Sucrose for analgesia in newborn infants undergoing painful procedures
Abstract
Background
Administration of oral sucrose with and without non‐nutritive sucking is the most frequently studied non‐pharmacological intervention for procedural pain relief in neonates.
Objectives
To determine the efficacy, effect of dose and safety of oral sucrose for relieving procedural pain in neonates.
Search methods
We used the standard methods of the Cochrane Neonatal Review Group. Electronic and manual searches were performed in November 2011 for published randomised controlled trials (RCTs) in MEDLINE (1950 to November 2011), EMBASE (1980 to 2011), CINAHL (1982 to November 2011) and the Cochrane Central Register of Controlled Trials (The Cochrane Library). We did not impose language restrictions.
Selection criteria
RCTs in which term, preterm, or both term and preterm neonates (postnatal age maximum of 28 days after reaching 40 weeks' postmenstrual age) received sucrose for procedural pain. Control conditions included no treatment, water, pacifier, positioning/containing or breastfeeding.
Data collection and analysis
Main outcome measures were physiological, behavioural, or both pain indicators with or without composite pain scores. A mean difference (MD) with 95% confidence intervals (CI) using the fixed‐effect model was reported for continuous outcome measures. Trial quality was assessed as per The Cochrane Collaboration
Main results
Fifty‐seven studies enrolling 4730 infants were included. Results from only a few studies could be combined in meta‐analyses. When Premature Infant Pain Profile (PIPP) scores were pooled, sucrose groups had significantly lower scores at 30 seconds (weighted mean difference (WMD) ‐1.76; 95% CI ‐2.54 to ‐ 0.97; 4 trials; 264 neonates] and 60 seconds (WMD ‐2.05; 95% CI ‐3.08 to ‐1.02; 3 trials' 195 neonates) post‐heel lance. For retinopathy of prematurity (ROP) examinations, sucrose did not significantly reduce PIPP scores (WMD ‐0.65; 95% CI ‐1.88 to 0.59; 3 trials; 82 neonates). There were no differences in adverse effects between sucrose and control groups. Sucrose significantly reduced duration of total crying time (WMD ‐39 seconds; 95% CI ‐44 to ‐34; 2 trials; 88 neonates), but did not reduce duration of first cry during heel lance (WMD ‐9 seconds; 95% CI ‐20 to 2; 3 trials; 192 neonates). Oxygen saturation (%) was significantly lower in infants given sucrose during ROP examination compared to controls (WMD ‐2.6; 95% CI ‐4.9 to ‐ 0.2; 2 trials; 62 neonates). Results of individual trials that could not be incorporated in meta‐analyses supported these findings. The effects of sucrose on long‐term neurodevelopmental outcomes are unknown.
Authors' conclusions
Sucrose is safe and effective for reducing procedural pain from single events. An optimal dose could not be identified due to inconsistency in effective sucrose dosage among studies. Further investigation on repeated administration of sucrose in neonates and the use of sucrose in combination with other non‐pharmacological and pharmacological interventions is needed. Sucrose use in extremely preterm, unstable, ventilated (or a combination of these) neonates needs to be addressed. Additional research is needed to determine the minimally effective dose of sucrose during a single painful procedure and the effect of repeated sucrose administration on immediate (pain intensity) and long‐term (neurodevelopmental) outcomes.
PICOs
Plain language summary
Sucrose for analgesia in newborn infants undergoing painful procedures
Healthcare professionals need strategies to reduce newborn babies' pain. Sucrose (sugar) provides pain relief for newborn babies having painful events such as needles or heel pricks. Pain medicine is usually given for major painful events (such as surgery), but may not be given for more minor events (such as taking blood or needles). Pain medicine can be used to reduce pain but there are several other methods including sucking on a pacifier (dummy) with or without sucrose. Researchers have found that giving sucrose to babies decreases their crying time and behaviours such as grimacing. More research is needed to determine if giving repeated doses of sucrose is safe and effective, especially for very low birthweight infants or infants on respirators.
