To assess pain and compare its severity in preterm infants during application of nasal-continuous positive airway pressure (nCPAP) and heated, humidified high-flow nasal cannulae (HHHFNC).
An observational cross-sectional study. Sixty preterm infants, categorized into nCPAP (n=37) and HHHFNC groups (n=23). Pain response was assessed using Premature Infant Pain Profile (PIPP), duration of first cry and salivary-cortisol concentrations.
The PIPP scores were significantly higher in the nCPAP compared with HHHFNC group (10 (7–12) vs 4 (2–6), P<0.01). None of the infants in the HHHFNC group had severe pain defined as a PIPP score >12, compared with 5 (13.5%) infants in the nCPAP group. Salivary-cortisol concentrations were significantly higher in nCPAP group compared with the HHHFNC group (5.0 (3.6–5.9) vs 1.6 (1.0–2.3) nmol l−1, P<0.01). A lower incidence of cry was observed for infants in the HHHFNC group compared with the nCPAP group (11 (47.8%) vs 30 (81.1%), P<0.001), however, the duration of first cry was not significantly different between groups. The respiratory rate was significantly lower after application of HHHFNC compared with nCPAP (P<0.001). There were no significant differences between groups with regard to fraction of inspired oxygen (FiO2), oxygen saturation by pulse oximeter (SpO2) and heart rate.
The application of HHHFNC in preterm infants is associated with less pain compared with nCPAP, as it is associated with less PIPP scores and lower salivary-cortisol concentrations.
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We thank Sabah Abdelnaser and Saber Elsheikh for their help in laboratory assessment of salivary cortisol, nursing staff of NICU, Mansoura University Children's Hospital, for their help in assessment of PIPP scores and patient recruitment, and all the parents and infants who took part in this study.
The authors declare no conflict of interest.
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Osman, M., Elsharkawy, A. & Abdel-Hady, H. Assessment of pain during application of nasal-continuous positive airway pressure and heated, humidified high-flow nasal cannulae in preterm infants. J Perinatol 35, 263–267 (2015). https://doi.org/10.1038/jp.2014.206
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