A recent Cochrane review conducted by Shah and colleagues evaluated the effectiveness of breastfeeding and supplemental breast milk administration in reducing procedural pain in neonates.1 The researchers also analyzed subgroups according to the type of control intervention, the painful procedure, the neonate's gestational age, and the amount of supplemental breast milk given. The review included a search of MEDLINE and other medical databases from 1966 to 2006 and a review of abstracts from annual meetings of the Society for Pediatric Research from 1994 to 2006.

Eleven randomized and quasirandomized trials compared breastfeeding (five trials) or supplemental breast milk administration (six trials) with no treatment or other treatment in both full-term and preterm neonates before or during a single potentially painful procedure (venipuncture or heel lance). Supplemental milk was placed on the tongue or fed by nasogastric or orogastric tube. To be included in the review, the studies had to have reported pain indicators, such as pain scores or physiologic or behavioral changes (such as an increase in heart rate or a reduction in crying, respectively).

Neonates breastfed during the painful procedure showed greater reductions in heart rate and duration and percentage of time crying, as well as improvements in other measures of pain such as lowered pain scores, than did neonates who received placebo, no intervention, or positioning. But breastfeeding did not as effectively reduce pain as high concentrations of sucked sucrose (such as 10% to 30%). Results from supplemental breast milk administration were variable. Higher concentrations of glucose produced greater reductions in heart rate and duration of crying and a nonsignificant trend toward lower pain scores.

The authors conclude that breastfeeding and supplemental breast milk administration should be used when available because these interventions provide better analgesia than either no intervention or positioning-pacifier-holding or swaddling in neonates undergoing a single painful procedure. The authors emphasize that none of the studies showed that the interventions eliminated procedural pain, but they point out that there are many hidden advantages to breastfeeding-particularly its cost-effectiveness and the opportunity it provides for maternal-infant bonding and comforting.

Findings in this review reinforce previous research showing the value of concentrated sucrose-glucose for brief painful procedures in neonates: high concentrations of sucrose-glucose were as effective as breastfeeding and more effective than supplemental breast milk administration in reducing several pain indicators. See "Pain Relief for Neonates," Pain Control, May 2004, for more on analgesia in neonates and the appropriate use of sucrose.

According to this review:

* Breastfeeding and supplemental breast milk administration were shown to reduce behavioral indicators of pain during a single procedure, such as venipuncture, in newborns.

* Breastfeeding was not shown to be as effective in reducing pain as high concentrations of sucked sucrose (such as 10% to 30%).

Section Description

This month's Pain Control deals with different aspects of pain treatment in newborns. One part is a discussion of the effects of breastfeeding and breast milk on pain in neonates; the second part discusses a study on pain assessment in the neonate.

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