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Pacifier and sucrose combo relieves feeding tube pain in preemies

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – When inserting a feeding tube through the nose, a pacifier and a squirt of sugar water can help relieve pain in preterm babies, according to a Norwegian study.

The research, published on Monday in Pediatrics, found that babies showed significantly fewer signs of pain when given both the pacifier and a sucrose solution compared to when they received neither. Giving the preemies a pacifier with or without a drop of water did not reduce pain.

Led by Laila Kristofferson, researchers measured signs of pain in 24 preterm infants at St. Olav’s University Hospital in Trondheim between 2005 and 2008. All infants had a gestational age of 28 to 32 weeks and were in stable condition but required nutrition from a nasogastric feeding tube.

Over three weeks, babies served as their own controls for six different treatments, given just before the tube was changed biweekly: pacifier or no pacifier, each with no fluid, sterile water (0.2 mL), or a 30% sucrose solution (0.2 mL). The treatments were given in a random order for each baby.

Observers who were blinded to the fluid part of treatment used the Premature Infant Pain Profile (PIPP) rating scale to score each baby’s level of pain, from 0 to 21, while the tube was being inserted and over the next 5 minutes.

A score of 4-6 on the PIPP scale is considered normal, while 12 and above represents significant pain and distress.

When infants were given no pain relief, the median PIPP value was 9 during tube insertion, indicating low to moderate pain. The combination of a pacifier and sucrose gave the most relief, with a median score of 7 (P < 0.001 versus no treatment); for sucrose only, that increased to 8. Giving infants a pacifier and sterile water resulted in a median score of 9; a pacifier only, 10; and sterile water only, 11. No matter what pain relief infants were given, PIPP scores dropped off rapidly over the 5 minutes after the tube was inserted, indicating to the researchers that inserting the tube produced “brief but measurable pain and discomfort.” In all treatments combined, median PIPP scores were 6 after one minute and 4 after five minutes. Kristofferson and colleagues concluded that when a pacifier isn’t suitable or available, sucrose alone is also a good option to reduce pain when preterm babies need a nasogastric feeding tube. But the researchers also added that “more research is needed on the mechanism of sweet solutions in neonates as well as the long-term neurodevelopmental effects of repeated sucrose use.” Pediatrics 2011.