INTRODUCTION:

Up to now, various nonpharmacological methods have been used to alleviate procedures pain in neonates, which include breast-feeding, oral sucrose, NNS, swaddling, facilitated tucking, kangaroo care, skin-to-skin contact, and music. Many researches proved that oral sucrose is safe and effective for reducing pain from single and short-term procedures,which has been suggested as the standard of pain care.¹

A growing number of studies examining infants undergoing immunizations suggest that this analgesic effect may extend past the neonatal period and into infancy. 9-14 Nevertheless,

One study was conducted on infants aged 4-26 weeks who were admitted to the ward in a tertiary pediatric hospital in Western Australia and who underwent a painful procedure of venipuncture or heel lance for blood sampling or intravenous (IV) cannulation.²

Oral sucrose administration has been associated with calming effects and reductions in observed pain behaviours in preterm, term, and postnatal infants. The mechanisms underlying the efficacy of sucrose as an analgesic are advanced through indirect evidence for endogenous opioid mediation that has been primarily derived from studies using animal models.³

Infants who are less sick or who are not in neonatal intensive care units usually do not receive an analgesic for painful procedures. Obviously, central analgesics cannot be used for pain associated with occasional blood sampling performed in newborns not in intensive care. It is therefore essential to find simple, acceptable, and well-tolerated methods to reduce pain in these infants. Non-nutritive sucking during heel prick procedures decreases behavioural distress in the newborn infant. Studies support the theory that sucrose (due to the sweet taste) and pain relief are interrelated through the body’s endogenous opioid system which provides natural analgesia. The analgesic effect of sucrose is reversed with administration of naloxone, an opioid antagonist, suggesting that sucrose activates the central endogenous opioid system, with an action similar to that of opioid analgesics.⁴

The paediatric nurses are responsible for eliminating pain and sufferings in children whenever possible and they should advocate for the appropriate treatment of pain in children. To accomplish this, the nurses, need to expand their knowledge, use appropriate assessment tools and techniques, anticipate painful experiences and intervene accordingly. Hence, the researcher was interested to examine the effectiveness of oral sucrose to reduce the pain among infants and promote comfort.⁵

STATEMENT OF THE PROBLEM:

A Study to Assess the Effectiveness of Oral Sucrose on Level of Pain during DPT Immunization among Infants at a Selected Hospital, Salem.

OBJECTIVES:

1. To assess the level of pain during DPT immunization among infants in experimental and control group

2. To determine the effectiveness of oral sucrose on level of pain during DPT immunization among infants in experimental and control group.

3. To associate the level of pain during DPT immunization among infants in experimental and control group with their selected demographic variables.

OPERATIONAL DEFINITIONS:

Effectiveness: Effectiveness refers to the reduced level of pain among infants in experimental group when compared to control group as measured by modified REILY infant pain Assessment Scale.

Oral sucrose: Oral sucrose refers to 24% sucrose solution (2ml) given to infants prior to administration of DPT immunization.

DPT Immunization: It is vaccine administered intramuscularly in vastus lateralis to prevent DPT.

Pain: Pain refers to an unpleasant experience observed in the infant during injection as measured by using modified REILY infant pain assessment scale (facial expression, body movement, activity, cry, consolability).

Infants: Infants refer to the babies of 6-14 weeks of age receiving DPT immunization.

Hypotheses:

H1: There will be significant difference in level of pain among infants in experimental and control group after oral sucrose administration during DPT immunization at P < 0.05 level.

H2: There will be significant association between the level of pain during DPT immunization among infants in experimental and control group with their selected demographic variables at p < 0.05 level.

Delimitations:

1. The study was delimited to the infants receiving DPT immunizations

2. The study period was limited to only 4 weeks

3. The sample size was limited to 60 samples

Conceptual Framework:

The investigator adopted goal attainment as a basic theory for conceptual framework, which is aimed to effectiveness of oral sucrose in reducing pain during DPT immunization. This involves inter action between the researcher and the infants.

METHODOLOGY:

Research Approach: Quantitative Evaluative Research Approach

Research Design: Quasi experimental design, in which post–test only control group design

Groups	Intervention	Post -Test
Experimental group	X (24 % Oral Sucrose Solution)	O1 (Level of Pain)
Control group	-	O2 (Level of Pain)

Setting: Salem Poly Clinic – Salem Tamil Nadu

Population: Infants between 6 to 14 weeks of age

Sample: Infants receiving DPT Immunization in outpatient paediatric department of Salem Polyclinic, Salem.

Sample Size: 60 (Experimental Group = 30 and Control Group = 30)

Sampling Technique: Non-Probability, Convenience Sampling Technique

Criteria for Sample Selection

Inclusion Criteria

· Infants between the age group 6 to 14 weeks.

· Infants of parents who are willing to participate in the study.

Exclusion Criteria: Infants who are

· Premature

· Low birth weight

· With congenital anomalies

· Having any other major health problems

Variable:

Independent Variable – 24 % oral sucrose solution

Dependent Variable – level of pain

Description of the Tool

This tool consists of two sections.

Section I: This section consists of demographic data like age, weight of the infant, gender.

Section II: This section deals with modified REILY infant pain observational checklist. It includes, Facial expression, Body movement, Cry, Activity, Consolability, which were as per the pain scale and the score was interpreted as follows:

Table 1: Scoring Procedure

Observations	Scores
Observations	Severe	Moderate	Mild	No Pain
Facial Expressions	3	2	1	0
Body Movement	3	2	1	0
Cry	3	2	1	0
Activity	3	2	1	0
Consolability	3	2	1	0

Each response was given a score of zero, one, two and three according to the level of pain as no pain, mild, moderate and severe pain respectively. The total score was 15. The total score for each infant was calculated and interpreted as follows:

Table 2: Scoring Interpretations

Scores	Level of Pain
0 – 5	Mild Pain
6 - 10	Moderate Pain
11 - 15	Severe Pain

Method of Data Collection:

The experimental group was administered with 2 ml of 24% oral sucrose solution 2 minutes prior to DPT immunization where as the control group was not administered with oral sucrose solution. The investigator assessed the level of pain during DPT immunization by using the modified REILY infant Pain Assessment Scale (Observation Checklist) for both experimental and control group.

Dara Analysis Method:

Descriptive and Inferential Statistics

Data Analysis and Interpretation:

Figure 2: Distribution of Infants According to Age

Figure 3: Distribution of Infants According to Weight (Kg)

Figure 4: Distribution of Infants According to Gender

Figure 5: Distribution of Infants According to DPT Dose

Table 2: Distribution of Infants According to Level of Pain(N = 60)

Level of Pain	Experimental Group		Control Group
Level of Pain	Frequency	%	Frequency	%
Moderate Pain	30	100 %	5	16.67 %
Severe Pain	0	0 %	25	83.33 %

From table – 2 it was clear that all the infants in experimental had moderate pain 30 (100 %) where as in control group an overwhelming majority of the infants 25 (83. 33 %) were with severe pain and only 5 (16.67 %) had moderate level of pain.

Table 3: Mean, Standard deviation, and Mean Percentage of Level of Pain Among Infants in Experimental and Control Group (N=60)

Groups	Mean	Standard Deviation	Mean %	Difference in Mean %
Experimental	8.03	0.91	53.53	24 %
Control	11.63	1.17	77.53	24 %

Table-3 shows the experimental group infants pain mean score and S.D was 8.03, + 0.91 and for those in control group it was 11.63. + 1.17. Mean % score in experimental group was 53.53 and for the control group 77.53. difference in the Mean % score was 24 %.

Table 4: Effectiveness of Oral Sucrose on level of Pain during DPT Immunization among Infants in experimental and Control Group

(N = 60)

Groups

Mean

Standard Deviation

t - value

Table Value

Experimental

8.03

0.91

13.33 *

(df = 58)

3.29

Control

11.63

1.17

*- indicates Highly Significant (P < 0.001)

Independent ‘t’ test was done to evaluate the effectiveness of oral Sucrose on level of pain among infants, shows that the mean level of pain for Experimental group was 8.03+0.91 whereas for control group it was 11.63+1.17. The ‘t’ value13.33 which was greater than the table value at 0.001level indicating the effectiveness of oral sucrose in reducing the level of Pain in experimental group. Hence the research hypothesis (H1) is retained.

Table 5: Association between level of pain and demographic variables in Control Group (N = 60)

S. No.	Demographic Variables	Control Group		df	Chi Square	Table Value
S. No.	Demographic Variables	Moderate Pain	Severe Pain	df	Chi Square	Table Value
1	Age
	a. 6 – 8 weeks	1	9
	b. 9 – 11 weeks	2	9	2	0.538	5.99
	c. 12 – 14 weeks	2	7
2	Weight of an Infant
	a. 3 – 4.5 kgs	2	11
	b. 4.6 – 6 kgs	3	9	2	1.615	5.99
	c. 6.1 – 7.5 kgs	0	5
3	Gender
	a. Male	4	12	1	7.976*	3.84
	b. Female	1	13
4	Dose of DPT
	a. 1^st dose	1	9
	b. 2^nd dose	2	9	2	0.538	5.99
	c. 3^rd dose	2	7

* Significant (P < 0.05)

Table-5 depicts the level of association between level of pain and selected demographic variables in control group.

There was a statistically significant association between level of pain and gender. The chi-square value was 7.976 for the degree of freedom 1. The table value was 3.84

The association for the experimental group was not calculated because there was no mild and severe pain.

DISCUSSION:

The analysed data were discussed according to the selected study objectives and its supportive studies.

The first objective of the study was to assess the level of pain during DPT immunizations among infants in experimental and control group.

Level of pain shows that all the infants 30(100%) in experimental group had moderate level of pain and none of them had severe pain. However, in Control group majority of them 25(83.33%) had severe pain. This reveals that the level of pain in experimental group was reduced when compared to control group. These findings were supported by the study done by Yilmaz G, Caylan N, Oguz M and Karacan D. C (2014) The purpose of this study was to determine the effect of sucrose solution given orally on infant crying times and measure the distress in a 16–19-month age group. A total of 537 healthy, 16–19-month-old infants attending for their immunizations with intramuscular diphtheria, tetanus, and acellular pertussis (DTaP)/Haemophilus influenza type b/IPV (along with oral polio vaccination (OPV)), intramuscular pneumococcus and intramuscular hepatitis A were randomized to receive 2mL of a 75% sucrose solution, a 25% sucrose solution or sterile water 2 min before injections. Infants receiving a 75% sucrose solution had significantly reduced total crying times and Children’s Hospital of Eastern Ontario Pain Scale scores (CHEOPS) compared with infants in the control and 25 % sucrose solution groups (p < 0.001). study result concluded that Sucrose solution reduces infant distress and is safe and clinically useful even for 16–19-month-old infants.⁶

The second objective of the study was to to Determine the Effectiveness of Oral Sucrose on Level of Pain among Infants in Experimental and Control Group During DPT Immunization.

Table – 4 shows the Independent ‘t ’test done to evaluate the effectiveness of oral sucrose on level of pain among infants shows that the mean level of pain for Experimental group was 8.03+0.91 whereas for control group it was 11.63+1.17. The calculated ‘t’ value 13.33 which was greater than the table Value at 0.01level indicating that the difference in mean was true difference. Hence, the research hypothesis (H1) Is retained. This finding was similar to the following study done by Meena P, Soniya M and Mazumder M (2019) aims to assess the effectiveness of sucrose solution on immunization pain among infants. The pretest means score of pain among infants was 5.47±1.50 and therefore the posttest mean score was 4.07±1.49. The calculated paired ‘t’ test value of t = 8.573 was found to be statistically highly significant at p< 0.001 level.⁷

Third objective of the study was to associate the Level of Pain during DPT Immunization among Infants in Experimental and Control Group with Their Selected Demographic Variables. In this study, level of pain and gender were statistically significant. The chi – square value was 7.976 for the degree of freedom 1. The table value was 3.84. hence the researcher rejected null hypothesis and accepted research hypothesis.

The following study was similar to the study findings of Chattopadhyay D, Kundu P, Gunri S, Bisoi S (2018) objective of the study was to evaluate the effectiveness of oral sucrose on Level of Pain during DPT Immunization among Infants at Selected Hospital Salem. The results of this study exhibits that There’s no significant association within the level of pain with age, weight and dose of DPT immunization up to speed group, aside from the variable gender, where significant association was found.⁸

CONCLUSION:

This study was done to evaluate the effectiveness of oral sucrose on level of pain among infants during DPT immunization at a selected hospital, Salem. The result of this study showed that most of the infants in experimental group had reduction of pain during injection after administration for oral sucrose. There is no significant association in the level of pain with age, weight and Dose of DPT immunization in control group, except for the variable gender, where significant association was found.

REFERENCES:

1. A Review of Non-Pharmacological Treatments for Pain Management in Newborn Infants [Internet]. [cited 2021 Feb 19]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC6210323/

2. A Randomized Controlled Trial Evaluating the Efficacy of Oral Sucrose in Infants 1 to 3 Months Old Needing Intravenous Cannulation-Desjardins-2016-Academic Emergency Medicine-Wiley Online Library [Internet]. [cited 2021 Feb 19]. Available from: https://onlinelibrary.wiley.com/doi/full/10.1111/acem.12991

3. Sucrose for analgesia in newborn infants undergoing painful procedures [Internet]. [cited 2021 Feb 19]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6457867/

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5. Verghese ST, Hannallah RS. Acute pain management in children. J Pain Res. 2010 Jul 15; 3: 105–23.

6. Yilmaz G, Caylan N, Oguz M, Karacan CD. Oral sucrose administration to reduce pain response during immunization in 16-19-month infants: a randomized, placebo-controlled trial. Eur J Pediatr. 2014; 173(11): 1527-32.

7. Effectiveness of oral sucrose on level of pain during DPT immunization among infants at selected hospital Salem [Internet]. [cited 2021 Feb 19]. Available from: https://1library.net/ document/4yrojopy-effectiveness-sucrose-level-immunization-infants-selected-hospital-salem.html

8. Chattopadhyay D, Kundu P, Gunri S, Bisoi S. Effect of oral sucrose on pain during DPT immunization in older infants. Indian Journal of Public Health. 2011 Apr 1; 55(2): 136.

Received on 19.02.2021 Modified on 10.03.2021

Int. J. of Advances in Nur. Management. 2021; 9(3):283-288.

DOI: 10.52711/2454-2652.2021.00063