Sucrose and non-nutritive sucking for the relief of pain in screening for retinopathy of prematurity: a randomised controlled trial

Elaine M Boyle ^1*, Yvonne Freer ², Zareena Khan-Orakzai ², Michael Watkinson ³, Elizabeth Wright ⁴, John R Ainsworth ³ and Neil McIntosh ⁵

¹ McMaster University Medical Centre, Canada
² Royal Infirmary of Edinburgh, United Kingdom
³ Birmingham Heartlands Hospital, United Kingdom
⁴ Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom
⁵ University of Edinburgh, United Kingdom

^* To whom correspondence should be addressed. E-mail: emboyle{at}doctors.org.uk.

Accepted 17 January 2006

Abstract

Background: Screening is necessary for infants at risk of retinopathy of prematurity. Despite local anaesthetic drops, infants find eye examinations distressing, displaying behavioural and physiological changes indicating acute pain. Oral sucrose and non- nutritive sucking reduce pain responses associated with invasive procedures. This study evaluates the use of oral sucrose and/or pacifier for reducing pain responses during eye examinations.

Methods: Forty infants <32 weeks gestation or <1500g birth weight, in two neonatal units, were randomised to one of four interventions administered 2 minutes before their first screening examination: 1ml sterile water as placebo (Group 1, n=10), 1ml 33% sucrose solution (Group 2, n=10), 1ml sterile water with pacifier (Group 3, n=9) or 1ml 33% sucrose solution with pacifier (Group 4, n=11). Examinations were videotaped. Two observers, blind to intervention, assessed recordings. Pain responses were scored using the Premature Infant Pain Profile (PIPP).

Results: The groups were similar in gestation, birth weight and age at examination. Mean PIPP scores were 15.3, 14.3, 12.3 and 12.1 for Groups 1, 2, 3, and 4 respectively. Analysis of variance showed a significant difference in PIPP score between groups (P=0.023). Infants randomised to pacifiers scored lower than those without pacifiers (P=0.003). There was no difference between groups receiving sucrose compared with those receiving water (P=0.321).

Conclusions: Non-nutritive sucking reduced distress responses in infants undergoing screening for retinopathy of prematurity. The difference in response was large enough to be detected by a validated assessment tool. No synergistic effect of sucrose and pacifier was apparent in this group.

Keywords: infant, pain, retinopathy of prematurity, sucrose, premature

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