Presented at the Neonatal Society 2006 Spring Meeting.
McCullough S, MacFarlane P, Halton T, Mowbray D
Department of Child Health and Pharmacy, Rotherham General Hospital, Moorgate Road, Rotherham S60 2UD, UK
Background: Oral sucrose is an effective analgesic for neonatal procedures such as venepuncture and heel lancing. It has a rapid onset, short-lived effect thought to be mediated by endogenous brain opioid release. Nasogastric tube (NGT) insertion is another frequently performed neonatal procedure, which is likely to be painful. In adult practice, topical anaesthesia is routinely used for NGT passage.
Objective: The aim of this double blind randomised placebo controlled trial was to determine whether oral sucrose modifies the pain response to NGT insertion in neonates.
Method: Ethical approval was obtained from the regional ethics committee. 20 stable preterm infants who required NGT insertion for feeding were recruited and randomised on 51 occasions to receive either oral 24% sucrose (n=26) or placebo (sterile water) (n=25). After baseline measurements, the test solution was administered and then the NGT was passed. A separate observer measured pain during and after NGT passage by behavioural response (0-4 point Neonatal Facial Coding System (NFCS) and by the presence or absence of cry), and by physiological response (heart rate (HR), SaO2). Adverse events during administration of the test solution, difficulty in passing the NGT, and adverse events during NGT passage were recorded.
Results: Baseline characteristics of the infants in each group were comparable. The group who received sucrose demonstrated a significantly lower NFCS during NGT passage compared to the placebo group, (median 1 (range 0 – 4) vs. 3 (0 – 4), p=0.004). There was a trend for sucrose treated infants to have reduced HR change during NGT passage compared with the placebo group (mean (SD) -0.73(23) vs +11(17) p=0.055). Mean SaO2 did not change significantly. Pain response measurements quickly returned to baseline after NGT insertion. Adverse effects, such as apnoea or oxygen desaturation, were few and occurred equally in each group.
Conclusion: NGT insertion induced a pain response comparable to previously reported responses to heel lance in neonates. Oral sucrose 24% is effective and safe in reducing the behavioural and physiological pain response to NGT passage.