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

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.study design: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.result: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).conclusion:cave technique of pet was associated with lesser procedure-related pain (n-pass scores) as compared with pp technique among neonates >32 weeks gestation.