Therapeutics/Prevention Randomised controlled trial
Sugar and warmth additively decrease pain in newborns getting vaccines 10.1136/ebmed-2015-110200
John W Harrington Children’s Hospital of The King’s Daughters, Norfolk, Virginia, USA Correspondence to: Dr John W Harrington, Children’s Hospital of The King’s Daughters, 601 Children’s Lane, Norfolk, VA 23507, USA; [email protected]
Commentary on: Gray L, Garza E, Zageris D, et al. Sucrose and warmth for analgesia in healthy newborns: an RCT. Pediatrics 2015;135:e607–14.
Context Sucrose as an analgesic has been well studied in the newborn and infant population undergoing brief noxious stimuli such as vaccines or heel sticks.1 Providing additional, non-pharmacological, therapeutic options to create a synergy with the sucrose has been considered in other studies.2 Breast feeding, which supplies the sweetness of sugar (breast milk) and skin-to-skin contact, has been thought to provide radiant body heat.3 4 The authors of this study draw on their previous work of using radiant heat as an analgesic for infants undergoing vaccination and hypothesise that pairing this with the sucrose may provide added painreducing benefits.5
Methods This was a randomised controlled trial of sucrose given orally to two groups with one group also receiving radiant heat (0.5°C above basal temperature for 2 min), in an infant warmer prior to receiving the hepatitis B vaccine. Fifteen infants were recruited in each group to show a statistically significant difference in the reduction of grimacing and crying as measured from videotaped recordings scored by blinded observers using the ‘Behavioral Indicators of Infant Pain’ scale.6 Infants were also monitored with neonatal ECG electrodes to monitor heart rate, a calculated amplitude of a respiratory sinus arrhythmia (RSA), where decreases in value meant more elicited pain, and a rectal temperature. The protocol consisted of a baseline period (5 min), intervention period (sucrose and radiant warmth +/− for 2 min), vaccination (10 s) and a recovery period for 5 min where heart rate, temperature and video recording were carried out.
Findings The sucrose plus warmer group (n=14) cried and grimaced on average 12.8–14.9 s versus the sucrose group only (n=15) who cried and grimaced on average 28.0–31.1 s ( p
Sugar and warmth additively decrease pain in newborns getting vaccines 10.1136/ebmed-2015-110200
John W Harrington Children’s Hospital of The King’s Daughters, Norfolk, Virginia, USA Correspondence to: Dr John W Harrington, Children’s Hospital of The King’s Daughters, 601 Children’s Lane, Norfolk, VA 23507, USA; [email protected]
Commentary on: Gray L, Garza E, Zageris D, et al. Sucrose and warmth for analgesia in healthy newborns: an RCT. Pediatrics 2015;135:e607–14.
Context Sucrose as an analgesic has been well studied in the newborn and infant population undergoing brief noxious stimuli such as vaccines or heel sticks.1 Providing additional, non-pharmacological, therapeutic options to create a synergy with the sucrose has been considered in other studies.2 Breast feeding, which supplies the sweetness of sugar (breast milk) and skin-to-skin contact, has been thought to provide radiant body heat.3 4 The authors of this study draw on their previous work of using radiant heat as an analgesic for infants undergoing vaccination and hypothesise that pairing this with the sucrose may provide added painreducing benefits.5
Methods This was a randomised controlled trial of sucrose given orally to two groups with one group also receiving radiant heat (0.5°C above basal temperature for 2 min), in an infant warmer prior to receiving the hepatitis B vaccine. Fifteen infants were recruited in each group to show a statistically significant difference in the reduction of grimacing and crying as measured from videotaped recordings scored by blinded observers using the ‘Behavioral Indicators of Infant Pain’ scale.6 Infants were also monitored with neonatal ECG electrodes to monitor heart rate, a calculated amplitude of a respiratory sinus arrhythmia (RSA), where decreases in value meant more elicited pain, and a rectal temperature. The protocol consisted of a baseline period (5 min), intervention period (sucrose and radiant warmth +/− for 2 min), vaccination (10 s) and a recovery period for 5 min where heart rate, temperature and video recording were carried out.
Findings The sucrose plus warmer group (n=14) cried and grimaced on average 12.8–14.9 s versus the sucrose group only (n=15) who cried and grimaced on average 28.0–31.1 s ( p
