Expressed breast milk for procedural pain in preterm neonates: a randomized, double‐blind, placebo‐controlled trial

Ou‐Yang, Mei‐Chen; Chen, I‐Lun; Chen, Chih‐Cheng; Chung, Mei‐Ing; Chen, Feng-Shun; Huang, Hsin‐Chun

doi:10.1111/apa.12045

Cited by 24 publications

(19 citation statements)

References 33 publications

(55 reference statements)

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“…When it came to crying, the results were similar to those found in previous studies and that was that neonates were more likely to cry in the EBM period than in the sucrose period, although the difference was not significant, and that any crying was shorter in the sucrose period. This finding may be explained by a review published by Cong et al , which suggested that crying is not a very sensitive sign of pain in preterm infants.…”

Section: Discussionsupporting

confidence: 87%

“…Another nonpharmacological measure that has been used in newborn infants is expressed breast milk (EBM), but studies have report higher Premature Infant Pain Profile (PIPP) scores for EBM than sucrose for relieving pain . However, their cohorts comprised healthy newborn or late preterm infants and they used higher quantities of sucrose, of up to 5 mL . The mechanism of action of EBM has been attributed to lactose and tryptophan , but the lactose level in human milk may vary according to multiple variables, such as the age and maturity of the neonate, as indicated in a study by Underwood .…”

Section: Introductionmentioning

confidence: 99%

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Randomised crossover trial showed that using breast milk or sucrose provided the same analgesic effect in preterm infants of at least 28 weeks

et al. 2017

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Aim: Repeated, ongoing exposure to pain influences the growth, cognitive and motor functions, behaviour, personality and neurodevelopment of preterm infants. We compared the analgesic effects of expressed breast milk (EBM) and 24% oral sucrose on preterm neonates during venipuncture.Methods: This multicentre randomised, noninferiority, crossover trial focused on five neonatal university units in Madrid, Spain, from October 2013 to October 2014. It comprised 66 preterm infants born at less than 37 weeks and randomly split into two groups. They received either EBM or sucrose two minutes before venepuncture, together with nonnutritive sucking and swaddling, then the opposite procedure at a later point. Pain was measured with the premature infant pain profile (PIPP) and crying was also measured.Results: There were no statistically significant differences between the groups. The PIPP scores were seven (4-9) with breast milk and six (4-8.25) with sucrose (p = 0.28). The 11 infants born at under 28 weeks of age showed higher median scores of nine (9-14) for breast milk and four (4-7) for sucrose (p = 0.009).Conclusion: EBM and 24% sucrose had the same analgesic effect during venipuncture in most of the preterm neonates, but sucrose worked better in extremely preterm infants.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Randomised crossover trial showed that using breast milk or sucrose provided the same analgesic effect in preterm infants of at least 28 weeks

et al. 2017

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“…[13][14][15][16][17] Vaccination is the most common procedure performed in infancy, although parents might have significant concerns regarding the pain associated with routine vaccinations. The medical and paramedical staffs usually ignore pain felt during these procedures.…”

mentioning

confidence: 99%

Comparison of analgesic effect of 24% sucrose and breast milk in healthy infants less than 2 months of age

Kavthekar

Patil

Kurane

et al. 2016

Int J Contemp Pediatr

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INTRODUCTIONThe myth regarding neonatal pain suggests that because of neurological immaturity, neonates do not experience pain. However, studies have shown that pain pathways as well as cortical and subcortical centres, necessary for pain perception are well developed late in gestation and physiological and behavioural responses to pain are well documented in neonates.1 Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. It is difficult to assess pain in infants, as infants cannot verbalise their pain ,as they are dependent on others to recognize it, intervene it, treat it. Many newborn babies undergo painful procedures like heel pricks, venepuncture and intramuscular injection for immunization, such procedures inflict distinct physiological, behavioral, hormonal and metabolic changes.3 Moreover painful experience very early in life can promote somatization later in life. 4 Dextrose and sucrose in varying concentration have been shown to relive pain during venepuncture or intramuscular injection. [5][6][7][8][9][10][11][12] Breastfeeding or expressed breast milk have ABSTRACT Background: Many newborns undergo painful procedures like heel pricks, venepuncture and intramuscular injection for immunization. The medical and paramedical staffs usually ignore pain felt during these procedures. The aim of this study was to compare analgesic activity of 24% sucrose solution with breast milk during 1st DPT vaccination using sterile water as placebo. Methods: This double blind, randomized placebo controlled trial was conducted in 150 healthy infants undergoing for their 1 st DPT vaccination. Infants were randomized in to three groups of 50 each and received sterile water, 24% sucrose and breast milk 2 minutes prior to vaccination. The outcome variables were total duration of cry, first cry, change in heart rate and modified facial coding score (MFCS). Results: Mean total cry was significantly lower in 24% sucrose babies 36.3 (25.34) seconds and breast milk babies 42.1 (26.13) seconds as compared to sterile water 137.2 (20.31) seconds. Mean first cry was significantly lower in 24% sucrose 18.2 (14.12) seconds and breast milk babies 25.1 (13.67) seconds as compared to sterile water 94.3 (23.26) seconds. Mean rise in heart rate (beats/min) at 3 minutes was significantly lower with 24% sucrose 3 (2.3)and breast milk 7.4 (4.6) as compared to sterile water 18.2 (4.61).Change in MFCS at 1min and 3 min was significantly lower in 24% sucrose and breast milk babies. Maximum reduction in total cry, first cry, lower rise in heart rate and low MFCS was with 24% sucrose as compared to breast milk group. Conclusions: 24% sucrose and breast milk had analgesic activity in infants less than two months of age undergoing DPT vaccination. The analgesic effect was better for 24% sucrose as compared to breast milk.

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“…However, PR and oxygen saturation recovered to baseline levels by 2 minutes after the examinations, from the conditions of increased PR and decreased oxygen saturation during the examinations. In the study by Ou-Yang and colleagues [21], preterm infants undergoing heel pricks did not show changes in PR or oxygen saturation. This may have been related to the brevity of the heel prick procedure or the large amount (5 mL) of human milk or 25% glucose administered.…”

Section: Discussionmentioning

confidence: 84%

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

Jang¹,

Lee²,

Jo³

et al. 2019

Child Health Nurs Res

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Purpose: This study compared the pain-relieving effects of human milk, sucrose, and distilled water during examinations for retinopathy of prematurity. Methods: Forty-five preterm infants were randomly assigned to receive a pacifier dipped in one of three solutions: human milk (n=14), 24% sucrose (n=15), or distilled water (n=16), 2 minutes before an eye examination. Their pain score, pulse rate, and oxygen saturation were measured at three time points: 5 minutes before the examination, 30 seconds after speculum introduction, and 2 minutes after the examination. Results: The infants' mean gestational age and weight at birth were 33.1±2.1 weeks and 1,842±470 g, respectively. There were no between-group differences in pain relief during the eye examination. The pain score significantly increased both during (p<.001) and after the examinations (p=.003). Oxygen saturation decreased during the examinations (p<.001); however, the infants in the 24% sucrose group showed higher oxygen saturation (p=.047) during the examinations than the infants in the other groups. Conclusion: Sucking on a pacifier dipped in human milk or 24% sucrose did not reduce the pain associated with eye examinations in preterm infants. Pacifiers dipped in sucrose can be used to maintain better oxygen saturation during these examinations.

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Expressed breast milk for procedural pain in preterm neonates: a randomized, double‐blind, placebo‐controlled trial

Abstract: Although milk did not significantly reduce crying time, our finding that pain scores were significantly lower in the milk group suggests that milk may reduce pain associated with heel lancing in preterm neonates.

Cited by 24 publications

References 33 publications

Randomised crossover trial showed that using breast milk or sucrose provided the same analgesic effect in preterm infants of at least 28 weeks

Randomised crossover trial showed that using breast milk or sucrose provided the same analgesic effect in preterm infants of at least 28 weeks

Comparison of analgesic effect of 24% sucrose and breast milk in healthy infants less than 2 months of age

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

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