Effects of combined oral sucrose and nonnutritive sucking (NNS) on procedural pain of NICU newborns, 2001 to 2016

Abstract

Background:Both oral sucrose (OS) and nonnutritive sucking (NNS) are effective nonpharmacological methods to alleviate procedures pain in neonatal intensive care unit (NICU) newborns when they were used alone, but the combined effect of OS+NNS remains controversial. So, we conducted this study to evaluate the efficiency of NNS combined with oral sucrose on pain relief in NICU newborns undergoing painful procedures.Methods:We searched PubMed, Ovid (Medline), Embase (Medline), Cochrane Central Library, and other resources such as Google Scholar, bibliographies of included literatures for all available articles. Two reviewers screened literatures and extracted data independently. The fixed effects model was used to pool the results using Reviewer Manager (RevMan) 5.3. As each study included in our meta-analysis had been approved by Ethics Committee or institutional review board, thus our study did not need ethical approval.Results:Seven randomized controlled trials, including 599 participants, were contained in our meta-analysis. The combination of oral sucrose and NNS is associated with reduced pain scores (mean difference [MD], −0.52; 95% confidence interval [CI], −0.68 to −0.36); shortened crying time (MD,−0.92; 95% CI, −1.39 to −0.44); but the 2 groups did not differ significantly in reducing bradycardia (MD, 0.73; 95% CI, 0.32–1.68), tachycardia (MD, 0.65; 95% CI, 0.38–1.10), or desaturations (MD, 0.73; 95% CI, 0.32–1.68).Conclusion:The pooled evidence indicates that the combination measures may serve as an evidence-based guideline for pain relief among patients having minor pain. Besides, it also indicates that OS combined with NNS can be an alternative for better prevention and management of procedure pain in NICU newborns. Nevertheless, the results may be limited due to incomplete data, and thus, more randomized controlled trials or well-designed studies are required to determine the effects of OS+NNS in the future.

Role of sucrose, pacifier and their combination as pain reliever among preterm neonates during painful procedures

“…[22] However, we used single OS dose with acceptable effect. Although studies reported that, combined pacifier and OS lowered O 2 saturation fluctuations and heart rate in comparison to OS alone, [23] a meta-analysis showed that, combined OS and pacifier did not differ signifi-cantly in lowering the risk of bradycardia, tachycardia, and O 2 desaturations incidence between the 2 groups [24] which is not the case in the current study.…”

“…They concluded that, the combination is effective not only for management but also for better prevention of procedure related pain among NICU newborns. [24] The combination of NNS with OS provided better pain relief during repeated painful procedures than each of them alone. The effect of NNS was similar to that of OS on repeated procedural pain.…”

Assistance flowchart for pain management in a Neonatal Intensive Care Unit

“…Non-nutritive sucking often associated with the use of 25% glucose can be considered as care technology, which provides a relief for the premature NB pain and contributes to its quality survival (31) . Scientific evidence found in a meta-analysis corroborates this statement (32) . Non-nutritive sucking inhibits hyperactivity, relieves NB discomfort, and minimizes pain when undergoing acute painful procedures.…”

Randomised controlled trial showed that neonates received better pain relief from a higher dose of sucrose during venepuncture

“…Swaddling and NNS were used in Norway, but not in South Africa. Such measures may have synergistic effects with sucrose during painful procedures in newborn infants , potentially related to different pathways for pain relief. Sucrose works, at least partly, by releasing endogenous opioids in the central nervous system , whereas NNS alleviates pain through nonopioid mechanisms .…”