A Cochrane review [Abstract] 1 included 66 studies; 36 studies evaluated breastfeeding and 29 evaluated supplemental breast milk; the procedures conducted in the studies were heel lance, venepuncture, intramuscular vaccination, eye examination for retinopathy, suctioning, and adhesive tape removal. Breastfeeding reduced increase in heart rate (8 studies, n=784) proportion of crying time (4 studies, n=359), and total crying time (16 studies, n=1866) compared to positioning (swaddled and placed in a crib), holding by mother, placebo, pacifier use, bottle feeding, skin-to-skin contact, or oral sucrose group. Breastfeeding reduced the Neonatal Infant Pain Scale (NIPS) score compared to no intervention, holding by mother, heel warming, music, EMLA cream, moderate glucose concentration, swaddling, swaddling and holding (12 studies, n=1432). Supplemental breast milk may reduce the increase in heart rate and duration of crying compared to water, positioning, massage or no intervention (11 studies, over 1500 neonates).
Another Cochrane review [Abstract]2 assessed oral sucrose for pain relief in neonates. 20 studies with a total of 2 071 neonates were included. When Premature Infant Pain Profile (PIPP) scores were pooled, sucrose groups had significantly lower scores at 30 seconds (weighted mean difference (WMD) -1.70; 95% CI -2.13 to - 1.26; 3 trials, 278 neonates, no heterogeneity) and 60 seconds (WMD -2.14; 95% CI -3.34 to -0.94; 2 trials, n=164, no heterogeneity) post-heel lance (high-quality evidence). There was high-quality evidence for the use of 2 mL 24% sucrose prior to venipuncture and intramuscular injections. There were no differences in adverse effects between sucrose and control groups. Sucrose significantly reduced duration of total crying time (WMD -39 seconds; 95% CI -44 to -34; 2 trials, n=88).
Comment: The quality of evidence is downgraded by imprecision.
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