Sucrose, potential painkiller for breast – feeding infants?

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The benefits of breastfeeding on invasive and painful therapies are known since antiquity. For example, during the community reviews of infants, they are a good way to get the vaccine like a not so traumatic experience for the little ones, and it is also widely used in paediatrics units. There are many references of it, and even my own clinical experience supports this fact.

However, today I want to talk about other non-pharmacological analgesic, the sucrose. I have to say I was completely unaware about its application in infants to relieve the pain. I plan to investigate more about it and see the evidence that support its use.

(400 BC.). However was DR Anand who demonstrated it through numerous studies and stated the need of analgesia at the mid-eighties.

crying babyActually, the fact of quantify the intensity of pain in infants is a difficult labour. There are metabolic, hormonal and biochemical studies that show the changes produced in a painful physical experience, such as activation of the pituitary-adrenal axis, with the increasing of cortisol and aldosterone, insulin, glucagon and growth hormone, but I do not want to go into much details. In the end, what I want to say with this is that pain in neonates is real. Even it is proved that a prolonged and intense pain increases neonatal morbidity.

Thereafter, it is obvious the need for analgesia in annoying/painful situations. As I mentioned earlier, there are two aspects in this area, pharmacological and non-pharmacological. Focus on the second, which is the main subject, understood it as the measures taken to reduce pain and not include the administration of medication.

Non-pharmacological analgesia is developed in various ways, through the release of endogenous endorphins, neuropeptides-activation systems that stimulate opioid receptors, or just distracting the child from pain.

What types of non-pharmacological analgesia could be used in infants?

  1. Non-nutritive sucking: sucking
  2. Containment: bending in a “nest” (sheets rolled into circular shape)
  3. Changing the environment: limiting the number of procedures, group manual handling, avoid too many stimuli (light, noise, hunger, cold, etc.), respect the rest of the baby.
  4. Diversionary tactics: encourage parents-contact, massage therapy, music therapy, soft voices, olfactory stimuli.
  5. Breast-feeding
  6. Administration of sucrose

sucrosaThe last one is the issue of this post, and I got some bibliography of recent events that support and even recommend its use. It is the most studied non-pharmacological intervention in neonatology.

I have found several studies about it and, although I am going to summarize a bit, I will leave the links on the bibliography at the end of the post in case you need. To show some figures, one study used 12% glucose against double distilled water and recorded a 50% reduction of crying and improved recovery of the glucose group versus double-distilled water group. Another study used 24% glucose and recorded a 30% reduction in minor painful procedures. I also found a meta-analysis by Stevens et al. with a systematic review that supports a full use, indicating the use of 0.24 to 0’50g sucrose 2 minutes before the painful procedure. But without doubt the most complete study I have found was a systematic review of the Cochrane performing the comparison of 21 randomized clinical trials and a placebo group, and a better score was observed in the PIPP scale (Premature Infant Pain Profile) in the group treated with sucrose than in the control group.

We could check that is a method with much evidence behind it, but what is the right way to manage it and how does it work in the paediatric patient?

Non-nutritive suckingSucrose is usually taken orally and about 2 minutes before the procedure. Depending on age, is administered from 0’1ml in premature babies of 24 weeks to 2ml in full-term in solutions from 24 to 50%. Its mechanism of action is based on the release of endogenous opioid neurotransmitters (beta-endorphins) which are activated by the sweet taste of sucrose.
It is established that over 6 months of life or in longer painful procedures, it becomes no longer an effective analgesic method for the child. If it is used along with adjuvants such as suction methods, nutritional or not, and the parent company, its effectiveness is increased considerably.
So, at the end of the day, it is a much studied approach that has good results in short procedures in children under 6 months old. For this reason, I encourage you to use it in your daily practice. See you soon!

 

Bibliography:

1. Lardón Fernández, M. Analgesia y sedación en pediatría. Artículo de revisión. U.G.C. Pediatría. Hospital Clínico Universitario San Cecilio. . Bol. SPAO Granada 2011; 5 (1). Págs. 13 – 24

2. Martínez-Tellería, A; Delgado, J. A; Cano, M. E; Núñez, J; Gálvez, R. Analgesia postoperatoria en el neonato. Rev. Soc. Esp. Dolor, Vol. 9, N.º 5, Junio-Julio. Págs. 317-327. Consultado el día 15 de abril de 2014. Disponible en: http://www.revista.sedolor.es/pdf/2002_05_02.pdf

3. Soriano Faura, J. Analgesia no farmacológica: necesidad de implantar esta práctica en nuestra atención a recién nacidos y lactantes ante procedimientos dolorosos. Evidencias en pediatría. 2010: 6, 72. Consultado el día 18 de abril de 2014. Disponible en: http://www.evidenciasenpediatria.es/files/41-11057-RUTA/72ED.pdf

4. Ettlin, G; Lain, A; Aldao, J; Bustos, R. Eficacia de la sacarosa oral en la analgesia para procedimientos dolorosos habituales en neonatología. Arch Pediatr Urug 2006; 77(3). Págs. 250-256. Consultado el día 18 de abril de 2014. Disponible en: http://www.sup.org.uy/Archivos/adp77-3/pdf/adp77-3_7.pdf

5. Blas, E. M; Hoffmeyer, L. B. Sucrose as an analgesic for newborn infants. Pediatrics. 1991; 87(2)

 

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