Asked and Answered: Sweet Solutions Are Effective for Procedural Pain Control in Neonates

December 16, 2016

Asked and Answered: Sweet Solutions Are Effective for Procedural Pain Control in Neonates

  1. Daniel M. Lindberg, MD

The evidence has been compelling for a long time, and placebo-controlled trials are no longer ethical.

  1. Daniel M. Lindberg, MD

Sweet solutions, such as those containing sucrose or glucose, have been shown to induce endogenous opioid analgesic mechanisms and improve pain for neonates during painful procedures. These authors conducted a cumulative meta-analysis to estimate the mean effect size and to demonstrate the strength of evidence in favor of sweet solutions. Cumulative meta-analyses chronologically add data based on study publication date to determine the point at which combined results first became statistically significant.

Using a robust search strategy, the authors identified 168 randomized, controlled trials of oral sweet solutions for procedural pain control in neonates, with outcomes of crying time or validated pain scores.

Meta-analysis of 29 trials involving 1775 neonates showed that sweet solutions reduce crying time by a mean of 23 seconds (95% confidence interval, 17–29 seconds). Meta-analysis of 50 trials involving 3341 infants showed a mean improvement in pain scores of 0.90 points (95% CI, 0.70–1.09 points). The cumulative results became statistically significant in 1999 for pain scores and in 2002 for crying time, yet dozens of studies have been performed since then.

Comment

Certainly, one statistically significant result should not foreclose future research. But at some point, it is unethical to ignore evidence that is clear and convincing. Sweet solutions improve crying time and pain scores for neonates, have virtually no untoward effects, and should be used for painful procedures. Future trials should not include a placebo arm.

Editor Disclosures at Time of Publication

  • Disclosures for Daniel M. Lindberg, MD at time of publication Royalties UpToDate Grant / Research support Colorado Clinical and Translational Sciences Institute; Colorado Traumatic Brain Injury Trust Fund; Eunice Kennedy Shriver National Institute of Child Health and Human Development Editorial boards The Quarterly Update: Reviews of Current Child Abuse Medical Research; Child Abuse & Neglect: The International Journal Leadership positions in professional societies The Helfer Society (Executive Board Member at Large)

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