1
|
Bueno M, Ballantyne M, Campbell‐Yeo M, Estabrooks C, Gibbins S, Harrison D, McNair C, Riahi S, Squires J, Synnes A, Taddio A, Victor C, Yamada J, Stevens B. A longitudinal observational study on the epidemiology of painful procedures and sucrose administration in hospitalized preterm neonates. PAEDIATRIC & NEONATAL PAIN 2024; 6:10-18. [PMID: 38504869 PMCID: PMC10946675 DOI: 10.1002/pne2.12114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 03/21/2024]
Abstract
Although sucrose is widely administered to hospitalized infants for single painful procedures, total sucrose volume during the entire neonatal intensive care unit (NICU) stay and associated adverse events are unknown. In a longitudinal observation study, we aimed to quantify and contextualize sucrose administration during the NICU stay. Specifically, we investigated the frequency, nature, and severity of painful procedures; proportion of procedures where neonates received sucrose; total volume of sucrose administered for painful procedures; and incidence and type of adverse events. Neonates <32 weeks gestational age at birth and <10 days of life were recruited from four Canadian tertiary NICUs. Daily chart reviews of documented painful procedures, sucrose administration, and any associated adverse events were undertaken. One hundred sixty-eight neonates underwent a total of 9093 skin-breaking procedures (mean 54.1 [±65.2] procedures/neonate or 1.1 [±0.9] procedures/day/neonate) during an average NICU stay of 45.9 (±31.4) days. Pain severity was recorded for 5399/9093 (59.4%) of the painful procedures; the majority (5051 [93.5%]) were heel lances of moderate pain intensity. Sucrose was administered for 7839/9093 (86.2%) of painful procedures. The total average sucrose volume was 5.5 (±5.4) mL/neonate or 0.11 (±0.08) mL/neonate/day. Infants experienced an average of 7.9 (±12.7) minor adverse events associated with pain and/or sucrose administration that resolved without intervention. The total number of painful procedures, sucrose volume, and incidence of adverse events throughout the NICU stay were described addressing an important knowledge gap in neonatal pain. These data provide a baseline for examining the association between total sucrose volume during NICU stay and research on longer-term behavioral and neurodevelopmental outcomes.
Collapse
Affiliation(s)
| | - Marilyn Ballantyne
- University of TorontoTorontoOntarioCanada
- Holland Bloorview Kids Rehabilitation HospitalTorontoOntarioCanada
| | - Marsha Campbell‐Yeo
- Dalhousie UniversityHalifaxNova ScotiaCanada
- IWK Health CentreHalifaxNova ScotiaCanada
| | | | | | - Denise Harrison
- University of MelbourneMelbourneVictoriaAustralia
- Murdoch Children's Research InstituteMelbourneVictoriaAustralia
- University of OttawaOttawaOntarioCanada
| | - Carol McNair
- The Hospital for Sick ChildrenTorontoOntarioCanada
| | | | | | - Anne Synnes
- University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Anna Taddio
- The Hospital for Sick ChildrenTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
| | - Charles Victor
- University of TorontoTorontoOntarioCanada
- The Institute of Health PolicyManagement and EvaluationTorontoOntarioCanada
| | - Janet Yamada
- Toronto Metropolitan UniversityTorontoOntarioCanada
| | - Bonnie Stevens
- The Hospital for Sick ChildrenTorontoOntarioCanada
- University of TorontoTorontoOntarioCanada
| |
Collapse
|
2
|
Yaprak D, Karagöl BS, Bozat AD, Kar İ. The role of time interval elimination on pain control of preterm infants by sucrose administration. Eur J Clin Pharmacol 2023; 79:841-848. [PMID: 37076639 DOI: 10.1007/s00228-023-03496-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 04/12/2023] [Indexed: 04/21/2023]
Abstract
PURPOSE The 2-min time interval of sucrose administration given before minor painful procedures in preterm infants is based on a few limited studies. We aimed to assess availability of sucrose analgesia in emergency states of minor procedural pain by eliminating the 2-min time interval prior to heel lance in preterm infants. The primary outcome was Premature Infants Pain Profile-Revised (PIPP-R) at 30 and 60 s. METHODS Healthy 69 preterms undergoing a heel lance, who were assigned randomly to 1 of 2 groups, i.e., group I, with the 2-min time interval of per oral 24% sucrose given prior to heel lance, or group II, without a time interval of per oral 24% sucrose, were recruited. Premature Infants Pain Profile-Revised, crying incidence, duration, and heart rate at 30 and 60 s following heel lance were the outcome measures in this single-center, randomized, prospective study. RESULTS The 2 groups did not differ significantly in PIPP-R scores at 30 s (6.63 vs. 6.32, p = .578) and 60 s (5.80 vs. 5.38, p = .478). The crying incidence was similar between the 2 groups (p = .276). The median crying duration was 6 s (range: 1-13 s) in group I and 4.5 s (range: 1-18 s) in group II (p = .226). No significant differences in the heart rates between the 2 groups and the proportion of adverse events by time interval elimination were recorded. CONCLUSIONS Eliminating the time interval did not decrease the analgesic effect of orally administered 24% sucrose given prior to heel lance. In emergency states of minor procedural pain, eliminating the 2-min time interval following sucrose administration is safe and efficacious in preterm infants.
Collapse
Affiliation(s)
- Deniz Yaprak
- Division of Neonatology, Department of Pediatrics, Gülhane Medicine Faculty, University of Health Sciences, Ankara, Turkey.
| | - Belma Saygili Karagöl
- Division of Neonatology, Department of Pediatrics, Gülhane Medicine Faculty, University of Health Sciences, Ankara, Turkey
| | - Ali Dinç Bozat
- Department of Pediatrics, Gülhane Medicine Faculty, University of Health Sciences, Ankara, Turkey
| | - İrem Kar
- Department of Biostatistics, Faculty of Medicine, Ankara University, Ankara, Turkey
| |
Collapse
|
3
|
Obeidat HM, Dwairej DA, Aloweidi AS. Pain in Preterm Infants: Different Perspectives. J Perinat Educ 2021; 30:185-195. [PMID: 34908817 DOI: 10.1891/j-pe-d-20-00032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In the last decades, there has been a tremendous change in approaching and managing neonates' pain. These changes began with rebutting the previous misconception about neonates' , particularly preterm infants' , pain. The development in neuroimaging has revealed that by 24 weeks of gestation the peripheral nervous system is mature and function fully. Researchers now know that neonates experience pain and premature infants have even lower pain thresholds. Since that time, a mounting amount of literature has addressed the issue of neonatal pain. Many pharmacological and non pharmacological pain reduction strategies have been investigated for their safety and analgesic effectiveness. Many interventions such as nonnutritive sucking (NNS), skin-to-skin contact (SSC), and facilitated tucking are effective in controlling neonates pain.
Collapse
|
4
|
Silveira ALDD, Christoffel MM, Velarde LGC, Rodrigues EDC, Magesti BN, Souza RDO. Effect of glucose and non-nutritive sucking on puncture pain in premature infants: a crossover clinical trial. Rev Esc Enferm USP 2021; 55:e03732. [PMID: 34076179 DOI: 10.1590/s1980-220x2020018303732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the effect of non-nutritive sucking, 25% oral glucose and 25% oral glucose combined with non-nutritive sucking in pain relief in premature infants submitted to heel puncture for blood glucose monitoring. METHOD This is a randomized crossover clinical trial with 34 preterm infants who randomly received interventions: non-nutritive sucking, 25% oral glucose and the two interventions combined for three consecutive days in heel puncture for blood glucose monitoring. Assessment by the Premature Infant Pain Profile for 30 seconds before the intervention, called the baseline period and for 5 minutes after puncture. RESULTS The combination of interventions made the premature infants return to baseline, with 1 minute and 30 seconds after heel puncture, promoting a 2.2% percentage reduction in the scale. CONCLUSION Comparing the effect of isolated and combined interventions showed that, when offered in combination, preterm infants were able to return to baseline parameters more quickly. Brazilian Clinical Trials Registry: RBR-3gm6w5.
Collapse
Affiliation(s)
- Ana Luiza Dorneles da Silveira
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Departamento de Enfermagem Materno-Infantil e Psiquiátrico, Niterói, RJ, Brasil
| | - Marialda Moreira Christoffel
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem Materno-Infantil, Rio de Janeiro, RJ, Brasil
| | | | - Elisa da Conceição Rodrigues
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem Materno-Infantil, Rio de Janeiro, RJ, Brasil
| | - Bruna Nunes Magesti
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Programa de Pós-Graduação em Enfermagem, Rio de Janeiro, RJ, Brasil
| | - Rebecca de Oliveira Souza
- Universidade Federal do Rio de Janeiro, Programa de Pós-Graduação em Estatística do Instituto de Matemática, Rio de Janeiro, RJ, Brasil
| |
Collapse
|
5
|
Ghaderi F, Ahmadbeigi M, Vossoughi M, Sardarian A. The efficacy of administrating a sweet-tasting solution for reducing the pain related to dental injections in children: A randomized controlled trial. Int J Paediatr Dent 2021; 31:184-190. [PMID: 32757418 DOI: 10.1111/ipd.12697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/12/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anaesthetic injections are an unpleasant experience for children in the dental office. Oral intake of sweet substances by newborns has been shown to be effective in reducing pain. AIM The purpose of this study was to determine whether a prior administration of a sweet-tasting solution has an effect on dental injection pain. DESIGN A total of 56 healthy children needing bilateral maxillary primary canine extraction were included in this split-mouth randomized clinical trial. In the test side, dental injection (local infiltration) was applied after the patient received a sweet-tasting solution, while in the control side sterile water was administered. The patients' demographic characteristics, body mass index (BMI), and sweet taste preference were recorded. Pain perception during injection was measured using visual analogue scale (VAS) and sound, eye, body movement (SEM). RESULTS Mean VAS (28.30 ± 6.43) and SEM (2.14 ± 0.78) in the test side were lower than the control side (45.80 ± 7.17 and 2.95 ± 1.00). It was shown that higher BMI was associated with reduction in the analgesic effect, while the individual's tendency to sweetness increased pain reduction. CONCLUSIONS Sweet taste administration before dental injections in children helps to control the associated pain. This effect is influenced by the individual's sweet taste tendency and BMI.
Collapse
Affiliation(s)
- Faezeh Ghaderi
- Department of Pediatric Dentistry, School of Dentistry, Shiraz University of Medical Science, Shiraz, Fars, Iran
| | - Mahboobe Ahmadbeigi
- School of Dentistry, Shaherkord University of Medical Sciences, Shahrekord, Chaharmahal Bakhtiari, Iran
| | - Mehrdad Vossoughi
- Oral and Dental Disease Research Center, Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Ahmadreza Sardarian
- Orthodontic Research Center, Department of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| |
Collapse
|
6
|
Mooney ER, Davies AJ, Pickering AE. Sweet taste does not modulate pain perception in adult humans. Wellcome Open Res 2020; 5:43. [PMID: 32704547 PMCID: PMC7361508 DOI: 10.12688/wellcomeopenres.15726.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2020] [Indexed: 01/07/2023] Open
Abstract
Background: Sugar is routinely used to comfort neonates undergoing painful procedures, and animal studies have shown that sucrose increases the time to withdrawal from painful stimuli. However, there are no published studies examining the effects of sweet substances on heat pain thresholds and percept in adult humans. Methods: Healthy adult volunteers (n=27, aged 18-48 years) were recruited to a controlled, double-blind, randomised, cross-over study to characterise the effect of tasting solutions of equivalent sweetness (10% sucrose and 0.016% sucralose) on warm detection and heat pain thresholds and the percept ratings of painfully hot stimuli. The effect of anticipation of a sweet taste on heat pain threshold was also assessed. Results: Tasting either sucrose or sucralose had no significant effect on the percept of an individually titrated hot stimulus (54.5±4.2 and 54.9±3.2 vs 53.2±3.5 for water, 0-100 visual analogue scale), on the warm detection or heat pain threshold (43.3±0.8, 43.2±0.8 vs 43.0±0.8°C). Anticipation of a sweet substance similarly did not affect heat pain thresholds. Conclusions: Sucrose and sucralose solutions had no analgesic effect when assessed using heat detection thresholds and percept ratings of painfully hot stimuli despite being perceived as sweeter and more pleasant than water. These findings are in contrast to results reported from previous animal studies in which thermal analgesia from sweet solutions is robust. Given the ubiquitous availability of sugar rich drinks in the modern environment, the lack of observable effect may be due to an insufficient hedonic value of the test solutions when compared to the experience of a laboratory rodent. Alternatively, sweet tastes may have a specific effect on pain tolerance rather than the threshold and acute percept measures assayed in this study.
Collapse
Affiliation(s)
- Elizabeth R Mooney
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences Building, University of Bristol, Bristol, BS8 1TD, UK,Anaesthesia, Pain & Critical Care Sciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Level 7, Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Alexander J Davies
- Nuffield Department of Clinical Neuroscience, University of Oxford, Level 6 West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Anthony E Pickering
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences Building, University of Bristol, Bristol, BS8 1TD, UK,Anaesthesia, Pain & Critical Care Sciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Level 7, Bristol Royal Infirmary, Bristol, BS2 8HW, UK,
| |
Collapse
|
7
|
Mooney ER, Davies AJ, Pickering AE. Sweet taste does not modulate pain perception in adult humans. Wellcome Open Res 2020; 5:43. [PMID: 32704547 PMCID: PMC7361508 DOI: 10.12688/wellcomeopenres.15726.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2020] [Indexed: 01/07/2023] Open
Abstract
Background: It is commonly observed that humans who are in pain or discomfort seek solace in the form of sweet foods and drinks. Sugar is routinely used to comfort neonates undergoing painful procedures, and animal studies have shown that sucrose increases the time to withdrawal from painful stimuli. However, there are no published studies examining the effects of sweet substances on heat pain thresholds and percept in adult humans. Methods: Healthy adult volunteers (n=27, aged 18-48 years) were recruited to a controlled, double-blind, randomised, cross-over study to characterise the effect of tasting solutions of equivalent sweetness (10% sucrose and 0.016% sucralose) on warm detection and heat pain thresholds and the percept ratings of painfully hot stimuli. The effect of anticipation of a sweet taste on heat pain threshold was also assessed. Results: Tasting either sucrose or sucralose had no significant effect on the percept of an individually titrated hot stimulus (54.5±4.2 and 54.9±3.2 vs 53.2±3.5 for water, 0-100 visual analogue scale), on the warm detection or heat pain threshold (43.3±0.8, 43.2±0.8 vs 43.0±0.8°C). Anticipation of a sweet substance similarly did not affect heat pain thresholds. Conclusions: Sucrose and sucralose solutions had no analgesic effect when assessed using heat detection thresholds and percept ratings of painfully hot stimuli despite being perceived as sweeter and more pleasant than water. These findings are in contrast to results reported from previous animal studies in which thermal analgesia from sweet solutions is robust. Given the ubiquitous availability of sugar rich drinks in the modern environment, the lack of observable effect may be due to an insufficient hedonic value of the test solutions when compared to the experience of a laboratory rodent. Alternatively, sweet tastes may have a specific effect on pain tolerance rather than the threshold and acute percept measures assayed in this study.
Collapse
Affiliation(s)
- Elizabeth R Mooney
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences Building, University of Bristol, Bristol, BS8 1TD, UK,Anaesthesia, Pain & Critical Care Sciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Level 7, Bristol Royal Infirmary, Bristol, BS2 8HW, UK
| | - Alexander J Davies
- Nuffield Department of Clinical Neuroscience, University of Oxford, Level 6 West Wing, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Anthony E Pickering
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences Building, University of Bristol, Bristol, BS8 1TD, UK,Anaesthesia, Pain & Critical Care Sciences, Translational Health Sciences, Bristol Medical School, University of Bristol, Level 7, Bristol Royal Infirmary, Bristol, BS2 8HW, UK,
| |
Collapse
|
8
|
Ranjbar A, Bernstein C, Shariat M, Ranjbar H. Comparison of facilitated tucking and oral dextrose in reducing the pain of heel stick in preterm infants: a randomized clinical trial. BMC Pediatr 2020; 20:162. [PMID: 32290829 PMCID: PMC7155270 DOI: 10.1186/s12887-020-2020-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the increase in hospitalization of premature infants in emergency departments and the painful procedure in these sectors, appropriate methods of pain relief are required. This study aimed to compare the effect of oral dextrose and facilitated tucking in the reduction of pain during heel sticks in premature infants and assess their effectiveness and feasibility for use in emergency settings. METHODS This study was a randomized controlled clinical trial with cross-over design. Sixty infants were recruited from a Neonatal Intensive Care Unit (NICU) at Valiasr hospital in Tehran, Iran from March 2015 to September 2016. They were randomly allocated into three groups (no pain relief method, oral dextrose and facilitated tucking). Six blood samples were collected by heel stick for each infant. Oral dextrose and facilitated tucking were compared with the routine method of blood sampling and pain was measured two times for each method. The pain scores was measured by the Premature Infant Pain Profile (PIPP). Repeated Measure ANOVA, ANOVA and Scheffe post-hoc test were used with SPSS 16. RESULTS The pain score's increase during heel stick was significantly lower after using oral dextrose (3.58 ± 0.34) and facilitated tucking (5.58 ± 0.53) in comparison to the routine method (8.91 ± 0.18) of blood sampling (P < 0.001, η2 = 0.971). Oral dextrose was more effective than facilitated tucking (P < 0.001, Cohen's d = 4.49). The emergency nurses rated oral dextrose as easier (t = 2.20, df = 118, p = 0.02, Cohen's d = 0.39) and more applicable method (t = 2.99, df = 118, p = 0.003, Cohen's d = 0.54) for the emergency department. CONCLUSIONS Facilitated tucking is an effective method of pain reduction which can be used in the absence of oral dextrose, in a situation in which it is contraindicated or in combination with oral dextrose. Based on the increase of infant's admission in emergency department future studies are needed to identify the best method of pain reduction for procedures in this setting. TRIAL REGISTRATION Current Controlled Trials IRCT201408029568N9, 2014-09-08.
Collapse
Affiliation(s)
| | - Colleen Bernstein
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Mamak Shariat
- Materno-Fetal, Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran.
| |
Collapse
|
9
|
McPherson C, Miller SP, El-Dib M, Massaro AN, Inder TE. The influence of pain, agitation, and their management on the immature brain. Pediatr Res 2020; 88:168-175. [PMID: 31896130 PMCID: PMC7223850 DOI: 10.1038/s41390-019-0744-6] [Citation(s) in RCA: 93] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/11/2019] [Accepted: 12/17/2019] [Indexed: 02/07/2023]
Abstract
Preterm infants are exposed to frequent painful procedures and agitating stimuli over the many weeks of their hospitalization in the neonatal intensive care unit (NICU). The adverse neurobiological impact of pain and stress in the preterm infant has been well documented, including neuroimaging and neurobehavioral outcomes. Although many tools have been validated to assess acute pain, few methods are available to assess chronic pain or agitation (a clinical manifestation of neonatal stress). Both nonpharmacologic and pharmacologic approaches are used to reduce the negative impact of pain and agitation in the preterm infant, with concerns emerging over the adverse effects of analgesia and sedatives. Considering benefits and risks of available treatments, units must develop a stepwise algorithm to prevent, assess, and treat pain. Nonpharmacologic interventions should be consistently utilized prior to mild to moderately painful procedures. Sucrose may be utilized judiciously as an adjunctive therapy for minor painful procedures. Rapidly acting opioids (fentanyl or remifentanil) form the backbone of analgesia for moderately painful procedures. Chronic sedation during invasive mechanical ventilation represents an ongoing challenge; appropriate containment and an optimal environment should be standard; when indicated, low-dose morphine infusion may be utilized cautiously and dexmedetomidine infusion may be considered as an emerging adjunct.
Collapse
Affiliation(s)
- Christopher McPherson
- 0000 0000 9953 7617grid.416775.6Department of Pharmacy, St. Louis Children’s Hospital, St. Louis, MO USA ,0000 0001 2355 7002grid.4367.6Department of Pediatrics, Washington University School of Medicine, St. Louis, MO USA
| | - Steven P. Miller
- 0000 0004 0473 9646grid.42327.30Department of Paediatrics, The Hospital for Sick Children and the University of Toronto, Toronto, ON Canada
| | - Mohamed El-Dib
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - An N. Massaro
- 0000 0004 1936 9510grid.253615.6Department of Pediatrics—Neonatology Division, The George Washington University School of Medicine and Children’s National Health System, Washington, DC USA
| | - Terrie E. Inder
- Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| |
Collapse
|
10
|
Abstract
The taste of sucrose is commonly used to provide pain relief in newborn humans and is innately analgesic to neonatal rodents. In adulthood, sucrose remains a strong motivator to feed, even in potentially hazardous circumstances (ie, threat of tissue damage). However, the neurobiological mechanisms of this endogenous reward-pain interaction are unclear. We have developed a simple model of sucrose drinking-induced analgesia in Sprague-Dawley rats (6-10 weeks old) and have undertaken a behavioral and pharmacological characterization using the Hargreaves' test of hind-paw thermal sensitivity. Our results reveal an acute, potent, and robust inhibitory effect of sucrose drinking on thermal nociceptive behaviour that unlike the phenomenon in neonates is independent of endogenous opioid signalling and does not seem to operate through classical descending inhibition of the spinal cord circuitry. Experience of sucrose drinking had a conditioning effect whereby the apparent expectancy of sucrose enabled water alone (in euvolemic animals) to elicit a short-lasting placebo-like analgesia. Sweet taste alone, however, was insufficient to elicit analgesia in adult rats intraorally perfused with sucrose. Instead, the sucrose analgesia phenomenon only appeared after conditioning by oral perfusion in chronically cannulated animals. This sucrose analgesia was completely prevented by systemic dosing of the endocannabinoid CB1 receptor antagonist rimonabant. These results indicate the presence of an endogenous supraspinal analgesic circuit that is recruited by the context of rewarding drinking and is dependent on endocannabinoid signalling. We propose that this hedonic sucrose-drinking model may be useful for further investigation of the supraspinal control of pain by appetite and reward.
Collapse
|
11
|
Smutzer G, Jacob JC, Tran JT, Shah DI, Gambhir S, Devassy RK, Tran EB, Hoang BT, McCune JF. Detection and modulation of capsaicin perception in the human oral cavity. Physiol Behav 2018; 194:120-131. [DOI: 10.1016/j.physbeh.2018.05.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 05/01/2018] [Accepted: 05/06/2018] [Indexed: 12/20/2022]
|
12
|
Repeated exposure to sucrose for procedural pain in mouse pups leads to long-term widespread brain alterations. Pain 2018; 158:1586-1598. [PMID: 28715355 DOI: 10.1097/j.pain.0000000000000961] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
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.
Collapse
|
13
|
Collados-Gómez L, Ferrera-Camacho P, Fernandez-Serrano E, Camacho-Vicente V, Flores-Herrero C, García-Pozo AM, Jiménez-García R. Randomised crossover trial showed that using breast milk or sucrose provided the same analgesic effect in preterm infants of at least 28 weeks. Acta Paediatr 2018; 107:436-441. [PMID: 29150862 DOI: 10.1111/apa.14151] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/20/2017] [Accepted: 11/13/2017] [Indexed: 01/29/2023]
Abstract
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.
Collapse
Affiliation(s)
- L Collados-Gómez
- Department of Neonatology; Hospital Universitario 12 de Octubre; Instituto de investigación Hospital 12 de octubre (i+12); Madrid Spain
| | - P Ferrera-Camacho
- Department of Neonatology; Hospital Universitario Severo Ochoa; Madrid Spain
| | | | - V Camacho-Vicente
- Department of Pediatrics; Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
| | - C Flores-Herrero
- Department of Neonatology; Hospital Universitario Getafe; Madrid Spain
| | - AM García-Pozo
- Department for the Management and Human Nursing Resource Development; Hospital General Universitario Gregorio Marañón; Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM); Madrid Spain
- Centro de Ciencias de la Salud San Rafael; Universidad Antonio de Nebrija Ciencias de la Salud; Madrid Spain
| | - R Jiménez-García
- Department of Medicine and Surgery, Psychology; Preventive Medicine and Public Health and Immunology, and Medical Microbiology; Universidad Rey Juan Carlos; Madrid Spain
| |
Collapse
|
14
|
Nowicka P, Bryngelsson S. Sugars or sweeteners: towards guidelines for their use in practice – report from an expert consultation. SCANDINAVIAN JOURNAL OF FOOD & NUTRITION 2016. [DOI: 10.1080/17482970600774736] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Paulina Nowicka
- Childhood Obesity Unit, Department of PaediatricsUniversity Hospital MalmöSweden
| | | |
Collapse
|
15
|
Hogan ME, Shah VS, Smith RW, Yiu A, Taddio A. Glucose for the management of procedural pain in neonates. Hippokratia 2015. [DOI: 10.1002/14651858.cd009721.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mary-Ellen Hogan
- University of Toronto; Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy; 144 College Street Toronto ON Canada M5S 3M2
| | - Vibhuti S Shah
- University of Toronto; Department of Paediatrics and Institute of Health Policy, Management and Evaluation; 600 University Avenue Toronto ON Canada M5G 1X5
| | - Ryan W Smith
- University of Toronto; Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy; 144 College Street Toronto ON Canada M5S 3M2
| | - Ashley Yiu
- University of Toronto; Leslie Dan Faculty of Pharmacy; 144 College Street Toronto ON Canada M5S 3M2
| | - Anna Taddio
- Hospital for Sick Children Research Institute; Graduate Department of Pharmaceutical Sciences; 555 University Avenue Toronto ON Canada M5G 1X8
| |
Collapse
|
16
|
Abstract
Neonatal abstinence syndrome (NAS) is reaching epidemic proportions related to perinatal use of opioids. There are many approaches to assess and manage NAS, including one we have outlined. A standardized approach is likely to reduce length of stay and variability in practice. Circumcision is a frequent, painful procedure performed in the neonatal period. The rationale for providing analgesia is presented as well as a review of methods. Pharmacogenomics and pharmacogenetics have expanded our understanding of diseases and their drug therapy. Some applications of pharmacogenomics to the neonatal period are presented, along with pediatric challenges of developmental expression of drug-metabolizing enzymes.
Collapse
|
17
|
Nesargi SV, Nithyanandam S, Rao S, Nimbalkar S, Bhat S. Topical anesthesia or oral dextrose for the relief of pain in screening for retinopathy of prematurity: a randomized controlled double-blinded trial. J Trop Pediatr 2015; 61:20-4. [PMID: 25376189 DOI: 10.1093/tropej/fmu058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Compare efficacy of 0.5% proparacaine eye drops and oral 25% dextrose in reducing pain during screening for retinopathy of prematurity (ROP). PATIENTS AND METHODS Double-blinded randomized controlled trial. Twenty eligible babies were randomized. Group I received 0.5% proparacaine eye drops at first ROP screening, while Group II received 25% dextrose orally. At second examination, babies received no intervention. Pain was assessed using Premature Infant Pain Profile (PIPP) score. RESULTS The mean ( ± SD) PIPP during procedure in Group I were 15.5 ± 2.06 and 14 ± 2.4 at first and second screening (p = 0.259). The mean ( ± SD) PIPP in Group II were 14.2 ± 1. 8 and 14.9 ± 2.5 at the first and second screening (p = 0.428). Differences were not statistically significant. The PIPP scores of Group I and Group II at the first screening were also not significantly different (p = 0.165). CONCLUSION ROP screening causes moderate to severe pain and neither proparacaine nor dextrose is an effective analgesic.
Collapse
Affiliation(s)
- Saudamini V Nesargi
- Department of Neonatology, St Johns Medical College Hospital, Bangalore 560034, India
| | - Suneetha Nithyanandam
- Department of Ophthalmology, St Johns Medical College Hospital, Bangalore 560034, India
| | - Suman Rao
- Department of Neonatology, St Johns Medical College Hospital, Bangalore 560034, India
| | - Somashekhar Nimbalkar
- Department of Neonatology, St Johns Medical College Hospital, Bangalore 560034, India
| | - Swarnarekha Bhat
- Department of Neonatology and Pediatrics, Mazumdhar Shaw Medical Centre, Narayana Health city, Bangalore, India
| |
Collapse
|
18
|
Suhrabi Z, Taghinejad H, Valian K, Sayehmiri K, Taheri S. A comparative study on the efficacy of glucose and sucrose on the vaccination pain: a randomized controlled clinical trial. J Clin Diagn Res 2014; 8:PC01-3. [PMID: 25478418 DOI: 10.7860/jcdr/2014/10057.5053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/26/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study was performed to compare the effectiveness of two analgesics for the management of vaccination pain. MATERIALS AND METHODS A total of 90 neonates to be vaccinated against Hepatitis B were assigned to Glucose, Sucrose and control groups at Shahid Mostafa Khomini hospital. 2cc oral Glucose 25% and 2cc oral Sucrose 25% with Syringe were given for 30 sec then 2 min later Hepatitis-B vaccine injected by vaccinator and pain intensity measured by Neonatal Infant Pain Scale (NIPS) during 1-2 min. The third group (control) no intervention was performed. The collected data were analysed by SPSS18 Software and ANOVA and LSD tests were used. RESULTS Research results showed that there were no significant differences between groups in term of Apgar score, delivery type, sex, head circumstance, weight and height. By comparison of pain severity in two groups, mean and Standard deviation of pain, group that received Glucose solution had more intensity than Sucrose group (3 ± 1.66 vs. 2.90 ± 1.44), but this difference was not significant statistically (p=0.78). Comparison of pain intensity in control and intervention groups showed that the pain intensity in control group is higher than intervention groups (p<0.001). CONCLUSION Patients who received Glucose or Sucrose had lower pain intensity in comparison with the other. The pain intensity in patients who received sucrose was less than the glucose group, but this difference was not significant statistically.
Collapse
Affiliation(s)
- Zainab Suhrabi
- Lecturer, Department of Midwifery, Ilam University of Medical Sciences , Ilam, IR Iran
| | - Hamid Taghinejad
- Assistant Professor, Department of Nursing, Ilam University of Medical Sciences , Ilam, IR Iran
| | - Kobra Valian
- Lecturer, Shahid Mostafa Khomieni (PBUH) Hospital, Ilam University of Medical Sciences , Ilam, IR Iran
| | - Kourosh Sayehmiri
- Associate Professor, Prevention of psychosocial injuries research center, Ilam University of Medical Sciences , Ilam, IR Iran
| | - Safoura Taheri
- Lecturer, Department of Midwifery, Ilam University of Medical Sciences , Ilam, IR Iran
| |
Collapse
|
19
|
Shahlaee A, Farahanchi A, Javadi S, Delfan B, Dehpour AR. Sucrose-induced analgesia in mice: role of nitric oxide and opioid receptor-mediated system. Indian J Pharmacol 2014; 45:593-6. [PMID: 24347767 PMCID: PMC3847249 DOI: 10.4103/0253-7613.121370] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 07/31/2013] [Accepted: 08/14/2013] [Indexed: 11/05/2022] Open
Abstract
Background: The mechanism of action of sweet substance-induced analgesia is thought to involve activation of the endogenous opioid system. The nitric oxide (NO) pathway has a pivotal role in pain modulation of analgesic compounds such as opioids. Objectives: We investigated the role of NO and the opioid receptor-mediated system in the analgesic effect of sucrose ingestion in mice. Materials and Methods: We evaluated the effect of intraperitoneal administration of 10 mg/kg of NO synthase inhibitor, N-nitro-L-arginine methyl ester (L-NAME) and 20 mg/kg of opioid receptor antagonist, naltrexone on the tail flick response in sucrose ingesting mice. Results: Sucrose ingestion for 12 days induced a statistically significant increase in the latency of tail flick response which was unmodified by L-NAME, but partially inhibited by naltrexone administration. Conclusions: Sucrose-induced nociception may be explained by facilitating the release of endogenous opioid peptides. Contrary to some previously studied pain models, the NO/cyclic guanosine monophosphate (cGMP) pathway had no role in thermal hyperalgesia in our study. We recommend further studies on the involvement of NO in other animals and pain models.
Collapse
Affiliation(s)
- Abtin Shahlaee
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran ; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Farahanchi
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shiva Javadi
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bahram Delfan
- Department of Pharmacology, Lorestan University of Medical Sciences, Faculty of Medicine, Khoram Abad, Iran
| | - Ahmad Reza Dehpour
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
20
|
Abstract
Preclinical and clinical studies have demonstrated the adverse consequences of untreated pain and stress on brain development in the preterm infant. Sucrose has widely been implemented as standard therapy for minor procedural pain. Anesthetics are commonly utilized in preterm infants during major surgery. Pharmacologic agents (benzodiazepines and opioids) have been examined in clinical trials of preterm infants requiring invasive mechanical ventilation. Controversy exists regarding the safety and long-term impact of these interventions. Ongoing multidisciplinary research will help define the impact of these agents and identify potential alternative therapies.
Collapse
|
21
|
Costa P, Bueno M, Oliva CL, Elci de Castro T, Ponce de Camargo P, Kimura AF. [Analgesia and sedation during placement of peripherally inserted central catheters in neonates]. Rev Esc Enferm USP 2013; 47:801-7. [PMID: 24310675 DOI: 10.1590/s0080-623420130000400005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 03/09/2013] [Indexed: 11/22/2022] Open
Abstract
This study aimed to characterize the analgesia and sedation strategies in neonates having a peripherally inserted central catheter (PICC) placed, and to relate it to the number of venipunctures, duration of procedure and catheter tip position. This was a cross-sectional study with prospective data collection, conducted in a neonatal intensive care unit of a private hospital in the city of São Paulo, during the period from August 31, 2010 to July 1, 2011, which evaluated 254 PICC insertions. The adoption of analgesic or sedative strategies occurred in 88 (34.6%) catheter placements and was not related to the number of venipunctures, duration of procedure or catheter tip position. Intravenous administration of midazolam, in 47 (18.5%), and fentanyl, in 19 (7.3%), catheter insertions were the most frequent strategies. Wider adoption of analgesic strategies is recommended before, during and after the procedure.
Collapse
Affiliation(s)
- Priscila Costa
- Laboratório de Ensino, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, Escola de Enfermagem, Universidade de São Paulo, São PauloSP, Brasil,
| | | | | | | | | | | |
Collapse
|
22
|
Marín Gabriel MÁ, del Rey Hurtado de Mendoza B, Jiménez Figueroa L, Medina V, Iglesias Fernández B, Vázquez Rodríguez M, Escudero Huedo V, Medina Malagón L. Analgesia with breastfeeding in addition to skin-to-skin contact during heel prick. Arch Dis Child Fetal Neonatal Ed 2013; 98:F499-503. [PMID: 23839984 DOI: 10.1136/archdischild-2012-302921] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the analgesic effect (measured with Neonatal Infant Pain Scale (NIPS)) of breastfeeding (BF) in addition to skin-to-skin contact (SSC) versus other methods of non-pharmacological analgesia during blood sampling through heel lance in healthy term neonates. DESIGN Randomised controlled trial. SETTING Tertiary level maternity ward. PATIENTS One hundred thirty-six healthy term newborns. INCLUSION CRITERIA healthy term neonates, wish to breastfeed and absence of feeding during the previous 60 min. INTERVENTION Neonates were randomly assigned to four groups: Group breastfed with SSC (BF+SSC Group) (n=35); Group sucrose with SSC (Sucrose+SSC Group) (n=35); SSC Group (n=33); or Sucrose Group (n=33). Babies were recorded with a video camera. OUTCOME MEASURES Three observers watched the videos and measured NIPS score at three time points (t0: 2 min before heel prick; t1: During heel prick; and t2: 2 min after the heel prick). The influences of non-pharmacological methods on crying time, percentage of crying while sampling, heart rate, number of attempts and duration of sampling were also studied. RESULTS BF+SSC Group achieved a significant lower median NIPS score (value=1) compared with other groups (value=2, 4 and 4, respectively). The percentage of neonates with moderate-to-severe pain was also lower in the BF+SSC Group. Both groups BF+SSC and Sucrose+SSC achieved a significant lower percentage of crying compared with SSC Group. CONCLUSIONS This study suggests that BF in addition to SSC provides superior analgesia to other kinds of non-pharmacological analgesia in healthy term neonates during heel prick.
Collapse
|
23
|
Nimbalkar S, Sinojia A, Dongara A. Reduction of neonatal pain following administration of 25% lingual dextrose: a randomized control trial. J Trop Pediatr 2013; 59:223-5. [PMID: 23264069 DOI: 10.1093/tropej/fms072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Neonates experience painful procedures during routine care. Orally administered, sweet tasting solutions are commonly used in management of neonatal pain. We conducted a double-blind randomized control trial in neonates admitted to Neonatal Intensive Care Unit of Shri Krishna Hospital, Karamsad-Gujarat-India, of lingual administration of 25% dextrose vs. no intervention, to evaluate reduction of pain following oropharyngeal infant feeding tube insertions. Pain was assessed using Premature Infant Pain Profile score. Almost all the patients in the control group (98%) experienced moderate-to-severe pain as compared with the intervention group (71%). Mean Premature Infant Pain Profile score was statistically significantly lower in the intervention group (8.21) as compared with control group (10.31). (p < 0.001, 95% CI 1.090-3.102). Lingual 25% dextrose is an effective analgesic for relieving pain during orogastric tube insertion.
Collapse
Affiliation(s)
- Somashekhar Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad 388325, Anand, Gujarat, India
| | | | | |
Collapse
|
24
|
Costa MCD, Eckert GU, Fortes BGB, Fortes Filho JB, Silveira RC, Procianoy RS. Oral glucose for pain relief during examination for retinopathy of prematurity: a masked randomized clinical trial. Clinics (Sao Paulo) 2013; 68:199-204. [PMID: 23525316 PMCID: PMC3584268 DOI: 10.6061/clinics/2013(02)oa13] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Accepted: 10/23/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Ophthalmologic examination for retinopathy of prematurity is a painful procedure. Pharmacological and non-pharmacological interventions have been proposed to reduce pain during eye examinations. This study aims to evaluate the analgesic effect of 25% glucose using a validated pain scale during the first eye examination for retinopathy of prematurity in preterm infants with birth weight <1,500 g and/or gestational age <32 weeks. METHODS A masked, randomized clinical trial for one dose of 1 ml of oral 25% glucose solution 2 minutes before the first ophthalmologic examination for retinopathy of prematurity was conducted between March 2008 and April 2010. The results were compared to those of a control group that did not receive oral glucose solution. Pain was evaluated using a Neonatal Infant Pain Scale immediately before and immediately after the ophthalmologic examination in both groups. Clinicaltrials.gov: NCT00648687 RESULTS One hundred and twenty-four patients who were examined for the first time for retinopathy of prematurity were included. Seventy were included in the intervention group and 54 in the control group. The number of patients with pain immediately before the procedure was similar in both groups. The number of patients with pain after ophthalmologic examination was 15.7% in the intervention group and 68.5% in the control group (p<0.001). CONCLUSIONS One ml of oral 25% glucose solution given 2 minutes before an ophthalmologic examination for retinopathy of prematurity was an effective measure for pain relief.
Collapse
Affiliation(s)
- Marlene Coelho da Costa
- Newborn Section, Departments of Pediatrics and Ophthalmology, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | | | | | | | | |
Collapse
|
25
|
Mekkaoui N, Issef I, Kabiri M, Barkat A. Analgesic effect of 30% glucose, milk and non-nutritive sucking in neonates. J Pain Res 2012. [PMID: 23204867 PMCID: PMC3508663 DOI: 10.2147/jpr.s30665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to evaluate nondrug management practices concerning pain induced by blood sampling in newborns in a Moroccan neonatal unit and to determine whether the results reported from a randomized clinical study of nondrug analgesia could be reproduced in a routine care setting. Methods Standardized prospective observation of analgesic practices used during blood sampling was performed. Pain was assessed using the Douleur Aiguë Nouveau-né (DAN, [Newborn Acute Pain]) scale that incorporates facial expression, vocal expression, and limb movements of the newborn during realization of a painful procedure. Five different nondrug analgesic practices were investigated in 125 infants. Results Median DAN scores for the five methods were 6 (1–10) for venous sampling with oral administration of 30% glucose, 5 (1–10) for venous sampling with sucking, 3 (0–6) for venous sampling with oral administration of 30% glucose combined with sucking, 4 (0–10) for venous sampling with oral administration of 30% glucose combined with sucking and administration of 2 mL of adapted infant formula, and 6 (3–8) for venous sampling with administration of 2 mL of adapted infant formula. Conclusion Oral administration of 30% glucose combined with sucking provided better control of pain induced by blood sampling in newborns at our neonatal unit.
Collapse
Affiliation(s)
- Nour Mekkaoui
- Neonatology and Intensive Care Unit, National Reference Center in Neonatology and Nutrition, Children's Hospital of Rabat, Rabat
| | | | | | | |
Collapse
|
26
|
Abstract
The use of oral sucrose has been the most extensively studied pain intervention in newborn care to date. More than 150 published studies relating to sweet-taste-induced calming and analgesia in human infants have been identified, of which 100 (65%) include sucrose. With only a few exceptions, sucrose, glucose, or other sweet solutions reduced pain responses during commonly performed painful procedures in diverse populations of infants up to 12 months of age. Sucrose has been widely recommended for routine use during painful procedures in newborn and young infants, yet these recommendations have not been translated into consistent use in clinical practice. One reason may be related to important knowledge and research gaps concerning analgesic effects of sucrose. Notably, the mechanism of sweet-taste-induced analgesia is still not precisely understood, which has implications for using research evidence in practice. The aim of this article is to review what is known about the mechanisms of sucrose-induced analgesia; highlight existing evidence, knowledge gaps, and current controversies; and provide directions for future research and practice.
Collapse
Affiliation(s)
- Denise Harrison
- Centre for Practice Changing Research, Children’s Hospital of Eastern Ontario, Ottawa, Canada.
| | | | | |
Collapse
|
27
|
The Cochrane Libraryand procedural pain in children: an overview of reviews. ACTA ACUST UNITED AC 2012. [DOI: 10.1002/ebch.1864] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
28
|
Gray L, Lang CW, Porges SW. Warmth is analgesic in healthy newborns. Pain 2012; 153:960-966. [PMID: 22424877 PMCID: PMC4219317 DOI: 10.1016/j.pain.2011.12.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Revised: 12/14/2011] [Accepted: 12/20/2011] [Indexed: 11/26/2022]
Abstract
This study identifies a behavioral and nonpharmacologic means of preventing and reducing newborn pain. Our objective was to determine whether warmth is analgesic in newborn infants undergoing vaccination-a routine painful hospital procedure. We used a prospective randomized controlled trial of 47 healthy full-term newborn infants. Infants were randomized into 1 of 3 conditions prior to vaccination: warmth exposure, pacifier suckling, or sucrose taste. Crying, grimacing, and heart rate differences were analyzed between groups before, during, and after vaccination as outcome measures. Warmer infants cried significantly less than sucrose taste or pacifier suckling after vaccination. Heart rate patterns reflected this analgesia. Core temperature did not differ between study groups. Providing natural warmth to newborn infants during a painful procedure decreases the crying and grimacing on par with the "gold" standard treatments of sucrose or pacifier.
Collapse
Affiliation(s)
- Larry Gray
- Developmental & Behavioral Pediatrics, Department of Pediatrics, University of Chicago Comer Children’s Hospital, 950 E. 61 Street, Suite 207, Chicago, IL 60637
| | - Colleen W. Lang
- Developmental & Behavioral Pediatrics, Department of Pediatrics, University of Chicago Comer Children’s Hospital, 950 E. 61 Street, Suite 207, Chicago, IL 60637
| | - Stephen W. Porges
- Director, Brain-Body Center, Department of Psychiatry, University of Illinois at Chicago, The Psychiatric Institute (MC 912), 1601 W. Taylor Street, Chicago, IL 60612, Office 312 355-1557
| |
Collapse
|
29
|
Abstract
Pain is harmful to newborn infants. Oral sucrose is safe, inexpensive, and effective at preventing and reducing pain in hospitalized babies who undergo invasive procedures. The sugar can be used alone or in combination with analgesics and other nonpharmacological interventions to provide analgesia. Parents expect nurses to serve as pain advocates for the parents' newborns and to protect the babies from needless suffering. It is incumbent upon nurses to stay abreast of the current evidence and integrate use of oral sucrose into daily pain management practice in emergency, acute, and critical care units.
Collapse
|
30
|
Hogan ME, Shah VS, Smith RW, Yiu A, Taddio A. Glucose for the management of procedural pain in neonates. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd009721] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
|
31
|
Raeside L. Physiological measures of assessing infant pain: a literature review. ACTA ACUST UNITED AC 2011; 20:1370-6. [DOI: 10.12968/bjon.2011.20.21.1370] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lavinia Raeside
- Neonatal Intensive Care Unit, Greater Glasgow and Clyde, Royal Hospital for Sick Children, Yorkhill, Southern General Hospital, Glasgow
| |
Collapse
|
32
|
Procedural pain management for neonates using nonpharmacological strategies: Part 1: sensorial interventions. Adv Neonatal Care 2011; 11:235-41. [PMID: 22123343 DOI: 10.1097/anc.0b013e318225a2c2] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neonates who are born preterm and are admitted to neonatal intensive care units endure frequent procedures that may be painful. Nonpharmacological interventions that have been studied to relieve their pain may be categorized in 2 main groups according to their nature: interventions that focus on creating a favorable environment and offering pleasant sensorial stimuli and interventions that are centered on maternal care. These interventions may be considered within the philosophy of developmental care, since they are aimed at adjusting the environment to the needs of the neonate and involve family-centered care. In this article, the first of a 2-part series, we will synthesize the evidence from experimental studies of interventions that focus on the environment and on tactile and gustatory stimulation. The mechanisms suggested by researchers as possible explanations for the efficacy of these interventions are pointed, and the implications for procedural pain management in neonatal care are drawn.
Collapse
|
33
|
|
34
|
Johnston CC, Fernandes AM, Campbell-Yeo M. Pain in neonates is different. Pain 2010; 152:S65-S73. [PMID: 20971562 DOI: 10.1016/j.pain.2010.10.008] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 09/30/2010] [Accepted: 10/05/2010] [Indexed: 12/16/2022]
Abstract
Pain processing and management in neonates, especially preterm neonates, differs from older populations. In this review, a brief background on pain processing in neonatal life, pain exposure in Neonatal Intensive Care Units (NICU), the consequences of untreated pain, and the difficulties in treating procedural pain pharmacologically will be presented. A more detailed review of non-pharmacological interventions for procedural pain in neonates will include sensory stimulation approaches, oral sweet solutions, and maternal interventions. Some possible mechanisms for the effectiveness of non-pharmacological interventions are offered. Finally, avenues of research into similar interventions as adjuvant therapies or drug-sparing effects in older populations are suggested.
Collapse
Affiliation(s)
- Celeste C Johnston
- McGill University School of Nursing, Montreal, Canada Coimbra School of Nursing, Coimbra, Portugal IWK Health Centre, Halifax, Canada
| | | | | |
Collapse
|
35
|
De Lima J, Carmo KB. Practical pain management in the neonate. Best Pract Res Clin Anaesthesiol 2010; 24:291-307. [DOI: 10.1016/j.bpa.2010.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
|
36
|
Fortuna JL. Sweet Preference, Sugar Addiction and the Familial History of Alcohol Dependence: Shared Neural Pathways and Genes. J Psychoactive Drugs 2010; 42:147-51. [DOI: 10.1080/02791072.2010.10400687] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
37
|
Abstract
Preterm and critically ill newborns admitted to a NICU undergo repeated skin-breaking procedures that are necessary for their survival. Sucrose is rapidly becoming the accepted clinical standard nonpharmacologic intervention for managing acute procedural pain for these infants. Although shown to be safe in single doses, only 4 studies have evaluated the effects of repeated doses of sucrose over relatively short periods of time. None has examined the use of sucrose throughout the NICU stay, and only 1 study evaluated the neurodevelopmental outcomes after repeated doses of sucrose. In that study, infants born at <31 weeks' gestational age and exposed to >10 doses per day in the first week of life were more likely to show poorer attention and motor development in the early months after discharge from the NICU. Results of studies in animal models have suggested that the mechanism of action of sucrose is through opioid pathways; however, in human infants, little has been done to examine the physiologic mechanisms involved, and the findings reported thus far have been ambiguous. Drawing from the growing animal literature of research that has examined the effects of chronic sugar exposure, we describe alternative amine and hormone pathways that are common to the processing of sucrose, attention, and motor development. In addition, a review of the latest research to examine the effects of repeated sucrose on pain processing is presented. These 2 literatures each can inform the other and can provide an impetus to initiate research to examine not only the mechanisms involved in the calming mechanisms of sucrose but also in the long-term neurodevelopmental effects of repeated sucrose in those infants born extremely preterm or critically ill.
Collapse
Affiliation(s)
- Liisa Holsti
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada.
| | - Ruth E. Grunau
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
38
|
Liu MF, Lin KC, Chou YH, Lee TY. Using non-nutritive sucking and oral glucose solution with neonates to relieve pain: a randomised controlled trial. J Clin Nurs 2010; 19:1604-11. [PMID: 20384669 DOI: 10.1111/j.1365-2702.2009.03014.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
AIM To compare the efficacies of non-nutritive sucking and glucose solution as pain-relief interventions for neonates undergoing a venipuncture procedure. BACKGROUND Neonates may be subjected to painful procedures. The individual efficacies of non-nutritive sucking or oral glucose solution used alone on pain-relief for neonates still remain controversial. DESIGN A randomised, parallel-group controlled trial was designed. METHODS A total of 105 neonates were randomly assigned to one of the three groups: non-nutritive sucking, glucose solution, or control group. When a neonate underwent a venipuncture during a newborn screening test, his/her pain manifestations were videotaped and subsequently measured using the Neonatal Infant Pain Scale. Both the stability analysis and the analysis of repeated relationships were performed by generalised estimating equations. RESULTS The level of pain was regressed over the study variables (time and group) and covariate (gestational age). Both the non-nutritive sucking and glucose solution groups had significantly lower pain scores than the control group during the venipuncture and recovery phases. Furthermore, non-nutritive sucking seemed to be more effective than glucose solution. CONCLUSION Nurses can use a pain assessment tool and the pain-relief intervention to improve the quality of neonatal care in clinical practice. This study indicates that either non-nutritive sucking or glucose solution can effectively decrease the level of pain. RELEVANCE TO CLINICAL PRACTICE If a painful procedure on neonates is inevitable, simple, convenient and effective pain-relief methods such as non-nutritive sucking or glucose solution can be provided alone. Based on a neonate's condition, nurses can provide 2 ml of 25% glucose solution through a syringe for a breastfeeding infant before an invasive procedure if nipple confusion is the concern.
Collapse
Affiliation(s)
- Mei-Fang Liu
- Department of Nursing, National Taipei College of Nursing, Taipei, Taiwan, China
| | | | | | | |
Collapse
|
39
|
Kassab M, Foster JP, Foureur M, Fowler C. Sweet-tasting solutions for needle-related procedural pain in infants one month to one year of age. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2010. [DOI: 10.1002/14651858.cd008411] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
40
|
Fernandes RM, van der Lee JH, Offringa M. A systematic review of the reporting of Data Monitoring Committees' roles, interim analysis and early termination in pediatric clinical trials. BMC Pediatr 2009; 9:77. [PMID: 20003383 PMCID: PMC2801486 DOI: 10.1186/1471-2431-9-77] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Accepted: 12/13/2009] [Indexed: 12/15/2022] Open
Abstract
Background Decisions about interim analysis and early stopping of clinical trials, as based on recommendations of Data Monitoring Committees (DMCs), have far reaching consequences for the scientific validity and clinical impact of a trial. Our aim was to evaluate the frequency and quality of the reporting on DMC composition and roles, interim analysis and early termination in pediatric trials. Methods We conducted a systematic review of randomized controlled clinical trials published from 2005 to 2007 in a sample of four general and four pediatric journals. We used full-text databases to identify trials which reported on DMCs, interim analysis or early termination, and included children or adolescents. Information was extracted on general trial characteristics, risk of bias, and a set of parameters regarding DMC composition and roles, interim analysis and early termination. Results 110 of the 648 pediatric trials in this sample (17%) reported on DMC or interim analysis or early stopping, and were included; 68 from general and 42 from pediatric journals. The presence of DMCs was reported in 89 of the 110 included trials (81%); 62 papers, including 46 of the 89 that reported on DMCs (52%), also presented information about interim analysis. No paper adequately reported all DMC parameters, and nine (15%) reported all interim analysis details. Of 32 trials which terminated early, 22 (69%) did not report predefined stopping guidelines and 15 (47%) did not provide information on statistical monitoring methods. Conclusions Reporting on DMC composition and roles, on interim analysis results and on early termination of pediatric trials is incomplete and heterogeneous. We propose a minimal set of reporting parameters that will allow the reader to assess the validity of trial results.
Collapse
Affiliation(s)
- Ricardo M Fernandes
- Departamento da Criança e da Família, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte-EPE, Laboratório de Farmacologia Clínica e Terapêutica, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Portugal.
| | | | | |
Collapse
|
41
|
Use of facilitated tucking for nonpharmacological pain management in preterm infants: a systematic review. J Perinat Neonatal Nurs 2009; 23:372-7. [PMID: 19915422 DOI: 10.1097/jpn.0b013e3181bdcf77] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Neonatal care demands attention to interventions that effectively reduce pain with pharmacological and nonpharmacological methods in preterm infants during invasive procedures. PURPOSE The aim of this systematic review was to determine the efficacy of facilitated tucking as nonpharmacological pain management in preterm infants. METHOD Electronic searches were conducted using the following databases: Ovid, Blackwell Synergy, ScienceDirect, PsychINFO, and CINAHL and with the following key words: facilitated tucking, preterm infant's pain responses, and randomized clinical trials for the period of 1995 to May 2008. RESULTS The search generated 15 articles; 5 articles fit to the criteria of the systematic review. The following outcomes were statistically significant: heart rate; increase in oxygen saturation; sleep-wake state; Premature Infant Pain Profile scores; and neonate infant pain scores. CONCLUSION The studies reviewed provide important preliminary findings that suggest facilitated tucking may be beneficial to preterm infants in attenuating their responses to painful procedures.
Collapse
|
42
|
Iturriaga GS, Unceta-Barrenechea AA, Zárate KS, Olaechea IZ, Núñez AR, Rivero MMR. [Analgesic effect of breastfeeding when taking blood by heel-prick in newborns]. An Pediatr (Barc) 2009; 71:310-3. [PMID: 19762295 DOI: 10.1016/j.anpedi.2009.06.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 06/24/2009] [Accepted: 06/28/2009] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the analgesic effectiveness of breastfeeding when taking blood by the heel-lance procedure in healthy newborns, as opposed to other procedures. PATIENTS AND METHODS We studied 228 term infants from the Maternity Unit of our Hospital. The study was developed in two consecutive phases. In the first stage, 150 newborns were distributed into three randomised groups, the first group (50 newborns) did not receive any specific analgesic intervention; the second and third groups (50 newborns) received non-nutritive sucking-placebo or non-nutritive sucking-24% sucrose respectively. In the second phase, 78 newborns participated, and the blood was taken during breast-feeding. The results on a discomfort scale were compared with those obtained in the rest of examined analgesic procedures. RESULTS The group that received analgesia with breast-feeding showed a score on the discomfort scale of 0'62 and an average time of crying of 0'19s. The comparative analysis of the results obtained during breastfeeding, as opposed to the rest of procedures, showed that breast-feeding is the best analgesic option, with a reduction in the discomfort of 51% and of 98% in the time of crying (P<0,001). CONCLUSIONS Breast-feeding during the blood test by heel-prick procedure represents the most effective analgesic method. A containment procedure along with non-nutritive sucking is the analgesic method of choice in the newborn that does not receive maternal lactation.
Collapse
|
43
|
Harrison D, Loughnan P, Manias E, Johnston L. Analgesics Administered During Minor Painful Procedures in a Cohort of Hospitalized Infants: A Prospective Clinical Audit. THE JOURNAL OF PAIN 2009; 10:715-22. [DOI: 10.1016/j.jpain.2008.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2008] [Revised: 12/05/2008] [Accepted: 12/17/2008] [Indexed: 10/20/2022]
|
44
|
Cohen LL. Behavioral approaches to anxiety and pain management for pediatric venous access. Pediatrics 2008; 122 Suppl 3:S134-9. [PMID: 18978007 DOI: 10.1542/peds.2008-1055f] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Pediatric venous access causes unnecessary anxiety and pain in children and, in turn, can have detrimental consequences. Behavioral approaches to pediatric venous access distress management can be organized temporally. Specifically, preparation before the procedure includes providing children with sensory and procedural information in an age-appropriate manner and providing training in coping skills. It is important to consider the timing, format, and content of the approach to provide optimal preparation for the unique circumstances of the individual patient. In addition to the child patient, preparing parents and teaching them which specific behaviors might be most helpful to their child should prove valuable to both patient and parents. During the procedure, there are benefits to providing secure and comfortable positioning. In addition, researchers recommend that adults encourage children to cope and actively engage children in distracting activities. For infants, there is support for the distress-mitigation properties of swaddling, skin-to-skin contact, breastfeeding, and sucrose. After venous access, distraction and encouragement of coping should speed recovery. In sum, research in behavioral approaches to pediatric pain management has provided recommendations for minimizing children's anxiety and pain associated with venous access.
Collapse
Affiliation(s)
- Lindsey L Cohen
- Department of Psychology, Georgia State University, Atlanta, GA 30302-5010, USA.
| |
Collapse
|
45
|
Codipietro L, Ceccarelli M, Ponzone A. Breastfeeding or oral sucrose solution in term neonates receiving heel lance: a randomized, controlled trial. Pediatrics 2008; 122:e716-21. [PMID: 18762508 DOI: 10.1542/peds.2008-0221] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The purpose of this work was to compare the efficacy of breastfeeding versus orally administered sucrose solution in reducing pain response during blood sampling through heel lance. METHODS; We conducted an open-label, randomized, controlled trial at a neonatal unit of a public hospital in northern Italy on 101 term neonates undergoing heel lance with an automated piercing device for routine neonatal screening for congenital disorders. Newborn infants were randomly assigned to breastfeeding during blood sampling or to the oral administration of 1 mL of 25% sucrose solution. We validated the multidimensional acute pain rating scale of the Premature Infant Pain Profile, heart rate increase, oxygen saturation decrease, crying behavior (duration of first cry, cry percentage in 2 minutes, and during blood sampling), duration of sampling, and the number of performed heel lances. RESULTS Median Premature Infant Pain Profile scores were lower in the breastfeeding group (3.0) than in the sucrose-solution group (8.5), and the median group difference was -5.0. The median heart rate increase, oxygen saturation decrease, and duration of first cry for the breastfeeding group were, respectively, 13.0, -1, and 3 and for sucrose group were 22, -3, and 21. Medians were significantly different between the groups. There were no significant differences in the sampling duration and numbers of heel lances. CONCLUSIONS This study suggests that breastfeeding provides superior analgesia for heel lance compared with oral sucrose in term neonates.
Collapse
Affiliation(s)
- Luigi Codipietro
- ASL 10 Agnelli Hospital, Stradale Fenestrelle 72, Pinerolo 10064, Italy.
| | | | | |
Collapse
|
46
|
Mörelius E, Theodorsson E, Nelson N. Stress at three-month immunization: parents' and infants' salivary cortisol response in relation to the use of pacifier and oral glucose. Eur J Pain 2008; 13:202-8. [PMID: 18486508 DOI: 10.1016/j.ejpain.2008.03.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2007] [Revised: 03/10/2008] [Accepted: 03/31/2008] [Indexed: 11/27/2022]
Abstract
The aims of the present study were to investigate (1) whether the salivary cortisol response could be dampened during a routine three-month immunization if the infant received sweet-tasting solution in combination with a pacifier and (2) stress experienced by parents during immunization of the infant. Ninety-eight infants were included into one of four intervention groups: 'glucose and pacifier', 'water and pacifier', 'glucose', or 'water'. Saliva was collected before and 30 min after the immunization. Infants' crying-time and parents' self-reported stress (VAS) were measured before and after immunization. Infants in the 'pacifier and glucose' group had a significantly smaller change in salivary cortisol than infants in the other groups (F(3,72)=3.1, p<0.05). In the 'glucose and pacifier' group the median salivary cortisol levels decreased 33% after the immunization. In the 'water and pacifier', 'glucose', and 'water' group median cortisol increased with 50%, 42%, and 8%, respectively. No significant differences in crying-time were observed between the intervention groups. If the infant cried before the immunization, the crying-time during the immunization was longer (p<0.01) and cortisol increased more (p<0.05). Median cortisol levels for parents decreased after the immunization (p<0.01). Median VAS increased 50% (p<0.0001) after immunization. First time parents rated higher stress on VAS before immunization (p<0.01). Parents' change in cortisol and VAS were significantly related to infants' crying time. In conclusion, the combination of oral glucose and pacifier dampen infants' salivary cortisol in response to the three-month immunization.
Collapse
Affiliation(s)
- Evalotte Mörelius
- Department of Molecular and Clinical Medicine, Division of Pediatrics, Linköping University Hospital, SE-581 85 Linköping, Sweden.
| | | | | |
Collapse
|
47
|
Evaluation of analgesic effect of skin-to-skin contact compared to oral glucose in preterm neonates. Pain 2008; 139:28-33. [PMID: 18434021 DOI: 10.1016/j.pain.2008.02.031] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2007] [Revised: 01/26/2008] [Accepted: 02/26/2008] [Indexed: 11/21/2022]
Abstract
Nonpharmacological interventions are important alternatives for pain relief during minor procedures in preterm neonates. Skin-to-skin contact or kangaroo mother care is a human and efficient way of caring for low-weight preterm neonates. The aim of the present study was to assess the analgesic effect of kangaroo care compared to oral glucose on the response of healthy preterm neonates to a low-intensity acute painful stimulus. Ninety-five preterm neonates with a postmenstrual age of 28-36 weeks were randomly assigned to three groups in a single-blind manner. In group 1 (isolette, n=33), the neonate was in the prone position in the isolette during heel lancing and did not receive analgesia. In group 2 (kangaroo method, n=31), the neonate was held in skin-to-skin contact for 10 min before and during the heel-lancing procedure. In group 3 (glucose, n=31), the neonate was in the prone position in the isolette and received oral glucose (1 ml, 25%) 2 min before heel lancing. A smaller variation in heart rate (p=0.0001) and oxygen saturation (p=0.0012), a shorter duration of facial activity (brow bulge, eye squeeze and nasolabial furrowing) (p=0.0001), and a lower PIPP (Premature Infant Pain Profile) score (p=0.0001) were observed in group 2. In conclusion, skin-to-skin contact produced an analgesic effect in preterm newborns during heel lancing.
Collapse
|
48
|
Buscemi N, Vandermeer B, Curtis S. The Cochrane Library and Procedural Pain in Children: An Overview of Reviews. ACTA ACUST UNITED AC 2008. [DOI: 10.1002/ebch.225] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
49
|
Curtis SJ, Jou H, Ali S, Vandermeer B, Klassen T. A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venipuncture in a pediatric emergency department. BMC Pediatr 2007; 7:27. [PMID: 17640375 PMCID: PMC1950500 DOI: 10.1186/1471-2431-7-27] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2006] [Accepted: 07/18/2007] [Indexed: 11/30/2022] Open
Abstract
Background Although sucrose has been accepted as an effective analgesic agent for procedural pain in neonates, previous studies are largely in the NICU population using the procedure of heel lance. This is the first report of the effect of sucrose, pacifier or the combination thereof for the procedural pain of venipuncture in infants in the pediatric emergency department population. Methods The study design was a double (sucrose) and single blind (pacifier), placebo-controlled randomized trial – factorial design carried out in a pediatric emergency department. The study population was infants, aged 0 – 6 months. Eighty-four patients were randomly assigned to one of four groups: a) sucrose b) sucrose & pacifier c) control d) control & pacifier. Each child received 2 ml of either 44% sucrose or sterile water, by mouth. The primary outcome measure: FLACC pain scale score change from baseline. Secondary outcome measures: crying time and heart rate change from baseline. Results Sucrose did not significantly reduce the FLACC score, crying time or heart rate. However sub-group analysis revealed that sucrose had a much greater effect in the younger groups. Pacifier use reduced FLACC score (not statistically significant), crying times (statistically significant) but not heart rate. Subgroup analysis revealed a mean crying time difference of 76.52 seconds (p < 0.0171) (0–1 month) and 123.9 seconds (p < 0.0029) (1–3 month). For subgroup age > 3 months pacifier did not have any significant effect on crying time. Age adjusted regression analysis revealed that both sucrose and pacifier had significant effects on crying time. Crying time increased with both increasing age and increasing gestational age. Conclusion Pacifiers are inexpensive, effective analgesics and are easy to use in the PED for venipuncture in infants aged 0–3 months. The benefits of sucrose alone as an analgesic require further investigation in the older infant, but sucrose does appear to provide additional benefit when used with a pacifier in this age group. Trial registration Current Controlled Trials ISRCTN15819627
Collapse
Affiliation(s)
- Sarah J Curtis
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Hsing Jou
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ben Vandermeer
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Terry Klassen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| |
Collapse
|
50
|
Abstract
A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.
Collapse
|