The research is published in the May 17 advance online edition of Pediatrics.
The research team, which also included scientists from Mount Sinai Hospital and the Leslie Dan Faculty of Pharmacy at the University of Toronto, studied 48 preterm infants who required microbiologic urine analysis to rule out infection.
Samples were obtained by one of two commonly performed techniques: suprapubic aspiration, which involves inserting a needle through the abdomen and into the bladder, and urine catheterization, which is conducted by running a plastic tube, or catheter, through the urethra and into the bladder. Both procedures are considered to be effective and are often used interchangeably.
Half the babies were randomly assigned to undergo each test. The infants’ facial and physiologic responses were monitored during the procedures to identify pain. Facial grimacing was assessed by tracking the percentage of time the infants displayed brow bulging. Other changes that can indicate the baby’s level of pain, such as heart rate and oxygen saturation, were also monitored. The researchers also assessed procedure success.
The researchers found that suprapubic aspiration was significantly more painful than urine catheterization. The technique also tended to have a higher rate of procedure failure.
“While both tests are frequently used with positive results, we now have the option to cause these babies less pain,” says Dr. Anna Taddio, principal investigator of the study and Adjunct Scientist and Pharmacist at SickKids. “By collecting the sample in a different way, we can actually reduce pain by 40 per cent. That’s not trivial.”
Suprapubic aspiration can only be performed by a physician and many have considered it to be the gold standard due to a lower risk of sample contamination. Urine catheterization can be performed by either a doctor or a nurse.
“Until now, clinicians have used these two procedures interchangeably; now we know that urine catheterization is less painful for preterm babies,” says Dr. Vibhuti Shah, Staff Neonatologist at Mount Sinai Hospital and Associate Professor/Clinician-Investigator, Paediatrics at the University of Toronto. “It is our hope that these findings will influence clinical practices so that routine procedures can be as comfortable as possible.”
While there have been previous studies on the success and side-effects related to these two techniques, this is the first study to assess the pain responses of premature infants undergoing these procedures.
Pain management has been proven to play a vital role in the care of neonates. Other studies have shown that repeated exposure to painful procedures is related to increased sensitivity to pain, as well as changes in behaviour and neurodevelopment.
“Pain is important,” says Dr. Taddio, who is also Associate Professor of Pharmacy at the University of Toronto. “Health-care providers wouldn’t make these babies suffer unnecessarily. Now they have another factor to consider when choosing between these two procedures.”
The study was supported by SickKids Foundation.
About The Hospital for Sick Children (SickKids)
The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision of Healthier Children. A Better World.™ For more information, please visit www.sickkids.ca.
About Mount Sinai Hospital
Mount Sinai Hospital is an internationally recognized, 472-bed acute care academic health sciences centre affiliated with the University of Toronto. It is known for excellence in the provision of compassionate patient care, innovative education, and leading-edge research. Mount Sinai’s Centres of Excellence include Women’s and Infants’ Health; Surgery and Oncology; Acute and Chronic Medicine; Laboratory Medicine and Infection Control, and the Samuel Lunenfeld Research Institute. For more information about Mount Sinai Hospital, please visit us online at www.mountsinai.ca.