Harrison Denise, Larocque Catherine, Bueno Mariana, Stokes Yehudis, Turner Lucy, Hutton Brian, Stevens Bonnie
Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada;
School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada.
Pediatrics. 2017 Jan;139(1). doi: 10.1542/peds.2016-0955. Epub 2016 Dec 16.
Abundant evidence of sweet taste analgesia in neonates exists, yet placebo-controlled trials continue to be conducted.
To review all trials evaluating sweet solutions for analgesia in neonates and to conduct cumulative meta-analyses (CMAs) on behavioral pain outcomes.
(1) Data from 2 systematic reviews of sweet solutions for newborns; (2) searches ending 2015 of CINAHL, Medline, Embase, and psychINFO.
Two authors screened studies for inclusion, conducted risk-of-bias ratings, and extracted behavioral outcome data for CMAs. CMA was performed using random effects meta-analysis.
One hundred and sixty-eight studies were included; 148 (88%) included placebo/no-treatment arms. CMA for crying time included 29 trials (1175 infants). From the fifth trial in 2002, there was a statistically significant reduction in mean cry time for sweet solutions compared with placebo (-27 seconds, 95% confidence interval [CI] -51 to -4). By the final trial, CMA was -23 seconds in favor of sweet solutions (95% CI -29 to -18). CMA for pain scores included 50 trials (3341 infants). Results were in favor of sweet solutions from the second trial (0.5, 95% CI -1 to -0.1). Final results showed a standardized mean difference of -0.9 (95% CI -1.1 to -0.7).
We were unable to use or obtain data from many studies to include in the CMA.
Evidence of sweet taste analgesia in neonates has existed since the first published trials, yet placebo/no-treatment, controlled trials have continued to be conducted. Future neonatal pain studies need to select more ethically responsible control groups.
新生儿甜味镇痛的证据确凿，但安慰剂对照试验仍在继续进行。
回顾所有评估新生儿甜味溶液镇痛效果的试验，并对行为疼痛结局进行累积荟萃分析（CMA）。
（1）两项关于新生儿甜味溶液的系统评价的数据；（2）截至2015年对CINAHL、Medline、Embase和psychINFO的检索。
两位作者筛选纳入研究，进行偏倚风险评级，并提取用于CMA的行为结局数据。使用随机效应荟萃分析进行CMA。
纳入168项研究；148项（88%）包括安慰剂/无治疗组。哭声持续时间的CMA纳入29项试验（1175名婴儿）。从2002年的第五项试验开始，与安慰剂相比，甜味溶液的平均哭声持续时间有统计学显著降低（-27秒，95%置信区间[CI]-51至-4）。到最后一项试验时，CMA显示甜味溶液有利23秒（95%CI-29至-18）。疼痛评分的CMA纳入50项试验（3341名婴儿）。从第二项试验开始结果有利于甜味溶液（0.5，95%CI-1至-0.1）。最终结果显示标准化均差为-0.9（95%CI-1.1至-0.7）。
我们无法使用或获取许多研究的数据以纳入CMA。
自首次发表试验以来，新生儿甜味镇痛的证据就已存在，但安慰剂/无治疗对照试验仍在继续进行。未来的新生儿疼痛研究需要选择更符合伦理责任的对照组。
