Comparative study of analgesic effect of breast feeding versus dextrose during heel lance in neonates

Aim: Firstly, to assess the level of pain in new-borns enrolled in the study, after heel lance. Secondly, to determine the effect of oral dextrose solution and breast feeding on procedural pain in new-borns in the experimental group. Materials and Methods: The index study was conducted in neonatal nursery of tertiary care teaching hospital (MMIMSR, Mullana). The participant cases were neonates with gestational age 34 weeks to 42 weeks who were on partial or complete breast-feeding scheduled for routine new-born screening blood test via heel lance (n 106). Neonates were randomized into 2 groups for analgesia, i.e. breast-feeding and 25% oral dextrose solution. The research variables include independent variables (oral 25% dextrose solution and breast feeding). The dependant variable was procedural pain (heel lance) in neonates. PIPP (Premature Infant Pain Profile) score was the primary outcome variable. PIPP score includes two physiologic indicators of pain (i.e. heart rate and oxygen saturation), three behavioural indicators (i.e. brow bulge, eye squeeze, and nasolabial furrow); and two contextual factors (i.e. corrected gestational age and behavioural state). Higher the score greater the pain. PIPP score was assessed before giving the stimulus and again at 30 sec after the stimulus. Results: In breast feeding group 89.8% children had no or minimal pain. In dextrose group maximum children 73.7% had experienced mild to moderate pain. In dextrose group 94.8% children had minimal to moderate pain, with 3(5.3%) having severe pain. But 44(89.8%) children are having no or minimal pain in breast feeding group, 10.2% suffered from mild to moderate pain. None of the children in breast feeding group showed features of severe pain. The mean pain score of 9.7 and 4.7 in dextrose and breast feeding groups respectively proves significant difference (p-value 0.000) was found in them. Lesser mean score in breast feeding group signifies the importance of breast feeding during painful procedures as compared to dextrose. Conclusion: Both breast feeding and 25% oral dextrose solution have analgesic effect during heel lance but breast feeding proved to have significantly superior analgesic effect during heel lance among neonates in comparison to dextrose. 25% oral dextrose solution or preferably breast feeding should be considered as pain-control measures for the neonate during heel-stick procedures.