Oral Sucrose and Pain Relief for Preterm Infants

Abstract and Introduction

Abstract

The frequency of painful procedures performed on preterm infants in the neonatal intensive care unit (NICU) presents a challenge to nurses who are attempting to provide effective pain relief, and to the infants themselves who may suffer adverse consequences in response to repeated painful procedures. One new pain relief intervention under study is the administration of oral sucrose, which may activate endogenous opioid systems within the body. Studies with preterm infants that have examined the use of oral sucrose as an analgesic during heelsticks and venipunctures have shown that sucrose is effective in reducing pain. Sucrose may also be combined with nonnutritive sucking to provide significant pain relief. The use of oral sucrose is now recommended with a wide range of painful procedures in the NICU. Promising results have been observed in studies with both term and preterm infants, but less research has occurred with preterm infants. Additional research is warranted to determine the most effective approaches for the administration of sucrose, to examine the effectiveness of sucrose with additional types of painful procedures, and to examine the effects of long-term repeated use of sucrose.

Introduction

Preterm infants need effective pain management during and after the frequent painful procedures that are performed in neonatal intensive care units (NICUs). It is a challenge for nurses who work in these areas to provide comfort to infants and to prevent and relieve pain during diagnostic and therapeutic procedures. The American Academy of Pediatrics (2000) states that "despite the advances in pain assessment and management, prevention and treatment of unnecessary pain attributable to anticipated noxious stimuli remain limited" (p. 2).

In recent years, nurses have placed increasing emphasis on developmentally sensitive care for preterm infants, recognizing the unique needs of these infants who may have difficulty coping with extrauterine life. Oral sucrose has been studied extensively in neonates and shows promise as a developmentally appropriate and effective means of relieving pain in preterm infants during procedures. The purpose of this article is to review the literature concerning the use of oral sucrose with preterm infants. This literature review will include physiologic mechanisms of sucrose action, current recommendations for sucrose use, and a critique of published studies involving the use of sucrose with preterm infants.

Cite this: Oral Sucrose and Pain Relief for Preterm Infants - Medscape - Jun 01, 2003.

Table 1. Table 1. Oral Sucrose and Pain Relief
Authors	Dose sucrose	Sample	Procedure	Pain Measure	Special Issues	Significant Results
Abad Diaz Domenech Robayna Rico, 1996	2 ml 12%2 ml 24%	28 infants <37 weeks	Venipuncture	Crying Physiologic data		Less crying with 24% group
Ramenghi Wood Griffith Levene, 1996	1 ml 25%	15 (crossover) 3234 weeks	Heelstick	Crying Heart rate Facial		Less crying and facial activity with sucrose
Bucher Moster Siebenthal Keel Wolf Duc, 1995	2 ml 50%	16 (crossover) 3336 weeks	Heelstick	Crying Physiologic data		Less crying Reduced increase in heart rate with sucrose
Johnston Stremler Stevens Horton, 1997	0.05 ml 24%	112 2534 weeks	Heelstick	Neonatal Facial Coding System Heart rate	Rocking Contextual factors	Less facial activity with sucrose
Johnston Stremler Horton Friedman, 1999	0.05 ml 24% every 2 min 3 times	48 2534 weeks	Heelstick	Premature Infant Pain Profile (PIPP)	Repeated doses versus single dose	Lower PIPP scores with repeated doses versus single dose
Stevens Johnston Franck Petryshen Jack Foster, 1999	Dipped pacifier (0.1 ml) 24%	128 (crossover) 2731 weeks	Heelstick	Premature Infant Pain Profile (PIPP)	Nonnutritive Sucking Positioning Contextual factors	Lower PIPP scores with pacifier and sucrose or water
Gibbins Stevens Hodnett Pinelli Ohlsson Darlington, 2002	0.5 ml 24%	190 2743 weeks	Heelstick	Premature Infant Pain Profile (PIPP)	Nonnutritive sucking	Lower PIPP scores with pacifier and sucrose

Table 1. Table 1. Oral Sucrose and Pain Relief
Authors	Dose sucrose	Sample	Procedure	Pain Measure	Special Issues	Significant Results
Abad Diaz Domenech Robayna Rico, 1996	2 ml 12%2 ml 24%	28 infants <37 weeks	Venipuncture	Crying Physiologic data		Less crying with 24% group
Ramenghi Wood Griffith Levene, 1996	1 ml 25%	15 (crossover) 3234 weeks	Heelstick	Crying Heart rate Facial		Less crying and facial activity with sucrose
Bucher Moster Siebenthal Keel Wolf Duc, 1995	2 ml 50%	16 (crossover) 3336 weeks	Heelstick	Crying Physiologic data		Less crying Reduced increase in heart rate with sucrose
Johnston Stremler Stevens Horton, 1997	0.05 ml 24%	112 2534 weeks	Heelstick	Neonatal Facial Coding System Heart rate	Rocking Contextual factors	Less facial activity with sucrose
Johnston Stremler Horton Friedman, 1999	0.05 ml 24% every 2 min 3 times	48 2534 weeks	Heelstick	Premature Infant Pain Profile (PIPP)	Repeated doses versus single dose	Lower PIPP scores with repeated doses versus single dose
Stevens Johnston Franck Petryshen Jack Foster, 1999	Dipped pacifier (0.1 ml) 24%	128 (crossover) 2731 weeks	Heelstick	Premature Infant Pain Profile (PIPP)	Nonnutritive Sucking Positioning Contextual factors	Lower PIPP scores with pacifier and sucrose or water
Gibbins Stevens Hodnett Pinelli Ohlsson Darlington, 2002	0.5 ml 24%	190 2743 weeks	Heelstick	Premature Infant Pain Profile (PIPP)	Nonnutritive sucking	Lower PIPP scores with pacifier and sucrose

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Oral Sucrose and Pain Relief for Preterm Infants

Abstract and Introduction

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