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New perspective for pain control in neonates: a comparative effectiveness research

Abstract

Objective

To compare sucrose 24% oral gel formulation to liquid formula and breastfeeding during a heel prick in neonates.

Study design

In this comparative effectiveness research 195 neonates >36 weeks’ gestation were randomised to three groups, receiving during heel stick: (i) breastfeeding, (ii) sucrose 24% liquid with non-nutritive sucking and (iii) sucrose 24% gel with non-nutritive sucking. The pain was assessed through the Neonatal Infant Pain Scale.

Results

All the methods analysed has shown to be effective in reducing pain. There was an increase in odds of pain following liquid sucrose compared to breastfeeding (OR = 1.60; 95% CI: 0.82–3.3; p = 0.17). A reduction of odds of pain was showed comparing sucrose to breastfeeding (OR = 0.78; 0.38–1.6; 0.48), and comparing sucrose gel to liquid formula (OR = 0.48; 0.23–0.96; p = 0.04).

Conclusion

Sucrose 24% gel with non-nutritive sucking seems to be a valid alternative when breastfeeding is not possible. Further research is needed.

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Fig. 1
Fig. 2: Treatment efficacy in the three groups.

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References

  1. Johnston CC, Fernandes AM, Campbell-Yeo M. Pain in neonates is different. Pain. 2011;152(3 Suppl):S65–73.

    Article  Google Scholar 

  2. Vinall J, Grunau RE. Impact of repeated procedural pain-related stress in infants born very preterm. Pediatr Res. 2014;75:584–7.

    Article  Google Scholar 

  3. Valeri BO, Holsti L, Linhares MB. Neonatal pain and developmental outcomes in children born preterm: a systematic review. Clin J Pain. 2015;31:355–62.

    Article  Google Scholar 

  4. Meaney MJ, Aitken DH. The effects of early postnatal handling on hippocampal glucocorticoid receptor concentrations: temporal parameters. Brain Res. 1985;354:301–4.

    Article  CAS  Google Scholar 

  5. Hatfield LA. Neonatal pain: what’s age got to do with it? Surg Neurol Int. 2014;5(Suppl 13):S479–89.

    Article  Google Scholar 

  6. Anand KJS, Eriksson M, Boyle EM, Avila-Alvarez A, Andersen RD, Sarafidis K, et al. Assessment of continuous pain in newborns admitted to NICUs in 18 European countries. Acta Paediatr. 2017;106:1248–59.

    Article  Google Scholar 

  7. Balice-Bourgois C, Zumstein-Shaha M, Vanoni F, Jaques C, Newman CJ, Simonetti GD. A systematic review of Clinical Practice Guidelines for acute procedural pain on neonates. Clin J Pain. 2020;36:390–8.

    Article  Google Scholar 

  8. Cignacco E, Hamers JP, Stoffel L, van Lingen RA, Gessler P, McDougall J, et al. The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain. 2007;11:139–52.

    Article  Google Scholar 

  9. Thakkar P, Arora K, Goyal K, Das RR, Javadekar B, Aiyer S, et al. To evaluate and compare the efficacy of combined sucrose and non-nutritive sucking for analgesia in newborns undergoing minor painful procedure: a randomised controlled trial. J Perinatol. 2016;36:67–70.

    Article  CAS  Google Scholar 

  10. Harrison D, Larocque C, Bueno M, Stokes Y, Turner L, Hutton B, et al. Sweet solutions to reduce procedural pain in neonates: a meta-analysis. Pediatrics. 2017;139:e20160955.

  11. Kirpalani H, Truog WE, D’Angio CT, Cotten M. Recent controversies on comparative effectiveness research investigations: challenges, opportunities, and pitfalls. Semin Perinatol. 2016;40:341–7.

    Article  Google Scholar 

  12. Lago P, Garetti E, Pirelli A, Merazzi D, Savant Levet P, Bellieni CV, et al. Linee giuda per la prevenzione ed il trattamento del dolore nel neonato. Ed. Biomedia, pp. 98–102.

  13. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993;12:59–66.

    CAS  PubMed  Google Scholar 

  14. Leite AM, Linhares MB, Lander J, Castral TC, dos Santos CB, Silvan Scochi CG. Effects of breastfeeding on pain relief in full-term newborns. Clin J Pain. 2009;25:827–32.

  15. Shah PS, Herbozo C, Aliwalas LL, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev. 2012;12:CD004950.

    PubMed  Google Scholar 

  16. Zurita-Cruz JN, Rivas-Ruiz R, Gordillo-Álvarez V, Villasis-Keever M. Breastfeeding for acute pain control on infants: a randomised controlled trial. Nutr Hosp. 2017;34:301–7.

    Article  Google Scholar 

  17. Erkul M, Efe E. Efficacy of breastfeeding on babies’ pain during vaccinations. Breastfeed Med. 2017;12:110–5.

    Article  Google Scholar 

  18. Simonse E, Mulder PG, van Beek RH. Analgesic effect of breast milk versus sucrose for analgesia during heel lance in late preterm infants. Pediatrics. 2012;129:657–63.

    Article  Google Scholar 

  19. Baudesson de Chanville A, Brevaut-Malaty V, Garbi A, Tosello B, Baumstarck K, Gire C. Analgesic effect of maternal human milk odor on premature neonates: a randomized controlled trial. J Hum Lact. 2017;33:300–8.

    Article  Google Scholar 

  20. Lima AH, Hermont AP, Friche AA. Analgesia in newborns: a case-control study of the efficacy of nutritive and non-nutritive sucking stimuli. Codas. 2013;25:365–8.

    Article  Google Scholar 

  21. Melzack R, Wall PD. Pain mechanisms: a new theory. Science. 1965;150:971–9.

    Article  CAS  Google Scholar 

  22. Blass EM, Ciaramitaro V. A new look at some old mechanisms in human newborns: taste and tactile determinants of state, affect, and action. Monogr Soc Res Child Dev. 1994;59:I–V. 1-81

    Article  CAS  Google Scholar 

  23. Bellieni CV, Johnston CCAnalgesia. nil or placebo to babies, in trials that test new analgesic treatments for procedural pain. Acta Paediatr. 2016;105:129–36.

    Article  Google Scholar 

  24. Leng HY, Zheng XL, Zhang XH, He HY, Tu GF, Fu Q, et al. Combined non-pharmacological interventions for newborn pain relief in two degrees of pain procedures: a randomised clinical trial. Eur J Pain. 2016;20:989–97.

    Article  CAS  Google Scholar 

  25. Fruhstorfer H, Schmelzeisen-Redeker G, Weiss T. Capillary blood sampling: relation between lancet diameter, lancing pain and blood volume. Eur J Pain. 1999;3:283–6.

    Article  CAS  Google Scholar 

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Acknowledgements

We thank all the members of our Neonatology Division who gave their contribution to this study. We thank Marco Chiera for his scientific help.

Funding

This study did not receive grant.

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Authors and Affiliations

Authors

Contributions

IB conceived the study and wrote the initial manuscript. GV, FR, ID and GVZ reviewed and revised the manuscript. CF performed statistical analysis and reviewed the manuscript. VF and GL conceived the study and reviewed the manuscript. All the authors discussed the results, commented on the manuscript and approved it as submitted.

Corresponding author

Correspondence to G. Lista.

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Conflict of interest

The authors declare no competing interests.

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Bresesti, I., Vanzù, G., Redaelli, F. et al. New perspective for pain control in neonates: a comparative effectiveness research. J Perinatol 41, 2298–2303 (2021). https://doi.org/10.1038/s41372-021-01025-6

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