β-Endorphin Concentration After Administration of Sucrose in Preterm Infants

Taddio, Anna; Shah, Vibhuti; Shah, Prakesh; Katz, Joel

doi:10.1001/archpedi.157.11.1071

Cited by 47 publications

(4 citation statements)

References 23 publications

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“…Moreover, results of rodent studies have suggested that sweet solutions modulate pain through opioid mechanisms [13,40,52]. The evidence is less clear in human infants with few studies having examined potential mechanisms of action of sucrose [14,31,63] and results suggest that mechanisms other than those mediated by opioid pathways may be involved in the effects of sucrose [35]. Further studies are needed.…”

Section: 0 Discussionmentioning

confidence: 99%

Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations

Tremblay

Ranger

Chau

et al. 2017

Pain

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Oral sucrose is administered routinely to reduce pain of minor procedures in premature infants and is recommended as standard care in international guidelines. No human or animal studies on effects of early repeated sucrose exposure on long-term brain development have been done in the context of pain. We evaluated the effects of repeated neonatal sucrose treatment before an intervention on long-term brain structure in mouse pups. Neonatal C57Bl/6J mice (n = 109) were randomly assigned to one of 2 treatments (vehicle vs sucrose) and one of 3 interventions (handling, touch, or needle-prick). Mice received 10 interventions daily from postnatal day 1 to 6 (P1-6). A dose of vehicle or 24% sucrose was given orally 2 minutes before each intervention. At P85-95, brains were scanned using a multichannel 7.0 T MRI. Volumes of 159 independent brain regions were obtained. Early repetitive sucrose exposure in mice (after correcting for whole brain volume and multiple comparisons) lead to smaller white matter volumes in the corpus callosum, stria terminalis, and fimbria (P < 0.0001). Cortical and subcortical gray matter was also affected by sucrose with smaller volumes of hippocampus and cerebellum (P < 0.0001). These significant changes in adult brain were found irrespective of the type of intervention in the neonatal period. This study provides the first evidence of long-term adverse effects of repetitive sucrose exposure and raises concerns for the use of this standard pain management practice during a period of rapid brain development in very preterm infants.

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Section: 0 Discussionmentioning

confidence: 99%

Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations

Tremblay

Ranger

Chau

et al. 2017

Pain

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“…While the analgesic action of sucrose taste analgesia may operate via an endogenous opioid mechanism in the animal model [9,11], parallel data in human infants remain elusive [27,62]. The mechanisms of thermal analgesia appear to be more closely related to the non-opioid mechanisms of maternal contact or skin-to-skin contact [10,12].…”

Section: Discussionmentioning

confidence: 99%

Warmth is analgesic in healthy newborns

Gray

Lang

Porges

2012

Pain

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This study identifies a behavioral and nonpharmacologic means of preventing and reducing newborn pain. Our objective was to determine whether warmth is analgesic in newborn infants undergoing vaccination—a routine painful hospital procedure. We used a prospective randomized controlled trial of 47 healthy full-term newborn infants. Infants were randomized into one of three conditions prior to vaccination: warmth exposure, pacifier suckling, or sucrose taste. Crying, grimacing, and heart rate differences were analyzed between groups before, during, and after vaccination as outcome measures. Warmer infants cried significantly less than sucrose taste or pacifier suckling after vaccination. Heart rate patterns reflected this analgesia. Core temperature did not differ between study groups. Providing natural warmth to newborn infants during a painful procedure decreases the crying and grimacing on par with the “gold” standard treatments of sucrose or pacifier.

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“…However, sucrose administration to preterm human infants does not produce a plasma β-endorphin response. 27 Also, a trial in term human newborns found no decrease in the impact of sucrose on pain-related behavior with concurrent opioid antagonist administration. 28 These results suggest additional mechanisms may be responsible for the behavioral effect of sucrose observed in infants.…”

Section: Sucrose For Minor Procedural Painmentioning

confidence: 99%

Neonatal Pain Control and Neurologic Effects of Anesthetics and Sedatives in Preterm Infants

McPherson

Grunau

2014

Clinics in Perinatology

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β-Endorphin Concentration After Administration of Sucrose in Preterm Infants

Abstract: Intraoral administration of sucrose in preterm infants did not lead to an increase in serum beta-endorphin concentrations at a point in time when the analgesic effects of sucrose were presumed to be present.

Cited by 47 publications

References 23 publications

Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations

Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations

Warmth is analgesic in healthy newborns

Neonatal Pain Control and Neurologic Effects of Anesthetics and Sedatives in Preterm Infants

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