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

The Combination of Sucrose and Nonnutritive Sucking

Some researchers have used oral syringes to administer sucrose, and some have given sucrose accompanied by nonnutritive sucking with a pacifier. A pacifier soothes an infant and may help to relieve the infant's pain (Campos, 1989; 1994; Corbo et al., 2000; Field, 1999; Field & Goldson, 1984). However, few studies have been carried out to determine whether a pacifier accompanied by sucrose is significantly more effective in relieving pain than a pacifier given alone or accompanied by sterile water.

A recent double-blind, randomized, crossover study compared the efficacy of nonnutritive sucking, sucrose, and prone positioning with standard care in relieving procedural pain in premature infants (Stevens, et al., 1999). Standard care consisted of no pacifier, no sucrose, and a supine or side-lying position. The sample consisted of 128 infants with gestational ages ranging from 27 to 31 weeks. The effect of the number of painful procedures experienced by the infants was controlled for using an analysis of covariance (ANCOVA). Every infant in the study received each of the following interventions in random order during a heelstick: prone positioning in a Snuggle Up; a pacifier dipped in sterile water given 5 minutes before the heelstick and redipped 2 minutes before the heelstick; a pacifier dipped in 24% sucrose given 5 minutes before the heelstick and redipped 2 minutes before the heelstick; and standard care. Pain response was measured using the PIPP (Stevens et al., 1996). The PIPP is a valid and reliable tool for evaluating pain in preterm infants.

Both the pacifier with sterile water (p = .003) and the pacifier with sucrose (p < .0001) were significantly more effective than standard care in relieving pain during a heelstick. However, there was a definite trend but no statistically significant difference between a pacifier with sterile water and a pacifier with sucrose (p = .059). A significant difference between these two interventions might be found with a larger sample. No differences in pain relief were found with prone positioning versus supine or side-lying positioning (Stevens et al., 1999).

(Gibbins et al. 2002) studied the effects of oral sucrose and nonnutritive sucking in 190 preterm and full-term infants. In this RCT, 3 treatment groups received sucrose with nonnutritive sucking, water with nonnutritive sucking, or sucrose alone. A single dose (.5 ml) of sucrose or water was administered 2 minutes before a heel lance, and in 2 of the groups, a pacifier was held in the mouth throughout the duration of the heel lance. Pain scores were measured by the PIPP at 30 seconds and 60 seconds following initiation of the heel lance. Statistical analysis with repeated measures analysis of variance (RM ANOVA) found a significant main effect of intervention (F = 22.49, p < .001). There were significantly lower PIPP scores in the sucrose and pacifier group compared with sucrose alone (p < .002), and significantly lower PIPP scores in the sucrose and pacifier group compared with the water and pacifier group (p < .001). There was not a statistically significant difference between PIPP scores in the sucrose-alone group and PIPP scores in the water with pacifier group (p = .57). This study indicates that the combination of sucrose and pacifier is important for effective pain relief.

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