Thursday, September 02, 2010

Sugar Does Not Relieve Newborn Pain

A physician I was interviewing recently informed me that when he performs circumcision surgery upon a newborn baby (96% undergoing prepuce amputation do not receive anesthesia for the procedure in the United States), "I give him a pacifier dipped in a solution of 25% sucrose, which helps to soothe him during surgery." Another OB/GYN who also uses sugar-dipped pacifiers during genital cutting said, "We don't use anesthesia here because that is just more mucking, and babies don't like being mucked with." According to the following news report by the UCL Research Department of Neuroscience, Physiology and Pharmacology (NPP), however, this sugar method of pseudo 'pain relief' is as bogus as we assumed it to be.


In 2001, recommendations were published, that suggested oral sucrose (sugar) be given to newborns to help relieve pain from invasive procedures (including circumcision surgery).

But a new study led by the UCL Research Department of Neuroscience, Physiology & Pharmacology (NPP) and published today in The Lancet, shows that giving sugar to newborn babies as a form of pain relief does not work.

Instead, sucrose changes the facial expressions of some babies giving the impression that pain is being relieved. The finding could lead to future changes in healthcare policy as oral sucrose is frequently given to relieve procedural pain in newborn babies who must undergo invasive procedures, such as taking blood from a vein or heel lances.

The trial, funded by the Medical Research Council, studied 59 newborn, healthy babies at University College Hospital and found that activity in the pain areas of the brain did not differ regardless of whether they were given sucrose for pain relief. There was little difference between the infants’ leg reflex reactions either, which also indicates discomfort.

Scientists measured pain activity in the brain and spinal cord before and after babies had undergone a routine heel lance – a standard procedure used to collect blood samples from babies. Half the babies were given a sucrose solution prior to the lance, as per the standard procedure, and the remainder were given sterilized water. Brain activity was measured using neonatal electroencephalography (EEG) and spinal cord pain reflex was recorded with electromyography (EMG).

Dr Rebeccah Slater (UCL Research Department of Neuroscience, Physiology & Pharmacology), who led the study, reports, “Our findings indicate that sucrose is not an effective pain relief drug. This is especially important in view of the increasing evidence that pain causes short and long-term adverse effects of infant neurodevelopment. While we remain unsure of the impact pain has, we suggest that it is not used routinely to relieve pain in infants without further investigation.”

Professor Chris Kennard, chair of the MRC’s Neuroscience and Mental Health funding board says, “This trial has significant implications for healthcare policy and is a first class example of where MRC research is helping bring scientific discoveries from laboratory bench to patient bedside more quickly. With uncertainty around the role that pain plays in a baby’s neurodevelopment, this research is a vital tool for informing healthcare decision makers. Scientific advancements like these would not be possible without the support of medical research volunteers, and families and scientists remain indebted to the huge contribution from members of the public.”

The paper, "Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial" is published in The Lancet today.



Citation:

Slater, Rebeccah, et al. "Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial." The Lancet, 10.1016/S0140-6736 (10)61303-7.

Background
Many infants admitted to hospital undergo repeated invasive procedures. Oral sucrose is frequently given to relieve procedural pain in neonates on the basis of its effect on behavioural and physiological pain scores. We assessed whether sucrose administration reduces pain-specific brain and spinal cord activity after an acute noxious procedure in newborn infants.

Methods
In this double-blind, randomised controlled trial, 59 newborn infants at University College Hospital (London, UK) were randomly assigned to receive 0·5 mL 24% sucrose solution or 0·5 mL sterile water 2 min before undergoing a clinically required heel lance. Randomisation was by a computer-generated randomisation code, and researchers, clinicians, participants, and parents were masked to the identity of the solutions. The primary outcome was pain-specific brain activity evoked by one time-locked heel lance, recorded with electroencephalography and identified by principal component analysis. Secondary measures were baseline behavioural and physiological measures, observational pain scores (PIPP), and spinal nociceptive reflex withdrawal activity. Data were analysed per protocol. This study is registered, number ISRCTN78390996.

Findings
29 infants were assigned to receive sucrose and 30 to sterilised water; 20 and 24 infants, respectively, were included in the analysis of the primary outcome measure. Nociceptive brain activity after the noxious heel lance did not differ significantly between infants who received sucrose and those who received sterile water (sucrose: mean 0·10, 95% CI 0·04—0·16; sterile water: mean 0·08, 0·04—0·12; p=0·46). No significant difference was recorded between the sucrose and sterile water groups in the magnitude or latency of the spinal nociceptive reflex withdrawal recorded from the biceps femoris of the stimulated leg. The PIPP score was significantly lower in infants given sucrose than in those given sterile water (mean 5·8, 95% CI 3·7—7·8 vs 8·5, 7·3—9·8; p=0·02) and significantly more infants had no change in facial expression after sucrose administration (seven of 20 [35%] vs none of 24; p<0·0001).>

13 comments:

  1. http://newbornbloodspot.screening.nhs.uk/education

    What terrible technique is being displayed in that photograph! See above link for how to do it properly!

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  2. Sugar. Seriously, sugar. *Sigh* I know this is nothing new, and when my husband and I educated ourselves over six years ago and didn't have our son circumcised, we read about pacifiers in sugar water back then. It's just so mind-bogglingly stupid. I wonder if it started as some sort of joke because who on earth could actually think it would work even for a second?

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    Replies
    1. Thank you, common sense would tell you that giving a child a lollipop won't relive their pain while someone is setting their arm, let alone removing their foreskin. Especially as the foreskin in a newborn is attached to the glans of the penis like your fingernail to your finger!

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  3. thank you for this. Sunday Surfing it

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  4. I was told in the NICU that sugar would help my premature son with the pain from the many procedures he had to endure. he was originally given morphine when he was on a respirator but the sedative effect was dangerous for more than very occasional use. I was sceptical, but HOPED that sugar would in fact help him as I knew that it was certainly not the most peaceful start in life for him. Despite this, I am glad to hear that this is being investigated even if it means my son suffered more than I had hoped was the case. Eventually, hopefully we will come up with some better strategies. I am thankful that he was blessed with the very loving care of older and very experienced nurses during that period. Their gentle loving touch and soothing voices was probably much more effective for him and I bless the love they showed him.

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  5. it stops/ lessen their crying not the pain...this is a common practice in Special Care Units/ Nurseries in government hospitals

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  6. I don't understand how anyone in their right mind ever thought that SUGAR could relieve pain. "Oh my arm just got chopped off, I think I'll eat some sugar." Yeah, makes perfect sense.

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    1. Thank you...that was my first thought...sugar isn't my first choice when I just stabbed my hand with a knife.

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  7. I find that I eat sugar when I get angry. Sugar does do SOMETHING to you. Is it enough to chop a body part off? Hell no! They put caffeine in pain relievers because it has some minimal effect, but that doesn't mean we can give our babies caffeine for surgery.

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  8. DAH! Did they really need a study to figure that out???? Isn't a baby screaming in pain enough?

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  9. It's like giving a full grown man a lollipop right before you kick him in the balls, "Don't worry, it won't hurt, just suck on this."

    ...only, much, much, much worse!

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  10. My NICU has *never* used sugar as a pain management method for painful procedures. We practice non-nutritive sucking, facilitating tucking and skin-to-skin with family to reduce pain. It helps to keep the babies more organized so they recover more quickly. For babies with painful conditions, we give analgesia, usually morphine. There are new studies coming out about the dangers of giving premies Tylenol and Ibuprofen (although Ibuprofen is used to close PDAs if the PDA is causing problems). We work with doctors, lab techs and other RNs to provide developmentally supportive care towards the babies. We also teach the parents, so that they can provide comfort during painful procedures if they wish (which 99% of the time they do!).

    I'm still amazed at how much blood that stupid PKU test takes. Geeze. Especially in a premie whose total blood volume is only 60ml.

    Your article doesn't talk about the damage sugar causes to the developing brain of the neonate! Sugar causes a rewiring of the brain circuits, although I'm unsure if it was just tested in infants who experienced regular painful procedures, or if it was done in a lab.

    In either case, it was a good theory, until it wasn't. Neonatology is in it's infancy (no pun intended) and developing rapidly. In the 1970's, people didn't believe babies could EXPERIENCE pain and routinely did surgery on babies who were only paralyzed. They were not even given a sedative or any kind of pain killer. You can imagine that the mortality rate from such procedures was pretty frickin high!!!!

    What I'm saying is that you have to start somewhere. Things I'm doing now will probably be totally backwards in 5 years. Giving sugar caused a decrease in crying, the BIIP score and outward signs of pain. It's easy to see that one would think it worked. It wasn't until they started going deeper into the theory that they discovered it didn't work.

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  11. Oh yeah, sugar outta stop any and all discomfort. Are you kidding me? Whoever believes that is a moron.

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