EFFECTIVENESS OF ORAL SUCROSE FOR ANALGESIA DURING IMMUNISATION AMONG INFANTS AGED 1-TO-19-MONTHS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Aim: To review the effectiveness of oral sucrose for analgesia during immunisation among infants aged 1- to 19-months Background: Although routine immunisations are vital for public health, they are the most common source of iatrogenic pain in childhood, and a significant source of distress for infants, patents and healthcare providers. Untreated pain increases the risk of longer-term sequelae such as needle phobia, non-compliance, medical care avoidance, increased pain during subsequent procedures. While sucrose is a commonly used non-pharmacological analgesia for mild to moderate pain, less is known about the analgesic effect beyond the neonatal period Methods: Six databases (CINAHL, Cochrane, Embase, ProQuest Dissertations and Theses, PubMed and Scopus) were systematically searched for English-language studies from inception until 28th January 2021. Quality of studies were evaluated using risk-of-bias and GRADE. Meta-analysis was conducted using the random-effects model using RevMan software. Heterogeneity was assessed using Chi2 and I2 statistics. Sensitivity analysis and subgroup analyses were conducted, and publication bias was assessed using funnel plots. Results: Of the 543 records were retrieved, 13 randomised-controlled trials (RCTS) were analysed using meta-analysis, involving 1833 participants across ten countries. Outcomes were graded very low using the GRADE methodology. Meta-analysis revealed large to very large effect favouring sucrose intervention on pain score during the recovery period and significant improvements to total cry durations. Subgroup analyses according to age, concentration, length of recovery period, number of injections and timing of administration were conducted. Conclusions: Sucrose produced significant improvement to pain score during recovery period and total cry duration while more conclusive evidence is needed to establish the relationship between sucrose and pain score at first injection. Recommendations: Findings are relevant to healthcare and public health providers interested in paediatric health. Future high-quality well-designed RCTs are required to ensure robustness of the evidence gathered.