Sabitri Acharya

College of Medical Sciences, Bharatpur, Chitwan, Nepal

Abstract Title:

Effectiveness of 25% Dextrose versus Expressed Breast Milk on Vital Parameters, Pain and Comfort Level during Heel Prick among Neonates Admitted in Neonatal Intensive Care Unit

Research Interests:

Background: Neonates frequently undergo painful procedures such as heel prick during their stay in the neonatal intensive care unit (NICU). Repeated exposure to untreated procedural pain may have adverse short- and long-term effects. Non-pharmacological interventions such as oral glucose solutions and expressed breast milk (EBM) are safe, practical, and cost-effective approaches for neonatal pain management. This study aimed to compare the effectiveness of 25% dextrose and expressed breast milk on vital parameters, pain, and comfort among neonates undergoing heel prick. Methods: A quasi-experimental pre-test post-test control group design was adopted among 140 neonates admitted to the NICUs of Lumbini Provincial Hospital and Siddhartha Women and Children Hospital, Lumbini Province, Nepal. Total enumerative sampling was used to select 70 neonates in the intervention group receiving 2 mL of 25% dextrose and 70 neonates in the control group receiving 2 mL of expressed breast milk. Vital parameters were assessed using a biophysiological assessment proforma, pain was assessed using the Revised Premature Infant Pain Profile (PIPP-R), and comfort was assessed using the Modified Comfort Behaviour Scale (MCBS). Data were analysed using descriptive and inferential statistics. Results: The pre-intervention vital parameters, pain, and comfort scores were comparable between the intervention and control groups. Following heel prick, neonates receiving 25% dextrose demonstrated a smaller increase in heart rate and respiratory rate, a lesser decrease in oxygen saturation, lower pain scores, and higher comfort scores compared with those receiving expressed breast milk, with statistically significant differences between the groups (p<0.01). Vital parameters and behavioural responses also returned to baseline more rapidly in the 25% dextrose group. A significant positive correlation was observed between heart rate and respiratory rate in both the intervention (rho=0.26, p=0.02) and control groups (rho=0.28, p<0.01). A significant negative correlation was observed between heart rate and oxygen saturation in the intervention group (rho=-0.24, p=0.04). Furthermore, a significant moderate negative correlation was found between pain and comfort scores in the intervention group (rho=-0.30, p<0.01), whereas the correlation in the control group was weak and statistically non-significant (rho=-0.12, p=0.32). Selected neonatal characteristics were largely not significantly associated with vital parameters, pain, and comfort; however, significant associations were observed between respiratory rate and gender (p=0.02), APGAR scores and respiratory rate, and reason for NICU admission with heart rate and respiratory rate (p<0.01). Conclusion: Both 25% dextrose and expressed breast milk were effective in reducing procedural pain, improving comfort, and stabilizing vital parameters among neonates undergoing heel prick. However, 25% dextrose demonstrated faster and more sustained effects, making it a more efficient option when rapid stabilization is required. Expressed breast milk remains a valuable alternative due to its nutritional and immunological benefits. Both interventions may be incorporated into routine neonatal pain management, particularly in resource-limited NICU settings. Keywords: 25% dextrose, expressed breast milk, heel prick, neonatal pain, and neonates