Oral sugar solutions for the treatment of procedural pain in term and preterm neonates

Objectives: We review the efficacy of oral sugar solutions for treating pro cedural pain in neonates and address the following questions: Do newborns n eed analgesic therapy for procedural pain during blood sampling? How do sug ars influence pain-reactions of neonates? What is the efficacy of sugar sol utions in clinical practice? Methods: We searched for relevant articles in the PubMed database from 1990 to September 2000. Results: Treatment of procedural pain in newborns is desirable because they are more sensitive to pain than adults, they show marked pain reactions du ring blood sampling and repeated acute pain in the newborn period results i n longterm behavioural changes. Oral sugar solutions have been studied for treatment of procedural pain in neonates. Their initial effect is the resul t of orotactile stimulation by the intraoral fluid. The orogustatory stimul ation by the sweet taste prolongs the effect for up to 10 minutes through e ndorphin release. In randomized-controlled trials oral sugar solutions (2 m l of 25 % sucrose or 30 % glucose) reduced pain reactions and crying and at tenuated the heart rate increase after capillary and venous blood sampling in term and preterm neonates. They are more effective than traditional calm ing strategies, like cuddling by parents, use of a pacifier, or breast feed ing. Yet, sugar solutions provide no adequate analgesia for more severe pai n, e.g. during circumcision. Conclusions: Sugar solutions effectively relieve procedural pain during blo od sampling in neonates. Additional studies are needed to determine the min imal effective dose and the efficacy and side effects of repeated sugar dos es in the same patient.