Oral dextrose reduced procedural pain without altering cellular ATP metabolism in preterm neonates: a prospective randomized trial

Abstract

Objective To examine the effects of 30% oral dextrose on biochemical markers of pain, adenosine triphosphate (ATP) degradation, and oxidative stress in preterm neonates experiencing a clinically required heel lance. Study design Utilizing a prospective study design, preterm neonates that met study criteria (n = 169) were randomized to receive either (1) 30% oral dextrose, (2) facilitated tucking, or (3) 30% oral dextrose and facilitated tucking 2 min before heel lance. Plasma markers of ATP degradation (hypoxanthine, uric acid) and oxidative stress (allantoin) were measured before and after the heel lance. Pain was measured using the premature infant pain profile-revised (PIPP-R). Results Oral dextrose, administered alone or with facilitated tucking, did not alter plasma markers of ATP utilization and oxidative stress. Conclusion A single dose of 30% oral dextrose, given before a clinically required heel lance, decreased signs of pain without increasing ATP utilization and oxidative stress in premature neonates.

Race and Ethnicity of Infants Enrolled in Neonatal Clinical Trials

“…The findings of this systematic review of data from 120 studies including a large sample of US neonatal clinical trial participants (14 479 participants) support 3 important conclusions. First, Asian, Black, Hispanic, and Indigenous infants were underrepresented in these studies compared with our proxy for the US clinical NICU population.…”

“…We identified 120 studies that were entered into Cochrane CENTRAL 2017 to 2021 and met our inclusion criteria (eFigure 1 in Supplement 1). There was a range in the articles’ availability via electronic publication (2016-2021) and publication year (2017-2023).…”

“…Figure 1 shows that the distribution of reporting vs not reporting race and ethnicity data in NICU clinical studies over the 5 years evaluated. We assessed reporting by NIH funding: of the 52 studies funded by the NIH, 35 studies (67%) included race and ethnicity data. Among 68 studies not funded by the NIH, 40 studies (58%) reported race and ethnicity data; the difference between NIH-funded and non-NIH–funded studies was not statistically significant by Pearson χ 2 .…”

“…Finally, we also extracted data regarding the geographic location of every clinical site in each study, including hospital name, city, state, and zip code. In this set of 120 studies, there was regional variation in the study sites included: 38 states and the District of Columbia were represented (Figure 3). There was a skew to the Northeast US (40 studies [33.3%]).…”

Excitatory and inhibitory neuronal signaling in inflammatory and diabetic neuropathic pain

“…On the opposite end of the connection between glucose levels and pain sensation is the observation that oral administration of glucose to newborn infants reduces painful reactions (Oliveira et al 2021 ), without affecting cellular ATP metabolism (Angeles et al 2020 ). Even if given orally against a control group of infants receiving breast milk, glucose was more effective in relieving pain (Varghese et al 2020 ).…”