Managing Procedural Pain in Preterm Babies- Is Sucrose Really Effective?

Preterm and critically ill babies have to undergo multiple skin breaking procedures which are essential part of their care. On an average, a baby admitted in the NICU undergoes about 6 to 24 such procedures everyday. However, these procedures are often painful as they involve breaching the tender skin of the newborns. The resultant pain can adversely affect the stress hormone systems of the baby. Repeated pain may result in early negative programming of these systems. To avoid this scenario, it is essential to provide adequate analgesic cover to the babies during these procedures.

Administering sucrose has been a long accepted clinical non-pharmacological intervention for managing acute procedural pain in term and preterm infants. Across Canada, 64% nurseries have protocols for administering sucrose at such times. Although sucrose is safe when given in single doses, its safety upon repeated doses at short intervals has not been studied properly. At present, there are only four such studies and none covers the entire duration of the baby’s stay in the NICU. Liisa Holsti and Ruth E. Granau from Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver and Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver respectively have analyzed the mechanism of action of sucrose on the pain pathways. They found that sucrose acted through opioid pathways in rodents but in human infants, the findings are not very clear. It may be effective through the amine and hormonal pathways.
 
It has been seen that sucrose is administered on the basis of its effect on behavioral and physiological pain scores. But studies show that oral sucrose does not have any significant effect on the neonatal brain or spinal cord nociceptive circuits and is therefore, not an affective analgesic. It does reduce crying and facial grimacing but that should not be mistaken as a sign of analgesia. Its effect may be more due to sedation. Pain reduction with sucrose ranges between 16% and 28% on pain assessment scales. In fact, breast feeding reduces pain more effectively. It is essential to carry out more studies, to understand the affect of repeated doses of sucrose on attention, orientation and motor development of the preterm babies. 
 
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