Sucrose Reduces Pain Reaction to Heel Lancing in Preterm Infants: A Placebo-Controlled, Randomized and Masked Study

Abstract

In term infants sucrose given by mouth has been reported to reduce duration of crying after a hcel prick. This study was designed primarily to investigate the cffect of sucrose administered orally immediately before heel lancing on the nociceptive reaction in pretcrm infants as assessed by change in heart rate and duration of crying. A secondary objective was to document changes in cerebral blood volume during acute pain. We used a randomized, masked, placebo-controlled, crossover trial in a neonatal intermediate care unit in a level 3 perinatal center. The patients studied were 16 preterm infants; birth weight, 900-1900 g; gestational wk, 27-34; corrected postmenstrual age at time of investigation, 33-36 wk. Each infant was assessed twice receiving 2 m L of sucrose 50% or 2 mL of distilled water in random order immediately before heel lance. Heart rate, thoracic movcPreterm infants usually endure many heel pricks and other stressful events during their first hospital stay, even if they do not need intensive care. There was a general belief that preterm infants are lcss sensitive to pain than more mature infants; as a result, analgesics and anesthetic agents were rarely used in preterm babies. There has been growing evidence in the last decade that preterm infants are anatomically and physiologically capable of feeling pain. This evidence has led to a change in clinical practice (1-3).Pain involves subjective and emotional associations that are difficult to define in neonates. Nociception (response of the pain-reception neurones), although less often used, would be a better definition as it is a purely physiologic term (4). W e use "pain" in this restricted sense of "nociception."Reaction to pain can be assessed in three ways: 1) watching behavior, including facial expression, body movements, and cry; 2) monitoring physiologic variables, such as heart rate, blood pressure, transcutaneous blood gases; and 3) measuring the release of stress hormones, such as catecholamines and ments, and transcutaneous blood gases were monitored continuously. Crying during the procedure was documented by a videocamera. A change in cerebral blood volume was assessed by near-infrared spectroscopy. We found the heart rate increased by a mean of 35 beatslmin (bpm) after sucrose and 51 bpm aftcr placebo (median difference 16 bpm, interquartile range 1-30 bpm, p = 0.005). Infants cried 67% of time after sucrose and 88% after placebo (median difference lo%, interquartile range 3-33%, 17 = 0.002). Cerebral blood volume decreased in 5 of 14 infants after sucrose and in 6 of 14 infants after placebo (difference not significant). We concluded that sucrose administered orally before a heel lance reduces the pain reaction in preterm infants. Response of cerebral blood volume to pain does not seem to be altered by sucrose. (Pediatr Res 38: 332-335, 1995) cortisol (5-7). For the present study monitoring of physiologic variables was chosen because they can be continuously recorded and easily quantified, and, therefore, are best suited to ...

A eficácia da sacarose no alívio de dor em neonatos: revisão sistemática da literatura

“…The volume used in studies performed with preterm neonates varied more, with studies of single dose interventions administering 0.05 ml, 36 1 ml 35,40 and 2 ml, 33,34,42 and studies of repeated doses used 0.05 ml 39 and 0.1 ml. 37,40,43 The concentrations administered were 15%, 40 24%, 37 25% 38,42 and 50% 33 in single-dose studies, and 24% 39,41,43 in studies of repeat doses.…”

“…Sixteen of the 29 articles selected were studies of fullterm neonate patient samples, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] eleven studied preterm neonates [33][34][35][36][37][38][39][40][41][42][43] and two included comparisons between preterm and fullterm neonates. 44,45 The volume of sucrose used in the majority of the studies involving fullterm neonates was 2 ml, [17][18][19][20][21][22][23][24][25][27][28][29][30][31][32] with concentrations of 12%, 20,24,30,31 12.5%, 18,32 24%, …”

“…Administering sucrose solution at 25% 29,35,38,42 and 50% 33 reduced the neonates heart rate, 29,33 time crying 29,33,38 and level of facial activity as measured by the Neonatal Facial Coding System (NFCS) 29,35,38 in response to painful procedures when compared with sterile water. In a study carried out by Ramenghi et al, 38 the sucrose solution was administered before capillary puncture to a sample of preterm neonates, on one occasion via oral route and on another via nasogastric tube, with the order of administration route being randomized in order to observe pre and post absorption effects.…”

“…Sucrose and sterile water control Eight studies 17,18,29,[33][34][35]38,42 compared the administration of a sucrose solution 2 minutes before a painful puncture procedure with administration of sterile water (control). Administering sucrose solution at 25% 29,35,38,42 and 50% 33 reduced the neonates heart rate, 29,33 time crying 29,33,38 and level of facial activity as measured by the Neonatal Facial Coding System (NFCS) 29,35,38 in response to painful procedures when compared with sterile water.…”

Implementation and Case-Study Results of Potentially Better Practices to Improve Pain Management of Neonates

“…Presentation of baseline data, coupled with staff education using medical literature that described the effectiveness and minimal adverse effects of sucrose analgesia, raised enthusiasm for the sucrose intervention. 8,[14][15][16][17][18][19] The LPCH team sequentially developed an evidencebased policy for administering sucrose, initiated staff education (eg, posters, e-mails, staff meeting presentations, required skills fair), infiltrated the nurseries with sucrose "super users" (staff nurses who were trained in the proper use of sucrose and championed sucrose use with one-on-one encouragement and teaching), involved the phlebotomists (who requested that the nurse give sucrose at the time of heel lance), and publicly displayed biweekly data. In addition, a preprinted, pro re nata (PRN) sucrose order was added to the admission order set.…”