The study describes an intervention procedure to reduce pain felt by forty infants at 2 and 4 months of age during their routine immunization visits. The design of the experiment was randomized, and double blind (receivers and givers of the treatment were unaware of the nature of the treatment given). There were two treatments: sterile water, (placebo), and 24% sucrose solution, which were administered directly with syringe to the infants’ mouths, followed by placing in a pacifier to induce the infant to suck.
Twenty infants were included in each treatment. The solutions were given at 2 minutes before the infants were injected with the scheduled vaccines. The pain expressed was assessed using the University of Wisconsin Children’s Hospital (UWCH) Pain Scale at baseline (when the solutions were given), then at 2 and 5 minutes after solution administration. The data was analyzed using appropriate analysis of variance procedures to detect significant differences in behavioural pain scores due to treatments and individual infant response.
Results showed that infants who were given 24% sucrose showed a significant decrease in the behavioural pain response 3 minutes after the last injection was given (this period corresponded to 5 minutes after sucrose was administered). At the time when the injections were given, both treatment groups experienced severe pain, and had the highest mean pain scores. However, at 5 minutes after the solution was given, infants who received sucrose showed a very low mean pain score of 0.
27, which is almost the normal value of zero pain. The placebo group remained at a high pain score of 3. 02, which was ~ 91% more of pain compared to the sucrose group. Age at immunization did not significantly affect the pain response at 2 and 5 minutes following treatment. Results show that oral sucrose given before the immunization procedure is effective in reducing infant pain response after immunizations. Critical Appraisal (20 marks) Information about groups at beginning of study
The study gave the minimum amount of information about the infants that were included in the study. It only included the ages, their birth weights, and the latest data like taking analgesics before the intervention and immunization. However, it appeared towards the end of the article that data on gender, nutrition (breastfed) and number of prior painful experiences were also collected. Breastfeeding is deemed to have a positive effect in reducing pain (Shah, Aliwalas, & Shah, 2006).
An inspection of several studies on pain in children revealed these also gave the same information presented by Hatfield in this article. Information about groups throughout the study The study was conducted on the same set of children at their second month and fourth month immunizations, but the paper did not give other information on the treatment groups following the initial description of the infants. Possibly, in the two-month period when no immunizations were given, changes in the infants’ experiences could affect their reaction to the pain.
Intervention and Measurements The only quantifiable intervention given in the study was 24% sucrose that was orally administered and supplemented with non-nutritive sucking (NNS) with the help of a pacifier. In a survey of 21 studies on the use of sucrose as analgesia in neonates, it was observed there was inconsistency in the effective dose range for sucrose, ranging from 0. 012 g 0. 12 g/kg body weight (Stevens, Yamada, & Ohlsson, 2004). The dose given by Hatfield in this study falls within the range that Stevens, Yamada and Ohlsson recommended.
This same sucrose concentration was also used in another study, and was sufficient to produce only a few adverse effects, and differences in pain perception (Hatfield, Dyer, & Polomano, 2008). Neonates and young children are usually subjected to painful procedures early in life. Although drugs can reduce pain, sucrose has been traditionally used to relieve pain. It is still unsure as to how sucrose reduces pain, and this capacity has been attributed to oral administration since intergastric application does not provide pain relief (Ramenghi, Evans, & Levene, 1999).