Efficacy and Safety of Sucrose for Procedural Pain Relief in Preterm and Term Neonates

Gibbins, Sharyn; Stevens, Bonnie; Hodnett, Ellen; Pinelli, Janet; Ohlsson, Arne; Darlington, Gerarda

doi:10.1097/00006199-200211000-00005

Cited by 158 publications

(126 citation statements)

References 110 publications

(174 reference statements)

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“…However, despite the potential damage caused by this environment, it is essential to monitor the premature newborn (9)(10)(11)(12)(13)(14) . In the presence of these stressful impacts, some authors (4,(15)(16)(17)(18)(19)(20)(21)(22) refer about the usage of sucrose as a measured nonpharmacological tool, observing that this substance has an analgesic effect and thus soothing. The sucrose was also used in research for speech, language and hearing sciences (2,23) , becoming evident as eliciting behavioral readiness upon feeding, particularly in alertness behavioral state, considered favorable (3) .…”

Section: Introductionmentioning

confidence: 99%

Efeitos da estimulação gustativa nos estados comportamentais de recém-nascidos prematuros

Medeiros

Sá

Alvelos

et al. 2013

Audiol., Commun. Res.

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Purpose: To observe the behavioral states presented by premature newborns in response to gustatory stimulation. Methods: Experimental, analytical and double-blind study. Ninety premature newborns born in a public maternity hospital in Sergipe took part in the test which was filmed and divided into three parts of five minutes. In the first and last, there was no stimulus; in the second, the gustatory stimulation was applied and the newborn children were divided into two groups (water or analysis for sucrose 12%). The observed behavioral states were deep sleep, light sleep, drowsy, alert, agitated/irritated and crying. The data were statistically analyzed. Results: In the sucrose group, during and after stimulation, the correlation was strong in the light sleep and alert behavioral states and decreased in the drowsy, agitated/irritated and crying states. In the water group there was an increase in correlation in the agitated/irritated and crying states after stimulation. Conclusion:The continuity or change of the behavioral state of the premature newborns was positively influenced by the administration of gustatory stimulus, pointing to the possibility of using sucrose in benefit of the favorable behavioral states of that population. Na primeira e na última, não houve estímulo; na segunda aconteceu estimulação gustativa, sendo que os recém-nascidos foram divididos em dois grupos (água ou sacarose para análise 12%). Os estados comportamentais observados foram sono profundo, sono leve, sonolento, alerta, irritado/agitado e choro. Os dados foram analisados estatisticamente. Resultados:No grupo sacarose houve correlação forte nos estados comportamentais sono leve e alerta, durante e após a estimulação, e redução de correlação nos estados sonolento, agitado/irritado e choro.Já no grupo água, após a estimulação houve aumento de correlação nos estados agitado/irritado e choro. Conclusão: A permanência ou mudança do estado comportamental do recém-nascido prematuro foi influenciada positivamente pela administração de estímulo gustativo, apontando para o possível uso da sacarose na contribuição de estados comportamentais favoráveis nessa população.

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Section: Introductionmentioning

confidence: 99%

Efeitos da estimulação gustativa nos estados comportamentais de recém-nascidos prematuros

Medeiros

Sá

Alvelos

et al. 2013

Audiol., Commun. Res.

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“…[15][16][17] They promote self-regulation of the infant and provide oro-tactile, oro-gustatory, and tactile stimulation, capable of reducing infants' pain responses during most painful procedures. 15,[18][19][20][21] Sucrose is recommended extensively for pain relief in preterm infants [22][23][24] and has shown to be highly effective and safe for single procedures by Stevens et al 17 Sweet taste solutions seem to trigger endogenous opioid and nonopioid pathways. 25,26 FT is described as holding the infant by placing a hand on his or her hands and feet and by positioning the infant in a flexed midline position while in either a side-lying, supine, or prone position.…”

mentioning

confidence: 99%

Oral Sucrose and “Facilitated Tucking” for Repeated Pain Relief in Preterms: A Randomized Controlled Trial

et al. 2012

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WHAT'S KNOWN ON THIS SUBJECT: Preterm infants are exposed to inadequately managed painful procedures during their NICU stay, which can lead to altered pain responses. Nonpharmacologic approaches are established for the treatment of single painful procedures, but evidence for their effectiveness across time is lacking. WHAT THIS STUDY ADDS:Oral sucrose with or without the added technique of facilitated tucking has a pain-relieving effect even in extremely premature infants undergoing repeated pain exposures; facilitated tucking alone seems to be less effective for repeated pain exposures over time.abstract OBJECTIVES: To test the comparative effectiveness of 2 nonpharmacologic pain-relieving interventions administered alone or in combination across time for repeated heel sticks in preterm infants. METHODS:A multicenter randomized controlled trial in 3 NICUs in Switzerland compared the effectiveness of oral sucrose, facilitated tucking (FT), and a combination of both interventions in preterm infants between 24 and 32 weeks of gestation. Data were collected during the first 14 days of their NICU stay. Three phases (baseline, heel stick, recovery) of 5 heel stick procedures were videotaped for each infant. Four independent experienced nurses blinded to the heel stick phase rated 1055 video sequences presented in random order by using the Bernese Pain Scale for Neonates, a validated pain tool.RESULTS: Seventy-one infants were included in the study. Interrater reliability was high for the total Bernese Pain Scale for Neonates score (Cronbach' s a: 0.90-0.95). FT alone was significantly less effective in relieving repeated procedural pain (P , .002) than sucrose (0.2 mL/kg). FT in combination with sucrose seemed to have added value in the recovery phase with lower pain scores (P = .003) compared with both the single-treatment groups. There were no significant differences in pain responses across gestational ages.CONCLUSIONS: Sucrose with and without FT had pain-relieving effects even in preterm infants of ,32 weeks of gestation having repeated pain exposures. These interventions remained effective during repeated heel sticks across time. FT was not as effective and cannot be recommended as a nonpharmacologic pain relief intervention for repeated pain exposure.

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“…These include use of oral sucrose/glucose, [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] breastfeeding, 77 nonnutritive sucking, 49,78 "kangaroo care" (skin-to-skin contact), 55,58 facilitated tuck (holding the arms and legs in a flexed position), 79 swaddling, 80 and developmental care, which includes limiting environmental stimuli, lateral positioning, the use of supportive bedding, and attention to behavioral clues. 61 These measures have been shown to be useful in preterm and term neonates in reducing pain from a heel stick, 68,[70][71][72][73]79,80 venipuncture, 62,64,65,67,74,77,81 and subcutaneous injections 81 and are generally more effective when used in combination than when used alone. 63,65,68,69,80,82 Concentrated oral sucrose has been widely studied.…”

Section: Nonpharmacologic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

“…61 These measures have been shown to be useful in preterm and term neonates in reducing pain from a heel stick, 68,[70][71][72][73]79,80 venipuncture, 62,64,65,67,74,77,81 and subcutaneous injections 81 and are generally more effective when used in combination than when used alone. 63,65,68,69,80,82 Concentrated oral sucrose has been widely studied. Oral sucrose eliminates the electroencephalographic changes associated with a painful procedure 83 in a neonate, but the mechanism of pain relief by sucking oral sucrose is not known for certain.…”

Section: Nonpharmacologic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

418

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The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

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Efficacy and Safety of Sucrose for Procedural Pain Relief in Preterm and Term Neonates

Cited by 158 publications

References 110 publications

Efeitos da estimulação gustativa nos estados comportamentais de recém-nascidos prematuros

Efeitos da estimulação gustativa nos estados comportamentais de recém-nascidos prematuros

Oral Sucrose and “Facilitated Tucking” for Repeated Pain Relief in Preterms: A Randomized Controlled Trial

Prevention and Management of Pain in the Neonate: An Update

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