01:18pm Wednesday 18 October 2017

The sweet side of pain management for babies

Professor Bonnie Stevens of the Lawrence S. Bloomberg Faculty of Nursing and Faculty of Medicine is principal author of the study entitled Sucrose for Analgesia in Newborn Infants Undergoing Painful Procedures, recently published in The Cochrane Database of Systematic Reviews.

Stevens, who is also associate chief of nursing research, the Signy Hildur Eaton Chair of Paediatric Nursing Research and a senior scientist at the Hospital for Sick Children, said she hopes this research will provide caregivers with the knowledge, and confidence, to routinely use sugar to manage babies’ pain.

“Pain has a lot of consequences,” Stevens said. “Our research has shown that just a drop or two of sucrose is effective for reducing pain for babies who undergo single, painful procedures such as heel sticks and injections.

“Health professionals and parents should do their best to make sure they advocate for the babies and use this simple method of sucrose to make sure babies’ pain is effectively reduced,” she said.

Stevens is also director of the University of Toronto Centre for the Study of Pain, a partnership among the faculties of dentistry, medicine, nursing and pharmacy.

Using sucrose is the most frequently studied approach to managing pain in infants and with this study, U of T researchers have now compiled the most comprehensive analysis of the data yet. They reviewed 44 studies involving over 3,000 newborn infants.

Despite 14 years of research showing that sick infants are exposed to large numbers of painful procedures with minimal or no provision of pain management, along with abundant evidence to support effectiveness of pain reduction strategies, insufficient practice changes have been made. Untreated pain in infancy has both immediate and longterm negative consequences such as increased sensitivity and responses to subsequent pain. Stevens advocates for widespread sustained practice changes to reduce this burden of pain.

Investigators assessed a broad range of procedures performed on infants in the neonatal intensive care unit and found that sucrose is safe and effective for reducing pain during single painful procedures. The study showed sugar water decreased babies’ crying time and behaviours associated with pain, like grimacing.

Stevens said more research is needed to determine the optimal dose to give babies and how effective sugar is when given repeatedly and in combination with other drugs.

Co-authors on the systematic review are Janet Yamada, a PhD candidate in nursing, and Professor Emeritus Arne Ohlsson of pediatrics. This review was first published in 1998 and updated in 2004. All three authors, along with a team of clinicians, researchers, professional association leaders and the CEO of the Canadian Association of Paediatric Health Centres are co-investigators on the knowledge synthesis project that supported this, and three other, systematic reviews of sweet solutions for reducing pain in infants and children. This research is funded by a CIHR Synthesis Grant: Knowledge Translation.


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