Untreated Procedural Pain Increases Urine Markers of Adenosine Triphosphate (ATP) Utilization in Preterm Neonates

14.00
Hdl Handle:
http://hdl.handle.net/10755/622063
Category:
Full-text
Format:
Text-based Document
Type:
Presentation
Level of Evidence:
N/A
Research Approach:
N/A
Title:
Untreated Procedural Pain Increases Urine Markers of Adenosine Triphosphate (ATP) Utilization in Preterm Neonates
Other Titles:
Pediatric Pain Management
Author(s):
Angeles, Danilyn Mag-akat; Boskovic, Danilo
Lead Author STTI Affiliation:
Non-member
Author Details:
Danilyn Mag-akat Angeles, PhD, RN, Professional Experience: I spent 20 years at as NICU nurse (3 years as the clinical director, 5 years as a nurse manager, 7 years educator, 5 years transport manager and bedside nurse). I am currently an NIH-NINR funded researcher examining the relationship between procedural pain and biochemical markers of hypoxia (hypoxanthine, xanthine, uric acid). My current grant tests non-pharmacological interventions that will not only reduce the signs of pain but reduce its metabolic costs. Author Summary: I am currently a Professor of Physiology at Loma Linda University School of Medicine with an NIH-funded grant examining the mechanisms that link procedural pain to cellular injury.
Abstract:

Purpose:

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.

Keywords:
Biochemical Markers; Neonate; Procedural Pain
Repository Posting Date:
24-Jul-2017
Date of Publication:
24-Jul-2017
Other Identifiers:
INRC17B12
Conference Date:
2017
Conference Name:
28th International Nursing Research Congress
Conference Host:
Sigma Theta Tau International
Conference Location:
Dublin, Ireland
Description:
Event Theme: Influencing Global Health Through the Advancement of Nursing Scholarship

Full metadata record

DC FieldValue Language
dc.language.isoen_USen
dc.type.categoryFull-texten
dc.formatText-based Documenten
dc.typePresentationen
dc.evidence.levelN/Aen
dc.research.approachN/Aen
dc.titleUntreated Procedural Pain Increases Urine Markers of Adenosine Triphosphate (ATP) Utilization in Preterm Neonatesen_US
dc.title.alternativePediatric Pain Managementen
dc.contributor.authorAngeles, Danilyn Mag-akaten
dc.contributor.authorBoskovic, Daniloen
dc.contributor.departmentNon-memberen
dc.author.detailsDanilyn Mag-akat Angeles, PhD, RN, Professional Experience: I spent 20 years at as NICU nurse (3 years as the clinical director, 5 years as a nurse manager, 7 years educator, 5 years transport manager and bedside nurse). I am currently an NIH-NINR funded researcher examining the relationship between procedural pain and biochemical markers of hypoxia (hypoxanthine, xanthine, uric acid). My current grant tests non-pharmacological interventions that will not only reduce the signs of pain but reduce its metabolic costs. Author Summary: I am currently a Professor of Physiology at Loma Linda University School of Medicine with an NIH-funded grant examining the mechanisms that link procedural pain to cellular injury.en
dc.identifier.urihttp://hdl.handle.net/10755/622063-
dc.description.abstract<p><strong>Purpose:</strong></p> <p>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.</p> <p><strong>Methods:</strong></p> <p>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.</p> <p><strong>Results:</strong></p> <p>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.</p> <p><strong>Conclusion: </strong>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.</p>en
dc.subjectBiochemical Markersen
dc.subjectNeonateen
dc.subjectProcedural Painen
dc.date.available2017-07-24T15:53:47Z-
dc.date.issued2017-07-24-
dc.date.accessioned2017-07-24T15:53:47Z-
dc.conference.date2017en
dc.conference.name28th International Nursing Research Congressen
dc.conference.hostSigma Theta Tau Internationalen
dc.conference.locationDublin, Irelanden
dc.descriptionEvent Theme: Influencing Global Health Through the Advancement of Nursing Scholarshipen
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