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Clinical JOP August 2018 - 1 | APS
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The Clinical Journal of Pain Summary

Highlight from The Clinical Journal of Pain (Volume 34, No. 8, August 2018)

Effectiveness of Sucrose Used Routinely for Pain Relief and Neonatal Clinical Risk in Preterm Infants: A Nonrandomized Study

Beatriz O. Valeri, Cláudia M. Gaspardo, Francisco E. Martinez, and Maria B. M. Linhares

The survival of preterm infants (PIs) necessitates hospitalization in a neonatal intensive care unit (NICU) in which infants are exposed to repeated painful and stressful procedures that increase developmental impairment likelihood. Effective pain management can attenuate the potential negative impact of the neonatal pain experience on early and late child development, which increases homeostasis and the ability to cope with painful and stressful events in the NICU setting. Oral sucrose is recommended as an acute pain relief intervention for preterm and full-term infants hospitalized in the NICU. However, according to an updated systematic review on sucrose, knowledge gaps remain regarding the efficacy of sucrose for pain relief in critically ill PIs and its interaction with neonatal and contextual variables. Investigators hypothesized that regardless of neonatal clinical risk (NCR) level, PIs undergoing routine sucrose intervention for pain relief in the NICU would experience lower pain reactivity and better recovery responses than infants who did not receive sucrose. The aim of this study was to examine the main and interactive effects of NCR and sucrose intervention as a routine clinical management for acute pain relief by evaluating biobehavioral pain reactivity and recovery responses in PIs hospitalized in the NICU. The study design was a nonrandomized controlled clinical trial with a historical control group (CG).

Infant sleep-wake states were coded according to systematic observations using the following system: deep sleep = 1, active sleep = 2, drowsy = 3, quiet alert = 4, active alert = 5, and crying = 6. For recording of the crying state, the cry facial mimic and irregular breathing with or without vocal sound were used.

Findings revealed that, regardless of NCR status, PIs who received sucrose routinely for acute pain relief in the NICU had less facial activity and crying time during a blood-sampling puncture than their counterparts in the historical CG. Results confirmed the hypothesis that PIs, at low and high NCR levels, had lower pain reactivity and better recovery responses under a routine sucrose protocol for acute pain relief than infants who were not under pain management with sucrose intervention. This evidence is relevant because sucrose, when adopted in the clinical routine, was effective in decreasing the crying state, which leads to stress. Crying is sensitive to the analgesic and calming effects of sucrose when it is given in low oral doses 2 minutes before acute painful procedures. The crying state is associated with increased heart rate and blood pressure, reduced oxygen saturation, increased cerebral blood pressure, and other problems. Therefore, the administration of sucrose can protect PIs, especially those undergoing ventilation or with low birth weight, against unnecessary energy expenditure.

Regardless of NCR level during the first 12 hours of postnatal age, sucrose routinely administered as part of the pain management protocol in the NICU resulted in pain relief effects on biobehavioral reactivity-recovery responses during the blood collection procedure.