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Analgesia in preterm newborns: the comparative effects of sucrose and glucose

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Abstract

The aim of this study was to evaluate the effectiveness of different oral carbohydrate solutions for alleviation of pain in healthy preterm babies. Thirty-one preterm infants who were having blood drawn by heel prick were given 2 ml of solution A (20% sucrose), solution B (20% glucose) or solution C (placebo, sterile water) into the mouth, 2 min before lancing. Behavioural responses to this painful stimulus were measured by duration of crying and facial expressions (Neonatal Facial Coding System, NFCS) and physiological responses were measured by heart rate (HR), respiratory rate (RR), and oxygen saturation changes (SaO2). Infants had a mean birth weight (±SD) of 1,401 g (406), gestational age of 30.5 weeks (2.7); at the time of the procedure the postmenstrual age was 32.3 weeks (1.5). There was no significant difference in the time spent squeezing the heel between the three groups (P = 0.669). After the heel prick of both the sucrose and glucose groups the duration of first cry and total crying time was significantly reduced (P = 0.005 and P = 0.007). When the babies received placebo they showed a significantly higher NFCS score at 4 and 5 min after the heel prick (P = 0.009 and 0.046 respectively). Following painful stimulus HR increased significantly in the first 3 min compared with baseline, and at the first minute the mean of the HR was found to be significantly higher in the placebo group than in the sucrose and glucose groups (P = 0.007). We concluded that both sucrose and glucose administered orally before a heel prick reduce the pain response in preterm infants.

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Abbreviations

HR:

heart rate

NFCS:

Neonatal Facial Coding System

NICU:

Neonatal Intensive Care Unit

RR:

respiratory rate

SaO2 :

oxygen saturation

References

  1. Akcam M, Ormeci AR (2004) Oral hypertonic glucose spray: a practical alternative for analgesia in the newborn. Acta Paediatr 93:1330–1331

    Article  PubMed  CAS  Google Scholar 

  2. Anand KJS, Hickey PR (1987) Pain and its effects in the human neonate and fetus. N Eng J Med 317:1312–1319

    Article  Google Scholar 

  3. Ballard JL, Khourjy JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R (1991) New Ballard score expanded to include extremely premature infants. J Pediatr 119:417–423

    Article  PubMed  CAS  Google Scholar 

  4. Barker D, Rutter N (1995) Exposure to invasive procedures in neonatal intensive care unit admissions. Arch Dis Child 72:F47–F48

    CAS  Google Scholar 

  5. Blass EM, Hoffmeyer LB (1991) Sucrose as analgesic in newborn infants. Pediatrics 87:215–218

    PubMed  CAS  Google Scholar 

  6. Blass EM, Shah A (1995) Pain-reducing properties of sucrose in human newborns. Chem Sens 20:29–35

    Article  CAS  Google Scholar 

  7. Blass EM, Shide DJ, Weller A (1989) Stress-reducing effects of ingesting milk, sugars, and fats: a developmental perspective. Ann N Y Acad Sci 575:292–305

    Article  PubMed  CAS  Google Scholar 

  8. Bucher HU, Moser T, Siebenthal K, Kell M, Wolf M, Duc G (1995) Sucrose reduces pain reaction to heel lancing in preterm infants. Pediatr Res 38:332–335

    PubMed  CAS  Google Scholar 

  9. Carbajal R, Chavuet X, Couderc S, Oliver-Martin M (1999) Randomised trial of analgesic effects of sucrose, glucose and pacifiers in term neonates. Br Med J 319:1397–1399

    Google Scholar 

  10. Carbajal R, Lenclen R, Gajdos V, Jugie M, Paupe A (2002) Crossover trial of analgesic efficacy of glucose and pacifier in very preterm neonates during subcutaneous injections. Pediatrics 110:389–393

    Article  PubMed  Google Scholar 

  11. Craig KD, Whitfield MF, Grunau RVE, Linton J, Hadjistavropoulos HD (1993) Pain in the preterm neonate: behavioural and physiological indices. Pain 52:287–299

    Article  PubMed  CAS  Google Scholar 

  12. Ekman P, Friesen WV (1978) Facial Action Coding System: a technique for the measurement of facial movement. Consulting Psychologist Press, Palo Alto, CA

    Google Scholar 

  13. Fearson I, Kiskevsky BS, Hains SM, Muir DW, Tranmer J (1997) Swaddling after heel lance: age-specific effects on behavioral recovery in preterm infants. J Dev Behav Pediatr 8:222–232

    Google Scholar 

  14. Field T, Goldson E (1984) Pacifying effects of nonnutritive sucking on term and preterm neonates during heelstick procedures. Pediatrics 74:1012–1025

    PubMed  CAS  Google Scholar 

  15. Goldstein R, Brazzy J (1991) Narcotic sedation stabilizes arterial blood pressure fluctations in sick premature infants. J Perinatol 11:365–371

    PubMed  CAS  Google Scholar 

  16. Grunau RV, Johnston CC, Craig KD (1990) Neonatal facial and cry responses to invasive and non-invasive procedures. Pain 42:295–305

    Article  PubMed  CAS  Google Scholar 

  17. Grunau RVE, Craig KD (1987) Pain expression in neonates: facial action and cry. Pain 28:395–410

    Article  PubMed  CAS  Google Scholar 

  18. Grunau RVE, Whitfield MF, Petrie JH (1994) Pain sensitivity and temperament in extremely low-birth-weight premature toddlers and preterm and full-term controls. Pain 58:341–346

    Article  PubMed  CAS  Google Scholar 

  19. Johnston CC, Strada ME (1986) Acute pain response in infants: a multidimensional description. Pain 24:373–382

    Article  PubMed  CAS  Google Scholar 

  20. Kaminski J, Hall W (1996) The effect of soothing music on neonatal behavioral states in the hospital newborn nursery. Neonatal Netw 5:45–54

    Google Scholar 

  21. Larsson BA, Nulman I, Goldbach M, IPP M, Koren G (1995) Does a local anaesthetic cream (EMLA) alleviate pain from heel-lancing in neonates? Acta Anaesthesiol Scand 23:1028–1031

    Article  Google Scholar 

  22. Larsson BA, Norman M, Bjerring P, Egekvist H, Lagercratz H, Olsson GL (1996) Regional variations in skin perfusion and skin thickness may contribute to varying efficacy of topical, local anaesthetics in neonates. Pediatr Anaesth 6:107–110

    Article  CAS  Google Scholar 

  23. McIntosh N, Van Veen L, Brameyer H (1995) Alleviation of the pain of heel prick in preterm infants. Arch Dis Child 70:F177–F181

    Google Scholar 

  24. Ramenghi LA, Evans DJ, Levene MI (1999) “Sucrose analgesia”: absorptive mechanism or taste perception? Arch Dis Child Fetal Neonatal Ed 80:F146–F147

    PubMed  CAS  Google Scholar 

  25. Ren K, Blass EM, Zhou Q, Dubner R (1997) Suckling and sucrose ingestion suppress persistent hyperalgesia and spinal Fos expression after forepaw inflammation in infant rats. Proc Natl Acad Sci 94:1415–1471

    Article  Google Scholar 

  26. Shah A, Taddio A, Ohlsson A (1998) Randomized controlled trial of paracetamol of heel prick pain in neonates. Arch Dis Child Fetal Neonatal Ed 79:F209–F211

    PubMed  CAS  Google Scholar 

  27. Shide DJ, Blass EM (1989) Opioid-like effects of intraoral infusions of corn oil and polycose on stress reactions in 10-day-old rats. Behav Neurosci 103:1168–1175

    Article  PubMed  CAS  Google Scholar 

  28. Skogsdal Y, Eriksson M, Schollin J (1997) Analgesia in newborns given oral glucose. Acta Paediatr 86:217–218

    PubMed  CAS  Google Scholar 

  29. Stevens B, Yamada J, Ohlsson A (2001) Sucrose for analgesia in newborn infants. Cochrane Database Syst Rev (4) CD001069

  30. Stevens BJ, Johnston CC, Horton L (1994) Factors that influence the behavioral pain responses of premature infants. Pain 59:101–109

    Article  PubMed  CAS  Google Scholar 

  31. Taddio A, Katz J (2005) The effects of early pain experience in neonates on pain responses in infancy and childhood. Paediatr Drugs 7:245–257

    Article  PubMed  Google Scholar 

  32. Yaster M (1987) Analgesia and anesthesia. J Pediatr 111:394–395

    Article  PubMed  CAS  Google Scholar 

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Author notes

  1. Fusun Okan

    Present address: , Tekin sok. Besen Sitesi. C blok D:4. 34718, Acibadem, Kadikoy, Istanbul, Turkey

Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, Sisli Children Hospital, Istanbul, Turkey

    Fusun Okan

  2. Division of Neonatology, Department of Pediatrics, Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Asuman Coban, Zeynep Ince & Gulay Can

  3. Division of Child Neurology, Department of Neurology, Faculty of Medicine, Istanbul University, Istanbul, Turkey

    Zuhal Yapici

Authors
  1. Fusun Okan
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  2. Asuman Coban
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  3. Zeynep Ince
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  4. Zuhal Yapici
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  5. Gulay Can
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Correspondence to Fusun Okan.

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Okan, F., Coban, A., Ince, Z. et al. Analgesia in preterm newborns: the comparative effects of sucrose and glucose. Eur J Pediatr 166, 1017–1024 (2007). https://doi.org/10.1007/s00431-006-0373-z

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  • DOI: https://doi.org/10.1007/s00431-006-0373-z

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