Oral Sucrose and Pain Relief for Preterm Infants

Anita Mitchell, RN, PhD, Patricia A. Waltman, RNC, EdD, NNP

Disclosures

Pain Manag Nurs. 2003;4(2) 

In This Article

Effectiveness of Oral Sucrose as a Single Treament Before Painful Procedures

Only one study examined the effectiveness of oral sucrose to relieve pain during venipunctures in preterm infants (Abad, Diaz, Domenech, Robayna, & Rico, 1996). This double-blind RCT was carried out with a small sample of 28 infants who were younger than 37 weeks' gestational age. Infants were randomly assigned to receive 2 ml of spring water, 12% sucrose, or 24% sucrose through a syringe 2 minutes before venipunctures were performed for routine blood collection. Venipunctures were performed at least 1 hour after feeding or suctioning, and during a period when the infants were awake and quiet. Infants were monitored at baseline, throughout the venipuncture process, and 5 minutes after the venipuncture. No significant differences were found in oxygen saturation levels or respiratory rates among the groups, and heart rate was lowest in the group that received 12% sucrose. Significantly less crying occurred in the 24% sucrose group when compared with the water group or the 12% sucrose group (p < .05).

In a double-blind, crossover RCT to determine the effectiveness of a single treatment of oral sucrose to relieve pain during heelsticks, a sample of 15 infants with gestational ages ranging from 32 to 34 weeks were evaluated (Ramenghi, Wood, Griffith, & Levene, 1996). Each infant received, at separate times, 1 ml of sterile water and 1 ml of 25% sucrose solution. Random allocation determined which treatment would be given first and which would be given second to each individual infant. Treatments were given 2 minutes before heelsticks. Pain was measured partially by timing the duration of crying. Infants demonstrated significantly shorter duration of first cry (p = .004) and total percentage of crying time longer than 5 minutes (p = .018) after sucrose administration as compared with water administration. A pain score based on facial expressions (i.e., brow bulge, eye squeeze, nasolabial furrow, and open mouth) was assessed, but this score was not based upon an established, validated tool. Infants who received water demonstrated significantly higher facial pain scores at 1 minute (p = .01) and 3 minutes (p = .03) after heelstick. No significant differences in heart rate were found between the two treatments. A third double-blind, crossover RCT used 16 preterm infants with gestational ages of 33 to 36 weeks to examine the effectiveness of oral sucrose as an analgesic during heelsticks (Bucher et al., 1995). Each infant was assessed twice, and received either 2 ml of distilled water or 2 ml of 50% sucrose in random order before heelsticks. Pain was assessed by timing the duration of crying and by noting physiologic data. Infants who received sucrose cried for a significantly shorter period (p = .002) and experienced significantly smaller increases in heart rate (p = .005). Oxygen levels and cerebral blood volumes did not differ significantly between treatments. Sucrose administration did not result in significantly increased blood glucose levels. Median glucose concentration after blood sampling with sucrose was 5.8 mmol/L and with water was 6 mmol/L.

All three of these studies reported that oral sucrose was effective in relieving pain. However, the results must be analyzed in light of the method used to measure pain, and these studies did not use valid tools designed to measure pain in preterm infants. All three studies evaluated pain response partially by timing the duration of crying. Crying may not be the most specific way to assess pain in preterm infants because these young infants do not consistently cry during painful procedures. The small and fragile preterm infant may not have the strength or energy to sustain an organized cry response in painful situations (Als, 1982; Stevens, Johnston, & Horton, 1994; Stevens, Johnston, Petryshen, & Taddio, 1996).

Facial activity is proposed to be the most sensitive measure of pain response in the preterm infant (Grunau & Craig, 1987; 1990; Lawrence, Alcock, McGrath, Kay, MacMurray, & Dulberg, 1993; Stevens et al., 1996). However, in two of these studies, facial expressions were not used as a measure of pain (Abad et al., 1996; Bucher et al., 1995). Changes in physiologic indicators, such as increased heart rate and decreased oxygen saturation, alert the caregiver that the infant may be experiencing pain (Craig, Whitfield, Grunau, Linton, & Hadjistavropoulos, 1993; Gonsalves & Mercer, 1993; Stevens & Johnston, 1994). All three of these studies used some form of valid physiologic measurements.

These three studies assigned infants randomly to treatment groups, included only healthy preterm infants, carried out blinding of the intervention and outcome measurement, and standardized all aspects of the procedure including the provision of a consistent health care provider to perform the heelstick or venipuncture. These studies did not include an examination of the frequency and timing of additional painful procedures experienced by the infants. An examination of these contextual factors is important because if the infant has undergone frequent or recent painful procedures, this may diminish the behavioral response to pain (Johnston & Stevens, 1996; Johnston, Stevens, et al., 1999; Stevens et al., 1994).

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