EBM Vs Sucrose for pain releif

[@llli*firespiral]

Hi

I have a friend in the NICU
She wants to use EBM for pain relief rather than the sucrose currently being used, but wants to see some sort of study providing evidence that it works.

She has seen a study saying that sucrose means 30% less crying ...
any links here?

ASAP please .. as I am sure you understand!

Thankyou xx

[@llli*juno]

What is the pain from? Why not use some sort of pain medicine?

[@llli*firespiral]

the baby is a 25weeker, regular cannula insertions
much medical stuff going on!

[@llli*juno]

That is so sad. I am sorry. I have no advice to offer on that subject

[@llli*amysmom]

What is her concern about using the sucrose? Here's an article about it: http://www.medscape.com/viewarticle/458592_3

Here's a Canadian study of breastfeeding / breast milk for pain relief: http://www.nichd.nih.gov/cochrane/shahprak/shahprak.htm

Reviewers' conclusions
If available, breastfeeding or breast milk should be used to alleviate procedural pain in neonates undergoing a single painful procedure compared to placebo, positioning or no intervention. Administration of glucose/sucrose had similar effectiveness as breastfeeding for reducing pain. The effectiveness of breast milk for repeated painful procedures is not established and further research is needed. These studies should include various control interventions including glucose/ sucrose and should target preterm neonates.

This article is more recent: ABM Clinical Protocol #23: Non-Pharmacologic Management of Procedure-Related Pain in the Breastfeeding Infant

Breastfeeding or human milk
1. When available, breastfeeding should be the first choice
to alleviate procedural pain in neonates undergoing a
single painful procedure, such as venipuncture or heel
lance.12–14 Breastfeeding should not be discontinued
prior to the procedure. Studies show that when
breastfeeding was stopped shortly before a painful
procedure, no significant differences were found
(compared to control groups) in outcomes in terms of
the orogustatory, emotional, tactile, or thermal experience.
15 When breastfeeding is not possible, whether
because of the unavailability of the mother or difficulties
with breastfeeding, consider the use of expressed
human milk by dropper, syringe, or bottle, which has
been shown to soothe newborns experiencing procedural
pain.16–19 Administration of human milk can also
be combined with sucking, by dipping a pacifier
(dummy) in the milk, as described below for sucrose.
2. Although some studies have demonstrated the efficacy
of human milk alone,17,20 human milk may not be
equivalent to breastfeeding because of breastfeeding’s
multicomponent experience. Breastfeeding throughout
the painful procedure is likely to be superior to human
milk alone on the basis of synergism between the
components of breastfeeding.15,20

and...

1. Skin-to-skin contact provides effective pain reduction
for premature newborns.40,41
2. In very-low-birth-weight neonates (27–31 weeks of
gestation) undergoing consecutive heel lances, a pacifier
dipped in sucrose or in water significantly reduced pain
compared with infants who did not receive any intervention.
42
3. The value of sucrose as a pain reducer in the preterm
infant is well established.39,43–45 The recommended
dosage in this population is 0.1–0.4mL of 24% sucrose
solution.1,44 Further pain reduction can be achieved
when preterm infants receive 24% sucrose as three doses
(0.1 mL, 2 minutes apart given 2 minutes and immediately
prior to heel lance and 2 minutes after lance)
rather than as a single dose.45
4. The efficacy of breastfeeding and human milk as a pain
reducer for the preterm or low-birth-weight infant is not
well established in the current literature and should be
the subject of further research; no studies have been
performed specifically in this population. Regardless, if
316 ABM PROTOCOL
a mother wishes to breastfeed or provide her infant
with human milk instead of sucrose, this should not be
discouraged.
5. Skin-to-skin contact plus sucrose has not been formally
evaluated in premature infants, but may provide pain
reduction for the preterm or low-birth-weight neonate.

[@llli*firespiral]

thanks for your reply
you asked what are her concerns around using sucrose .. well, it is not a natural foodsource for a baby, let alone a premature one.
concerns include the effects such may have an an immature gut, immature pancreas and the delicate nature of neonate brain that requires the right balance of sugars to live.

I believe EBM (with it's natural sucrose) will provide the same pain relief as the hospy sucrose; but just wanting a link/study/article that will support this. Furthermore, since bub is currentl NBM (nil by mouth) any drop of EBM has to be a good thing!

Thankyou for this (quoted from above);

"Administration of human milk can also
be combined with sucking, by dipping a pacifier
(dummy) in the milk, as described below for sucrose."

That is what i was looking for

[@llli*firespiral]

Oh .. have you a direct link for that article please?

[@llli*amysmom]

Oh .. have you a direct link for that article please?

It's a PDF download, but if you google the name of the article you'll get the link to it. I'm glad it was helpful.

I find it sad that there hasn't been more research into this. You'd think that with studies leaning towards it being just as effective that they'd study it more. The articles I found all suggested "further studies".

[@llli*jenniebean5]

Amysmom - that was really interesting, thanks!

When my son was in the NICU, I remember being surprised when I was there for a painful procedure and they gave him sucrose. I felt like you're friend...why give him something like that instead of EBM, which they did use drops of EBM or a dipped pacifier at times, too. His nurses told me they use drops/pacifier with EBM for more minor things and the sucrose for more painful things.

I think sometimes when your baby is in the NICU and there's very little you can do for him/her, moms feel a loss of control/power over the situation and so they try to get some control over certain things. Looking back, I know I did. Not saying that's what your friend is necessarily doing here, but wanted to put it out there, because it may be helpful for you to ask her if she feels this way and let her talk about how that feels.

[@llli*el.ro]

Hi firespiral,
in our NICU they used 20% sucrose as well. But at times they said a child would not accept it and so they used anything else that kept the child interested in sucking, especially EBM (so sucking here is another reliefing factor). When DS was breastfeeding later on they said they would like to make their procedures (like taking blood from the feet, giving eye-drops etc.) meanwhile since they said they knew studies that while nursing children "feel" less pain. (Only I did not want it after one successful try to not let him associate nursing with pain and other stressing procedures). Plus they said sucrose loses it's power when the children get older (they told us this when DS was something around 30 weeks of gestational age.)

I have not read the papers so I am not sure how they objectified "less pain", only I often felt it was more a question of preemies concentration and feeling safe, that they endured the procedures whith less struggling.

Ah, and in the beginning some nurses just injected the scurose into the mouth, but most put the sucrose/ebm on a cotton bud and let the baby suck. When the babies were big enough, they often put the sucrose/ebm on a pacifier.

Best luck to your friend and her baby!!!