Sucrose: An Effective and Safe Pain Management for Infants During Venepuncture, Cochrane Review Finds
A recent Cochrane review, led by Mariana Bueno, an Assistant Professor at the Lawrence Bloomberg Faculty of Nursing, indicates that sucrose administration is an effective and safe method for pain management in hospitalized infants undergoing venepuncture. The review, which included studies from various countries, found sucrose to be beneficial in providing comfort to babies during the procedure, especially when compared to no treatment. Combining sucrose with a pacifier can enhance its pain-relieving effects.
Sucrose administration is an effective and safe method for pain management in hospitalized infants undergoing venepuncture.
Comparing Sucrose with Other Interventions
Other infant pain management interventions include skin-to-skin contact, breastfeeding, and topical anesthetics. Bueno noted that further research is required to compare the effectiveness of these methods with sucrose. However, the study's findings strongly support the use of a pain intervention before venepuncture whenever possible.
Alignment with Guidelines, Yet Implementation Lags
Bueno, also a Pain Scientist at the University of Toronto Centre for the Study of Pain (UTCSP), stated that these findings align with existing recommendations for sucrose administration in many infant care guidelines. A key challenge remains the routine implementation of pain management strategies by clinicians.
The Critical Need for Infant Pain Management
Venepuncture, a common procedure for hospitalized infants for blood tests or IV insertion, is often poorly managed regarding pain, particularly in low, middle, and high-income countries.
Repeated exposure to untreated acute pain early in life may lead to short and long-term changes in the somatosensory system, affecting how the brain processes external stimuli.
This can negatively impact growth and development, especially for infants with extended hospital stays.
Sucrose: A Medication Requiring Judicious Use
Sucrose is considered a medication, and its long-term effects from repetitive use require further evaluation. Clinicians are advised to use it judiciously to prevent unnecessary administration for managing infant stress or crying, despite its underutilization in clinical practice. Sucrose is easily administered on an infant's tongue two minutes before a procedure. There is a recognized gap in engaging clinicians to integrate this evidence into their practice.
A Priority List for Infant Pain Management
To address these barriers, Bueno suggested a priority list for pain management:
- First, offering skin-to-skin contact.
- Second, breastfeeding.
- If those are not available, administering sucrose.
The overarching message is that infants should receive pain management before procedures like venepuncture.
Overcoming Barriers in NICUs
Challenges in Neonatal Intensive Care Units (NICUs), such as fast-paced environments, clinicians' perceptions that procedures are quick or that babies will not remember, and a lack of worldwide supply, contribute to the infrequent use of pain management. Bueno stated that these challenges can be overcome through clinical practice guidelines and locally developed evidence-based protocols to improve pain care in NICUs.