TABLE 1.
Characteristics of included studies
| Author (reference), year; n | Comparison groups | Outcome measures and main results |
|---|---|---|
| Heel lance | ||
|
| ||
| Ahn et al (43), 2006; n=60 term infants | 50% glucose | Lower NIPS scores for glucose group (P=0.020, P=0.021, P=0.033 at all time points). |
| Water | No significant differences in HR, respiration rate, O2Sat and cry. | |
| No intervention | ||
| Akcam and Ormeci (21), 2004; n=60 term infants | 30% glucose | Lower DAN scores for both glucose groups compared with water (P<0.001 for both). |
| 30% glucose spray | No significant differences between glucose solution and spray for DAN scores. | |
| Water | ||
| Akcam (18), 2004; n=34 term infants | 30% glucose | Lower DAN scores for glucose and fructose groups (P<0.001 for both compared with water). |
| 30% fructose | No significant differences between glucose and fructose for DAN scores. | |
| Water | ||
| Bellieni et al (25), 2007; n=66 term infants | SS by nurses, 33% glucose and pacifier | Lower ABC scores for SS by mothers (P=0.03) and by nurses (P=0.006) compared with glucose and pacifier alone. |
| SS by mothers, 33% glucose and pacifier | ||
| 30% glucose and pacifier | ||
| Bellieni et al (30), 2003; n=17 preterm infants | 10% glucose and sucking | Reduced crying time for SS, glucose and sucking group (P=0.0004) compared with no intervention. SS, glucose and sucking more effective than glucose and sucking alone at reducing crying time (P=0.01). |
| SS plus 10% glucose and sucking | ||
| No intervention | ||
| Bellieni et al (29), 2002; n=120 term infants | 33% Glucose | Lower DAN scores for glucose and sucking; SS, glucose and sucking (P<0.0001 for both); and water and sucking (P=0.001) compared with no intervention. |
| 33% Glucose and sucking | ||
| SS, water and sucking | SS and glucose more effective than glucose and sucking at reducing DAN score (P=0.004). | |
| SS, 33% glucose and sucking | ||
| Water and sucking | ||
| No intervention | ||
| Bellieni et al (27), 2001; n=17 preterm infants | 10% glucose | Lower PIPP scores for glucose alone (P<0.01), sucking (P<0.01), glucose and sucking (P<0.001), and SS (P< 0.0001) compared with no intervention. |
| 10% glucose and sucking | ||
| SS and glucose | SS and glucose more effective than glucose and sucking (P<0.01) at reducing PIPP scores. | |
| Water and sucking | ||
| No intervention | ||
| Bonetto et al (47), 2008; n=76 term infants | 25% glucose | No significant differences in PIPP scores between the groups. |
| Acetaminophen | Lower NIPS scores for glucose group compared with 2.5% lidocaine/2.5% prilocaine cream, acetaminophen and water groups. No P values provided. | |
| 2.5% lidocaine/2.5% prilocaine cream | ||
| Water | ||
| Brovedani et al (44), 2007; n=197 term infants | 20% glucose | No significant differences in PIPP scores between glucose and breastfeeding groups. |
| SS | Breastfeeding more effective than SS and swaddling (P<0.001 for both) at reducing PIPP scores. | |
| Swaddling | ||
| Breastfeeding | ||
| Bucher et al (17), 2000; n=80 term infants | Glycine | No significant differences in IBCS and NFCS scores among the groups. Lower combined score (IBCS and NFCS) for the sweetener group (P=0.036). No significant difference in HR increase among all groups. HR recovered more quickly in the sweetener group compared with other groups (P=0.04). Reduced crying time (P=0.04) for sweetener group and longer crying time for glycine group (P=0.01) compared with other solutions. Quicker recovery (P=0.01) for sweetener group compared with other solutions. |
| Artificial sweetener | ||
| Expressed breast milk | ||
| Water | ||
| Freire et al (50), 2008; n=95 preterm infants | 25% glucose | Lower PIPP scores for glucose group compared with no intervention (overall P=0.0001) |
| Skin to skin contact | Skin to skin contact more effective than glucose at reducing PIPP scores. | |
| No intervention | ||
| Guala et al (28), 2001; n=65 term infants | 5% glucose | Higher HR increase for 5% glucose group compared with no intervention (P<0.01) 33% glucose (P<0.05) |
| 33% glucose | ||
| Water | ||
| No intervention | ||
| Guala and Giroleti (37), 1998; n=140 term infants | 5% glucose | No significant differences in HR values among the groups. |
| 33% glucose | ||
| 50% glucose | ||
| 33% sucrose | ||
| 50% sucrose | ||
| Water | ||
| No intervention | ||
| Isik et al (38), 2000; n=113 term infants | 10% glucose | No significant differences in HR values among the groups. |
| 30% glucose | No significant differences in crying time for 10% and 30% glucose groups compared with water. | |
| 30% sucrose | Sucrose superior to 10% glucose (P=0.003) and 30% glucose (P=0.006) for crying time. | |
| Water | ||
| Jatana et al (40), 2003; n=125 term infants | 10% glucose | Higher concentrations of glucose (25% and 50%) more effectively reduced grimacing, crying time, HR increase and O2Sat decrease than 10% glucose and EBM (P<0.05 for all, except for grimacing, for which P value is not provided). |
| 25% glucose | ||
| 50% glucose | ||
| EBM | No significant differences between 25% and 50% glucose groups, or between 10% glucose and EBM groups for all outcomes. | |
| Water | ||
| Okan et al (36), 2007; n=31 preterm infants | 20% glucose | Lower NFCS scores at 4 min (P=0.009) and 5 min (P=0.046) postlancing for glucose and sucrose groups compared with water. |
| 20% sucrose | ||
| Water | Lower HR values in glucose and sucrose groups compared with water at 1 min postlancing (P=0.007). No significant differences between the groups for crying time, respiration rate and O2Sat . |
|
| Ramenghi et al (19), 2001; n=15 infants | Honey | Reduced crying time for honey group compared with water group (P=0.04). |
| Water | ||
| Ramenghi et al (20), 1996; n=60 term infants | 40% maltitol | Lower modified NFCS scores for sweet solution groups at 1 min before lancing (P=0.04) and at 3 min postlancing (P=0.05). |
| 50% sucrose | ||
| 25% sucrose | Lower HR increase for 50% sucrose and maltitol groups compared with water group (P=0.009) | |
| Water | Reduced crying time for all sweet solution groups compared with water (P=0.02). | |
| Skogsdal et al (48), 1997; n=120 term and preterm infants | 30% glucose | Lower HR increase for 30% glucose group compared with all other groups (P<0.05). |
| 10% glucose | Reduced incidence of cry for 30% glucose group (P<0.01) compared with all other groups. | |
| EBM | ||
| No intervention | ||
| Venipuncture | ||
|
| ||
| Bauer et al (35), 2004; n=58 preterm infants | 30% glucose (2 mL) | Lower PIPP scores for 2 mL glucose group compared with water (P=0.01). |
| 30% glucose (0.4 mL) | Reduced crying time and incidence of cry for 2 mL glucose group compared with water (P<0.05). | |
| Water | No significant differences in HR and oxygen consumption between groups. | |
| Carbajal et al (22), 1999; n=150 term infants | 30% glucose | Lower DAN scores for glucose group compared with water (P=0.005) during venipuncture but higher DAN scores for glucose group compared with sucking (P=0.0001). |
| 30% sucrose | ||
| 30% sucrose and sucking | No other comparison with glucose group was made | |
| Sucking | ||
| Water | ||
| No intervention | ||
| Carbajal et al (24), 2003; n=179 term infats | 30% glucose and sucking | Lower DAN scores and PIPP scores for glucose group compared with water (P<0.0001). No significant differences among glucose and sucking compared with breastfeeding groups for DAN or PIPP. |
| Breast feeding | ||
| Water | ||
| No intervention | ||
| Deshmukh and Udani (39), 2002; n=60 preterm infants | 10% glucose | No significant differences in HR, O2Sat and respiratory rate between groups. |
| 25% glucose | Reduced crying time for 25% glucose compared with control (P=0.002) and 10% glucose (P=0.002). | |
| Water | No significant differences in crying time between 10% glucose and water groups (P=0.23). | |
| Gharehbaghi and Ali (34), 2007; n=60 term and preterm infants | 25% glucose | Lower CRIES scores for glucose group compared with water (P=0.0001). Reduced crying time for glucose group compared with water (P=0.0001). No significant differences in HR after puncture between the groups. |
| Water | ||
| Gradin et al (31), 2002; n=196 preterm and term infants | 30% glucose | Lower PIPP scores in glucose group compared with 2.5% lidocaine/2.5% prilocaine cream (P=0.0314). No significant differences for changes in HR between groups. Reduced crying time for glucose group compared with 2.5% lidocaine/2.5% prilocaine cream (P<0.0001). |
| 2.5% lidocaine/2.5% prilocaine cream | ||
| Gradin et al (41), 2004; n=111 term infants | 30% glucose | Lower PIPP scores for glucose with or without breastfeeding compared with breastfeeding and water or water groups (P=0.004). Reduced crying time in breastfeeding and glucose group compared with breastfeeding and water (P=0.008), glucose (P=0.022) and water (P≤0.001) groups. Reduced crying time for glucose compared with water groups (P=0.009). |
| 30% glucose and breastfeeding | ||
| Breastfeeding and water | ||
| Water | ||
| Ling et al (42), 2005; n=52 term infants | 30% glucose | Lower NIPS scores for glucose group compared with water (P=0.03). |
| Water | Reduced crying time for glucose group compared with water (P=0.03). | |
| Liu et al (60), 2010; n=105 term and preterm infants | 25% glucose | Lower NIPS scores for glucose group compared with water (P=0.005). |
| Sucking | Sucking was more effective than glucose (P<0.017). | |
| No intervention | ||
| Shadkam and Lofti (46), 2008; n=220 term infants | 30% glucose and placebo cream | Lower NIPS scores for glucose group compared with water and 2.5% lidocaine/2.5% prilocaine cream (P<0.001). |
| Water and 2.5% lidocaine/2.5% prilocaine cream | Reduced crying time for glucose group compared with water and 2.5% lidocaine/2.5% prilocaine cream (P<0.01). | |
| Heel lance and venipuncture | ||
|
| ||
| Eriksson et al (49), 1999; n=120 term infants | 30% glucose | Lower PIPP scores during heel lance (P<0.0001) and venipuncture (P<0.0241) for glucose group compared with water. Higher increase in HR for glucose group compared with water, for both procedures (P=0.0201). Reduced crying time for glucose group versus water for heel lance (P<0.0001) but not venipuncture. |
| No intervention | ||
| Heel lance and pharyngeal suctioning | ||
|
| ||
| Axelin et al (51), 2009; n=20 preterm infants | 24% glucose | Lower PIPP scores for the glucose group compared with water during heel lance (P≤0.001) and pharyngeal suctioning (P=0.014). No comparison between glucose and other groups. No significant differences in NIPS scores of glucose group compared with water during heel lance (P=0.072) and pharyngeal suctioning (P=0.642). No comparisons between glucose and other groups. |
| Facilitated tucking | ||
| Oxycodone | ||
| Water | ||
| Intramuscular injection | ||
|
| ||
| Chermont et al (52), 2009; n=640 term infants | 25% glucose | Lower NFCS, NIPS and PIPP scores for skin-to-skin contact and 25% glucose group compared with each intervention alone and no intervention group (P<0.001 for each comparison). |
| Skin to skin contact | ||
| Skin to skin contact and 25% glucose | Skin to skin contact superior to 25% glucose group in reducing NFCS and NIPS (P=0.045). | |
| No intervention | ||
| Golestan et al (45), 2007; n=90 term infants | 50% glucose | No significant differences in HR between glucose and the other groups. Reduced crying time for glucose group compared with no intervention (P=0.0001) but not compared with water (P=0.191). |
| Water | ||
| No intervention | ||
| Sajedi et al (33), 2006; n=64 term infants | 30% glucose | Lower NIPS scores for glucose group compared with water (P= 0.001). |
| Water | No significant differences in HR between groups. | |
| Subcutaneous injection | ||
|
| ||
| Carbajal et al (23), 2002; n=39 preterm infants | 30% glucose | Lower DAN scores for glucose group compared with water (P=0.03). |
| 30% glucose and pacifier | No significant differences in DAN scores between glucose and glucose and pacifier groups. | |
| Water | ||
| Eye examination for retinopathy of prematurity | ||
|
| ||
| Olsson and Eriksson (53), 2011; n=30 preterm infants | 30% glucose | No significant differences in PIPP scores, cry, HR or O2Sat between groups. |
| Water | ||
| Circumcision | ||
|
| ||
| Kass and Holman (32), 2001; n=71 infants | 50% glucose | Results favoured DPNB group compared with water or glucose groups for MBPS scores (P<0.001), HR increase (P=0.005), O2Sat (P=0.03) and cry duration (P=0.001). |
| DPNB | ||
| Water | ||
| Peripherally inserted central catheter | ||
|
| ||
| Michel et al (26), 2010; n=59 term and preterm infants | Sevoflurane | Higher occurrence of bradycardia (P=0.02), tachycardia (P<0.001) and hypertension (P=0.003) for the glucose group. No significant differences on hypotension, O2Sat or episodes of apnea. Higher occurrence of body movements for the glucose group (P<0.017). |
| 30% glucose and pacifier | ||
CRIES Crying, Requires oxygen, Increased vital signs, Expression, Sleepless; DAN Douleur Aigue du Nouveau-Né; DPNB Dorsal penile nerve block; EMB Expressed breast milk; HR Heart rate; IBCS Infant Body Coding System; MBPS Modified Behavioural Pain Scale; NIPS Neonatal Infant Pain Scale; NFCS Neonatal Facial Coding System; O2Sat Oxygen saturation; PIPP Premature Infant Pain Profile; SS Sensorial saturation