Sucrose and non-nutritive sucking for the relief of pain in screening for retinopathy of prematurity: a randomised controlled trial.
BACKGROUND
Screening is necessary for infants at risk of retinopathy of prematurity. Despite local anaesthetic drops, infants find eye examinations distressing, displaying behavioural and physiological changes indicating acute pain. Oral sucrose and non-nutritive sucking reduce pain responses associated with invasive procedures.


OBJECTIVE
To evaluate the use of oral sucrose and/or pacifier for reducing pain responses during eye examinations.


METHODS
Forty infants <32 weeks gestation or <1500 g birth weight, in two neonatal units, were randomised to one of four interventions administered two minutes before their first screening examination: 1 ml sterile water as placebo (group 1, n = 10), 1 ml 33% sucrose solution (group 2, n = 10), 1 ml sterile water with pacifier (group 3, n = 9), or 1 ml 33% sucrose solution with pacifier (group 4, n = 11). Examinations were videotaped. Two observers, blind to the intervention, assessed recordings. Pain responses were scored using the premature infant pain profile (PIPP).


RESULTS
The groups were similar in gestation, birth weight, and age at examination. Mean PIPP scores were 15.3, 14.3, 12.3, and 12.1 for groups 1, 2, 3, and 4 respectively. Analysis of variance showed a significant difference in PIPP score between groups (p = 0.023). Infants randomised to pacifiers scored lower than those without pacifiers (p = 0.003). There was no difference between groups receiving sucrose and those receiving water (p = 0.321).


CONCLUSIONS
Non-nutritive sucking reduced distress responses in infants undergoing screening for retinopathy of prematurity. The difference in response was large enough to be detected by a validated assessment tool. No synergistic effect of sucrose and pacifier was apparent in this group.
Boyle
E M
EM
University Medical Centre, Department of Pediatrics, Room 4G40, 1200 Main Street West, Hamilton, Ontario L8S 4J9, Canada. emboyle@doctors.org.uk
Freer
Y
Y
Khan-Orakzai
Z
Z
Watkinson
M
M
Wright
E
E
Ainsworth
J R
JR
McIntosh
N
N
D000284:Administration, Oral; D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015997:Neonatal Screening; D041361:Pacifiers; D010146:Pain / Q000517:prevention & control*; D010808:Physical Examination / Q000009:adverse effects; D012178:Retinopathy of Prematurity / Q000175:diagnosis*; D013391:Sucking Behavior; D013395:Sucrose / Q000008:administration & dosage*; D016896:Treatment Outcome
D000700:Analgesics; D013395:Sucrose