Sucrose as a Pain Reliever for Newborn Procedures
Can sucking on a sugar solution ease your baby’s pain during painful procedures?
When I read that sucrose could be an effective pain reliever for newborns undergoing painful procedures, I wanted to know more. From the day they are born, almost all babies are subjected to minor but painful procedures – heel sticks, injections, examinations. Some sick or premature babies are unfortunate enough to undergo major invasive procedures, including diagnostic and therapeutic surgeries; some babies must undergo unnecessary or ritual procedures such as circumcision. For many years, it was assumed that babies had little sensation of pain and that they didn’t need pain relief for these procedures. However, it is now known that babies suffer pain as much as, and maybe more than, older children and adults. If something as simple as sucking on a something containing a sugar solution can be helpful, we should all be aware of it and using it in our daily practice.
As usual, my first line of investigation to find out more was the Cochrane Reviews. I found a review entitled “Sucrose for analgesia in newborn infants undergoing painful procedures,” (Stevens, Yamada, Ohlsson) which was undertaken “to determine the efficacy, effect of dose, and safety of sucrose for relieving procedural pain as assessed by validated individual pain indicators and composite pain scores.” Randomized controlled trials in which term and/or preterm neonates received sucrose via oral syringe, NG-tube, dropper or pacifier for procedural pain from heel lance or venipuncture were assessed. In the control group, water, pacifier or positioning/containing were used. Studies in which the painful stimulus was circumcision were excluded.
The reviewers concluded that sucrose is safe and effective for reducing procedural pain from single painful events (heel lance, venipuncture). There was inconsistency in the dose of sucrose that was effective (dose range of 0.012 g to 0.12 g), and therefore an optimal dose to be used in preterm and/or term infants could not be identified.
According to the authors, further research is needed on the use of repeated administrations of sucrose in neonates as well as the use of sucrose in combination with other behavioral (e.g., facilitated tucking, kangaroo care) and pharmacologic (e.g., morphine, fentanyl) interventions. Use of sucrose in newborns who are of very low birth weight, unstable and/or ventilated also needs to be addressed.
A recent study validating the use of sucrose for pain relief in newborns undergoing heel lance was published by the same group in Nursing Research in 2002 (Gibbins, Stevens, Hodnett et al). The authors designed a study to “compare the efficacy and safety of three interventions for relieving procedural pain associated with heel lances in preterm and term neonates, and to explore the influence of contextual factors including sex, severity of illness, and prior painful procedures on pain responses.” They randomized190 newborns to receive (a) sucrose and nonnutritive sucking (n = 64), (b) sucrose alone (n = 62), or (c) sterile water and nonnutritive sucking (control) (n = 64) to evaluate the efficacy and safety (adverse events) following a scheduled heel lance during the first week of life.
Significant differences in pain response existed among treatment groups, with the lowest pain scores in the sucrose and nonnutritive sucking group. Efficacy of sucrose following a heel lance was not affected by severity of illness, postnatal age, or number of painful procedures. Few adverse events occurred, and none of them required medical or nursing interventions. The authors concluded that the combination of sucrose and nonnutritive sucking is the most efficacious intervention for single heel lances. They suggested future research on the effects of gestational age on the efficacy and safety of repeated doses of sucrose.
Why do sucrose and nonnutritive sucking work as a pain reliever in infants? Gibbins and Stevens theorize that the sweet taste is thought to activate endogenous opioid pathways (natural pain relievers produced in the brain) with resulting calming and pain-relieving effects. The analgesic effects of nonnutritive sucking, on the other hand, are probably activated through nonopioid pathways by stimulation of orotactile and mechanoreceptor mechanisms. In any case, these simple, inexpensive, non-invasive methods of helping babies to get through a painful ordeal, however minor and temporary, should be used routinely by all of us who care for them and about them.
Gibbins S, Stevens B, Hodnett E, Pinelli J, Ohlsson A, Darlington G. Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nurs Res 2002 Nov-Dec;51(6):375-82.
Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures (Cochrane Review). In: The Cochrane Library, Issue 1 2003. Oxford: Update Software.
Gibbins S, Stevens B. Mechanisms of sucrose and non-nutritive sucking in procedural pain management in infants. Pain Res Manag 2001 Spring;6(1):21-8