Running head: LITERATURE REVIEW 1

Literature Review

Lauren Herr

Grand Canyon University: NSG-324

April 14, 2020

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Literature Review

Throughout the healthcare industry, one of the main goals is patient safety and

maintaining the well-being of all patients. With this, comes a multitude of interventions to ensure

that the negative outcomes are reduced to provide optimal care to the patients. An issue this

paper addresses is maintaining pain levels to avoid any negative outcomes that may follow.

Neonates in the neonatal intensive care unit (NICU) are exposed to a variety of procedures that

cause the neonate to feel painful stimuli. This is a common issue that occurs within the NICU

since many neonates have to a high number of procedures that occur daily as their normal routine

such as heel lancet, venipuncture, or suctioning. It is vital to help control the neonate's pain

levels in the NICU because it could lead to prolonged hospitalization, instability of vital signs,

learning disabilities, or even morbidity. This clinical issue has led to the discovery of different

nonpharmacological and pharmacological methods to help determine the most effective form of

pain management for the neonates. As a result, researchers started to look into using sucrose with

non-nutritive sucking to understand and determine if it helped reduce the painful stimuli the

neonates experienced. This paper will review three different articles that have been analyzed and

reviewed to provide support for the PICOT that states, in neonates hospitalized in the neonatal

intensive care unit (NICU), does the use of non-nutritive sucking with sucrose compared to non-

nutritive sucking alone provide better pain relief during painful procedures?

Methods

Through discovering and researching evidence on the use of non-nutritive sucking with

sucrose relating to reduction in painful stimuli felt by the neonates, there were specific criteria

that had to be met for the articles to be utilized in this paper. The first criteria that the articles had

to have was that it was published within the last five years. This is a result of how ever-changing
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the medical field is and how quickly it can advance. Ensuring that these articles have the most

recent information is essential for evidence-based practice and safe practice. The next criterion

for this paper was that the articles and authors had to be credible. This was done by researching

solely peer-reviewed articles and scientific journals that were supported by a plethora number of

credible sources. This would ensure the validity of the paper and the PICOT question. Another

criterion for the articles was how the articles had to be primary sources. This was ensured

through choosing a specific design which included either a quantitative or qualitative design.

Finally, the last criterion that had to be met was that the study had to include neonates in the

intensive care unit that endured a painful procedure.

Synthesize of Literature

The articles that were used as evidence for the PICOT question were very similar but had

a couple of different aspects to them. The first article that was utilized was called, Comparison of

the analgesic effect of oral sucrose and/ or music in preterm neonates: A double-blind

randomized clinical trial. This article was a quantitative study that aimed to assess the analgesic

effect of sucrose, music, and a combination of sucrose and music in stable preterm infants during

venipuncture as a painful procedure. It was revealed that the administration of sucrose either

alone or in combination with music reduced pain scores during the venipuncture. The methods

that were used was a double-blind randomized control trial while simultaneously recording the

neonates’ faces, and the monitoring from two min before the venipuncture until 10 minutes after

its completion by the same nurse. It was noted that sucrose is a definite way in which the

neonate's pain level is reduced as a result of the neonate’s facial expressions returned to baseline

quicker with the use of sucrose (Barandouzi, Keshavarz, Montazeri, Ashayeri, & Rajaei, 2020).
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The second article that was utilized was called, Comparison of the effectiveness of

breastfeeding, oral 25% dextrose, kangaroo-mother care method, and EMLA cream on pain

score level following heal pick sampling in newborns: a randomized clinical trial. This was a

quantitative study that aimed to compare how efficient the four methods of relieving infants’

pain (breastfeeding, oral 25% dextrose, kangaroo mother care method (KMCM), and EMLA

cream) based on a pain score level following heal-prick sampling in term newborns. The method

in this study was a double-blind controlled randomized trial in which the neonates were

randomly divided into four different groups. Key findings revealed that the pain was less severe

with those who received breastmilk feeding (group A) 15 minutes before the painful procedure

(Soltani, Zohoori, & Adineh, 2018). However, sugar was the second most effective way of

controlling pain. While breast milk may be superior to other methods, it still confirms that

sucrose is second best. This could be a result due to the similarities in the sugar content of the

sucrose and breastmilk giving off the same analgesic effect.

The last article that was utilized as a quantitative study called, Effect of non-nutritive

sucking and sucrose alone and in combination for repeated procedural pain in preterm infants: A

randomized controlled trial. The purpose of the study was to compare what effect non-nutritive

sucking and sucrose alone would have on patients when combining multiple interventions during

the painful procedure. This was a randomized controlled trial that consisted of three non-

consecutive heel sticks. The study revealed that both non-nutritive sucking and sucrose reduced

the preterm infant’s PIPP score and percentage of crying time. Additionally, through using

sucrose, the neonates were able to return to their baseline data quicker which helps them in the

long run (Gao et al., 2018).

Areas of Further Study

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After analyzing and reviewing the three different articles utilized to support the PICOT

question, the results revealed the same conclusion. Based on the research and proven evidence, it

can be concluded that implementing the use of sucrose with non-nutritive sucking in the NICU

units helps decrease the pain of the neonate's experience. While these studies prove that sucrose

is a form of mild analgesia, there is still more research that should be done throughout more

NICU hospitals with larger subject groups. Doing so would get more evidence that could be used

to support all patients in the NICU rather than those who meet the narrow requirements in past

studies. Another aspect that could be altered for future studies is directly studying the similarities

between sucrose and breastmilk to determine if they give off the same comfort to the NICU

patient. Lastly, it is important to further evaluate how effective non-nutritive sucking and sucrose

are effective in other painful procedures other than a heel stick. Overall, these articles share more

similarities when justifying the use of sucrose as a mild analgesic.

Conclusions

By looking at how sucrose effectively calms down the neonates and helps them return to

baseline quicker, it can be concluded that through the reduction in pain, neonates can maintain

their well-being better. After analyzing the three different articles, it was proven that sucrose is a

mild form of analgesia that helps reduces the neonate's pain levels positively. This provides

patients with a safer stay in the hospitals allowing them to recover quicker and avoid any long-

term effects. Therefore, it can be concluded that sucrose is a safe and effective form of pain

management and should be implemented in hospitals.

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References

Barandouzi, Z. A., Keshavarz, M., Montazeri, A., Ashayeri, H., & Rajaei, Z. (2020). Comparison

of the analgesic effect of oral sucrose and/or music in preterm neonates: A double-blind

randomized clinical trial. Complementary Therapies in Medicine, 48. Retrieved from

https://search-proquest-com.lopes.idm.oclc.org/docview/2344540782?accountid=7374

Gao, H., Li, M., Gao, H., Xu, G., Li, F., Zhou, J., Zou, Y., & Jiang, H. (2018). Effect of non-

nutritive sucking and sucrose alone and in combination for repeated procedural pain in

preterm infants: A randomized controlled trial. International Journal of Nursing Studies,

83, 25-33. Retrieved from

https://www.sciencedirect.com/science/article/pii/S0020748918300853?via%3Dihub#!

Soltani, S., Zohoori, D., & Adineh, M. (2018). Comparison of the effectiveness of breastfeeding,

oral 25% dextrose, kangaroo-mother care method, and EMLA cream on pain score level

following heal pick sampling in newborns: a randomized clinical trial. Electronic

Physician, 10(5), 6741–6748. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033133/