Randomized control trial to compare effect of time after sucrose administration on preterm neonatal pain control during heel prick

International Association for the Study of Pain defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage [1]. Repeated painful exposures can have deleterious consequences. These consequences include altered pain sensitivity (which may last into adolescence) and permanent neuroanatomic and behavioral abnormalities, as found in animal studies.

Neonates admitted to NICU receive multiple painful procedures as a part of their medical management and care. They are frequently exposed to repeated procedural pain and experience significant stress during critical period of physiological vulnerability and rapid neurological development.

Neonates and more predominantly preterm neonates have the nociceptive circuitry but this system is functionally immature [2,3]. Cutaneous nociceptors fields are large in the neonates, and peripheral sensory fibers are extremely sensitive to tissue injury and have reduced peak firing frequencies.[2-5] They also have low discriminatory ability to discriminate between noxious and non-noxious stimuli.[6,7] Subpalate Neurons which are a important of Thalamic efferent circuitry connecting thalamus to cerebral cortex and Preoligiodendrocytes which are precursors to myelin producing oligodendrocytes are particularly vulnerable to pain, and may undergo apoptosis following exictotoxic free radical or inflammatory damage.[8,9] Multiple studies have shown the benefits of sucrose on neonatal pain reduction.[10-12] However, ideal sucrose administration time before the pain stimuli has not been studied adequately.

As per previous study in our instutite pain was reduce if sucrose given before 30 seconds,hence we belived that even sucrose given before 15 second of heel prick it would reduce pain so we  want to know  that sucrose <15 second before the procedure reduces  the neonatal pain by randomized control trial to compare effect of time after sucrose administration on preterm neonatal pain control during heel prick.