THE ASSESSMENT OF PAIN IN VERY LOW AND EXTREMELY LOW BIRTHWEIGHT INFANTS DURING CAPILLARY BLOOD SAMPLING AND THE USE OF NONDRUG ANALGESIA MODES

Analgesia in very low and extremely low birth weight (VLBW, ELBW) infants is an urgent problem. Both drug and non-drug analgesic modes are used. Every method has its advantages and disadvantages. In addition, changing the glycemic status during painful procedures may lead to sequels unfavorable for the baby. Objective. To evaluate the glycemic status in VLBW and ELBW infants during painful maneuvers (finger pricking) and the efficiency of nondrug anesthetic modes. Subject and methods. Forty-three neonatal infants, including 22 ELBW and 21 VLBW infants, treated in the intensive care unit, V.I. Kulakov Research Center of Obstetrics, Gynecology and Perinatology, were examined. All the infants were divided into three groups: 1) 11 babies who were anesthetized with glucose solution; 2) 14 neonates who were given a pacifier for pain relief. These infants were compared with a control group of 18 babies who were not anesthetized. Results. Skin conduction examination of the infants when pricking the finger showed differences in peak/sec values between the control and 20% glucose solution groups (Me = 0.31 [0.2-0.43] Hz and Me = 0.125 [0.05-0.215] Hz, respectively; p = 0.026; Mann Whitney U-test) and between the control and pacifier groups (Me = 0.31 [0.2 0.43] Hz and 0.07 [0.05-0.1] Hz, respectively; р = 0.001; Mann Whitney U-test). In both groups, blood glucose levels remained within the normal range. Both before and 30 minutes after the painful maneuver, the blood glucose levels in Group 1 were 5.2±1.5 and 5.3±2.2 mmol/l, respectively; and these were 5.6±1.6 and 5.5±1.1 mmol/l in Group 2 and 5,4±1.1 and 5.6±1.1 mmol/l in the control group. Conclusion. Pacifier-sucking or 20% glucose solution use was clinically effective and safe in pain relief when finger capillary blood was sampled in premature neonatal infants. The use of glucose solution for pain relief was not followed by the development of hyperglycemia in extremely premature babies during painful maneuvers. This pain assessment method using an algesimeter is probably most accurate than subjective pain assessment (with a pain rating scale).

premature infants, pain assessment methods, anesthesia modes, blood glucose level, hyperglycemia