The effect of different concentration of oral glucose solutions and supportive positioning methods on pain and physiologic variables during heel stick sampling in premature neonates: a randomized controlled study

Purpose: The aim of this study was to determine the effects of different concentrations of oral glucose solutions and supportive positioning methods on pain scores, physiologic variables and total crying time in premature neonates. Methods: A single-center, quadruple-blind, parallel-group randomized experimental study was conducted between 06th June 2022 and 08th June 2023 in the level II and 4a neonatal intensive care unit of a university hospital in Mersin. A total of 128 premature neonates with a gestational age at birth of 33-36 weeks, a postnatal age of less than 7 days, and no contraindication to supportive positioning and oral glucose solution administration were divided into four different intervention groups by block randomization. Facilitated tucking with swaddling and nesting were used as supportive positioning methods. "Supportive positioning methods + oral sterile distilled water (n=32)", "supportive positioning methods + oral 10% glucose solution (n=32)", "supportive positioning methods + oral 20% glucose solution (n=32)", "supportive positioning methods + oral 30% glucose solution (n=32)" interventions were applied to premature neonates and video recordings were taken. Data were collected using the Infant Information and Observation Form and the Neonatal Pain Agitation and Sedation Scale (N-PASS). The N-PASS assessment was performed by two independent nurses. Data were analyzed using chi-square, one-way ANOVA, two-way ANOVA with repeated measures, and post-hoc Bonferonni tests. Results: The intervention groups were similar in terms of descriptive and clinical characteristics (p>0.05). Intraobserver agreement and reliability were found to be almost perfect in the N-PASS assessments. It was found that there were differences in pain scores, physiologic variables and total crying time of premature neonates according to intervention group, time, group and time interaction. It was determined that oral 20% and 30% glucose solutions administered to premature neonates with supportive positioning methods are the most effective interventions in reducing pain (p<0.05). It was found that oral 20% and 30% glucose solutions administered to premature neonates in combination with supportive positioning methods have a similar effect on pain relief (p<0.05). Conclusion: In premature neonates, oral 20% glucose solution can be used safely in combination with supportive positioning methods to reduce the pain response to heel stick sampling and to improve pain regulation. Keywords: Procedural pain; premature neonates; supportive position; oral glucose solution