Sucrose is an effective analgesic for procedural pain in preterm infants. The analgesic effects of sucrose are hypothesized to be mediated by the release of endogenous opioids. This study found that preterm infants at a mean gestational age of 28 weeks did not show an elevation in endogenous β-endorphin concentrations after an oral dose of 30% sucrose at a time when the analgesic effects were presumed to be present. Other neurotransmitters may be responsible for mediating the analgesic effect of sucrose.
With the increasing number of immunizations infants now receive, parents and physicians have become more concerned with the pain of routine vaccination. Reis and colleagues conducted a randomized controlled trial of different soothing techniques in infants receiving 4 injections. A combination of oral sucrose, oral tactile stimulation, and holding by parents during immunization significantly reduced crying in these infants and improved parental satisfaction with multiple vaccinations.
Untreated pain in premature infants has both short- and long-term detrimental effects. In this study of 151 neonates during the first 2 weeks of their stay in the neonatal intensive care unit, Simons and colleagues documented the painful procedures experienced by these infants. On average, each neonate underwent 14 procedures per day, and most were estimated to be painful. Pretreatment with analgesia was provided to less than 35% of neonates each day, and 2 of every 5 neonates received no analgesia therapy.
The use of kangaroo care, or skin-to-skin holding of neonates, is gaining acceptance as a standard of care in neonatal intensive care units around the world. This study found that it was also effective in reducing pain during procedures. In a randomized crossover design, 74 premature infants undergoing heel lancing for blood sampling were found to have lower pain reactions, as measured by facial grimace, maximum heart rate, and oxygen saturation, when receiving kangaroo care during the procedure compared with lying prone in the isolette. Kangaroo care may be an important method for reducing some procedural pain in neonates.
This Month in Archives of Pediatrics & Adolescent Medicine. Arch Pediatr Adolesc Med. 2003;157(11):1049. doi:10.1001/archpedi.157.11.1049