Effectiveness of oral sucrose and simulated rocking on pain response in preterm neonates

Abstract

Feeding and carrying have been interventions used by caregivers throughout history in relieving distress in infants. Recent studies on the food substance sucrose have elucidated the comforting effect of the taste component of feeding while studies of rocking have examined the comforting effect of the vestibular component of carrying. The purpose of this study was to determine the effectiveness of sucrose and simulated rocking alone and in combination on diminishing pain response in preterm neonates undergoing routine heelstick procedure in the neonatal intensive care unit (NICU). Preterm infants (n = 85) between 25-34 weeks post-conceptual age (PCA) and 2-10 days postnatal age (PNA) were randomly assigned to one of four conditions for routine heelstick procedure. The conditions were (1) sucrose alone: 0.05 ml of 24% sucrose was placed on the anterior surface of the tongue just prior to the lancing of the heel; (2) simulated rocking alone: 15 min prior to and during the heelstick procedure, the infant was swaddled and put on an oscillating mattress; (3) combination of sucrose and simulated rocking; and (4) placebo: 0.05 ml sterile water administered just prior to heelstick. Physiological (heart rate) and behavioural (facial actions) responses from baseline across 90 s following heelstick were scored second-to-second. Facial actions were analysed with repeated measures MANCOVA and heart rate with repeated measures ANCOVA. Behavioural state and gestational age were covariates. The groups that received sucrose alone or in combination with simulated rocking showed less facial actions indicative of pain than the rocking alone or control group. The addition of rocking to the sucrose condition tended to further blunt the facial expression of pain, but this enhancement did not reach a significant level. Heart rate was not decreased by any intervention compared to the control condition. Although the simulated rocking did promote quiet sleep, which has been reported in earlier studies to blunt pain response, there was no difference between simulated rocking and control groups in either facial expressions indicative of pain or heart rate. The implication of these results is that sucrose, but not simulated rocking may be a means of diminishing pain from minor procedures in preterm infants. Further research is needed on the use of sucrose for more than one procedure as well as examining the contact component of natural rocking, as opposed to simulated rocking.

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

“…13,15,43,46, [92][93][94] Because infants at such low gestational ages are exposed to numerous painful procedures over months of hospitalization, the consequences of both pain exposure and interventions to reduce pain need to be studied carefully. Only 4 of the 125 studies evaluated repeated doses of sucrose over more than a few days.…”

Pain Catastrophizing in Borderline Morbidly Obese and Morbidly Obese Individuals with Osteoarthritic Knee Pain

“…Along these lines, there is emerging evidence that increasing food intake can reduce psychological distress and alleviate acute pain (11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Although binge eating may provide acute pain and distress relief in morbidly obese OA patients, increased eating can promote a vicious cycle that results in increased weight, increased pain, increased eating, and so on.…”

“…Converging lines of research indicate that, in morbidly obese patients, eating may serve to temporarily alleviate physical (eg, pain) and psychological discomfort. Ingesting high-fat meals and high levels of sucrose has been shown to increase pain tolerance (11)(12)(13)(14)(15)(16)(17)(18)(19), while estimates suggest that up to one-third of individuals increase their food intake during times of stress (12,20). Morbidly obese OA patients who engage in pain catastrophizing may be at a particular risk for overeating.…”

A eficácia da sacarose no alívio de dor em neonatos: revisão sistemática da literatura

“…Sixteen of the 29 articles selected were studies of fullterm neonate patient samples, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] eleven studied preterm neonates [33][34][35][36][37][38][39][40][41][42][43] and two included comparisons between preterm and fullterm neonates. 44,45 The volume of sucrose used in the majority of the studies involving fullterm neonates was 2 ml, [17][18][19][20][21][22][23][24][25][27][28][29][30][31][32] with concentrations of 12%, 20,24,30,31 12.5%, 18,32 24%, …”

“…The volume used in studies performed with preterm neonates varied more, with studies of single dose interventions administering 0.05 ml, 36 1 ml 35,40 and 2 ml, 33,34,42 and studies of repeated doses used 0.05 ml 39 and 0.1 ml. 37,40,43 The concentrations administered were 15%, 40 24%, 37 25% 38,42 and 50% 33 in single-dose studies, and 24% 39,41,43 in studies of repeat doses.…”