Sucrose for analgesia in newborn infants undergoing painful procedures

Stevens, Bonnie; Yamada, Janet; Ohlsson, Arne; Haliburton, Sarah; Shorkey, Allyson

doi:10.1002/14651858.cd001069.pub5

Cited by 201 publications

(206 citation statements)

References 176 publications

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“…An equivalent dose of sucrose per weight comparable to the recommended dose for human neonates was given. The standard guideline recommends 0.5mL per dose for very preterm infants (24 to 32 weeks of gestation), which correspond to 0.08g–0.2g of sucrose per body weight (kg) [62]. Each pup received 0.1–0.2g of sucrose per kg of mouse body weight.…”

Section: 0 Materials and Methodsmentioning

confidence: 99%

“…Currently, oral sucrose is administered routinely to reduce pain of minor procedures in infants and is recommended as standard care in international guidelines [4,5,43], which are based on evidence of safety and efficacy of a single dose of sucrose to reduce pain behaviors [62]. Importantly, long-term benefits or risks of repeated sucrose administration in the context of pain, in human or animal neonates, on brain development have not been studied.…”

Section: 0 Introductionmentioning

confidence: 99%

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Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations

Tremblay

Ranger

Chau

et al. 2017

PAIN

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Oral sucrose is administered routinely to reduce pain of minor procedures in premature infants and is recommended as standard care in international guidelines. No human or animal studies on effects of early repeated sucrose exposure on long-term brain development have been done in the context of pain. We evaluated the effects of repeated neonatal sucrose treatment before an intervention on long-term brain structure in mouse pups. Neonatal C57Bl/6J mice (n = 109) were randomly assigned to one of 2 treatments (vehicle vs sucrose) and one of 3 interventions (handling, touch, or needle-prick). Mice received 10 interventions daily from postnatal day 1 to 6 (P1-6). A dose of vehicle or 24% sucrose was given orally 2 minutes before each intervention. At P85-95, brains were scanned using a multichannel 7.0 T MRI. Volumes of 159 independent brain regions were obtained. Early repetitive sucrose exposure in mice (after correcting for whole brain volume and multiple comparisons) lead to smaller white matter volumes in the corpus callosum, stria terminalis, and fimbria (P < 0.0001). Cortical and subcortical gray matter was also affected by sucrose with smaller volumes of hippocampus and cerebellum (P < 0.0001). These significant changes in adult brain were found irrespective of the type of intervention in the neonatal period. This study provides the first evidence of long-term adverse effects of repetitive sucrose exposure and raises concerns for the use of this standard pain management practice during a period of rapid brain development in very preterm infants.

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Section: 0 Materials and Methodsmentioning

confidence: 99%

Section: 0 Introductionmentioning

confidence: 99%

Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations

Tremblay

Ranger

Chau

et al. 2017

PAIN

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“…Routine sedation of ventilated neonates with opiates or midazolam is not supported by evidence [149, 150]. Sucrose analgesia and other non-pharmacological methods may be employed to reduce minor procedural pain [151]. …”

Section: Pain and Sedationmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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“…First, the RV is a sweet-tasting solution containing sucrose that acts as an analgesic effect to relieve pain from injection in young infants 8,10,11 . Many studies have confirmed that the oral administration of sweet-tasting solutions, such as oral sucrose or glucose, before painful procedures can reduce signs of pain in young infants 12–17 . This effect is attributable to the release of endogenous opioids that are activated by the sweet taste 18 .…”

Section: Discussionmentioning

confidence: 99%

Comparison of iatrogenic pain between rotavirus vaccination before and after vaccine injection in 2-month-old infants

Yin

Shih

Lee

et al. 2017

Human Vaccines & Immunotherapeutics

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Oral rotavirus vaccine (RV) administration in conjunction with other injectable vaccines has been used worldwide. However, whether the sequence of RV administration is associated with the reduction of injection-induced pain remains unclear.In this randomized controlled trial, we enrolled 6–12-wk-old healthy infants. The pain response of the infants was scored on the basis of their crying, irritability, facial expression, gagging and distress. A multivariate logistic regression model was used to compare the pain response after adjustment for possible confounders.We enrolled 352 infants, of whom 176 infants received RV before injection (experimental group) and 176 infants received an RV after injection (comparison group). Sex, number of injections, main caregiver, feeding type, and RV type did not differ significantly between the 2 groups. Multivariate regression analyses showed that, at 30 s after the intervention, the episode of gagging was more frequent in the comparison group than in the experimental group (p = 0.004). At 180 s after the intervention, the infants cried more often in the comparison group (p < 0.001). Furthermore, the infants in the experimental group more often relaxed (p < 0.001), rested quietly (p = 0.001), and were smiling (p = 0.001) than did those in the comparison group.Our results indicate that compared with oral RV administration after injection, oral RV administration before injection is more effective in reducing injection-induced pain in 2-mo-old infants. The findings can provide a clinical strategy for relieving pain from vaccination in young infants.

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Sucrose for analgesia in newborn infants undergoing painful procedures

Abstract: Analysis 2.12. Comparison 2 Heel lance: sucrose (20% to 33%) versus water, Outcome 12 Skin blood flow during heel lance (perfusion units (PU)

Cited by 201 publications

References 176 publications

Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations

Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Comparison of iatrogenic pain between rotavirus vaccination before and after vaccine injection in 2-month-old infants

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