The Minimally Effective Dose of Sucrose for Procedural Pain Relief in Neonates: a Randomized Controlled Trial

Overview

Journal BMC Pediatr

Publisher Biomed Central

Specialty Pediatrics

Date 2018 Feb 25

PMID 29475433

Citations 35

Authors

Bonnie Stevens

Janet Yamada

Marsha Campbell-Yeo

Sharyn Gibbins

Denise Harrison

Kimberley Dionne

Anna Taddio

Carol McNair

Andrew Willan

Marilyn Ballantyne

Kimberley Widger

Souraya Sidani

Carole Estabrooks

Anne Synnes

Janet Squires

Charles Victor

Shirine Riahi

Affiliations

Soon will be listed here.

Abstract

Background: Orally administered sucrose is effective and safe in reducing pain intensity during single, tissue-damaging procedures in neonates, and is commonly recommended in neonatal pain guidelines. However, there is wide variability in sucrose doses examined in research, and more than a 20-fold variation across neonatal care settings. The aim of this study was to determine the minimally effective dose of 24% sucrose for reducing pain in hospitalized neonates undergoing a single skin-breaking heel lance procedure.

Methods: A total of 245 neonates from 4 Canadian tertiary neonatal intensive care units (NICUs), born between 24 and 42 weeks gestational age (GA), were prospectively randomized to receive one of three doses of 24% sucrose, plus non-nutritive sucking/pacifier, 2 min before a routine heel lance: 0.1 ml (Group 1; n = 81), 0.5 ml (Group 2; n = 81), or 1.0 ml (Group 3; n = 83). The primary outcome was pain intensity measured at 30 and 60 s following the heel lance, using the Premature Infant Pain Profile-Revised (PIPP-R). The secondary outcome was the incidence of adverse events. Analysis of covariance models, adjusting for GA and study site examined between group differences in pain intensity across intervention groups.

Results: There was no difference in mean pain intensity PIPP-R scores between treatment groups at 30 s (P = .97) and 60 s (P = .93); however, pain was not fully eliminated during the heel lance procedure. There were 5 reported adverse events among 5/245 (2.0%) neonates, with no significant differences in the proportion of events by sucrose dose (P = .62). All events resolved spontaneously without medical intervention.

Conclusions: The minimally effective dose of 24% sucrose required to treat pain associated with a single heel lance in neonates was 0.1 ml. Further evaluation regarding the sustained effectiveness of this dose in reducing pain intensity in neonates for repeated painful procedures is warranted.

Trial Registration: ClinicalTrials.gov : NCT02134873. Date: May 5, 2014 (retrospectively registered).

Citing Articles

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Cumulative sucrose exposure for repeated procedural pain in preterm neonates and neurodevelopment at 18 months of corrected age: a prospective observational longitudinal study.

Bueno M, Ballantyne M, Campbell-Yeo M, Estabrooks C, Gibbins S, Harrison D BMJ Paediatr Open. 2024; 8(1).

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Healthcare professionals' perspectives on optimizing pain care-related education at a Canadian children's hospital: A qualitative study.

Kammerer E, Linkiewich D, Ali S Paediatr Child Health. 2024; 29(3):163-167.

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Ullsten A, Campbell-Yeo M, Eriksson M Front Pain Res (Lausanne). 2024; 5:1375868.

PMID: 38689885 PMC: 11058235. DOI: 10.3389/fpain.2024.1375868.

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