Effect of Repeated Doses of Sucrose during Heel Stick Procedure in Preterm Neonates

Johnston, Céleste; Stremler, Robyn; Horton, Linda; Friedman, Allison

doi:10.1159/000014092

Cited by 132 publications

(107 citation statements)

References 29 publications

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“…Our findings correspond to those of Johnston et al, 44 who examined the effects of repeated doses of sucrose in preterm infants receiving sucrose solution or sterile water either 2 minutes before, just before, or 2 minutes after the heel stick. Their results showed that repeated doses of sucrose, at 2-minute intervals, increases the analgesic effect in preterm infants.…”

Section: Figuresupporting

confidence: 91%

Oral Sucrose and “Facilitated Tucking” for Repeated Pain Relief in Preterms: A Randomized Controlled Trial

et al. 2012

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WHAT'S KNOWN ON THIS SUBJECT: Preterm infants are exposed to inadequately managed painful procedures during their NICU stay, which can lead to altered pain responses. Nonpharmacologic approaches are established for the treatment of single painful procedures, but evidence for their effectiveness across time is lacking. WHAT THIS STUDY ADDS:Oral sucrose with or without the added technique of facilitated tucking has a pain-relieving effect even in extremely premature infants undergoing repeated pain exposures; facilitated tucking alone seems to be less effective for repeated pain exposures over time.abstract OBJECTIVES: To test the comparative effectiveness of 2 nonpharmacologic pain-relieving interventions administered alone or in combination across time for repeated heel sticks in preterm infants. METHODS:A multicenter randomized controlled trial in 3 NICUs in Switzerland compared the effectiveness of oral sucrose, facilitated tucking (FT), and a combination of both interventions in preterm infants between 24 and 32 weeks of gestation. Data were collected during the first 14 days of their NICU stay. Three phases (baseline, heel stick, recovery) of 5 heel stick procedures were videotaped for each infant. Four independent experienced nurses blinded to the heel stick phase rated 1055 video sequences presented in random order by using the Bernese Pain Scale for Neonates, a validated pain tool.RESULTS: Seventy-one infants were included in the study. Interrater reliability was high for the total Bernese Pain Scale for Neonates score (Cronbach' s a: 0.90-0.95). FT alone was significantly less effective in relieving repeated procedural pain (P , .002) than sucrose (0.2 mL/kg). FT in combination with sucrose seemed to have added value in the recovery phase with lower pain scores (P = .003) compared with both the single-treatment groups. There were no significant differences in pain responses across gestational ages.CONCLUSIONS: Sucrose with and without FT had pain-relieving effects even in preterm infants of ,32 weeks of gestation having repeated pain exposures. These interventions remained effective during repeated heel sticks across time. FT was not as effective and cannot be recommended as a nonpharmacologic pain relief intervention for repeated pain exposure.

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Section: Figuresupporting

confidence: 91%

Oral Sucrose and “Facilitated Tucking” for Repeated Pain Relief in Preterms: A Randomized Controlled Trial

et al. 2012

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“…74 Maximum reductions in physiologic and behavioral pain indicators have been noted when sucrose was administered ∼2 minutes before a painful stimulus, and the effects lasted ∼4 minutes. [74][75][76] Procedures of longer duration, such as ophthalmologic examinations or circumcision, may require multiple doses of sucrose to provide continual analgesic effect. 76 In animal studies, the analgesic effects of sucrose appear to be a sweet-taste-mediated response of opiate, endorphin, and possibly dopamine or acetylcholine pathways; however, the mechanism of action is not well understood in human neonates.…”

Section: Pharmacologic Treatment Strategies Sucrose and Glucosementioning

confidence: 99%

Prevention and Management of Procedural Pain in the Neonate: An Update

Keels¹,

Sethna²,

Watterberg³

et al. 2016

Pediatrics

318

171

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The prevention of pain in neonates should be the goal of all pediatricians and health care professionals who work with neonates, not only because it is ethical but also because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor, yet painful procedures. Therefore, every health care facility caring for neonates should implement (1) a pain-prevention program that includes strategies for minimizing the number of painful procedures performed and (2) a pain assessment and management plan that includes routine assessment of pain, pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and measures for minimizing pain associated with surgery and other major procedures.

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“…These include use of oral sucrose/glucose, [62][63][64][65][66][67][68][69][70][71][72][73][74][75][76] breastfeeding, 77 nonnutritive sucking, 49,78 "kangaroo care" (skin-to-skin contact), 55,58 facilitated tuck (holding the arms and legs in a flexed position), 79 swaddling, 80 and developmental care, which includes limiting environmental stimuli, lateral positioning, the use of supportive bedding, and attention to behavioral clues. 61 These measures have been shown to be useful in preterm and term neonates in reducing pain from a heel stick, 68,[70][71][72][73]79,80 venipuncture, 62,64,65,67,74,77,81 and subcutaneous injections 81 and are generally more effective when used in combination than when used alone. 63,65,68,69,80,82 Concentrated oral sucrose has been widely studied.…”

Section: Nonpharmacologic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

“…75,86 Some authors have suggested that multiple doses for a procedure (2 minutes before and 1-2 minutes after) are more effective than a single dose. 73,75 The long-term safety of multiple doses of oral sucrose for painful procedures in neonates has not been established. 87 Additional research is needed to fully understand the mechanism of action, optimal dose, and safety of repeated doses of oral sucrose in neonates; nevertheless, available data suggest that this is an effective means of alleviating pain for many minor neonatal procedures.…”

Section: Nonpharmacologic Pain Prevention For Minor Proceduresmentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

413

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The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

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Effect of Repeated Doses of Sucrose during Heel Stick Procedure in Preterm Neonates

Cited by 132 publications

References 29 publications

Oral Sucrose and “Facilitated Tucking” for Repeated Pain Relief in Preterms: A Randomized Controlled Trial

Oral Sucrose and “Facilitated Tucking” for Repeated Pain Relief in Preterms: A Randomized Controlled Trial

Prevention and Management of Procedural Pain in the Neonate: An Update

Prevention and Management of Pain in the Neonate: An Update

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