Comparison of intra-procedural pain between a novel continuous arteriovenous exchange and conventional pull-push...

We compared intra-procedural neonatal pain, agitation and sedation scale (N-PASS) scores between a novel 'continuous arteriovenous exchange' (CAVE) and conventional pull-push (PP) techniques of partial exchange transfusion (PET) among neonates with polycythemia.

Neonates >32-0/7 weeks gestation, requiring PET for polycythemia, were randomized to PP or CAVE techniques. The procedure was video-recorded and edited to mask the technique. Intra-procedural N-PASS scores assigned by two trained and masked neonatal fellows were compared.

Twenty-two neonates were randomized to CAVE (n=12) or PP (n=10) method. The area under curve for cumulative N-PASS scores was significantly lesser in CAVE group (mean difference-11.9 (95% CI=-4.2, -19.6), P=0.005)). Decrease in hematocrit and complications of PET were comparable. Time for PET was longer with CAVE technique (16 (9, 29) min vs 10 (6, 12) min, P=0.016).

CAVE technique of PET was associated with lesser procedure-related pain (N-PASS scores) as compared with PP technique among neonates >32 weeks gestation.