A recent Cochrane review led by Mariana Bueno, Assistant Professor at the Lawrence Bloomberg Faculty of Nursing, has identified sucrose as an effective and safe method for managing pain in hospitalized infants undergoing venepuncture. The review analyzed studies from around the world and found that administering sucrose to infants provided comfort and reduced pain during procedures, particularly when compared to no intervention.
Venepuncture is a common procedure for hospitalized infants, used for blood tests or IV insertions. While it can be less painful than heel lancing when performed by skilled clinicians, it is often not successful on the first attempt. According to Bueno, "These findings also support what is already a recommendation in many infant care guidelines when it comes to sucrose administration. The challenge remains that more clinicians need to find a way to routinely implement pain management strategies for procedures."
Bueno highlighted that other methods of pain relief for infants include skin-to-skin contact, breastfeeding, or topical anesthetics. However, further research is needed to directly compare these interventions with sucrose administration. She emphasized that some form of pain management should be considered before performing venepuncture on infants.
The review also addressed concerns about untreated procedural pain in infants worldwide. Bueno stated, "We know that procedural pain for infants is poorly managed in low, middle and high-income countries, and that repeated exposure to untreated acute pain at early stages in life may lead to short and long-term changes to the structure and connectivity of the somatosensory system – essentially how the brain processes and perceives external stimuli." Untreated pain can negatively affect growth and development, especially in infants who are hospitalized for extended periods.
Although sucrose is regarded as a medication and its long-term effects require further evaluation, Bueno noted that its use remains limited in clinical settings. She advised caution against using sucrose unnecessarily for stress or crying but stressed its ease of administration: "Sucrose is easy to administer on the baby's tongue two minutes before the procedure," said Bueno. She also pointed out gaps in clinician engagement with current evidence-based practices.
To improve pain management strategies for infants, Bueno suggested a prioritized approach: "A first choice would be to offer skin to skin, then breastfeeding, and if those options are not available then sucrose should be administered. The message from our findings is ultimately that infants need and should receive pain management before a procedure such as venepuncture," she said.
Challenges remain due to complex neonatal intensive care unit (NICU) environments where clinicians may skip pain management because procedures are quick or due to assumptions about infant memory. Additionally, global supply issues mean doses of sucrose are not always readily available.
"These challenges can be addressed," said Bueno. "By using clinical practice guidelines and locally developed evidence-based protocols, we can improve pain care in NICUs."
