Lactancia materna para el dolor durante los procedimientos en lactantes más allá del período neonatal
Información
- DOI:
- https://doi.org/10.1002/14651858.CD011248.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 28 octubre 2016see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Dolor y cuidados paliativos
- Copyright:
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- Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Denise Harrison (DH) oversaw the entire process of conducting the systematic review. In addition, DH arbitrated if required when there were disagreements relating to data collection, data extraction, and 'Risk of bias' ratings. All authors assisted in the conduct of the systematic review. Jessica Reszel (JR) and Mariana Bueno (MB) were primarily responsible for reviewing and rating articles. Catherine Larocque (CL) supported all aspects of organizing and entering data, supporting data analysis and reviewing and editing draft versions. Lucy Turner (LT) served as the methodological expert. Margaret Sampson (MS) developed the search strategies. Vibhuti Shah (VSS) and Anna Taddio (AT) provided clinical, methodological and editing expertise throughout the entire process.
Sources of support
Internal sources
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CHEO, CHEO Foundation and University of Ottawa, Canada
Personnel support for Harrison and Reszel
External sources
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CHEO Research Institute Summer Studentship (Catherine Larocque), Canada
Personnel support for student research internship
Declarations of interest
DH: none known. DH is a registered nurse and midwife, and specialist in neonatal and infant pain research.
JR: none known.
MB: none known. MB is a registered nurse and specialist in neonatal and infant pain research.
MS: none known.
VSS: none known. VSS is a specialist physician and manages patients in the neonatal intensive care unit.
AT: none known. AT is a specialist pharmacist and researches knowledge translation about immunisation pain.
CL: none known.
LT: none known.
Acknowledgements
We thank Jo Abbott, Information Specialist, Cochrane Pain, Palliative and Supportive Care Review Group, for peer review of the MEDLINE search strategy.
Cochrane Review Group funding acknowledgement: The National Institute for Health Research (NIHR) is the largest single funder of the Cochrane Pain, Palliative and Supportive Care Review Group. Disclaimer: The views and opinions expressed in this review are those of the authors and do not necessarily reflect those of the NIHR, National Health Service (NHS), or the Department of Health.
Version history
| Published | Title | Stage | Authors | Version |
| 2016 Oct 28 | Breastfeeding for procedural pain in infants beyond the neonatal period | Review | Denise Harrison, Jessica Reszel, Mariana Bueno, Margaret Sampson, Vibhuti S Shah, Anna Taddio, Catherine Larocque, Lucy Turner | |
| 2014 Aug 11 | Breastfeeding for procedural pain in infants beyond the neonatal period | Protocol | Denise Harrison, Jessica Reszel, Mariana Bueno, Margaret Sampson, Vibhuti S Shah, Anna Taddio, Catherine Larocque, Lucy Turner | |
Differences between protocol and review
We had stated in our protocol that we would exclude quasi‐randomised controlled trials using a non‐random process (e.g. odd or even date of birth; hospital or clinic record number). However, we revised this exclusion, and included all such studies.
In addition, in our protocol we stated that we would use the Oxford Quality Score as the basis for inclusion (Jadad 1996), limiting inclusion to studies that were randomised and double‐blind as a minimum. We did not use this, as the blinding of breastfeeding is not possible.
Notes
Assessed for updating in 2018
A restricted search in June 2018 did not identify any potentially relevant studies likely to change the conclusions. Therefore this review will be reassessed for updating in two years. If appropriate, we will update the review before this date if new evidence likely to change the conclusions is published, or if standards change substantially which necessitate major revisions.
Assessed for updating in 2020
At July 2020 we are aware of new potentially relevant studies, but none are likely to change the conclusions. Therefore, this review has now been stabilised following discussion with the authors and editors. The review will be reassessed for updating in two years. If appropriate, we will update the review before this date if new evidence likely to change the conclusions is published, or if standards change substantially which necessitate major revisions.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
- Anesthetics, Local [administration & dosage];
- *Breast Feeding;
- Crying [physiology];
- Glucose [administration & dosage];
- Heart Rate [physiology];
- Infant Care [methods];
- Lidocaine [administration & dosage];
- Lidocaine, Prilocaine Drug Combination;
- Massage;
- Pain [etiology, physiopathology, *prevention & control];
- Pain Management [methods];
- Pain Measurement [methods];
- Prilocaine [administration & dosage];
- Randomized Controlled Trials as Topic;
- Time Factors;
- Vaccination [*adverse effects];
Medical Subject Headings Check Words
Female; Humans; Infant;
PICO
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Forest plot of comparison: 1 Breastfeeding versus control, outcome: 1.1 Cry duration.
Forest plot of comparison: 1 Breastfeeding versus control, outcome: 1.2 All pain scores during injection.
Forest plot of comparison: 1 Breastfeeding versus control, outcome: 1.3 NIPS.
Comparison 1: Breastfeeding versus control, Outcome 1: Cry duration
Comparison 1: Breastfeeding versus control, Outcome 2: All pain scores during injection
Comparison 1: Breastfeeding versus control, Outcome 3: NIPS
Comparison 1: Breastfeeding versus control, Outcome 4: Heart rate after injection
| Breastfeeding compared with other interventions, oral water, or no treatment for pain during vaccination in infants 1 to 12 months | ||||
| Patient or population: Infants 1 to 12 months during vaccination Settings: Diverse community settings Intervention: Breastfeeding Comparison: Other interventions, such as cuddling, sweet solutions, or placebo (oral water) or no treatment | ||||
| Outcomes | No of Participants | Effect Estimates and 95% CI | Quality of the evidence | Comments |
|---|---|---|---|---|
| Cry duration Seconds cry time during procedure or proportion of crying during procedure. Crying was measured during and up to 3 minutes following completion of vaccination. | 547 (6 studies) | MD (seconds) ‐38 ( ‐49.84 to 26.35) | Moderate | Not further downgraded: Breastfeeding consistently resulted in a reduction of crying time. However, as most trials included infants aged 1 to 6 months, further research including older infants up to 12 months of age may have an important impact on our confidence in the estimate of effect and may change the estimate. |
| All pain scores during injection Due to range of pain scores used, data analysed using SMDs. Pain scores were measured during and up to 3 minutes following completion of vaccination. | 310 (5 studies) | SMD ‐1.7 ( ‐2.2 to ‐1.3) | Moderate | Downgraded once: Breastfeeding consistently resulted in a reduction of pain scores. However, only 5 studies and 310 infants were included, and most of the trials included the younger infants aged 1 to 6 months. Further research including older infants up to 12 months of age and larger sample sizes may have an important impact on our confidence in the estimate of effect. |
| NIPS score during injection The NIPS was measured during and up to 3 minutes following completion of vaccination. | 174 (3 studies) | MD ‐1.89 (‐2.55 to ‐1.24) | Low | Not further downgraded: Grade of evidence already taken into account. Only 3 studies and 174 infants were included. Further studies using this pain assessment score may lead to more certainty and have an important impact on our confidence in the estimate of effect. |
| Heart rate after injection Heart rate in the period following completion of the injections was measured in 2 studies. | 186 (2 studies) | MD (beats per minute) ‐3.6 ( ‐23 to 16) | Low | Not further downgraded: Grade of evidence already taken into account. Breastfeeding did not have an effect on heart rate change from baseline. As only 2 studies were included in this outcome, further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. |
| Adverse events | No studies reported on adverse events. | ‐ | Very low | No studies reported on outcomes such as coughing or gagging. |
| CI: confidence interval; MD: mean difference; NIPS: Neonatal Infant Pain Scale; SMD: standardised mean difference | ||||
| GRADE Working Group grades of evidence | ||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1.1 Cry duration Show forest plot | 6 | 547 | Mean Difference (IV, Random, 95% CI) | ‐38.09 [‐49.84, ‐26.35] |
| 1.2 All pain scores during injection Show forest plot | 5 | 310 | Std. Mean Difference (IV, Random, 95% CI) | ‐1.73 [‐2.20, ‐1.25] |
| 1.3 NIPS Show forest plot | 3 | 174 | Mean Difference (IV, Random, 95% CI) | ‐1.89 [‐2.55, ‐1.24] |
| 1.4 Heart rate after injection Show forest plot | 2 | 186 | Mean Difference (IV, Random, 95% CI) | ‐3.56 [‐23.17, 16.05] |
