Pre-term infant refers to an infant
that is born before 37 weeks of gestation. Because they are born too early,
preterm babies (or preemies) weigh much less than full-term babies.
Preemies are susceptible to a multitude of health problems since their organs
are not fully developed. Their survival need highly sophisticated intensive
care. They stay in neonatal intensive care units (NICUs) until their organ
systems can work on their own.
Intensive care is associated with an
exceedingly high number of painful procedures. Infants with
extremely low gestational ages (GAs) are particularly subjected to these. Repeated pain exposures can affect the
normal development of the central nervous system ultimately leading to
permanent defects. These ensue in altered pain thresholds and stress
responses, defective perceptions, learning and reasoning, behavioral disorders,
and long-term disabilities.
Despite the understanding of the aftermath of pain exposure, most of the painful procedures in NICUs are performed without any analgesia. Resorting to drugs for analgesia may have a negative impact on neonatal outcome. Side effects and
questionable efficacy are other deterrents forcing a choice of
non-pharmacological means of pain relief.
(NPIs) or where no analgesia is used for effective reduction of pain for minor
to moderately painful procedures include oral
sucrose, breastfeeding, non-nutritive sucking, facilitated tucking (FT),
kangaroo care, and swaddling. Through mechanisms like provision of oro-tactile,
oro-gustatory, and tactile stimulation and promotion of self-regulation, NPIs
are capable of reducing infants' pain responses during painful procedures.
Sweet taste solutions such as sucrose are recommended
extensively for pain relief in preterm infants. Sucrose has been shown
to be safe and highly effective. Facilitated
tucking (FT) is a nursing method in which a parent holds the infant in a
flexed position. FT gives the infant a chance to control his or her own body,
and provides support. Previous studies have shown that FT has the added
advantage of providing parents an active role in the pain care of their preterm
A new study compared the
impact of sucrose and FT alone and in combination on pain responses of preterm
infants across multiple painful procedures. The effectiveness of these
interventions during repeated heel sticks was assessed. Heel stick is a common
way to draw blood from newborns. The newborn baby's heel is pricked and a small
amount of blood is collected with a capillary glass tube or a filter paper. It
is a minimally invasive and easily accessible method.
results reassure the efficacy of NPIs. Sucrose with or without facilitated tucking
was found to remain effective during repeated heel sticks across time. FT did not
produce an encouraging result. It failed to be effective over repeated pain
exposures and hence cannot be recommended as an independent non-pharmacological
intervention. Researchers tried to elicit the benefit of combining oral
sucrose and FT. Results were not clinically meaningful, but rather demanded
additional resources for implementation.
efficacy of oral sucrose as an analgesic during painful procedures thus stands
the tests of time. The results are of significant clinical implications for the
management of pain in preterm infants. Sweet
taste solutions such as sucrose can effectively reduce the stress of painful
procedures that preterms undergo during their NICU stay. Facilitated tucking
cannot be recommended in a setting of repeated pain exposures.
Sucrose and "Facilitated Tucking" for Repeated Pain Relief in Preterms: A
Randomized Controlled Trial; Eva Cignacco et al; Pediatrics 2012
E, Hamers J, van Lingen RA, et al.Neonatal procedural pain exposure and pain
management in ventilated preterm infants during the first 14 days of life.
Swiss Med Wkly. 2009;139(15-16):226-232.