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Pain Reduction at Venipuncture in Newborns: Oral Glucose Compared With Local Anesthetic Cream

Maria Gradin, RN BSN^*, Mats Eriksson, RN, BSN^*, Gunilla Holmqvist, RN, BSN, Åsa Holstein, RN and Jens Schollin, MD, PhD^*

^* Department of Pediatrics, Örebro University Hospital, Örebro
Department of Pediatrics, Karolinska Institutet, Huddinge Hospital

--> Objective. A number of studies have shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. The local anesthetic cream EMLA has recently been shown to be safe for use in neonates. This study compared the pain-reducing effect of orally administered glucose with that of EMLA cream during venipuncture in newborns.

Methods. Randomized, controlled, double-blind study including 201 newborns undergoing venipuncture for clinical purposes. Ninety-nine of the newborns received EMLA on the skin and orally administered placebo (sterile water), and 102 received glucose 30% orally and placebo (Unguentum Merck) on the skin. Symptoms associated with pain at venipuncture were measured with the Premature Infant Pain Profile (PIPP) scale (also validated for full-term infants). Heart rate and crying time were recorded.

Results. There were no differences in background variables between the 2 groups.

The results shows that the PIPP scores were significantly lower in the glucose group (mean: 4.6) compared with the EMLA group (mean: 5.7). The duration of crying in the first 3 minutes was significantly lower in the glucose group (median: 1 second) than in the EMLA group (median: 18 seconds). There were significantly fewer patients in the glucose group who were scored having pain (defined as PIPP score above 6); 19.3% compared with 41.7% in the EMLA group. The changes in heart rate were similar in both groups.

Conclusions. We found that glucose is effective in reducing symptoms associated with pain from venipuncture in newborns and seems to be better than the local anesthetic cream EMLA.

Key Words: newborn • pain • PIPP • glucose • EMLA

Abbreviations: PIPP, Premature Infant Pain Profile • SD, standard deviation

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