Sucrose Plus Radiant Warmth Relieves Newborns' Pain

Diedtra Henderson

February 16, 2015

Giving infants a few drops of 24% sucrose solution and exposing them briefly to radiant warmth, which mimics some elements of breast-feeding, before vaccination led to a 50% reduction in time the newborns spent crying and grimacing after the vaccination, according to a small study.

Larry Gray, MD, from the Department of Pediatrics, University of Chicago, Illinois, and colleagues report the findings of their 29-infant randomized controlled trial in an article published online February 16 in Pediatrics.

A growing body of evidence points to the pain-alleviating effects that the taste of sucrose, sucking on a pacifier, and breast-feeding have on infants, but the research team conducted the trial in full-term newborns to tease out the calming effect of adding radiant warmth to the sucrose administration. Breast-feeding mothers transmit warmth to their babies.

The researchers note that in younger, high-risk populations, more than 60% of newborns are not breast-fed.

Early in life, healthy infants undergo a number of painful episodes, such as circumcision, lancing the heel during screenings, and needle sticks associated with drawing blood and receiving immunizations. They cannot tell us about their pain and, instead, scream, make pouty faces, gasp for air, and have difficulty sleeping. Later in infancy, the long-term effects may include an exaggerated response to pain and "the neurotoxicity of untreated pain in the developing brain," Dr Gray and colleagues write. Strong medicines are rarely used in healthy neonates because of the risk for serious adverse effects, and milder, topical anesthetics are less effective in infants.

Dr Gray and colleagues enrolled 29 infants born from July to August 2008 whose parents had given consent for hepatitis B vaccination in the delivery room.

They randomly assigned 15 infants to receive 0.24 g of 24% sucrose alone before the vaccination. Fourteen neonates received 0.24 g of sucrose plus 0.5°C additional radiant warmth for 2 minutes before the injection. Infants in both groups began in a "calm and drowsy" state.

The researchers analyzed the babies' videotaped faces for grimacing, defined as simultaneous bulging brows, eyes squeezed tight, and nasolabial furrowing, and for duration of audible crying.

"The sucrose plus warmer group cried and grimaced for 50% less time after the vaccination than the sucrose alone group," Dr Gray and coauthors write. "Infants in the sucrose plus warmer group (n = 14) cried and grimaced on average 12.8 and 14.9 seconds, respectively. Infants who received sucrose alone (n = 15) cried and grimaced on average for 28.0 and 31.1 seconds, respectively."

Heart rate monitors indicated that the neonates who received just sucrose had greater increases in heart rate, at 20 beats per minute compared with 11 beats per minute for the sucrose plus warmer group, and greater decreases in respiratory sinus arrhythmia, at 1.83 natural log units compared with 0.65 natural log units for the neonates who also received radiant warmth. The authors write that the higher respiratory sinus arrhythmia indicates a more optimal ability to "physiologically self-regulate during the stressful parts of vaccination."

The conclude, "Encouraging breastfeeding in the newborn nursery and keeping the mother and healthy infant together is an increasingly important priority for the health care provider. When breastfeeding is not possible, however, this study adds another natural nonpharmacologic analgesic technique for health care providers to protect the newborn from the pain of a routine immunization needle stick."

Financial support for the study was provided by the National Institute of Child Health and Human Development and the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Pediatrics. Published online February 16, 2015. Abstract


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