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Article Reviews and Commentary

Pain Reduction at Venipuncture in Newborns: Oral Glucose Compared with Local Anesthetic Cream.
Gradin, Eriksson, Holmqvist et al. Pediatrics 2002:110; 1053-1057

The authors of this study compared the pain reducing effect of 0.5 gm EMLA cream with oral administration of 1ml of 30% glucose. The study design was randomized double-blinded. Newborns who received EMLA were given water (placebo) and the newborns who had oral 30% glucose had a placebo cream (Unguentum) placed on the venipuncture site. Heart rate, crying and the PIPP (Premature Infant Pain Profle, also validated for term newborns) were used to assess the newborns behavior during the venipuncture. The higher the score, the greater the pain response

The PIPP scores were significantly lower in the group who received oral glucose (mean = 4.6) compared with the EMLA group (mean = 5.7). The duration of crying in the oral glucose group (mean = 1 sec.) was significantly lower than the EMLA group (mean = 18 sec.). There were significantly fewer newborns in the oral glucose group were scored as having pain (PIPP > 6) in the oral glucose group (19%) compared to the EMLA group (42%). Heart rates were similar in the two groups.

The authors conclude that oral glucose is superior to EMLA in decreasing the pain response in newborns undergoing venipuncture.

Commentary
Thomas J. Mancuso, MD, FAAP

The results of this study supports previous work which has demonstrated that the administration of oral glucose was associated with decreased pain responses in newborns. The effect of oral glucose demonstrated in this paper is dramatic. In this study, only 20% of the newborns had PIPP scores indicative of experiencing pain. It is difficult to understand why EMLA was only moderately effective in the newborns in this study. The technique of application and the duration it was left on the skin were what is used clinically.

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