The comparative efficacy and safety of sweet solutions to reduce preterm infants’ pain levels: a systematic review and network meta-analysis
Abstract
Sweet solutions are widely used to reduce procedural pain in preterm infants, but their comparative efficacy and safety remain unclear. We searched CINAHL, MEDLINE, Embase, CENTRAL, Scopus, and ProQuest for randomized controlled trials comparing glucose, sucrose, or expressed breast milk with control or with each other in preterm infants. We performed a random-effects frequentist network meta-analysis across three pain time points (reactivity, regulation, recovery). Pain level served as the primary outcome, while heart rate, oxygen saturation, respiratory rate, crying time, and adverse events were designated as secondary outcomes. Treatment efficacy was subsequently ranked using P-scores and a beading plot. We screened 10,043 records, included 42 RCTs (2733 infants), and analyzed 38 RCTs (2367 infants) in the network meta-analysis. Compared to the controls alone, glucose (standardized mean difference [SMD], −0.72; 95% confidence interval [CI], −1.19 to −0.25) and sucrose (SMD, −0.56; 95% CI, −1.04 to −0.07) were associated with lower pain responses in the reaction phase. In the regulation and recovery phases, pain reduction was consistently linked to glucose, sucrose, and expressed breast milk. Those interventions were supported by results of P-scores that ranged from 0.877 to 0.917 showing glucose’s superiority in the three phases. Glucose was associated with a higher risk of adverse events. Half of the 38 trials in the network meta-analysis had a low risk of bias. The…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 2,733 participants or records.
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