Sucrose for analgesia in newborn infants undergoing painful procedures

Stevens B, Yamada J, Ohlsson A

Published Online:

January 20, 2010

Sucrose (sugar) provides pain relief for newborn babies having painful events such as needles or heel pricks. Newborn babies undergoing these events need strategies to reduce their pain. 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 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 birth weight infants or infants on respirators.

Abstract (click to read)

Background:

Administration of oral sucrose with and without non-nutritive sucking is frequently used as a 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 strategy:

The standard methods of the Cochrane Neonatal Collaborative Review Group were used.

Selection criteria:

Randomized controlled trials in which term and/or preterm neonates (postnatal age maximum of 28 days corrected for postmenstrual age) received sucrose for procedural pain. Control conditions included water, pacifier, positioning/containing or breastfeeding.

Data collection and analysis:

The main outcome measures were physiological and/or behavioural pain indicators and/or composite pain scores. A weighted mean difference (WMD) with 95% confidence intervals (CI) using the fixed effects model was reported for continuous outcome measures.

Main results:

Forty-four studies enrolling 3,496 infants were included. Results from only a few studies could be combined in meta-analyses. Sucrose significantly reduced duration of total crying time (seconds) [WMD -39.26 (95% CI -44.29, -34.24), 88 neonates], but did not reduce duration of first cry (seconds) during heel lance [WMD -8.99 (95% CI -20.07, 2.10), 192 neonates]. No significant differences were found for percent change in heart rate from baseline at one minute [WMD 0.90 (95% CI -5.81, 7.61), 86 neonates] and three minutes [WMD -6.20 (95% CI -15.27, 2.88), 86 neonates] post-heel lance, or for mean heart rate at three minutes post-heel lance [WMD -0.98 (95% CI -8.29, 6.32), 154 neonates]. Oxygen saturation (%) was significantly lower in infants given sucrose during ROP examination compared to controls [WMD -2.58 (95% CI -4.94, - 0.23), 62 neonates]. Infants given sucrose post-heel lance had significantly lower PIPP scores at 30 seconds [WMD -1.64 (95% CI -2.47, - 0.81), 220 neonates] and 60 seconds [WMD -2.05 (95% CI -3.08, -1.02), 195 neonates]. For ROP exams, sucrose did not significantly reduce PIPP scores [WMD -0.65 (95% CI -1.88, 0.59), 82 neonates]. There were no differences in adverse effects between sucrose and control groups.

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 (e.g. behavioural, physical) and pharmacologic interventions is needed. Sucrose use in extremely low birth-weight and unstable and/or ventilated neonates needs to be addressed.

This record should be cited as:

Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD001069. DOI: 10.1002/14651858.CD001069.pub3

Assessed as up to date:

August 25, 2009

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Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Pain control

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Sucrose for analgesia in newborn infants undergoing painful procedures

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