Salivary Cortisol and Pain Scoring to Compare the Efficacy of Oral Dextrose and Pacifier for Neonatal Pain Control

Hyunseung Jin; In Ah Kim; RN Min Hee Jeong; Kie Young Park; Bong Seong Kim

doi:10.14734/PN.2018.29.02.83

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Jin, Kim, Jeong, Park, and Kim: Salivary Cortisol and Pain Scoring to Compare the Efficacy of Oral Dextrose and Pacifier for Neonatal Pain Control

Original Article

Perinatology 2018;29(2):83-88.

Published online: 19 June 2018

DOI: https://doi.org/10.14734/PN.2018.29.02.83

Salivary Cortisol and Pain Scoring to Compare the Efficacy of Oral Dextrose and Pacifier for Neonatal Pain Control

Hyunseung Jin, MD, PhD, In Ah Kim, RN Min Hee Jeong, MD, Kie Young Park, MD, PhD, Bong Seong Kim, MD, PhD

Department of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea

Correspondence to Hyunseung Jin, MD, PhD Department0 of Pediatrics, Gangneung Asan Hospital, University of Ulsan College of Medicine, 38 Bangdong-gil, Sacheon-myeon, Gangneung 25440, Korea Tel: +82-33-610-3168 Fax: +82-33-641-8148 E-mail: childlove72@naver.com

Received 6 March 201817 April 2018 Accepted 23 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Objective

Pain assessment usually involves the use of subjective pain scales; as their use may be associated with inter-/intra-observer bias, objective pain measurements, such as assessment of cortisol response to pain, are needed. This study aimed to compare the efficacy of oral dextrose and a pacifier in neonatal pain control using an objective measurement of salivary cortisol level and subjective pain scoring.

Methods

This prospective, randomized, partially blinded clinical trial included healthy newborns from a nursery (n=142). Blood was sampled using a lancet and newborns were randomly assigned to four groups by drawing lots: control (n=33), sterile water (n=35), 25% dextrose (n=35), and pacifier group (n=39). For all groups, neonatal infant pain scale, neonatal facial coding system, and premature infant pain profile scores were evaluated before, during, and 2 minutes after newborn screening test by two independent observers who watched recorded videos. Moreover, samples of saliva were collected before and 30 minutes after the pain procedure, and salivary cortisol level was measured using an enzyme-linked immunosorbent assay.

Results

Subjective pain scores were not statistically different among the four groups before, during, and after blood sampling using a lancet. However, the salivary cortisol level in the 25% dextrose group was significantly lower than that in the other groups (P=0.045).

Conclusion

Oral administration of 25% dextrose solution for pain control during the newborn screening test led to a significantly lower salivary cortisol level than the use of sterile water or a pacifier. However, no difference in pain scores was found among groups.

Keywords: Newborn, Pain, Glucose, Cortisol, Pain measurement

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Fig. 1

Trial profile and newborns flow. NICU, neonatal intensive care unit.

Table 1.

Clinical Characteristics of Newborns

	Control group (n=33)	Sterile water group (n=35)	Dextrose group (n=35)	Pacifier group (n=39)
Birth weight (g)	3,257.5±704.2	3,224.5±381.6	3,225.0±365.6	3,331.3±453.6
Gestational age (wks^days)	) 38⁶±0⁶	38⁴±0⁶	38²±0⁵	38⁴±1¹
Mother age (yrs)	33.2±4.0	32.3±4.3	33.1±5.2	33.8±0.5
PROM	0 (0)	1 (2.9)	1 (2.9)	1 (2.6)
Male	17 (51.5)	20 (57.1)	16 (45.7)	23 (59.0)
1 minute Apgar	8.3±0.8	8.2±0.8	8.1±0.8	8.4±0.6
5 minutes Apgar	9.3±0.6	9.2±0.6	9.1±0.6	9.4±0.5
Time to procedure after	birth (hrs) 86.0±7.2	86.9±8.8	89.2±3.3	88.1±4.2
Crying time (seconds)	514.8±277.2	499.4±566.0	332.3±298.0	421.8±280.2

Values are presented as mean±standard deviation or number (%). All P values are >0.05 by analysis of variance (ANOVA). Abbreviation: PROM, premature rupture of membrane.

Table 2.

Neonatal Pain Scores according to Analgesic Procedures

	NIPS scores			NFCS scores PIPP scores			PIPP scores
	Baseline	Pain	Recovery	Baseline	Pain	Recovery	PIPP scores
Control group	2.5±2.0	6.2±1.5	5.0±2.3	2.1±2.0	6.6±1.9	5.0±2.7	11.2±4.5
Sterile water group	p 2.6±2.3	5.6±2.1	4.5±2.6	2.2±2.1	6.3±2.6	4.5±2.9	9.8±5.1
Dextrose group	2.3±2.1	6.1±1.7	4.1±2.8	1.9±1.9	6.7±2.5	4.2±3.0	10.1±5.1
Pacifier group	2.1±2.0	5.8±2.4	5.2±2.6	1.9±1.9	6.7±2.6	5.5±2.8	11.5±5.2

Values are presented as mean±standard deviation. All P values comparing 4 groups at each time point are >0.05 by Kruskal-Wallis test. Abbreviations: NIPS, Neonatal Infant Pain Scores; NFCS, Neonatal Facial Coding System Scores; PIPP, Premature Infant Pain Profile.

Table 3.

Comparison of Score Changes of Neonatal Infant Pain Scale and Neonatal Facial Coding System from Baseline to Injection and Recovery

	NIPS scores∗		NFCS scores^†
	Δ Pain^‡	Δ Recovery^§	Δ Pain^‡	Δ Recovery^§
Control group	3.7±2.0	2.4±2.2	4.5±2.2	2.9±2.6
Sterile water group	3.0±2.1	1.9±2.8	4.1±2.4	2.3±2.9
Dextrose group	3.8±1.9	1.8±3.0	4.8±2.1	2.4±3.0
Pacifier group	3.7±2.3	3.0±2.5	4.9±2.6	3.6±2.8

Values are presented as mean±standard deviation. Abbreviations: NIPS, Neonatal Infant Pain Scores; NFCS, Neonatal Facial Coding System Scores.

^∗ P value for interaction of group and time effect=0.02, but P value for group effect >0.05 at each time points by repeated measures analysis of variance (MANOVA).

^† P value for interaction of group and time effect and group effect >0.05 by MANOVA.

^‡ Score changes from baseline to pain phase.

^§ Score changes from baseline to recovery phase.

Table 4.

Comparison of Cortisol Levels and Changes of Cortisol Levels from Baseline to Pain

	Baseline (µg/dL)	Pain (µg/dL) Δ Pain∗	P value^†
Control group	1.260±1.121	2.156±1.908 0.897±1.567	Reference
Sterile water group	1.240±0.958	1.553±1.060 0.313±1.181	0.229
Dextrose group	1.194±1.281	1.246±0.959 0.052±1.577	0.046
Pacifier group	1.162±1.434	1.532±1.380 0.369±1.430	0.284

Values are presented as mean±standard deviation.

^∗ Cortisol level changes for baseline to pain phase.

^† P values comparing four groups <0.05 by the Analysis of variance (ANOVA) and the post-hoc analysis for comparison against control group was done based on the Dunnett correction method.

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