The Efficacy of Developmentally Sensitive Interventions and Sucrose for Relieving Procedural Pain in Very Low Birth Weight Neonates

Abstract

The most efficacious interventions for reducing pain from single painful events were the pacifier with sucrose and the pacifier with sterile water. Research on the efficacy and safety of implementing these interventions, alone and in combination, for repeated painful procedures is needed. In addition, research is needed on the influence of implementing these interventions on pain response and clinical outcomes (e.g., health status and neurodevelopmental status) in VLBW neonates in the NICU.

Prevention and Management of Pain in the Neonate: An Update

“…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.…”

“…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. Oral sucrose eliminates the electroencephalographic changes associated with a painful procedure 83 in a neonate, but the mechanism of pain relief by sucking oral sucrose is not known for certain.…”

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%, …”

“…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. Two studies 34,40 assessed the sucrose solution at varying volumes and concentrations.…”

“…The instrument used to assess responses to pain in four 37,39,42,44 studies was multidimensional and had been validated for the evaluation of neonatal pain, the Premature Infant Pain Profile (PIPP). The instrument assesses facial expression, heart rate, oxygen saturation, behavior and gestational age and returns a single overall score.…”