Artificial sweetener reduces nociceptive reaction in term newborn infants

Bucher, HU; Baumgartner, R. W.; Bucher, Nancy L. R.; Seiler, Michelle; Fauchère, JC

doi:10.1016/s0378-3782(00)00085-2

Cited by 67 publications

(62 citation statements)

References 17 publications

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“…The methods used in previous studies of nonpharmacologic analgesia in neonates have led to a considerable reduction but not elimination of signs of pain perception (21,(33)(34)(35)(36)(37)(38)(39). The best results have been obtained with simultaneous administration of oral sugar and pacifier (40), which also has been used during venous blood sampling (31).…”

Section: Discussionmentioning

confidence: 99%

“…Different sensory stimuli have been used to activate gatecontrol mechanisms to block nociceptive transmission: massage (51) or water mattresses (52), tactile (53) and acoustic (54) stimuli or both (55), sucking (39), oral sucrose or glucose (28, 35, 36, 38, 40, 56 -58), and other sweet liquids (22,34). Nevertheless, the technique used in the present study is the first to obtain an evident and significant decrease in the response to pain in term neonates by stimulating various sensory channels simultaneously and in a codified manner.…”

Section: Discussionmentioning

confidence: 99%

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Effect of Multisensory Stimulation on Analgesia in Term Neonates: A Randomized Controlled Trial

et al. 2002

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Many attempts have been made to obtain safe and effective analgesia in newborns. Oral glucose-water has been found to have analgesic properties in neonates. We investigated whether other sensory stimulation added to oral glucose provided more effective analgesia than oral glucose alone. In a randomized prospective double-blind trial, we studied 120 term newborns during heel prick. The babies were divided randomly into six groups of 20, and each group was treated with a different procedure during heel prick: A) control; B) 1 mL 33% oral glucose given 2 min before the heel prick; C) sucking; D) 1 mL 33% oral glucose plus sucking; E) multisensory stimulation including 1 mL 33% oral glucose (sensorial saturation); F) multisensory stimulation without oral glucose. Sensorial saturation consisted in massage, voice, eye contact, and perfume smelling during heel prick. Each heel prick was filmed and assigned a point score according to the Douleur Aiguë du Nouveau-né (DAN) neonatal acute pain scale. Camera recording began 30 s before the heel prick, so it was impossible for the scorers to distinguish procedure A (control) from B (glucose given 2 min before), C (sucking water) from D (sucking glucose), and E (multisensory stimulation and glucose) from F (multisensory stimulation and water) from the video. Procedure E (multisensory stimulation and glucose) was found to be the most effective procedure, and the analgesia was even more effective than that produced by procedure D (sucking glucose). We conclude that sensorial saturation is an effective analgesic technique that potentiates the analgesic effect of oral sugar. It can be used for minor painful procedures on newborns. Newborns feel pain (1, 2). Repeated painful stimuli lower their pain threshold (3, 4) by overstimulation of NMDA receptors, which may lead to excitotoxic brain damage (5). Until a few years ago, it was claimed that the word pain was inappropriate for newborns, as pain is a subjective experience that newborns, because of their age, cannot have (6). Until the 1980s, analgesics were rarely administered to newborns even in the case of surgery (7). Now we know that anesthesia reduces brain damage due to hypoxemia, hypertension, tachycardia, variations in heart rate, and increased intracranial pressure (8, 9), all of which are particularly dangerous because of immature cerebral vasoregulation in the premature (10).The number of painful stimuli needs to be kept to a minimum, and every effort should be made to render them less painful. Guidelines for neonatal analgesia have been suggested (11-15), especially for the most routine type of pain, blood sampling, which is usually performed by heel prick. To avoid the drawbacks of general and local analgesics (16 -21), types of nonpharmacologic analgesia have been proposed, including nonnutritional sucking and instillation of glucose or other sweet liquids on the newborn's tongue (22). The analgesic effect of glucose is thought to stimulate an increase in plasma concentrations of ␤-endorphin (23-27) by a preabsorptiv...

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effect of Multisensory Stimulation on Analgesia in Term Neonates: A Randomized Controlled Trial

et al. 2002

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“…[52][53][54][55][56][57] Kangaroo care 58,59 and breastfeeding [60][61][62][63][64] were more or equally effective, compared with sucrose alone, in most studies, with few exceptions. [65][66][67] Sucrose or glucose was equal to or more effective than eutectic mixture of topical anesthetics during heel lances, 68 finger pricks, 69 …”

Section: Additional Interventions Studiedmentioning

confidence: 99%

Analgesic Effects of Sweet-Tasting Solutions for Infants: Current State of Equipoise

et al. 2010

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OBJECTIVE: The goal was to review published studies of analgesic effects of sweet solutions, to ascertain areas with sufficient evidence of effectiveness and areas of uncertainty. METHODS: Databases searched included Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature database, and PsycINFO, using the terms pain*, infant*, neonat*, newborn*, sucrose, glucose, and alternative sugars. Publications were sorted according to type, year, painful procedure studied, placebo/no-treatment groups, population studied, and country of publication. RESULTS: A total of 298 relevant unique publications involving human infants were identified; 125 (42%) were primary research studies, of which 116 (93%) were randomized controlled trials. Healthy preterm or term newborns were included in 82 studies (65%), and sick or very low birth weight infants were included in 22 (18%). Most studies included single episodes of painful procedures, with only 3 (2%) conducted over long periods. Procedures investigated most frequently were heel lance (49%), venipuncture (14%), and intramuscular injection (14%). Placebo or no-treatment groups were included in 111 studies (89%); in 103 (93%) of those studies, sweet solutions reduced behavioral responses, compared with placebo/ no treatment. CONCLUSION: Clinical equipoise relating to analgesic effects of sweet solutions no longer exists for single episodes of procedures for healthy preterm and term newborn infants. Uncertainties include outcomes after prolonged use of sweet solutions, concomitant use of other analgesics, and effectiveness beyond the newborn period. Future research should focus on addressing these knowledge and research gaps.

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“…Thus, no additional heel prick was required. For all blood samplings, the nurse administered an oral sweetener for pain relief [6] before pricking the pre-warmed heel and taking the two capillary blood samples. Blood sampling occurred within 10 min after the application of the three non-invasive methods.…”

Section: Study Proceduresmentioning

confidence: 99%

Detection of hyperbilirubinaemia in jaundiced full-term neonates by eye or by bilirubinometer?

et al. 2004

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The aim of this study was to compare predictions of hyperbilirubinaemia by eye, performed by trained physicians and nurses, with predictions obtained using two commercial bilirubinometers. Jaundice was assessed in 92 white and 48 non-white healthy full-term neonates using three non-invasive methods and by total serum bilirubin as the reference method. Clinical assessment of cephalocaudal progression of jaundice was carried out independently by a physician and by nurses. Simultaneously, the Minolta Airshields JM-102 was applied on the sternum, the BiliCheck on both the forehead and the sternum, and finally, serum bilirubin concentrations were determined. The Minolta JM-102 showed the best performance with r 2 =0.90, an intraclass correlation coefficient (ICC) of 0.93, and a 95% confidence interval (CI) of ±4 units (approx. 56 lmol/l). The BiliCheck performed slightly better on the forehead than over the sternum with r 2 =0.90, an ICC of 0.88, and a CI of ±62 lmol/l. Assessment of jaundice by eye was least accurate with r 2 =0.74, an ICC of 0.67, and a CI of ±1.5 zones (corresponding to ±75 lmol/l). Skin pigmentation and ambient light both adversely affected noninvasive bilirubin estimation. Conclusion: All three non-invasive methods are well suited for estimation of serum bilirubin but show large confidence intervals. In healthy term newborns, hyperbilirubinaemia (>250 lmol/l) can be safely ruled out by eye if jaundice does not reach the abdomen or the extremities (Kramer zones 1 and 2), with <22 units (<230 lmol/l) for the Minolta JM-102, or with a cut-off of 190 lmol/l for the BiliCheck. If these respective thresholds are exceeded, serum bilirubin concentrations should be measured.

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Artificial sweetener reduces nociceptive reaction in term newborn infants

Cited by 67 publications

References 17 publications

Effect of Multisensory Stimulation on Analgesia in Term Neonates: A Randomized Controlled Trial

Effect of Multisensory Stimulation on Analgesia in Term Neonates: A Randomized Controlled Trial

Analgesic Effects of Sweet-Tasting Solutions for Infants: Current State of Equipoise

Detection of hyperbilirubinaemia in jaundiced full-term neonates by eye or by bilirubinometer?

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