Efficacy and safety of combined oral sucrose and nonnutritive sucking in pain management for infants: A systematic review and meta-analysis

Li, Qiaohong; Tan, Xuerong; Li, Xueqing; Tang, Wenjun; Ma, Lin; Zou, Yongrong

doi:10.1371/journal.pone.0268033

Cited by 10 publications

(17 citation statements)

References 63 publications

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“…Non-nutritive and or sucrose/glucose suckling are well studied and established methods that are helpful [ 98 ] albeit for mild pain [ 94 ]. Breastfeeding especially direct, has been found to be the best practice in non-pharmacological pain management [ 61 ], compared all other methods [ 76 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 ].…”

Section: Discussionmentioning

confidence: 99%

“…NNS is considered a safe and effective method of pain relief during the pinprick procedure in neonates [ 71 ]. But it is more effective in conjunction with sucrose/glucose sucking [ 94 ]. A randomized controlled clinical trial with cross-over design [ 97 ] in an Iranian NICU with 60 infants demonstrated the effectiveness of using oral dextrose for pain management during a heel prick in comparison to facilitated tucking.…”

Section: Non-pharmacological Methodsmentioning

confidence: 99%

“…But it was noted that sucrose alone is not superior to behavioral pain management compared to the combination of methods [ 98 ]. A significant reduction in pain scores was found in neonates with NNS as well as sucrose administration compared to NNS or sucrose alone in a 2022 study [ 94 ] albeit for mild pain caused. Short duration of the sucrose administration pain relief effect has been reported previously [ 95 , 96 ].…”

Section: Non-pharmacological Methodsmentioning

confidence: 99%

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Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

et al. 2022

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Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain.

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Section: Discussionmentioning

confidence: 99%

Section: Non-pharmacological Methodsmentioning

confidence: 99%

Section: Non-pharmacological Methodsmentioning

confidence: 99%

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Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

et al. 2022

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“…None of the published studies on the impact of frenulotomy take into account the fact that sucking and feeding are soothing to infants and as such, the observed improvements immediately following frenulotomy may be a response to the pain associated with the procedure rather than a result of the procedure itself ( 42 , 43 ). It has been shown that non-nutritive sucking attenuates the pain associated with circumcision ( 43 ) and in the author's experience, infants feed vigorously immediately after circumcision.…”

Section: Discussionmentioning

confidence: 99%

What is tongue-tie and does it interfere with breast-feeding? – a brief review

Borowitz

2023

Front. Pediatr.

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The most common symptom attributed to ankyloglossia is difficulty breast feeding due to poor latch, inefficient milk extraction and/or maternal nipple pain. During the past two decades, despite a declining birth rate, there has been a dramatic increase in the number of infants diagnosed with and treated for ankyloglossia in the United States, Canada and Australia. Despite a dramatic increase in the diagnosis and treatment of ankyloglossia in these countries, there remains no universally agreed upon definition of ankyloglossia and none of the published scoring systems have been rigorously validated. However ankyloglossia is defined, the majority of infants with ankyloglossia are asymptomatic. Perhaps, infants with ankyloglossia have a greater incidence of difficulty breast feeding. Lingual frenulotomy may decrease maternal pain and at least transiently improve the quality of breast feeding in some infants however no published studies take into account the fact that sucking and feeding are soothing to infants and the observed improvements immediately following frenulotomy may be a response to the pain associated with the procedure rather than a result of the procedure itself. While there are almost certainly some infants in whom tongue-tie interferes with breast-feeding, there is currently no good evidence lingual frenulotomy leads to longer duration of breast-feeding. Frenulotomy appears to be a generally safe procedure however there are reports of serious complications. Finally, there are no studies of long-term outcomes following frenulotomy during infancy and given traditional thinking that the lingual frenulum is a cord of connective tissue tethering the tongue to the floor of the mouth may be incorrect and the frenulum contains motor and sensory branches of the lingual nerve, the procedure may be less benign than previously thought.

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“…Data from a subset of 5399 babies on the type of procedure associated with sucrose administration or whether complementary NNS were also explored. NNS has been shown, in a recent systematic review, to complement sucrose resulting in lower pain intensity outcomes 10 . Using this combination of strategies to reduce pain during the entire NICU stay and their effect of outcomes requires further investigation.…”

Section: Discussionmentioning

confidence: 99%

A longitudinal observational study on the epidemiology of painful procedures and sucrose administration in hospitalized preterm neonates

Bueno,

Ballantyne,

Campbell‐Yeo

et al. 2023

Paediatric and Neonatal Pain

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Although sucrose is widely administered to hospitalized infants for single painful procedures, total sucrose volume during the entire neonatal intensive care unit (NICU) stay and associated adverse events are unknown. In a longitudinal observation study, we aimed to quantify and contextualize sucrose administration during the NICU stay. Specifically, we investigated the frequency, nature, and severity of painful procedures; proportion of procedures where neonates received sucrose; total volume of sucrose administered for painful procedures; and incidence and type of adverse events. Neonates <32 weeks gestational age at birth and <10 days of life were recruited from four Canadian tertiary NICUs. Daily chart reviews of documented painful procedures, sucrose administration, and any associated adverse events were undertaken. One hundred sixty‐eight neonates underwent a total of 9093 skin‐breaking procedures (mean 54.1 [±65.2] procedures/neonate or 1.1 [±0.9] procedures/day/neonate) during an average NICU stay of 45.9 (±31.4) days. Pain severity was recorded for 5399/9093 (59.4%) of the painful procedures; the majority (5051 [93.5%]) were heel lances of moderate pain intensity. Sucrose was administered for 7839/9093 (86.2%) of painful procedures. The total average sucrose volume was 5.5 (±5.4) mL/neonate or 0.11 (±0.08) mL/neonate/day. Infants experienced an average of 7.9 (±12.7) minor adverse events associated with pain and/or sucrose administration that resolved without intervention. The total number of painful procedures, sucrose volume, and incidence of adverse events throughout the NICU stay were described addressing an important knowledge gap in neonatal pain. These data provide a baseline for examining the association between total sucrose volume during NICU stay and research on longer‐term behavioral and neurodevelopmental outcomes.

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Efficacy and safety of combined oral sucrose and nonnutritive sucking in pain management for infants: A systematic review and meta-analysis

Cited by 10 publications

References 63 publications

Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

What is tongue-tie and does it interfere with breast-feeding? – a brief review

A longitudinal observational study on the epidemiology of painful procedures and sucrose administration in hospitalized preterm neonates

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