REVIEW QUESTION

Is administering sucrose to newborns undergoing painful hospital procedures effective and safe?

TYPE OF REVIEW

An intervention review of 74 randomized controlled trials (RCTs).

RELEVANCE FOR NURSING

Infants hospitalized in the neonatal ICU are often subjected to many painful procedures. The use of pain-relieving interventions in newborns varies widely in practice and is generally suboptimal. The administration of oral sucrose with and without nonnutritive sucking (pacifiers) is the most commonly studied nonpharmacologic intervention for pain relief in newborns. It is believed that oral sucrose and other similar solutions affect endogenous opioid pathways, which are stimulated by the sweet taste. However, there is no clear guidance on the optimal percentage of sucrose in the solution, how much solution to administer, and how often to administer it.

CHARACTERISTICS OF THE EVIDENCE

This systematic review included 74 RCTs examining the effectiveness of sucrose as pain relief in a total of 7,049 neonates, both preterm and term, undergoing painful procedures. Examples of these procedures included arterial puncture, venipuncture, heel lance, injections, eye examinations, and circumcision.

The intervention-a sucrose solution administered via dropper or syringe or with a pacifier-was compared with a control regimen of breastfeeding; administering formula, water, or breast milk; positioning; pacifier only; glucose; facilitated tucking; acupuncture; or local anesthetic. Primary outcomes were composite pain score and long-term neurodevelopmental outcomes. Secondary outcomes included individual behavioral pain indicators (such as duration of crying) and individual physiologic pain indicators (such as heart and respiratory rate).

Sucrose in concentrations of 20% to 30% reduced composite and multidimensional behavioral pain scores, as well as individual behavioral and physiologic pain indicators, associated with heel lance. Other pain-reducing interventions such as nonnutritive sucking and swaddling together with sucrose provided further pain relief. Sucrose in concentrations of 24% to 30% reduced composite and multidimensional behavioral pain scores and cry variables associated with venipuncture. There was high-quality evidence that sucrose reduces pain associated with intramuscular injections.

There was insufficient evidence to judge whether sucrose was beneficial in reducing pain associated with arterial puncture or subcutaneous injections. There was limited evidence that sucrose may confer some pain relief for eye examinations when combined with other pain-reducing interventions. Sucrose was insufficient for pain relief from circumcision. Long-term neurodevelopmental outcomes were not assessed in any of the studies. Sucrose reduced procedural pain with minimal to no reported adverse effects.

BEST PRACTICE RECOMMENDATIONS

There is high-quality evidence that sucrose reduces pain from heel lance, venipuncture, and intramuscular injection. Unit protocols establishing the use of oral sucrose for painful procedures should be developed.

RESEARCH RECOMMENDATIONS

More research is needed to address the analgesic and calming effects of sucrose and its interaction with other behavioral and pharmacologic interventions. The optimal dose of sucrose for pain relief in term and preterm infants has not yet been established. Further research is also required to assess the effectiveness of sucrose in reducing pain during bladder catheterization and orogastric or nasogastric tube insertion.

REFERENCE