The Clinical Journal of Pain Summary
Highlight from The Clinical Journal of Pain (Volume 34, Issue 7, July 2018)
Cortical Pain Response of Newborn Infants to Venepuncture: A Randomized Controlled Trial Comparing Analgesic Effects of Sucrose Versus Breastfeeding
Stéphane Rioualen, Virginie Durier, David Hervé, Laurent Misery, Jacques Sizun, and Jean-Michel Roué
- Pediatric Department, Brest University Hospital, Brest, France
- Laboratory of Neurosciences of Brest, University of Western Brittany, Brest, France
- Inserm CIC 1412, Centre for Clinical Investigation, Brest University Hospital, Brest, France
- UMR CNRS 6552, Animal and Human Ethology (Ethos), Rennes 1 University, Rennes
- European University of Brittany, Brest, France
Analgesic effects of nonpharmacological treatments such as sucrose or glucose, nonnutritive sucking, and breastfeeding have led to a decrease in term and preterm infants’ behavioral responses to pain. As a result, nonpharmacological analgesic treatments are highly recommended in numerous national and international guidelines.
Biochemical, physiological, and behavioral changes occur when neonates respond to painful stimuli. Consequently, newborn infants’ pain responses may not be precisely assessed when only using behavioral parameters. The discrepancy reported between behavioral and cortical responses has been related to the administration of sucrose but not breastfeeding. The mechanism of action of sucrose in human neonates remains unclear, however. These investigators hypothesized that breastfeeding would result in a better analgesic effect than sucrose administration, which is associated with holding and nonnutritive sucking during painful procedures in healthy term neonates. The prospective randomized controlled trial was designed to measure differences in cortical processing and conventional behavioral measures during medically necessary venipuncture.
There were no significant differences in the somatosensory cortical total hemoglobin concentration (HbT) changes measured with near-infrared spectroscopy (NIRS) during venipuncture between breastfed and sucrose-fed (involving holding and nonnutritive sucking) healthy 3-day-old newborns. The maximum HbT change was considered as pain-specific cortical activity and persisted in both groups, even for infants who expressed no pain behavior. However, fewer infants showed behavioral signs of pain in the sucrose group than in the breastfed group. Moreover, no real increase in the contralateral somatosensory cortex HbT was revealed when evaluating the mean HbT change (i.e., the difference between the mean HbT and the baseline HbT). In addition, no significant difference was observed between groups for skin conductance and salivary cortisol levels and after adjustments for sex and birth weight for all outcomes. No difference was identified between sucrose administration, which was associated with holding and nonnutritive sucking, and breastfeeding on activity measured by NIRS in the contralateral somatosensory cortex during a painful procedure.
Sucrose appeared to reduce behavioral expressions of pain more efficiently, but more research is needed to understand pain relief mechanisms and the specific impact of each nonpharmacological method.