether an infant had received which of the interventions. All infants were also offered pacifiers or the chance to suck on the parents' or nurse's finger during the procedure.


Assessment of the newborns' pain responses to the regularly scheduled venipuncture were gathered via the Premature Infant Pain Profile (PIPP). This tool rated facial expressions, heart rate, and oxygenation saturation levels before, during, and after the venipuncture was performed. Data were also gathered on the duration of the neonate's crying.


The PIPP results showed that only 19.3% in the Glucose Group experienced pain; whereas, 41.7% of the EMLA(R) Group did so. Crying episodes were also lower in the Glucose group. There were no differences in the groups related to heart rate changes.


The researchers noted that the results were impressive related to the reduction of pain in the Glucose Group. However, they proposed that the sucking behavior in the group could have been enhanced by the glucose causing the non-nutritive sucking also to be of analgesic benefit. More research needs to be done in the area of pain reduction in newborns


Janet T. Ihlenfeld RN, PhD


Janet T. Ihlenfeld, RN, PhD, is a Professor of Nursing at D'Youville College in Buffalo, NY.


Sedation in PICU Should Be Strictly Controlled

Cornfield DN, Tegtmeyer K, Nelson MD, Milla CE, Sweeney M. Continuous propofol infusion in 142 critically ill children. Pediatrics. 2002;110:1177-1181.


The use of propofol continuous infusion to induce sedation in children was studied in one pediatric intensive care unit (PICU). This study took place before an FDA letter that indicated that safety concerns existed relating to the use of propofol in children at a dosage of 5.5 mg/kg/h. The current study capped the total dose of propofol at 4 mg/kg/h.


The sample consisted of 142 patients in the PICU who needed sedation. This sedation was needed to decrease the child's anxiety, to provide for better mechanical ventilation, and to reduce the incidence of tube and/or catheter displacement. Nurses' notes were reviewed to obtain data on the level of sedation in the child.


Results showed that the patients were sedated by the continuous propofol infusion. There were no incidents of tubes or catheters being pulled out, nor were there metabolic acidosis events that could be attributed solely to the propofol. The researchers noted that the propofol seemed to be safe in the strictly controlled doses used in this study.


Janet T. Ihlenfeld RN, PhD


Janet T. Ihlenfeld, RN, PhD, is a Professor of Nursing at D'Youville College in Buffalo, NY.