A Randomized Controlled Trial of the Use of Oral Glucose with or without Gentle Facilitated Tucking of Infants during Neonatal Echocardiography

Pascal M Lavoie, Amelie Stritzke, Joseph Ting, Mohammad Jabr, Amish Jain, Eddie Kwan, Ela Chakkarapani, Paul Brooks, Rollin Brant, Patrick J McNamara, Liisa Holsti, Pascal M Lavoie, Amelie Stritzke, Joseph Ting, Mohammad Jabr, Amish Jain, Eddie Kwan, Ela Chakkarapani, Paul Brooks, Rollin Brant, Patrick J McNamara, Liisa Holsti

Abstract

Objective: To compare the effect of oral glucose given with or without facilitated tucking (FT), versus placebo (water) to facilitate image acquisition during a targeted neonatal echocardiography (TNE).

Design: Factorial, double blind, randomized controlled trial.

Setting: Tertiary neonatal intensive care unit (NICU).

Patients: Infants born between 26 and 42 weeks of gestation (GA).

Interventions: One of four treatment groups: oral water (placebo), oral glucose (25%), facilitated tucking with oral water or facilitated tucking with oral glucose, during a single, structured TNE. All infants received a soother.

Main outcome measure: Change in Behavioral Indicators of Infant Pain (BIIP) scores.

Results: 104 preterm infants were randomized (mean ± SD GA: 33.4 ± 3.5 weeks). BIIP scores remained low during the echocardiography scan (median, [IQ range]: 0, [0 to 1]). There were no differences in the level of agitation of infants amongst the treatment groups, with estimated reductions in mean BIIP relative to control of 0.27 (95%CI -0.40 to 0.94) with use of oral glucose and .04 (-0.63 to 0.70) with facilitated tucking. There were also no differences between treatment groups in the quality and duration of the echocardiography scans.

Conclusions: In stable infants in the NICU, a TNE can be performed with minimal disruption in a majority of cases, simply by providing a soother. The use of 25% glucose water in this context did not provide further benefit in reducing agitation and improving image acquisition.

Clinical trial registration: Clinical Trials.gov: NCT01253889.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1. Study flow diagram.
Fig 1. Study flow diagram.
Fig 2. Boxplots for the Behavioral Indicators…
Fig 2. Boxplots for the Behavioral Indicators of Pain total scores by treatment group and echocardiography phase.
Due to the preponderance of 0 values in the data, we also provide the percentage of such values below each boxplot.
Fig 3
Fig 3
(A) Decrease in scan time among each TNE operator (1 to 4) with increasing number of Tn-ECHO scans over the progression of the study. Relationship (B) between quality and duration of Tn-ECHO scan, (C) between of number of images acquired and duration of Tn-ECHO scan, and (D) between quality of Tn-ECHO scan and number of images acquired. Linear regression (solid lines) with 95% confidence limits (dotted lines).

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