Perinatology.  2018 Jun;29(2):83-88. 10.14734/PN.2018.29.2.83.

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

• Jin H
• Kim IA
• Jeong MH
• Park KY
• Kim BS

• KMID: 2468554
• DOI: http://doi.org/10.14734/PN.2018.29.2.83

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.

Keyword

Newborn; Pain; Glucose; Cortisol; Pain measurement

MeSH Terms

Administration, Oral
Bias (Epidemiology)
Clinical Coding
Enzyme-Linked Immunosorbent Assay
Glucose*
Humans
Hydrocortisone*
Infant
Infant, Newborn
Infant, Premature
Mass Screening
Nurseries
Pacifiers*
Pain Measurement
Prospective Studies
Saliva
Water
Weights and Measures
Glucose
Hydrocortisone
Water

Figure

• 

  Fig. 1 Trial profile and newborns flow. NICU, neonatal intensive care unit.

Reference

1). Anand KJ., Aranda JV., Berde CB., Buckman S., Capparelli EV., Carlo W, et al. Summary proceedings from the neonatal pain-control group. Pediatrics. 2006. 117(3 Pt 2):S9–22.

2). Peterson BS., Vohr B., Staib LH., Cannistraci CJ., Dolberg A., Schneider KC, et al. Regional brain volume abnormalities and long-term cognitive outcome in preterm infants. JAMA. 2000. 284:1939–47.

3). Hall RW., Anand KJS. Short- and long-term impact of neonatal pain and stress: more than an ouchie. NeoReviews. 2005. 6:e69–75.

4). Witt N., Coynor S., Edwards C., Bradshaw H. A guide to pain assessment and management in the neonate. Curr Emerg Hosp Med Rep. 2016. 4:1–10.

5). Slater R., Cantarella A., Franck L., Meek J., Fitzgerald M. How well do clinical pain assessment tools reflect pain in infants? PLoS Med. 2008. 5:e129.

6). Smith GC., Gutovich J., Smyser C., Pineda R., Newnham C., Tjoeng TH, et al. Neonatal intensive care unit stress is associated with brain development in preterm infants. Ann Neurol. 2011. 70:541–9.

7). COMMITTEE ON FETUS and NEWBORN and SECTION ON ANESTHE-SIOLOGY AND PAIN MEDICINE. Prevention and management of procedural pain in the neonate: an update. Pediatrics. 2016. 137:e20154271.

8). Lago P., Garetti E., Bellieni CV., Merazzi D., Savant Levet P., Ancora G, et al. Systematic review of nonpharmacological analgesic interventions for common needle-related procedure in newborn infants and development of evidence-based clinical guidelines. Acta Paediatr. 2017. 106:864–70.

9). Spence K., Henderson-Smart D., New K., Evans C., Whitelaw J., Woolnough R, et al. Evidenced-based clinical practice guideline for management of newborn pain. J Paediatr Child Health. 2010. 46:184–92.

10). Lawrence J., Alcock D., McGrath P., Kay J., MacMurray SB., Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993. 12:59–66.

11). Grunau RV., Craig KD. Pain expression in neonates: facial action and cry. Pain. 1987. 28:395–410.

12). Stevens B., Johnston C., Petryshen P., Taddio A. Premature infant pain profile: development and initial validation. Clin J Pain. 1996. 12:13–22.

13). Shah VS., Ohlsson A. Venepuncture versus heel lance for blood sampling in term neonates. Cochrane Database Syst Rev. 2011. 10:CD001452.

14). Khurana S., Hall RW., Anand KJS. Treatment of pain and stress in the neonate: when and how. NeoReviews. 2005. 6:e76–86.

15). Mörelius E., Theodorsson E., Nelson N. Salivary cortisol and mood and pain profiles during skin-to-skin care for an unselected group of mothers and infants in neonatal intensive care. Pediatrics. 2005. 116:1105–13.

16). Mörelius E., Theodorsson E., Nelson N. Stress at three-month immunization: parents' and infants' salivary cortisol response in relation to the use of pacifier and oral glucose. Eur J Pain. 2009. 13:202–8.

17). South MM., Strauss RA., South AP., Boggess JF., Thorp JM. The use of nonnutritive sucking to decrease the physiologic pain response during neonatal circumcision: a randomized controlled trial. Am J Obstet Gynecol. 2005. 193:537–42. discussion 542-3.

18). Mörelius E., He HG., Shorey S. Salivary cortisol reactivity in preterm infants in neonatal intensive care: an integrative review. Int J Environ Res Public Health. 2016. 13:337.

19). Mörelius E., Broström EB., Westrup B., Sarman I., Örtenstrand A. The Stockholm neonatal family-centered care study: effects on salivary cortisol in infants and their mothers. Early Hum Dev. 2012. 88:575–81.

20). Herrington CJ., Olomu IN., Geller SM. Salivary cortisol as indicators of pain in preterm infants: a pilot study. Clin Nurs Res. 2004. 13:53–68.

21). Gunnar MR., Hertsgaard L., Larson M., Rigatuso J. Cortisol and behavioral responses to repeated stressors in the human newborn. Dev Psychobiol. 1991. 24:487–505.

22). Peters KL. Neonatal stress reactivity and cortisol. J Perinat Neonatal Nurs. 1998. 11:45–59.

23). Gunnar MR., Malone S., Vance G., Fisch RO. Coping with aversive stimulation in the neonatal period: quiet sleep and plasma cortisol levels during recovery from circumcision. Child Dev. 1985. 56:824–34.

24). Ramsay DS., Lewis M. The effects of birth condition on infants' cortisol response to stress. Pediatrics. 1995. 95:546–9.

25). Naughton KA. The combined use of sucrose and nonnutritive sucking for procedural pain in both term and preterm neonates: an integrative review of the literature. Adv Neonatal Care. 2013. 13:9–19. quiz 20-1.

26). Stevens B., Johnston C., Franck L., Petryshen P., Jack A., Foster G. The efficacy of developmentally sensitive interventions and sucrose for relieving procedural pain in very low birth weight neonates. Nurs Res. 1999. 48:35–43.

27). Akman I., Ozek E., Bilgen H., Ozdogan T., Cebeci D. Sweet solutions and pacifiers for pain relief in newborn infants. J Pain. 2002. 3:199–202.

28). Gibbins S., Stevens B., Hodnett E., Pinelli J., Ohlsson A., Darlington G. Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nurs Res. 2002. 51:375–82.

29). Elserafy FA., Alsaedi SA., Louwrens J., Bin Sadiq B., Mersal AY. Oral sucrose and a pacifier for pain relief during simple procedures in preterm infants: a randomized controlled trial. Ann Saudi Med. 2009. 29:184–8.

30). Kim MK., Kim IA., Jung MH., Han MK., Park KY., Kim BS, et al. Nonpharma-cologic pain relief with oral 25% dextrose or/and pacifier for newborn infants. J Korean Soc Neonatol. 2011. 18:353–8.