The Face Of An Infant's Suffering; Can It Be Sugarcoated?

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Main Category: Pain / Anesthetics
Also Included In: Pediatrics / Children's Health
Article Date: 02 Sep 2010 - 10:00 PDT

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When your newborn infant is crying with uncomfortable teething or otherwise obviously suffering, feeding sugar to the little one has been a home remedy for years based on not only perceived behavior, but also physiological reactions. However, a new article by Dr. Rebeccah Slater of University College London that appears in the current issue of The Lancet, shows there is no direct connection between pain reduction activity in the spinal cord or brain and the administration of sucrose. It does however, and is proven, to simply change face expressions that leave caretakers feeling more secure that the baby is feeling much better from those sweet treats.

In order to measure pain activity in infants, Dr. Slater and colleagues pricked the heels of babies as is commonly the procedure to collect blood samples from humans. These "pricks," or professionally known as single heel lances, generate a very specific pain activity in the brain measured by EEG or neonatal electroencephalography. Meanwhile spinal reflexes and withdrawals are scaled by an electromyography, or EMG.

The London based study consisted of the following procedures outlined here. First, fifty-nine newborns were randomly chosen to either ingest a half milliliter, 24% sucrose solution or a control of a half milliliter sterilized water two minutes prior to receiving the heel prick or lance. Twenty-nine received the sugar mixture and 30 the water respectively. With EEG monitoring, brain activity linked directly with pain was recorded. The secondary outcome consisted of key baseline observational pain scores, behavioral and physiological data, and spinal reflex withdrawal. No large difference in the two group's brain activity or in spinal reflex was demonstrated.

Interesting to note however is that according to the premature infant pain profiles or PIPP scores, a substantially reduced number of infants (35%) did not change their facial expression after sucrose ingestion compared to those given sterile water with a mean 5•8 compared to 8•5.

Lack of facial expression could be attributed to the use of sucrose in infants, but the EEG still hints at pain reception according to the study's formers.

The authors wrote:

Sucrose seems to blunt facial expression activity after painful procedures, but our data suggest that it does not reduce direct [pain] activity in central sensory circuits, and therefore might not be an effective analgesic drug.

Why is this significant? The authors of the study continue:

This notion is especially important in view of the increasing evidence for short-term and long-term adverse effects of infant pain experience on neurodevelopment. The absence of evidence for an analgesic action of sucrose in this study, together with uncertainty over the long-term benefits of repeated sucrose administration, suggest that sucrose should not be used routinely for procedural pain in infants without further investigation.

Alas, there is some debate that the study was not large enough to make this a clean determination of sucrose induced pain relief in infants.

Statistically the study has only a one in three chance of detecting a 'medium' effect size difference and only a one in ten chance of detecting a 'small' size difference, according to Dr. Robert E Lasky, University of Texas Medical School at Houston, and University of Chicago's Dr. Wim van Drongelen.

This group concludes in rebuttal:

Therefore we should not be surprised that the study failed to detect an effect of sucrose on cortical evoked responses. Small sample sizes also increase concerns that treatment-condition imbalances, despite random allocation, could account for the study's results.

However in light support of Dr. Slater's work they state in addition:

Slater and colleagues' study adds an important and innovative measurement to evaluating pain management in newborn babies.

"Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial"
Rebeccah Slater, Laura Cornelissen, Lorenzo Fabrizi, Debbie Patten, Jan Yoxen, Alan Worley, Stewart Boyd, Judith Meek, Maria Fitzgerald
The Lancet Published Online September 1, 2010
DOI:10.1016/S0140-6736(10)61303-7

Written by: Sy Kraft, B.A. - Journalism - California State University, Northridge (CSUN)
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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