From the Guidelines
Breast milk is the preferred analgesic for infants undergoing lumbar puncture procedures, due to its superiority over oral sugar solutions in reducing pain, as evidenced by a high level of certainty in a systematic review and meta-analysis 1. When considering analgesia for infants undergoing lumbar puncture, the options of breast milk and sucrose are often compared.
- Breast milk has been shown to have a higher efficacy in pain reduction, with standardized mean differences (SMDs) of –1·40 [95% CI –1·96 to –0·84] in PIPP score and –2·20 [–2·91 to –1·48] in NIPS score, compared to placebo or no intervention 1.
- In contrast, oral sugar solutions have been found to have a moderate level of certainty for pain reduction, with SMDs of –0·38 [–0·61 to –0·16] in heart rate and 0·23 [0·04 to 0·42] in SpO2, compared to placebo or no intervention 1. The recommendation is to use breastfeeding as the first-line analgesic treatment, initiated at least 2 minutes pre-procedure, and if breastfeeding is not possible, to use 1–2 mL of expressed breastmilk as the first-line analgesic, or 1–2 mL of oral sugar (≥10% concentration) as the second-line analgesic 1. In clinical practice, the choice between breast milk and sucrose may depend on factors such as the availability of the mother, the clinical setting, and the infant's feeding status.
- However, based on the evidence, breast milk should be the preferred choice for analgesia in infants undergoing lumbar puncture procedures, due to its superior efficacy and additional benefits of providing comfort through skin-to-skin contact and familiar scent 1.
From the Research
Comparative Efficacy of Sucrose versus Breast Milk for Analgesia in Infants
- The available evidence does not directly compare the efficacy of sucrose versus breast milk for analgesia in infants undergoing lumbar puncture (LP) procedures 2, 3, 4, 5, 6.
- Studies have investigated the use of sucrose as an analgesic for procedural pain relief in neonates, including heel lance, venipuncture, and intramuscular injection 3, 4, 6.
- There is high-quality evidence for the beneficial effect of sucrose in reducing pain assessed with validated composite pain scores, such as the Premature Infant Pain Profile (PIPP) 3.
- Breast milk has been used as a control intervention in some studies, but its efficacy as an analgesic for procedural pain relief in infants is not well established 3.
- One study found that breast milk was used as a control intervention, but the results did not provide a direct comparison with sucrose 3.
- Further research is needed to determine the efficacy of breast milk as an analgesic for procedural pain relief in infants and to compare its efficacy with sucrose.
Key Findings
- Sucrose is effective in reducing procedural pain from single events such as heel lance, venipuncture, and intramuscular injection in both preterm and term infants 3, 4, 6.
- The optimal dose, method of administration, and safety of sucrose for relieving procedural pain in neonates are not well established 3, 4, 6.
- Breast milk may have some analgesic properties, but its efficacy and safety for procedural pain relief in infants are not well established 3.
Gaps in Evidence
- There is a lack of direct comparison between sucrose and breast milk for analgesia in infants undergoing LP procedures.
- Further research is needed to determine the efficacy and safety of breast milk as an analgesic for procedural pain relief in infants.
- The optimal dose, method of administration, and safety of sucrose for relieving procedural pain in neonates need to be established.