What is the Best Pain Management During Gastric Tube Insertion for Infants Aged 0-12 months: A Systematic Review

Problem: Synthesized evidence on the effectiveness of pain management for nasogastric tube (NGT) and orogastric tube (OGT) insertions in infants is lacking. This paper is a systematic review of the effectiveness of pain management for gastric tube (GT) insertion in infants. Eligibility Criteria: Randomized control trial (RCT) or quasi-experimental studies published up to April 2016, on pain management strategies during GT insertions (either NGT or OGT) in infants up to 12 months of age. Databases searched included seven English databases and three Chinese databases. Results: Six English studies out of 1236 screened met the eligibility criteria and were included in the review. Two studied OGT insertion and four studies focused on NGT insertion. All six studies evaluated oral sweet solutions (24%-30% sucrose and 25% glucose) compared to placebo (water) or no treatment and all focused on newborn infants. Data from four studies which used the Premature Infant Pain Profile (PIPP) were pooled for meta-analysis. Results showed a significant reduction in PIPP scores during or immediately after the procedure for sweet solution interventions (MD = -2.18, 95% CI (-3.86, -0.51), P = 0.01), compared to no intervention or placebo. Conclusions: Small volumes of oral sweet solutions reduce pain during GT insertion procedure in newborn infants. Implications: Oral sweet solutions can be recommended before GT insertion for newborns in clinical practice. Further studies determining the effect of sweet solution beyond the newborn period, different concentrations of sweet solution and comparison with other pain management strategies are warranted. Systematic review registration number: CRD42016038535. http://www.crd.york.ac.uk/prospero/. (C) 2017 Elsevier Inc. All rights reserved.