The influence of gestational age on the efficacy and short-term safety of sucrose for procedural pain relief.
BACKGROUND
Physiologic and behavioral responses to procedural pain are influenced by gestational age (GA). Compared with term neonates, hospitalized preterm neonates are subjected to more painful procedures aimed at improving their clinical outcome. Although several trials to determine the efficacy of sucrose for managing procedural pain have been conducted, none have examined the influence of GA.


OBJECTIVE
To examine the influence of GA on the efficacy and short-term safety of oral sucrose for relieving procedural pain associated with heel lances. To explore GA differences in behavioral and physiologic indicators of pain.


METHODS
As part of a larger randomized controlled trial (RCT) to examine the efficacy and safety of sucrose during heel lance, 190 neonates were stratified by GA: (a) 27 to 316/7 weeks (group 1; n = 63), (b) 32 to 356/7 weeks (group 2; n = 63), and (c) >36 weeks (group 3; n = 64). They were then randomized to receive (a) oral sucrose and non-nutritive sucking (NNS), (b) sucrose alone, or (c) sterile water and NNS (control) for a heel lance. The influence of GA was determined by examining the short-term safety, as defined by the number of associated adverse events (choking, coughing or vomiting, sustained tachycardia, sustained tachypnea or dyspnea, or sustained oxygen desaturation). The efficacy was measured by changes in a validated pain measure, scored during each phase of the intervention and analyzed according to GA groups.


RESULTS
Significant differences in pain response existed in each GA group, with the lowest mean pain scores in the sucrose and NNS group. Significant GA differences in behavioral and physiologic responses were found, with the most mature neonates demonstrating the greatest magnitude of pain response. The greatest number of short-term adverse effects to treatment occurred in the lowest GA group.


CONCLUSIONS
In a secondary analysis of a larger RCT, sucrose and NNS was the most efficacious intervention for single heel lances in each of 3 GA groups. However, infants of lower GA experienced more adverse events. Research on the efficacy and safety of repeated doses of oral sucrose, tested in infants from a wide range of GA, is required.
Gibbins
Sharyn
S
Sunnybrook & Women's College Health Sciences Centre, 76 Grenville St, Room 445, Toronto, Ontario, Canada M5A 1B2. sharyn.gibbins@sw.ca
Stevens
Bonnie
B
D000704:Analysis of Variance; D001800:Blood Specimen Collection; D005260:Female; D005865:Gestational Age; D006365:Heel / Q000098:blood supply; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D017283:Neonatal Nursing / Q000379:methods; D009730:Nursing Assessment; D015403:Nursing Evaluation Research; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D012449:Safety; D012720:Severity of Illness Index; D013391:Sucking Behavior; D013395:Sucrose / Q000627:therapeutic use*; D013997:Time Factors; D016896:Treatment Outcome
D013395:Sucrose