title: Comparison of iatrogenic pain between rotavirus vaccination before and after vaccine injection in 2-month-old infants.
abstract: Oral rotavirus vaccine (RV) administration in conjunction with other injectable vaccines has been used worldwide. However, whether the sequence of RV administration is associated with the reduction of injection-induced pain remains unclear. In this randomized controlled trial, we enrolled 6-12-wk-old healthy infants. The pain response of the infants was scored on the basis of their crying, irritability, facial expression, gagging and distress. A multivariate logistic regression model was used to compare the pain response after adjustment for possible confounders. We enrolled 352 infants, of whom 176 infants received RV before injection (experimental group) and 176 infants received an RV after injection (comparison group). Sex, number of injections, main caregiver, feeding type, and RV type did not differ significantly between the 2 groups. Multivariate regression analyses showed that, at 30 s after the intervention, the episode of gagging was more frequent in the comparison group than in the experimental group (p = 0.004). At 180 s after the intervention, the infants cried more often in the comparison group (p < 0.001). Furthermore, the infants in the experimental group more often relaxed (p < 0.001), rested quietly (p = 0.001), and were smiling (p = 0.001) than did those in the comparison group. Our results indicate that compared with oral RV administration after injection, oral RV administration before injection is more effective in reducing injection-induced pain in 2-mo-old infants. The findings can provide a clinical strategy for relieving pain from vaccination in young infants.
authors.affiliation: a Department of Nursing , Chang Gung Memorial Hospital, Chang Gung University, College of Nursing , Taipei , Taiwan.
authors.forename: Hui-Chu
authors.initials: HC
authors.lastname: Yin
authors.affiliation: b Graduate Institute of Health Care, Chang Gung Universality of Science and Technology , Taoyuan , Taiwan.
authors.forename: Whei-Mei
authors.initials: WM
authors.lastname: Shih
authors.affiliation: a Department of Nursing , Chang Gung Memorial Hospital, Chang Gung University, College of Nursing , Taipei , Taiwan.
authors.forename: Hsiu-Lan
authors.initials: HL
authors.lastname: Lee
authors.affiliation: a Department of Nursing , Chang Gung Memorial Hospital, Chang Gung University, College of Nursing , Taipei , Taiwan.
authors.forename: Huei-Jing
authors.initials: HJ
authors.lastname: Yang
authors.affiliation: a Department of Nursing , Chang Gung Memorial Hospital, Chang Gung University, College of Nursing , Taipei , Taiwan.
authors.forename: Yu-Li
authors.initials: YL
authors.lastname: Chen
authors.affiliation: c Department of Pediatrics , Chang Gung Memorial Hospital, Chang Gung University, College of Medicine , Taipei , Taiwan.
authors.forename: Shao-Wen
authors.initials: SW
authors.lastname: Cheng
authors.affiliation: d Department of Public Health , Kaohsiung Medical University , Kaohsiung , Taiwan.
authors.forename: Chun-Yuh
authors.initials: CY
authors.lastname: Yang
authors.affiliation: e Master Program in Global Health and Development , College of Public Health, Taipei Medical University , Taipei , Taiwan.
authors.forename: Ya-Wen
authors.initials: YW
authors.lastname: Chiu
authors.affiliation: c Department of Pediatrics , Chang Gung Memorial Hospital, Chang Gung University, College of Medicine , Taipei , Taiwan.
authors.forename: Yi-Hao
authors.initials: YH
authors.lastname: Weng
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000284:Administration, Oral; D000700:Analgesics / Q000008:administration & dosage; D003448:Crying; D005260:Female; D006801:Humans; D007223:Infant; D007267:Injections; D016015:Logistic Models; D008297:Male; D010146:Pain / Q000209:etiology*; D012400:Rotavirus Infections / Q000517:prevention & control / Q000821:virology; D022243:Rotavirus Vaccines / Q000008:administration & dosage*; D014611:Vaccination / Q000009:adverse effects* / Q000379:methods; D014612:Vaccines / Q000008:administration & dosage*
chemical_list: D000700:Analgesics; D022243:Rotavirus Vaccines; D014612:Vaccines; D000082:Acetaminophen
keywords: infant; injection; pain; rotavirus vaccine; vaccination