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Efficacy of Sucrose in Procedural Pain Relief among Neonates: Article Critique

Efficacy of Sucrose in Procedural Pain Relief among Neonates: Article Critique

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Introduction

Sucrose is known to relief pain amongst newborn infants exposed to painful events like heel pricks and needles. These events are critical in the formative stages of newborn babies thus making it necessary to formulate strategies of reducing pain. Although there are pain medicines, they are a reserve of major painful events like surgery thus, they may not be appropriate for such minor cases like needles and taking blood. Several researchers have explored various dimensions of administering sucrose to new born as a strategy of relieving the pain (Carbajal et al., 1999). Some of have them have concluded that administering sucrose to babies reduces groaning, crying and such acts as grimacing. Nevertheless, there is sufficient gap in knowledge on the effectiveness and safety of sucrose amongst the babies. In the quest to fill this gap, Johnston and other sought to establish the efficacy of sucrose used in procedural pain relief amongst preterm neonates within the first week of delivery. In their paper titled, “Routine Sucrose Analgesia during the First Week of Life in Neonates Younger than 31 Weeks’ Postconceptional Age”, the team sought the facts through a study, which forms the center of focus in this paper (Johnston et al., 2002). This critique examines the study in comparison with those done by Steven Bonnie and others.


Research question

The research question of this study sought to find out the effectiveness of using sucrose as a pain relief in preterm infants with postconceptional age of more than 31 weeks. Its core objective was to show empirical evidence for or against the wide conception that sucrose reduces pain among the selected sample.

This research was prompted by the emerging data stipulating that untreated procedural pain leads to negative behavioral sequel.

It operates on the hypothesis that if procedural pains were sufficiently managed amongst preterm infants, then there is a possibility of obtaining positive developmental effects. In a bid to arrive at conclusive information about this topic, the team of researchers sought an inquiry in to the efficacy of sucrose administration in preterm neonates of postconceptional age less than 31 weeks.

Details of research design

The study was designed in such a way that the preterm infants of more than 31 weeks’ PCA were captured. To further enhance the reliability of the study, these researchers selected sample of 107 preterm neonates in a randomized, double blind but controlled method. By doing this, the study succeeded in eliminating chances of biasness with regard to the desire to meet the requirements of research question. Control process was run concurrently using sterile water was chosen as a foolproof mechanism of checking the study. Other features of this research design are outlined below.

Primarily, the study was carried out in three level III Neonatal Intensive Care Units affiliated the university. As a statutory requirement, the three sites provided ethics approval through the review board. Although the three sites have not adopted similar levels of infant’s acuity and teaching programs, they met minimum selection criteria encompassing parents consent, minimum weight and considerably sound health conditions to warrant being study sample. Out of the 281 infants falling in the required age category admitted to the facilities, 107 were found to be appropriate for study after meeting all the requirements. This includes mother’s health, logistical problems among researchers and status at birth whether still or alive. Out of the selected 107 infants, only four of them were withdrawn due to arising factors, which rendered them unfit for further study. Across the three sites, selected infants bore similar features in terms of PCA, birth weight and CRIB score. The only characteristic difference was the levels of indomethacin administered to infants in one of the sites. This ensured that there was no skewed behavior in the outcome of the study.

Intervention

After the establishment of the study sample, enrolled infants went through the study characterized by the administration of either sucrose or water through a computer-generated random schedule. 0.1mL of 24% sucrose or water was made readily available in sterile syringes at the unit medicine refrigerators for easy access. All infants who were in the pool of the study were administered with the solutions in syringe through the mouth every time the infants were to go through invasive or non-invasive but considerably uncomfortable procedure. Chances of stage-managing the behavior of infants in the process were eliminated by setting up videotaping lasting for five minutes through a semiautonomous mechanism. The mechanism captured facial actions of the infant administered with sucrose as a means of establish the immediate analgesic impact sugar. Facial orientations at different stages of the process were coded according to presets of Neonatal Facial Coding System concentrating on upper facial component. This proved as the only means of studying the reaction of infants upon administration of sucrose since the preterm infants are still in their formative stages in communication and other features.

Outcomes

The major parameter of examining the efficacy of administering sucrose to preterm infants during procedural events is neurobehavioral development assessed through alertness, orientation, vigor of crying, and percentage asleep ratings. With the use of Neurobehavioral Assessment of the Preterm Infants (NAPI), Neuro-Biological Risk Score (NBRS), and Clinical Risk Index for Infants (CRIB), the study established the infant’s response to external stimuli occasioned by pain inflicting procedures and sucrose occasioned relief. All these are secondary measures of illness severity in the process of intervention.

Strengths and weaknesses of the study

Every research process is aimed at delivering the most accurate findings based on justifiable evidence through data collection and sequential analysis of the same. This study is no exceptional of other studies as it aimed at arriving at conclusive deliberation over the effects of sucrose administration to preterm infants. However, in the process of seeking facts the study has its strengths and weaknesses alike. The following are various strengths and weaknesses inherent in the study.

Strengths

Control

The study has an outstanding strength amidst others. The decision to incorporate control experiment running parallel to the core tests raised the integrity of the study to acceptable levels. In the study, 0.1mL of 24% sucrose was administered as a core process and sterile water as a control experiment representing normal cases where no sugar is given to infants.

Random

The selection criteria of study subject for each case was random with the help of computer-generated numbers. Using this technique eliminates chances of biasness in data collection whose ultimate effects may be detrimental to the results. The study enjoyed wide scope of randomness including that of technicians who remained oblivious of the process while carrying out their duties on the study subjects.

Another notable strength of this study is inherent in the three sites chosen as sources of samples. Collection of samples from three different locations helped in universalizing the study findings. One can hardly doubt the integrity of the findings since the study drew its samples from various sites.

Weakness


Small sample

An outstanding weakness of this study is in the size of sample chosen to draw conclusions. The size was too small to be reliable making a conclusion on such a sensitive matter of health.

Overall assessment

Out of the statistic collected from the study, the researchers found out that there are no differences on both neurobehavioral developmental outcomes and illness severity for patients who received sucrose and water during painful procedures. However, alterations on the levels of sucrose administered showed decreased facial expressions of pain implying that sucrose is effective in reducing pain upon exceeding of tolerance levels. Therefore, the efficacy of sucrose in relieving pain amongst preterm infants can be said to b effective after tolerable limits have been surpassed.

Comparison with Steven’s

Research findings of this study are in tandem with those of Bonnie Stevens and others in their study of the efficacy of sucrose in alleviating procedural pain among neonates of very low birth weight (Stevens et. al., 2000). The only difference between the two is in the area of specialization among neonates. While the earlier study concentrated on the preterm neonates of less than 31 weeks, the later one concentrates on extremely low birth weight neonates. Nevertheless, the two studies agree that sucrose brings about relieve of procedural pain in neonates regardless of weight and PCA. Furthermore, both studies acknowledge that there is a need for further research in the effectiveness and suitability of sucrose as a procedural pain reliever in neonates.

References

Carbajal, R., Chauvet, X., Couderc, S., Olivier-Martin, M., (1999).Randomized Trial Of Analgesic Effects Of Sucrose, Glucose, And Pacifiers In Term Neonates. British Medical Journals. 319 (7222), 1393–1397.

Johnston, C.C., Filion, F., Snider, L., Majnemer, A., Limperopoulos, C., et al. (2002).

Routine Sucrose Analgesia during the First Week of Life in Neonates Younger Than 31 Weeks’ Postconceptional Age. Pediatrics, 110 (3), 523 -528.

Stevens, B., Johnston, C., Franck, L., Petryshen, P., Jack, A., & Foster, G. (2000).

The Efficacy of Developmentally Sensitive Interventions and Sucrose for Relieving Procedural Pain in Very Low Birth Weight Neonates. Cochrane Database of Systemic Reviews, 48(1), 35-43.


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