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Pain reduction on insertion of a feeding tube in preterm infants: a randomized controlled trial
Laila Kristoffersen1, Eirik Skogvoll, Mia Hafström
1Department of Paediatrics, St Olav's University Hospital, Norway. laila.kristoffersen@stolav.no
Insights
Pain during feeding tube insertion in preterm infants can be reduced. Combining a pacifier with 30% sucrose provided the most effective pain relief for these vulnerable infants.
Area of Science:
- Neonatal care
- Pediatric pain management
Background:
- Preterm infants often require gavage feeding due to inability to feed independently.
- Feeding tube insertion is a painful procedure, necessitating effective pain relief strategies.
Purpose of the Study:
- To assess pain and discomfort associated with nasal feeding tube insertion in preterm infants.
- To evaluate the efficacy of different interventions for pain reduction during this procedure.
Main Methods:
- A randomized controlled trial involving 24 preterm infants (postmenstrual age 28-32 weeks).
- Each infant served as their own control over 3 weeks, with 6 feeding tube changes.
- Interventions included pacifier use and oral administration of sterile water or 30% sucrose.
- Pain was assessed using the Premature Infant Pain Profile (PIPP) tool.
Main Results:
- The median PIPP score during insertion was 9, decreasing to 4 after 5 minutes.
- The combination of a pacifier and oral 30% sucrose resulted in the lowest pain scores.
- Sterile water without a pacifier led to the highest pain scores.
Conclusions:
- Feeding tube insertion in preterm infants causes significant pain and discomfort, as measured by the PIPP.
- A combination of a pacifier and 30% sucrose is the most effective method for alleviating pain during this procedure.
Background:
Gavage feeding is required in preterm infants who cannot feed by themselves. Insertion of the feeding tube is painful, and reducing the discomfort in these patients is desirable.
Objective:
The aim of this study was to assess pain and discomfort during nasal insertion of a feeding tube, and to evaluate different measures for pain relief.
Methods:
We included 24 preterm infants with postmenstrual age 28 to 32 weeks' who were in stable condition. Each infant acted as his or her own control over a 3-week period during which the tube was changed 6 times. On these occasions, 6 different treatment combinations were given in randomized order: pacifier or no pacifier, combined with no fluid, sterile water, or 30% sucrose. Pain and discomfort were assessed by at least 2 independent and experienced observers using a pain assessment tool, the Premature Infant Pain Profile; score range: 0 to 21. In general, scores of 4 to 6 are interpreted as normal or no discomfort; ≥ 12 usually signals significant pain and distress.
Results:
The median Premature Infant Pain Profile score during the procedure was 9 and decreased gradually toward 4 after 5 minutes. The lowest pain score was achieved by combining a pacifier with oral sucrose. Sterile water without a pacifier gave the highest score.
Conclusions:
Insertion of a feeding tube in preterm infants leads to a measurable degree of pain and discomfort, according to the Premature Infant Pain Profile assessment tool. Pain relief was best achieved by combining a pacifier with 30% sucrose.
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