• Jagdish Prasad Sahoo, Suman Rao, Saudamini Nesargi, Thomas Ranjit, C Ashok, and Swarnarekha Bhat.
• Department of Neonatology, St Johns Medical College and Hospital, Bangalore, Karnataka, India. dr_jagdish_sahoo@yahoo.co.in
• Indian Pediatr. 2013 Feb 1; 50 (2): 203-7.

ObjectiveTo compare the effect of expressed breast milk (EBM), 25% dextrose (25 D) and sterile water (SW) on procedural pain in neonates as assessed by the premature infant pain profile (PIPP), changes in heart rate (HR), oxygen saturation (SpO2) and duration of crying.DesignProspective, double blind, randomized controlled trial.SettingPostnatal ward of a tertiary-care hospital.Participants210 babies who required venipuncture for blood sampling and who were on oral feeds were recruited into the study after parental informed consent.MethodsThe enrolled babies were randomized into intervention groups (EBM, 25% dextrose) and control group (sterile water). Two ml of test solution was given to baby by paladay (a traditional cup with a spout) 2 min before venipuncture. The face and crying of baby were video graphed by an independent, blinded observer. The facial response to pain (brow bulge, eye squeeze, nasolabial furrow) was analysed from the video. Maximum HR and minimum SpO2 were recorded during, and 1, 3 and 5 min after venipuncture by another blinded observer.Outcome VariablePIPP score, HR, SpO2 and crying time at 0/1/3/5 min after sampling.Results160 babies were considered for final analysis with 50 in 25 D, 62 in EBM and 48 in SW group. The mean PIPP score in the 3 groups were 5.22, 6.84 and 11.22 at 0-30 sec after venipuncture; 4.52, 6.34, and 10.88 at 1-1½ min; 3.96, 6.15 and 9.35 at 3-3½ min; and 3.12, 4.68 and 7.83 at 5-5½ min; respectively (P<0.001). The median crying time was 10, 37.5 and 162 seconds in 25 D, EBM and SW groups, respectively (P<0.001).ConclusionsEBM significantly reduces procedural pain in neonates though to a lesser extent as compared to 25% dextrose.

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