Intra-Oral Administration of Sweet-Tasting Substances and Infants’ Crying Response to Immunization: A Randomized, Placebo-Controlled Trial

Abstract

The analgesic effects of four solutions administered intra-orally (25 and 50% sucrose solutions, hydrogenated glucose, and a sterile water placebo) were tested in groups of babies receiving routine DTP (diphtheria, tetanus, and pertussis) and HIB (Haemophilus influenzae type B) injections at the first, second, or third immunization. The duration of the baby’s cry during 3 min following DTP and HIB injections was measured as main outcome. For all three immunization groups, the babies receiving the placebo generally spent most time crying. For both the DTP and HIB injections, the difference between 50% sucrose and placebo was most evident in the group receiving the 3rd immunization. Intra-oral administration of the 50% sucrose solution, compared to placebo, appeared to reduce the cry response to painful experiences in babies beyond the neonatal period.

Effectiveness of sucrose analgesia in newborns undergoing painful medical procedures

“…In contrast, previous studies reported analgesic effects in newborns undergoing heel lancing 12 and in older infants undergoing intramuscular injections of vaccines. [23][24][25] To rule out an effect of baseline newborn and maternal characteristics on the effectiveness of sucrose, we performed post-hoc analyses adjusted for birth characteristics. Among newborn of diabetic mothers, we also adjusted for indices of illness.…”

The Analgesic Properties of Intraoral Sucrose

“…From reported outcomes, it can be assumed that investigators considered proportion, percentage, or duration of crying to be the most valid indicator of pain in infants. [28][29][30][31][32] Few investigators used a composite pain assessment or multidimensional approach to pain measurement that represents a more comprehensive conceptualization of pain. Although research on infant cry has delineated certain cry characteristics such as pitch, intensity, melody, and harmonics as being acceptable indicators of pain, 33 these characteristics were not routinely assessed within studies of oral sucrose administration.…”

“…62 In preterm neonates, 0.24 g administered 2 minutes before the painful procedure (2 mL of 12% weight/volume sucrose) has demonstrated efficacy for heel lances, 63,64 retinopathy of prematurity examinations, [65][66][67][68] and intramuscular injections. 28,[30][31][32] Although the validity of findings is limited by the utilization of cry as the outcome measure, recent studies, 19,26 and the utilization of valid and reliable multidimensional behavioral pain scales, offer some indication as to the onset and duration of analgesia and timing of peak effects of sucrose. 19 The pharmacokinetic and pharmacodynamic properties of oral sucrose have not been adequately described.…”

Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline

“…Eleven trials with a total of 1452 infants and children 17,[23][24][25][26][27][28][29][30][31][32] were included in the systematic review. 12 A meta-analysis of data from six trials involving single or multiple vaccine injections (n = 665 infants up to 12 months of age) 17,[26][27][28]31,32 showed that sucrose solution with or without non-nutritive sucking reduced acute pain.…”

“…12 A meta-analysis of data from six trials involving single or multiple vaccine injections (n = 665 infants up to 12 months of age) 17,[26][27][28]31,32 showed that sucrose solution with or without non-nutritive sucking reduced acute pain. One study of glucose solution 30 yielded positive results.…”