Giving sugar to infants to control pain

Researchers at the University College London, in the UK, tell us, “Many infants admitted to [the] hospital undergo repeated invasive procedures. Oral sucrose is frequently given to relieve procedural pain in neonates on the basis of its effect on behavioral and physiological pain scores.”

Here are the results of their study that measured brain activity during an acute painful procedure.

First, the details.

• 59 newborn infants receiving a heel lance were randomly assigned to receive a treatment 2 minutes before the procedure.
  • 0.5 mL of 24% sucrose solution
  • 0.5 mL sterile water
• Pain-specific brain activity was monitored, as were other signs of discomfort including observational pain scores, and spinal pain reflex withdrawal activity.
• Neither the patients (parents) nor researchers knew the treatment given — double blind.

And, the results.

• Brain activity consistent with pain after the noxious heel lance did not differ between treatments.
• There was no difference between treatments in the magnitude or delay of the spinal pain reflex withdrawal recorded from the biceps femoris (muscle used to flex the knee) of the stimulated leg.
• The observational pain scores were significantly lower in infants given sucrose vs sterile water.
• Significantly more infants had no change in facial expression after sucrose administration.

The bottom line?

The authors concluded, “Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug.”

But what about the observational pain scores and lack of facial expressions?

The authors state, “The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.”

International guidelines recommend an oral dose of sucrose to relieve neonatal procedural pain. A review on Medscape covers the overwhelming consensus supporting this position.

Yes, these recommendations are based on studies that used observational signs of a pain response.

But in light of the latest research results, should the use of sucrose be influenced by what lights up on a brain scan or the apparent lack of awareness on an infant’s face?

9/4/10 16:29 JR