Background: Newborns perceive pain, and several non-pharmacologic analgesic methods have been used during painful procedures. Activation of the neonatal somatosensory cortex, in association with a painful procedure without analgesia, has been demonstrated by two-channel near-infrared spectroscopy (NIRS). Objectives: To evaluate both cortical and behavioural responses of healthy term newborns to a painful procedure during two non-pharmacologic analgesic interventions, i.e. glucose solution and breastfeeding. Methods: The effects of glucose and breastfeeding on pain-associated neonatal cortical activity were studied in two groups (n = 30) by multichannel NIRS during a heel prick. Cortical activation was identified by variations in oxygenated haemoglobin. Neonatal pain expression was assessed by a validated scale. Results: No significant variations in cortical activity emerged using glucose solution, whereas breastfed newborns showed widespread cortical activation. Breastfed neonates showed significantly less behavioural pain expression. Conclusions: Glucose is associated with no significant cortical activation and may interfere with pain-associated response at the cortical level. Conversely, breastfeeding analgesia is associated with generalized cortical activation and may act by multisensory stimulation, possibly overwhelming pain perception.

Keywords:
Cortical activation, Multisensory experience, Near-infrared spectroscopy, Pain in newborns
1.
Anand KJ, International Evidence-Based Group for Neonatal Pain: Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001;155:173-180.
2.
Carbajal R, Chauvet X, Couderc S, Olivier-Martin M: Randomised trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates. BMJ 1999;319:1393-1397.
3.
Codipietro L, Ceccarelli M, Ponzone A: Breastfeeding or oral sucrose solution in term neonates receiving heel lance: a randomized, controlled trial. Pediatrics 2008;122:716-721.
4.
Bartocci M, Bergqvist LL, Lagercrantz H, Anand KJ: Pain activates cortical areas in the preterm newborn brain. Pain 2006;122:109-117.
5.
Slater R, Cantarella A, Galella S, Worley A, Boyd S, Meek J, Fitzgerald M: Cortical pain responses in human infants. J Neurosci 2006;26:3662-3666.
6.
Slater R, Cornelissen L, Fabrizi L, Patten D, Yoxen J, Worley A, Boyd S, Meek J, Fitzgerald M: Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial. Lancet 2010;376:1225-1232.
7.
Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C: The development of a tool to assess neonatal pain. Neonatal Netw 1993;12:59-66.
8.
Meek J: Basic principles of optical imaging and application to the study of infant development. Dev Sci 2002;5:371-380.
9.
Genovese CR, Lazar NA, Nichols T: Thresholding of statistical maps in functional neuroimaging using the false discovery rate. Neuroimage 2002;5:870-878.
10.
Lagercrantz H, Changeux J: The emergence of human consciousness: from fetal to neonatal life. Pediatr Res 2009;65:255-260.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.