BMJ 2003;326:13 ( 4 January )

Papers

Analgesic effect of breast feeding in term neonates: randomised controlled trial

Ricardo Carbajal, paediatrician, ^a Soocramanien Veerapen, general practitioner, ^b Sophie Couderc, paediatrician, ^c Myriam Jugie, paediatrician, ^a Yves Ville, professor. ^b

^a Department of Paediatrics, Poissy-Saint Germain Hospital, 78300 Poissy, France, ^b Department of Gynaecology and Obstetrics, Poissy-Saint Germain Hospital, ^c Maternity Ward, Poissy-Saint Germain Hospital

Correspondence to: R Carbajal carbajal{at}club-internet.fr

Objectives: To investigate whether breast feeding is effective for pain relief during venepuncture in term neonates and compare any effect with that of oral glucose combined with a pacifier.
Design: Randomised controlled trial.
Participants: 180 term newborn infants undergoing venepuncture; 45 in each group.
Interventions: During venepuncture infants were either breast fed (group 1), held in their mother's arms without breast feeding (group 2), given 1 ml of sterile water as placebo (group 3), or given 1 ml of 30% glucose followed by pacifier (group 4). Video recordings of the procedure were assessed by two observers blinded to the purpose of the study.
Main outcome measures: Pain related behaviours evaluated with two acute pain rating scales: the Douleur Aiguë Nouveau-né scale (range 0 to 10) and the premature infant pain profile scale (range 0 to 18).
Results: Median pain scores (interquartile range) for breast feeding, held in mother's arms, placebo, and 30% glucose plus pacifier groups were 1 (0-3), 10 (8.5-10), 10 (7.5-10), and 3 (0-5) with the Douleur Aiguë Nouveau-né scale and 4.5 (2.25-8), 13 (10.5-15), 12 (9-13), and 4 (1-6) with the premature infant pain profile scale. Analysis of variance showed significantly different median pain scores (P<0.0001) among the groups. There were significant reductions in both scores for the breast feeding and glucose plus pacifier groups compared with the other two groups (P<0.0001, two tailed Mann-Whitney U tests between groups). The difference in Douleur Aiguë Nouveau-né scores between breast feeding and glucose plus pacifier groups was not significant (P=0.16).
Conclusions: Breast feeding effectively reduces response to pain during minor invasive procedure in term neonates.

What is already known on this topic Current pharmacological treatments are not appropriate for pain relief during minor procedures like venepuncture or heel prick in newborn infants Oral sweet solutions, non-nutritive sucking, and skin to skin contact reduce procedural pain in newborn infants What this study adds Breast feeding during a painful procedure effectively reduces the response to pain in newborn infants The analgesic properties of breast feeding are at least as potent as the combination of sweet solutions and a pacifier

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Rapid Responses:

Read all Rapid Responses

Strengthens the clinical practice

Dr saroj kumar Patnaik
bmj.com, 3 Jan 2003 [Full text]

Methodology casts doubt on validity of findings

George Hill
bmj.com, 4 Jan 2003 [Full text]

Breast is the best: is it the best analgesic for newborn?

Roy K Philip
bmj.com, 14 Jan 2003 [Full text]

I'm a newborn

Sergio Conti Nibali
bmj.com, 23 Jan 2003 [Full text]

Newborns are very demanding patiens

Carlo V. Bellieni, et al.
bmj.com, 2 Feb 2003 [Full text]

the effects is probably due to melatonin in milk

James M. Howard
bmj.com, 16 Apr 2003 [Full text]

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