title: Comparison of intra-procedural pain between a novel continuous arteriovenous exchange and conventional pull-push techniques of partial exchange transfusion in neonates: a randomized controlled trial.
abstract: OBJECTIVE
  We compared intra-procedural neonatal pain, agitation and sedation scale (N-PASS) scores between a novel 'continuous arteriovenous exchange' (CAVE) and conventional pull-push (PP) techniques of partial exchange transfusion (PET) among neonates with polycythemia.
  
  
  METHODS
  Neonates >32-0/7 weeks gestation, requiring PET for polycythemia, were randomized to PP or CAVE techniques. The procedure was video-recorded and edited to mask the technique. Intra-procedural N-PASS scores assigned by two trained and masked neonatal fellows were compared.
  
  
  RESULTS
  Twenty-two neonates were randomized to CAVE (n=12) or PP (n=10) method. The area under curve for cumulative N-PASS scores was significantly lesser in CAVE group (mean difference-11.9 (95% CI=-4.2, -19.6), P=0.005)). Decrease in hematocrit and complications of PET were comparable. Time for PET was longer with CAVE technique (16 (9, 29) min vs 10 (6, 12) min, P=0.016).
  
  
  CONCLUSIONS
  CAVE technique of PET was associated with lesser procedure-related pain (N-PASS scores) as compared with PP technique among neonates >32 weeks gestation.
authors.affiliation: Neonatal Unit, Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: S
authors.initials: S
authors.lastname: Patil
authors.affiliation: Neonatal Unit, Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: S S
authors.initials: SS
authors.lastname: Saini
authors.affiliation: Neonatal Unit, Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: P
authors.initials: P
authors.lastname: Kumar
authors.affiliation: Neonatal Unit, Department of Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
authors.forename: R
authors.initials: R
authors.lastname: Shah
mesh_terms: D005078:Exchange Transfusion, Whole Blood / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006400:Hematocrit; D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000628:therapy*; D008297:Male; D010146:Pain / Q000209:etiology / Q000503:physiopathology*; D011086:Polycythemia / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D014741:Video Recording