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Intervention Review

Sucrose for analgesia in newborn infants undergoing painful procedures

  1. Bonnie Stevens2,
  2. Janet Yamada1,*,
  3. Arne Ohlsson3

Editorial Group: Cochrane Neonatal Group

Published Online: 20 JAN 2010

Assessed as up-to-date: 24 AUG 2009

DOI: 10.1002/14651858.CD001069.pub3

How to Cite

Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD001069. DOI: 10.1002/14651858.CD001069.pub3.

Author Information

  1. 1

    The Hospital for Sick Children, Nursing, Toronto, Ontario, Canada

  2. 2

    The Hospital for Sick Children, Associate Chief of Nursing Research, Toronto, Ontario, Canada

  3. 3

    University of Toronto, Departments of Paediatrics, Obstetrics and Gynaecology and Health Policy, Management and Evaluation, Toronto, Ontario, Canada

*Janet Yamada, Nursing, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8, Canada. janet.yamada@sickkids.ca.

Publication History

  1. Publication Status: New search for studies and content updated (no change to conclusions)
  2. Published Online: 20 JAN 2010

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This is not the most recent version of the article. View current version (31 JAN 2013)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Administration of oral sucrose with and without non-nutritive sucking is frequently used as a non-pharmacological intervention for procedural pain relief in neonates.

Objectives

To determine the efficacy, effect of dose and safety of oral sucrose for relieving procedural pain in neonates.

Search methods

The standard methods of the Cochrane Neonatal Collaborative Review Group were used.

Selection criteria

Randomized controlled trials in which term and/or preterm neonates (postnatal age maximum of 28 days corrected for postmenstrual age) received sucrose for procedural pain. Control conditions included water, pacifier, positioning/containing or breastfeeding.

Data collection and analysis

The main outcome measures were physiological and/or behavioural pain indicators and/or composite pain scores. A weighted mean difference (WMD) with 95% confidence intervals (CI) using the fixed effects model was reported for continuous outcome measures.

Main results

Forty-four studies enrolling 3,496 infants were included. Results from only a few studies could be combined in meta-analyses. Sucrose significantly reduced duration of total crying time (seconds) [WMD -39.26 (95% CI -44.29, -34.24), 88 neonates], but did not reduce duration of first cry (seconds) during heel lance [WMD -8.99 (95% CI -20.07, 2.10), 192 neonates]. No significant differences were found for percent change in heart rate from baseline at one minute [WMD 0.90 (95% CI -5.81, 7.61), 86 neonates] and three minutes [WMD -6.20 (95% CI -15.27, 2.88), 86 neonates] post-heel lance, or for mean heart rate at three minutes post-heel lance [WMD -0.98 (95% CI -8.29, 6.32), 154 neonates]. Oxygen saturation (%) was significantly lower in infants given sucrose during ROP examination compared to controls [WMD -2.58 (95% CI -4.94, - 0.23), 62 neonates]. Infants given sucrose post-heel lance had significantly lower PIPP scores at 30 seconds [WMD -1.64 (95% CI -2.47, - 0.81), 220 neonates] and 60 seconds [WMD -2.05 (95% CI -3.08, -1.02), 195 neonates]. For ROP exams, sucrose did not significantly reduce PIPP scores [WMD -0.65 (95% CI -1.88, 0.59), 82 neonates]. There were no differences in adverse effects between sucrose and control groups.

Authors' conclusions

Sucrose is safe and effective for reducing procedural pain from single events. An optimal dose could not be identified due to inconsistency in effective sucrose dosage among studies.

Further investigation on repeated administration of sucrose in neonates and the use of sucrose in combination with other non-pharmacological (e.g. behavioural, physical) and pharmacologic interventions is needed. Sucrose use in extremely low birth-weight and unstable and/or ventilated neonates needs to be addressed.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Sucrose for analgesia in newborn infants undergoing painful procedures

Sucrose (sugar) provides pain relief for newborn babies having painful events such as needles or heel pricks. Newborn babies undergoing these events need strategies to reduce their pain. Pain medicine is usually given for major painful events (such as surgery) but may not be given for more minor events (such as taking blood or needles). Pain medicine can be used to reduce pain but there are several other methods including sucking on a pacifier with or without sucrose. Researchers have found that giving sucrose to babies decreases their crying time and behaviours such as grimacing. More research is needed to determine if giving repeated doses of sucrose is safe and effective, especially for very low birth weight infants or infants on respirators.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

對新生嬰兒進行會產生疼痛之醫療行為時使用蔗糖 (Sucrose) 來止痛

口服蔗糖,合併或不合併非營養式之吸吮,這樣的方式常被用來當作一種非藥理性質的醫療介入行為,來緩解新生兒在醫療行為時所造成的疼痛。

目標

評估使用口服蔗糖對於緩解新生兒在醫療行為時所造成的疼痛的效果、劑量的影響、以及安全性。

搜尋策略

採用Cochrane Neonatal Collaborative Review Group標準搜尋策略

選擇標準

針對接受蔗糖以緩解處置時所造成的疼痛之足月兒或早產兒(矯正年齡最大為28天)所進行的隨機對照試驗。對照組的條件包括了喝水、吸奶嘴、擺位姿勢/包覆方式或是哺餵母乳。

資料收集與分析

主要的結果測量為生理疼痛指標或行為疼痛指標或綜合型的疼痛評分。針對具有連續性數據的結果測量方式,有報告使用固定效果模型之95% 信賴區間(CI)的加權平均差(WMD)。

主要結論

共收集了包含3,496名嬰兒參與在內的44份研究。當中只有的少數研究所得到的結果可以在統合分析當中加以合併。蔗糖很明顯地縮短了整個哭鬧時間(秒數)的長度[WMD−39.26(95% CI −44.29,−34.24),88名新生兒],但是在腳跟穿刺期間,並沒有縮短扎腳跟採血之醫療行為時第1次哭鬧的時間[WMD −8.99(95% CI −20.07,2.10),192名新生兒]。在扎腳跟採血後1分鐘[WMD 0.90(95% CI −5.81,7.61),86名新生兒]及3分鐘[WMD −6.20(95% CI −15.27,2.88),86名新生兒]之心跳速率相對於基礎線之百分比變化,以及3分鐘時[WMD −0.98(95% CI −8.29,6.32),154名新生兒]之平均心跳速率而言,都沒有發現到任何明顯的差異。跟對照組相較起來,在ROP (視網膜病變) 檢查之醫療行為時,接受蔗糖的嬰兒身上所測得的血氧濃度(%)明顯地比較低[WMD −2.58 (95% CI −4.94, −0.23), 62名新生兒]。對於腳跟穿刺之後接受了蔗糖的嬰兒而言,在30秒時 [WMD −1.64(95% CI −2.47, −0.81),220名新生兒]以及60秒時 [WMD −2.05(95% CI −3.08, −1.02),195名新生兒]所測得的PIPP (綜合型的疼痛評分) 得分,很明顯地都比較低。就ROP檢查來看,蔗糖並不能夠明顯地讓PIPP得分下降[WMD −0.65(95% CI −1.88,0.59),82名新生兒]。在蔗糖與對照組之間,並沒有發現副作用方面有任何的差異。

作者結論

從單獨1項事件中看來,對於降低醫療行為所造成之疼痛來說,蔗糖是安全而有效的。在所有的研究當中,因為蔗糖劑量的有效使用劑量並不一致,所以並不能夠決定出最佳的劑量值。對於新生兒重複給予蔗糖、在使用蔗糖的時候合併其他非藥理性質(例如行為方面、生理方面)及有藥理性質的醫療介入行為,針對這些方面做更深入研究,仍然是有必要的。在極低出生體重、病情不穩定或接受呼吸器的新生兒身上,針對蔗糖的使用情形必須要再加研究。

翻譯人

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

對新生嬰兒進行會產生疼痛之醫療行為時使用蔗糖來止痛:對於發生了疼痛狀況的新生兒來說,像是以打針或是扎腳跟採血,蔗糖(糖)可以緩解疼痛之產生。剛出生的嬰兒要是經歷了這些狀況,就需要運用某些策略來降低他們的疼痛。對於重大的痛苦狀況(例如手術),通常會採用疼痛醫學的方法,但是對於更多的輕度狀況(例如抽血或是打針),則可能不會採用這樣的方法。我們可以使用疼痛醫學來減輕疼痛,但是還有許多種其他的方法,包括了用奶嘴來進行吸吮,同時可以搭配或不搭配蔗糖來使用。研究人員發現,對於嬰兒們給予蔗糖的時候,就會縮短他們哭鬧的時間,而且也會減少他們擺出猙獰表情的行為。重複給予蔗糖的劑量是否安全而有效,針對這樣的問題,還需要有更多的研究來確認,尤其是對於那些出生時體重非常輕的嬰兒,或是有使用呼吸器的嬰兒。