Effect of expressed breast milk versus swaddling versus oral sucrose administration on pain associated with suctioning in preterm neonates on assisted ventilation: A randomized controlled trial

Abstract

Objective:The objective of our study was to assess the pain associated with suctioning in preterm neonates on assisted ventilation and comparing the use of expressed breast milk (EBM), sucrose, and swaddling to alleviate pain.Methods:Study design: A randomized controlled clinical trial.Inclusion Criteria:Preterm neonates on assisted ventilation.Exclusion Criteria:Major congenital anomalies and severe encephalopathy.Study Duration and Site:6 months in level III neonatal Intensive Care Unit. In the first phase, we used premature infant pain profile (PIPP) score to assess pain associated with suctioning in preterm neonates on assisted ventilation. In the second phase, the effect of EBM, swaddling, and sucrose on pain relief during suctioning in neonates on assisted ventilation was assessed.Results:There was a significant increase in pain associated with suctioning in preterm neonates on assisted ventilation (preprocedure PIPP score 7.90 ± 2.50; procedural PIPP score 13.63 ± 2.57; P < 0.05). The postintervention mean procedural PIPP score was not significantly different between the EBM, swaddling, and sucrose groups (P = 0.24).Conclusions:Suctioning is painful for preterm neonates on assisted ventilation. There was no difference between EBM, swaddling, and sucrose in relieving pain associated with suctioning.

Efficacy and safety of non‐pharmacological interventions for endotracheal suctioning pain in preterm infants: A systematic review

“…The sample size of the studies ranged from 20 to 108, the weight of participants was more than 560 grams, and the gestational age ranged from 23 and 37 weeks. In addition, the types of respiratory support were different, including non‐invasive ventilation (Axelin et al, 2009; Rodrigues et al, 2017; Vezyroglou et al, 2015), invasive mechanical ventilation (Alinejad‐Naeini et al, 2014; Fatollahzade et al, 2020; Taplak & Bayat, 2021; Ward‐Larson et al, 2004) and both of them (Axelin et al, 2006; Desai et al, 2017; Mitchell et al, 2013).…”

“…Table 3 summarizes the characteristics of the interventions in each study. A total of nine non‐pharmacological interventions were reported: gentle human touch (GHT) (Fatollahzade et al, 2020), FT (Alinejad‐Naeini et al, 2014; Axelin et al, 2006, 2009; Taplak & Bayat, 2021; Ward‐Larson et al, 2004), swaddling (Desai et al, 2017), oral sucrose (Desai et al, 2017), oral glucose (OG) (Axelin et al, 2009; Rodrigues et al, 2017; Vezyroglou et al, 2015), EBM (Desai et al, 2017; Rodrigues et al, 2017), KC (Mitchell et al, 2013), breast milk smell (BMS) (Taplak & Bayat, 2021) and white noise (WN) (Taplak & Bayat, 2021). The timing of the assessment varied from 5 min before the pain procedure to 5 min after the procedure.…”

“…Figure 2 reported the risk of bias. Five studies (Axelin et al, 2009; Mitchell et al, 2013; Rodrigues et al, 2017; Taplak & Bayat, 2021; Vezyroglou et al, 2015) had a low risk of bias, and four studies were judged to raise some concerns (Alinejad‐Naeini et al, 2014; Axelin et al, 2006; Desai et al, 2017; Fatollahzade et al, 2020), and one study (Ward‐Larson et al, 2004) was assessed to have some concerns in two domains (randomization process and measurement of the outcome). However, given that participants included were premature infants and the intervention process was strictly required, we still believed in the reliability of the result.…”

“…In addition, FT and WN groups were more effective in relieving pain more than BMS in premature infants 1 min before the procedure ( p = .048). One randomized controlled clinical trial (Desai et al, 2017) evaluated the analgesic effects of three different interventions during suctioning: swaddling, EBM and sucrose. The mean procedural PIPP score for sucrose (11.47 ± 3.23) was lower than the other two groups (EBM: 12.88 ± 3.59; Swaddling: 12.11 ± 3.87), but there was no statistical difference between the three groups ( p = .24).…”

Comparison of the Pain-relieving Effects of Human Milk, Sucrose, and Distilled Water during Examinations for Retinopathy of Prematurity: A Randomized Controlled Trial

“…The pain-relieving effects of human milk, which contains natural and potentially risk-free nutrients, have also been investigated in preterm infants in response to painful procedures [11][12][13]. Human milk is believed to be a relatively safe solution as opposed to sucrose, the repeated administration of which can induce hyperglycemia in younger preterm infants [14]. The pain-relieving effects of human milk have been compared with those of distilled water or sucrose in preterm infants undergoing venipuncture and ROP examinations [11,15,16].…”