Analgesic Effects of Sweet-Tasting Solutions for Infants: Current State of Equipoise

Abstract

OBJECTIVE: The goal was to review published studies of analgesic effects of sweet solutions, to ascertain areas with sufficient evidence of effectiveness and areas of uncertainty. METHODS: Databases searched included Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature database, and PsycINFO, using the terms pain*, infant*, neonat*, newborn*, sucrose, glucose, and alternative sugars. Publications were sorted according to type, year, painful procedure studied, placebo/no-treatment groups, population studied, and country of publication. RESULTS: A total of 298 relevant unique publications involving human infants were identified; 125 (42%) were primary research studies, of which 116 (93%) were randomized controlled trials. Healthy preterm or term newborns were included in 82 studies (65%), and sick or very low birth weight infants were included in 22 (18%). Most studies included single episodes of painful procedures, with only 3 (2%) conducted over long periods. Procedures investigated most frequently were heel lance (49%), venipuncture (14%), and intramuscular injection (14%). Placebo or no-treatment groups were included in 111 studies (89%); in 103 (93%) of those studies, sweet solutions reduced behavioral responses, compared with placebo/ no treatment. CONCLUSION: Clinical equipoise relating to analgesic effects of sweet solutions no longer exists for single episodes of procedures for healthy preterm and term newborn infants. Uncertainties include outcomes after prolonged use of sweet solutions, concomitant use of other analgesics, and effectiveness beyond the newborn period. Future research should focus on addressing these knowledge and research gaps.

Sweet Solution Analgesia

“…Furthermore, this efect of sweet tasting solutions does not persist beyond infancy [21]. This sweet taste-induced analgesia does not extend to adults, and it seems to be related to the degree of sweetness; thus higher sucrose concentration were preferred by children compared to adults [49].…”

“…Sucrose was beneicial when paired with other analgesic for pain relief during circumcision, probably since circumcision is a more intensely painful procedure than other routine procedures undertaken at NICU, yet it gave a synergistic efect with other analgesic methods [41]. The concentration of the sweet agent also matered; a more concentrated sugar solution was found to be a more efective analgesic than less concentrated ones [21].…”

“…Although there is no evidence yet about the dose-response efects [21], dose ranging from 0.5 to 2 mL of 12-24% strength show pain-relief efect [11,22]. For premature neonates, dose is calculated in accordance to their weight/volume ratio.…”

“…Fructose, lactose, milk and noncaloric sweeteners had been used for analgesia, although less frequently [21]. Glucose 20-30% solution is efective for heel lance and venipuncture in preterm and term infants [42,43].…”

Be sweet to toddlers during needles: pilot randomized controlled trial of sucrose compared to placebo

“…3 Extensive high quality evidence from randomized controlled trials (RCTs) and systematic reviews demonstrate analgesic effects of sweet solutions in infants undergoing needle related procedures. 4 It is uncertain if the same analgesic effects persist beyond infancy. Only two trials in a Cochrane systematic review of sweet solutions for procedural pain reduction in children included young children up to three years of age and results of these trials were conflicting.…”