INTRODUCTIONThe myth regarding neonatal pain suggests that because of neurological immaturity, neonates do not experience pain. However, studies have shown that pain pathways as well as cortical and subcortical centres, necessary for pain perception are well developed late in gestation and physiological and behavioural responses to pain are well documented in neonates.1 Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is difficult to assess pain in infants, as infants cannot verbalise their pain ,as they are dependent on others to recognize it, intervene it, treat it. Many newborn babies undergo painful procedures like heel pricks, venepuncture and intramuscular injection for immunization, such procedures inflict distinct physiological, behavioral, hormonal and metabolic changes.3 Moreover painful experience very early in life can promote somatization later in life. 4 Dextrose and sucrose in varying concentration have been shown to relive pain during venepuncture or intramuscular injection. [5][6][7][8][9][10][11][12] Breastfeeding or expressed breast milk have ABSTRACT Background: Many newborns undergo painful procedures like heel pricks, venepuncture and intramuscular injection for immunization. The medical and paramedical staffs usually ignore pain felt during these procedures. The aim of this study was to compare analgesic activity of 24% sucrose solution with breast milk during 1st DPT vaccination using sterile water as placebo. Methods: This double blind, randomized placebo controlled trial was conducted in 150 healthy infants undergoing for their 1 st DPT vaccination. Infants were randomized in to three groups of 50 each and received sterile water, 24% sucrose and breast milk 2 minutes prior to vaccination. The outcome variables were total duration of cry, first cry, change in heart rate and modified facial coding score (MFCS). Results: Mean total cry was significantly lower in 24% sucrose babies 36.3 (25.34) seconds and breast milk babies 42.1 (26.13) seconds as compared to sterile water 137.2 (20.31) seconds. Mean first cry was significantly lower in 24% sucrose 18.2 (14.12) seconds and breast milk babies 25.1 (13.67) seconds as compared to sterile water 94.3 (23.26) seconds. Mean rise in heart rate (beats/min) at 3 minutes was significantly lower with 24% sucrose 3 (2.3)and breast milk 7.4 (4.6) as compared to sterile water 18.2 (4.61).Change in MFCS at 1min and 3 min was significantly lower in 24% sucrose and breast milk babies. Maximum reduction in total cry, first cry, lower rise in heart rate and low MFCS was with 24% sucrose as compared to breast milk group. Conclusions: 24% sucrose and breast milk had analgesic activity in infants less than two months of age undergoing DPT vaccination. The analgesic effect was better for 24% sucrose as compared to breast milk.

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Background: International clinical guidelines recommend oral sucrose to be given to relieve procedural pain in neonate. Objective: The aim of this is to study analgesic effect of 24% sucrose beyond neonatal age up to 4 months by comparing its effect during the 2nd and 3rd diphtheria-pertussis-tetanus (DPT) vaccinations with the 1st DPT. Materials and Methods: This prospective study was conducted in 150 healthy infants undergoing for their 1st, 2nd and 3rd DPT vaccination of 50 each and received 24% Sucrose 2 ml 2 min before vaccination. The outcome variables were total duration of cry, first cry, change in heart rate and modified facial coding score (MFCS). The data were analyzed statistically. Results: Mean total duration of cry was significantly longer in 3rd DPT 94.4 (30.12) s and 2nd DPT babies 50.6 (26.14) s than 1st DPT babies 36.3 (25.34) s. Mean duration of the first cry was significantly higher in 3rd DPT 52.1 (13.12) s and 2nd DPT babies 37.3 (15.14) s than 1st DPT babies 18.2 (14.12) s. Mean change, that is, rise in heart rate (beats/min) from baseline was significantly higher in 3rd DPT 16.6 (4.9) and 2nd DPT babies 10.3 (5.2) than 1st DPT babies 3 (2.3) Change in median MFCS at 1 and 3 min was significantly higher with 3rd DPT (3, 2) and 2nd DPT (2, 1) groups as than 1st DPT (1, 0). Longer mean total and first cry, and increase in heart rate was maximum in 3rd DPT group. Conclusion: Nearly 24% sucrose had less analgesic activity in babies receiving 3rd and 2nd DPT vaccination compared to those receiving 1st DPT, and it suggested 24% sucrose had less analgesic effect between 2 and 4 months of age babies.