Pain Control Interventions in Preterm Neonates: Few concerns

Correspondence

Indian Pediatr 2018;55: 616-617

	Pain Control Interventions in Preterm Neonates: Few concerns
Sankalp Dudeja¹ and Tapas Bandyopadhyay² ¹Division of Neonatology, Department of Pediatrics, PGIMER, Chandigarh and ²Department of Neonatology, PGIMER and Dr.RML Hospital, New Delhi; India. Email: [email protected]
We read with interest the recent article by Shukla, et al. [1], which concluded that Kangaroo mother care with and without Music therapy (with expressed breast milk) significantly reduces pain on heel-stick as compared to expressed breast milk alone. In this study, authors have combined multiple interventions for reducing procedure-related pain in preterm neonates. In principle, combining different interventions would provide multisensory stimulation (tactile, gustatory, auditory and visual) to the baby and would lead to ‘sensorial saturation’ that should reduce the perception of pain to noxious procedures [2]. The study is a well-designed randomized controlled trial and addresses a clinically relevant issue. However, we would like to highlight a few concerns: 1. In the present study, after randomization and allocation to a particular group, the desired intervention (Music Therapy) could not be given to one participant, and his group was changed. Instead of changing the group at time of analysis, the participant should have been retained in the same group (Intention-to-treat analysis) or excluded from the analysis (per protocol analysis) [3]. 2. The gestational age of the study population mentioned in abstract and the main text is different (26-36 weeks in abstract and 28-36 weeks in the text). 3. For music therapy, the authors have used flute-based music using mobile phone. Instead of this, the mother could be asked to speak/sing to the infant at the time of painful stimulus. This would be easier to do and would not require any special equipment. 4. One of the exclusion criteria of the study was hypoxic ischemic encephalopathy (HIE), and Sarnat criteria was used to stage HIE. However, Sarnat staging is for neonates >36 weeks of gestational age and not for preterms below 36 weeks [4]. References 1. Shukla VV, Bansal S, Nimbalkar A, Chapla A, Phatak A, Patel D, et al. Pain control interventions in preterm neonates: A randomized controlled trial. Indian Pediatr. 2018;55:292-60. 2. Bellieni CV, Buonocore G, Nenci A, Franci N, Cordelli DM, Bagnoli F. Sensorial saturation: an effective analgesic tool for heel-prick in preterm infants. Neonatology. 2001;80:15-8. 3. Montori VM, Guyatt GH. Intention-to-treat principle. Can Med Assoc J. 2001;165:1339-41. 4. Sarnat HB, Sarnat MS. Neonatal encephalopathy following fetal distress: A clinical and electroencephalographic study. Arch Neurol. 1976;33:696-705.