Effect of oral 25% dextrose on early post-procedural pain following lumbar puncture in neonates assessed using the neonatal infant pain scale: a prospective case series

Abstract

Lumbar puncture is a painful but essential diagnostic procedure in neonates. Although oral sweet solutions are established non-pharmacological analgesics for neonatal procedural pain, evidence specifically addressing oral 25% dextrose during lumbar puncture is limited. This prospective case series included 15 term neonates undergoing diagnostic lumbar puncture. Each infant received 2 ml of oral 25% dextrose 2 minutes before the procedure, with facilitated tucking maintained throughout. Behavioural pain was assessed using the neonatal infant pain scale (NIPS) at baseline, 1 minute, and 2 minutes after completion of the procedure. The mean NIPS score was 0.40±0.63 at baseline, increased to 2.73±0.70 at 1 minute after lumbar puncture, and decreased to 1.33±0.62 at 2 minutes. At 1 minute, 10 neonates (66.7%) had NIPS scores of 0–2 and 5 (33.3%) had scores of 3–4; no neonate had a score ≥5. At 2 minutes, all 15 neonates (100%) had NIPS scores of 0–2. These findings indicate a transient early post-procedural behavioural pain response followed by a reduction in NIPS scores within 2 minutes among neonates who received oral 25% dextrose with facilitated tucking. Because there was no control group, the observed response cannot be attributed to dextrose alone. Nevertheless, the findings provide preliminary procedure-specific evidence supporting the feasibility of oral 25% dextrose as a simple adjunct to comfort measures during neonatal lumbar puncture and support further controlled evaluation.