We previously published that a single dose of oral sucrose significantly increased plasma markers of adenosine triphosphate (ATP) utilization (hypoxanthine) and oxidative stress (xanthine, allantoin) in neonates undergoing a clinically required heel lance [1,2]. However, the effect of repeated doses of sucrose and other sweet solutions such as glucose on above markers is unknown.
Methods:
Using a prospective randomized double blind clinical trial, we measured urinary markers of ATP utilization and oxidative stress in preterm neonates over days of life 3-7. Subjects were preterm neonates who are 28-34 weeks in gestation. Exclusion criteria include: significant cardiovascular and respiratory disease, IVH, NEC, on opioids or sedatives. After obtaining parental consent, subjects were randomly assigned to receive standard of care (control, n=12) or either 24% oral sucrose (n=14) or 30% oral glucose (n=13) two minutes before any tissue-damaging procedure (TDP). Demographic data for categorical variables were analyzed using Chi-square test. Repeated measures ANOVA for one between subject factor (group) and one within subject factor (time) were assessed to evaluate the effect of the procedures (control, 24% oral sucrose, 30% oral glucose) over time. Interaction terms in the General Linear Model were used for this purpose.
Results:
We found that neonates who received 24% oral sucrose tend to have higher urinary concentration of xanthine compared to those who received 30% oral glucose, specifically at day of life 4. However, the highest urinary concentrations of xanthine (P=0.019) and uric acid (P=0.028) were found in control subjects who received the least amount of oral sucrose analgesia.
Conclusion: These data support our previous findings that untreated pain results in increased ATP utilization and oxidative stress [2]. In addition, this finding suggests that 30% oral glucose may be an acceptable and metabolically less demanding alternative to oral sucrose as a non-pharmacological intervention to procedural pain. Further studies are required to examine more effective ways to decrease procedural pain in preterm neonates.