Giving sucrose, a sugary liquid, to infants is an effective way to manage pain in babies in the neonatal intensive care unit when drawing blood from a vein, a University of Toronto researcher has found.
The Cochrane review , which included studies worldwide, found that sucrose is an effective and safe option to manage pain and provide comfort to babies during what is known as venepuncture - especially when compared to no treatment.
"Giving infants a pacifier in addition to sucrose can make the analgesic or pain-relieving effects of sucrose even better," says Mariana Bueno, an assistant professor in U of T's Lawrence Bloomberg Faculty of Nursing.
Other forms of pain management intervention for infants can include skin-to-skin contact, breastfeeding or topical anaesthetics. Bueno notes that further research will be needed to compare the effectiveness of these interventions to sucrose administration, but that findings from this study indicate that, when possible, a pain intervention should be used before venepuncture.
"These findings also support what is already a recommendation in many infant care guidelines when it comes to sucrose administration," says Bueno, who is also a pain scientist at the University of Toronto Centre for the Study of Pain . "The challenge remains that more clinicians need to find a way to routinely implement pain management strategies for procedures."
Venepuncture is a procedure most often used for hospitalized infants - either for blood tests or to give fluids and medication through IV insertion. When performed by a skilled clinician, venepuncture can be less painful than heel lancing, another common method used for blood draws in infants, but it is often unsuccessful on the first attempt.
"We know that procedural pain for infants is poorly managed in low-, middle- and high-income countries, and that repeated exposure to untreated acute pain at early stages in life may lead to short- and long-term changes to the structure and connectivity of the somatosensory system - essentially how the brain processes and perceives external stimuli," Bueno says.
Repetitive and untreated pain in the early stages of life can have a negative impact on growth and development. Infants hospitalized for extended periods are at an even greater risk of experiencing negative side effects because they may be more repeatedly exposed to acute pain for procedures.
Since sucrose is considered a medication, Bueno cautions that the long-term effects of repetitive sucrose use still need further evaluation. Clinicians, she says, should be judicious in prescribing it to avoid it being used unnecessarily to manage stress or crying in infants.
"Sucrose is easy to administer on the baby's tongue two minutes before the procedure," says Bueno. "But there is a gap in the work being done to engage clinicians in changing their practice and using this evidence more intentionally when caring for hospitalized infants."
Bueno suggests that clinicians adopt a list that prioritizes pain management strategies for infants.
"A first choice would be to offer skin to skin, then breastfeeding - and if those options are not available then sucrose should be administered," she says. "[But] the message from our findings is, ultimately, that infants need and should receive pain management before a procedure such as venepuncture."
Given that neonatal intensive care units are complex and fast-paced environments, Bueno says some clinicians avoid providing pain management for infants because they feel the procedure is quick and the baby won't remember. There may also be issues with the availability of sucrose in some countries, she says.
"These challenges can be addressed. By using clinical practice guidelines and locally developed evidence-based protocols, we can improve pain care in [neonatal intensive care units]."
