Mary Poppins was right—a spoonful of sugar does help.
New research from Brazil suggests that sugar and hugs appear to reduce the pain felt by newborns when they are given a shot, more so than sugar (dextrose) or skin-to-skin contact alone, or standard care.
The study, published this week in the journal Pediatrics, suggests that simple inexpensive steps could have a big effect on newborns.
In the largest study ever conducted on newborn pain, Brazilian researchers randomly assigned 640 newborns to four analgesia groups of 160 each: no analgesia, dextrose on the tongue, skin-to-skin contact with mom (holding), or dextrose and holding by mom.
Standard pain gauges, including facial expressions, crying duration, and heart rate, were used to gauge newborn pain during and after a routine vaccination. Which newborns received dextrose or plain water was not known by the researchers, but it was impossible to obscure which newborns were being held, making this study only partially blinded.
Combining skin-to-skin contact and a drop of dextrose to the newborn's tongue 2 minutes prior to the needle stick led to a "significant" reduction in pain scores compared to either technique alone, or no-analgesia, the investigators found.
The typical healthy newborn undergoes a number of routine but painful procedures before leaving the hospital including immunization, blood collection and intramuscular injections.
Distraction and other techniques to reduce stress and pain in adults and children do not work in newborns, according to Duke University School of Nursing professor, Dr. Diane Holditch-Davis. As a result, doctors have sought other strategies.
Previous smaller studies have identified the pain reduction benefits of 10 to 30 minutes of skin-to-skin contact or a dose of sugar water separately.
Holditch-Davis works with the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) to develop and evaluate guidelines for the care of infants. The sugar and hug technique of pain control "is a very conservative and reasonable" method for comforting newborns, she told Reuters Health in a telephone interview.
Implementation, she said, should have a "trivial impact" on staff workloads.
The current study found that holding for as little as two minutes prior and two minutes following needle stick was sufficient, Holditch-Davis noted. "That makes the technique even more feasible to do because less planning is needed. The baby can be handed to the mother for the several minutes it takes the nurse to prepare the injection," she pointed out.
The pain relief achieved through holding involves more than just skin-to-skin contact, Dr. Ruth Guinsburg, professor of pediatrics, Federal University of São Paulo, Brazil, who was involved in the study, noted in an email to Reuters Health.
This suggests mom, not substitutes, are involved in achieving pain relief.
"The touch and smell of the mother and the sound of her heartbeat may block" pain signals to the central nervous system or may fuel the release of the body's own pain-relieving hormones, the investigator say. New studies are needed to understand the mechanism underlying this simple non-drug pain-relieving approach.
In the meantime: "I hope that our results will encourage neonatologists, pediatricians and nurses to apply simple, non-expensive non-pharmacological analgesic strategies to decrease pain triggered by routine procedures performed in healthy neonates," Guinsburg said.
Holditch-Davis, agreed. "There's no harm in doing any of these things and it doesn't take that much time so, why wouldn't you do it?" she said.
SOURCE: Pediatrics, December 2009
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