| CTRI Number |
CTRI/2025/07/090168 [Registered on: 04/07/2025] Trial Registered Prospectively |
| Last Modified On: |
03/07/2025 |
| Post Graduate Thesis |
No |
| Type of Trial |
Interventional |
|
Type of Study
|
Preventive |
| Study Design |
Randomized, Parallel Group, Multiple Arm Trial |
|
Public Title of Study
|
Comparing the efficacy of breast milk and sweet solution in reducing pain during blood sampling in newborn babies |
|
Scientific Title of Study
|
Comparing the efficacy of breast milk and dextrose solutions in reducing procedural pain during venipuncture in neonates |
| Trial Acronym |
NIL |
|
Secondary IDs if Any
|
| Secondary ID |
Identifier |
| NIL |
NIL |
|
|
Details of Principal Investigator or overall Trial Coordinator (multi-center study)
|
| Name |
Nikunj Bhatnagar |
| Designation |
Senior Resident |
| Affiliation |
ESIC Hospital and PGIMSR, Basaidarapur |
| Address |
Neonatal ICU, Department of Pediatrics, 1st floor, C-block, ESIC Hospital and PGIMSR, Basaidarapur, Ring Road, Delhi - 110015
West DELHI 110015 India |
| Phone |
7982945101 |
| Fax |
|
| Email |
nikunjbhatnagar10@gmail.com |
|
Details of Contact Person Scientific Query
|
| Name |
Nikunj Bhatnagar |
| Designation |
Senior Resident |
| Affiliation |
ESIC Hospital and PGIMSR, Basaidarapur |
| Address |
Neonatal ICU, Department of Pediatrics, 1st floor, C-block, ESIC Hospital and PGIMSR, Basaidarapur, Ring Road, Delhi - 110015
DELHI 110015 India |
| Phone |
7982945101 |
| Fax |
|
| Email |
nikunjbhatnagar10@gmail.com |
|
Details of Contact Person Public Query
|
| Name |
Nikunj Bhatnagar |
| Designation |
Senior Resident |
| Affiliation |
ESIC Hospital and PGIMSR, Basaidarapur |
| Address |
Neonatal ICU, Department of Pediatrics, 1st floor, C-block, ESIC Hospital and PGIMSR, Basaidarapur, Ring Road, Delhi - 110015
DELHI 110015 India |
| Phone |
7982945101 |
| Fax |
|
| Email |
nikunjbhatnagar10@gmail.com |
|
|
Source of Monetary or Material Support
|
| Neonatal ICU, Department of Pediatrics, 1st floor, C-block, ESIC Hospital and PGIMSR, Basaidarapur, Ring Road, Delhi - 110015 |
|
|
Primary Sponsor
|
| Name |
Nikunj Bhatnagar |
| Address |
ESIC and PGIMSR, Basaidarapur, Ring Road, Delhi |
| Type of Sponsor |
Other [Self] |
|
|
Details of Secondary Sponsor
|
|
|
Countries of Recruitment
|
India |
|
Sites of Study
|
| No of Sites = 1 |
| Name of Principal
Investigator |
Name of Site |
Site Address |
Phone/Fax/Email |
| Dr Nikunj Bhatnagar |
ESIC Hospital |
Neonatal ICU, Department of Pediatrics, 1st floor, C-block, ESIC and PGIMSR, Basaidarapur, Ring Road, Delhi - 110015 West DELHI |
7982945101
nikunjbhatnagar10@gmail.com |
|
|
Details of Ethics Committee
|
| No of Ethics Committees= 1 |
| Name of Committee |
Approval Status |
| ESIC and PGIMSR IEC |
Approved |
|
|
Regulatory Clearance Status from DCGI
|
|
|
Health Condition / Problems Studied
|
| Health Type |
Condition |
| Patients |
(1) ICD-10 Condition: R52||Pain, unspecified, |
|
|
Intervention / Comparator Agent
|
| Type |
Name |
Details |
| Intervention |
10% Dextrose |
Administration of 5 ml of 10% dextrose orally by a paladai in 2 minutes by a staff nurse. She will clean excess solution, remove the paladai and envelope containing the name of solution. Then investigator and observer will enter the room and routine venepuncture for TSB sampling will be done along with recording the PIPP score (premature infant pain profile score) and vital (like heart rate, respiratory rate, spo2) followed by RBS estimation by heel prick one hour after the administration of solution |
| Intervention |
25% Dextrose |
Administration of 2 ml of 25% dextrose orally by a paladai in 2 minutes by a staff nurse. She will clean excess solution, remove the paladai and envelope containing the name of solution. Then investigator and observer will enter the room and routine venepuncture for TSB sampling will be done along with recording the PIPP score (premature infant pain profile score) and vital (like heart rate, respiratory rate, spo2) followed by RBS estimation by heel prick one hour after the administration of solution |
| Intervention |
Expressed Breast Milk |
Administration of 7 ml of Expressed breast milk of babys own mother orally by a paladai in 2 minutes by a staff nurse. She will clean excess milk from mouth of baby, remove the paladai and envelope containing the name of solution. Then investigator and observer will enter the room and routine venepuncture for TSB sampling will be done along with recording the PIPP score (premature infant pain profile score) and vital (like heart rate, respiratory rate, spo2) followed by RBS estimation by heel prick one hour after the administration of solution |
| Comparator Agent |
Premature infant pain profile score |
standardised tool to assess pain in term and preterm infants. |
|
|
Inclusion Criteria
|
| Age From |
0.00 Day(s) |
| Age To |
28.00 Day(s) |
| Gender |
Both |
| Details |
All vitally stable newborns of greater or equal to 37 weeks gestation who are on exclusive breast
feeding and have been admitted for phototherapy for jaundice requiring routine sampling of
total serum bilirubin by venepuncture |
|
| ExclusionCriteria |
| Details |
Neonates with
1. Cerebral injury in form of perinatal asphyxia / hypoxic-ischemic encephalopathy /
meningitis / bilirubin induced neuro-disability
2. Any obvious congenital malformation like cleft palate, cleft lip.
3. Requiring more than one prick
4. Who have passed stools during procedure
5. Who are small for gestational age or large for gestational age |
|
|
Method of Generating Random Sequence
|
Computer generated randomization |
|
Method of Concealment
|
Sequentially numbered, sealed, opaque envelopes |
|
Blinding/Masking
|
Participant and Investigator Blinded |
|
Primary Outcome
|
| Outcome |
TimePoints |
| Measures the PIPP score of babies during venepuncture in 2 ml D-25% or 5 ml D-10% or 7 ml expressed breast milk groups |
The principal investigator will record the PIPP score during venepuncture of baby, which will be recorded in the patient proforma.
|
|
|
Secondary Outcome
|
| Outcome |
TimePoints |
Record the changes in Heart rate, Respiratory rate, SpO2 & RBS measurement after 1 hour of administration of 2 ml D-25% or 5 ml D-10% or 7 ml
expressed breast milk |
The observer will be recording the vital which will include heart rate, respiratory rate, SpO2. This measurement will be done at baseline (before venepuncture & before administration of test solution [intervention]), 0 minutes (during venepuncture), 1 minute, 3 minutes & 5 minutes after venepuncture.
The observer will also measure the RBS (random blood sugar) by heel prick 1 hour after administration of test solution. |
|
|
Target Sample Size
|
Total Sample Size="135" Sample Size from India="135"
Final Enrollment numbers achieved (Total)= "Applicable only for Completed/Terminated trials"
Final Enrollment numbers achieved (India)="Applicable only for Completed/Terminated trials" |
|
Phase of Trial
|
N/A |
|
Date of First Enrollment (India)
|
20/07/2025 |
| Date of Study Completion (India) |
Applicable only for Completed/Terminated trials |
| Date of First Enrollment (Global) |
Date Missing |
| Date of Study Completion (Global) |
Applicable only for Completed/Terminated trials |
|
Estimated Duration of Trial
|
Years="0" Months="6" Days="0" |
|
Recruitment Status of Trial (Global)
|
Not Applicable |
| Recruitment Status of Trial (India) |
Not Yet Recruiting |
|
Publication Details
|
N/A |
|
Individual Participant Data (IPD) Sharing Statement
|
Will individual participant data (IPD) be shared publicly (including data dictionaries)?
Response - YES
- What data in particular will be shared?
Response - All of the individual participant data collected during the trial, after de-identification.
- What additional supporting information will be shared?
Response - Study Protocol Response - Statistical Analysis Plan Response - Clinical Study Report
- Who will be able to view these files?
Response - Anyone
- For what types of analyses will this data be available?
Response - To achieve aims in the approved proposal.
- By what mechanism will data be made available?
Response (Others) - After completion of analysis, the research will be sent for publication to international neonatal journals or if unapproved then to indian journals of pediatrics.
- For how long will this data be available start date provided 01-05-2026 and end date provided 31-12-2090?
Response - Immediately following publication. No end date.
- Any URL or additional information regarding plan/policy for sharing IPD?
Additional Information - NIL
|
|
Brief Summary
|
Neonates admitted in NICU
for various indications universally undergo some painful procedures in form of
venepunctures and cannulation for blood testing. Such painful procedures in
neonates have the capability to alter their homeostasis, creating an
“allostatic load” rendering them prone to derangement in their physiology. Their
inability to fully express themselves and subtle signs have the potential to be
missed in events of painful procedures. Pharmacological methods for pain
reduction applied in adults cannot be extrapolated in neonatal science. Many
drugs become contraindicated and more often studies and evidence on their safety
profile and side effects are lacking. This forces us to utilize
non-pharmacological, neonatal friendly alternatives like breast feeding,
kangaroo mother care (KMC) and administration of sweet substances like dextrose
which have shown to be effective in reducing neonatal pain as evident in number
of studies. While administration of 25% dextrose (osmolarity 1390 mOsm/L) has been found to be most
effective in reducing pain in neonates in some studies and is routinely
followed in some neonatal intensive care units, it is known that administration
of hypertonic solutions to neonates result in adverse effects of vomiting and
feed intolerance. Though multiple comparative studies between dextrose and
breastmilk have been conducted, volume-based studies using different dextrose
concentrations with same sugar amount is lacking. Such a study would aid in
determining if low osmolarity sweet solutions (like 10% dextrose - osmolarity 505 mOsm/L) and breast milk (osmolarity 300 mOsm/L) with same sugar
content can be as effective in producing analgesia in newborn babies thus
preventing unnecessary administration of hypertonic solutions to the newborn. Therefore, this study holds the research hypothesis that there is an effect of 5 ml of 10% Dextrose and 7 ml of expressed breast milk in reducing procedural
pain in term neonates as compared to 2 ml of 25% Dextrose as measured by premature infant pain
profile score. In this study 135 term neonates (whose parents have consented for participating
in study) admitted to NICU for neonatal jaundice requiring only phototherapy
will be included. During routine sampling for total serum bilirubin, 5 ml of
10% dextrose OR 2 ml of 25 % dextrose OR 7 ml of mother’s expressed breast milk
will be administered orally two minutes before sampling using a paladai.
Sampling will be done as per the protocol for neonatal jaundice treatment. Baseline
RBS will be taken and neonatal response to pain using PIPP score (premature
infant pain profile score) will be recorded. One repeat RBS after one hour of administering solution will
be taken. No extra sampling of the baby will be done. The responses will be
recorded in a sheet of paper for later analysis which will be hidden from investigators till all data collection is complete. This will be a double blind,
prospective, parallel group, randomised control trial and data analysis will be
carried out using latest software. |