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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.

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