Physiological Analgesia for BCG vaccination induced pain in Neonates

BACKGROUND Blood sampling, intravenous catheterization and vaccination are some of the common painful procedures in newborn. Pain may contribute to immediate hemodynamic fluctuations as well as late significant behavioral changes. Physiological measures (such as holding, swaddling, breastfeeding) and pharmacological measures (such as acetaminophen, sucrose and opioids) have been used to alleviate pain in newborn. OBJECTIVES To assess the BCG vaccination induced pain response in healthy term neonates. To identify the least painful period in relation to the time of breast feeding.METHODOLOGY This cross sectional study was performed at Coimbatore Medical College Hospital for 3 months. Term healthy, exclusive breastfed neonates receiving BCG vaccine were included. Neonates with any illness and on analgesic or sedative drugs prior to vaccination were excluded. Vaccine was administered by trained nurses and an observer performed Neonatal Infant Pain Scale (NIPS) scoring without the knowledge of feeding schedule. NIPS is a validated score for assessing the pain response. Scores range from 0 to 7 and scores above 4 indicates moderate to severe pain. RESULTS A total of 113 neonates were assessed for pain. NIPS scores were significantly less in the time period between 30 to 60 minutes after breast feeding (Pvalue -0.001). In general, alert status did not significantly influence pain but sleeping neonates scored less during the time between 30to 60 minutes from breast feeding (P value-0.002). In hungry neonates and immediately after fed state scores were high. CONCLUSION Less painful period is between 30 to 60 minutes from breast feeding, especially if the neonate is sleeping. All elective procedures may be performed in this period however this results needs to be confirmed in different settings and procedures