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Pain Research and Management
Volume 18, Issue 3, Pages 153-161

A Systematic Review and Meta-Analyses of Nonsucrose Sweet Solutions for Pain Relief in Neonates

Mariana Bueno,1 Janet Yamada,2,3 Denise Harrison,4,5,6,7 Sobia Khan,3 Arne Ohlsson,8,9 Thomasin Adams-Webber,3 Joseph Beyene,3,9 and Bonnie Stevens2,3,8,10

1School of Nursing, Federal University of Minas Gerais, Belo Horizonte, Brazil
2Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
3The Hospital for Sick Children, Toronto, Canada
4Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
5Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
6Critical Care and Neurosciences, Murdoch Children’s Research Institute, Royal Children’s Hospital, Victoria, Australia
7Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Australia
8Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
9Department of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
10University of Toronto Centre for the Study of Pain, University of Toronto, Toronto, Ontario, Canada

Copyright © 2013 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


BACKGROUND: Sucrose has been demonstrated to provide analgesia for minor painful procedures in infants. However, results of trials investigating other sweet solutions for neonatal pain relief have not yet been synthesized.

OBJECTIVE: To establish the efficacy of nonsucrose sweet-tasting solutions for pain relief during painful procedures in neonates.

METHOD: The present article is a systematic review and meta-analyses of the literature. Standard methods of the Cochrane Neonatal Collaborative Review Group were used. Literature searches were reviewed for randomized controlled trials investigating the use of sweet solutions, except sucrose, for procedural pain management in neonates. Outcomes assessed included validated pain measures and behavioural and physiological indicators.

RESULTS: Thirty-eight studies (3785 neonates) were included, 35 of which investigated glucose. Heel lancing was performed in 21/38 studies and venipuncture in 11/38 studies. A 3.6-point reduction in Premature Infant Pain Profile scores during heel lances was observed in studies comparing 20% to 30% glucose with no intervention (two studies, 124 neonates; mean difference −3.6 [95% CI −4.6 to −2.6]; P<0.001; I2=54%). A significant reduction in the incidence of cry after venipuncture for infants receiving 25% to 30% glucose versus water or no intervention was observed (three studies, 130 infants; risk difference −0.18 [95% CI −0.31 to −0.05]; P=0.008, number needed to treat = 6 [95% CI 3 to 20]; I2=63%).

CONCLUSIONS: The present systematic review and meta-analyses demonstrate that glucose reduces pain scores and crying during single heel lances and venipunctures. Results indicate that 20% to 30% glucose solutions have analgesic effects and can be recommended as an alternative to sucrose for procedural pain reduction in healthy term and preterm neonates.