Breastfeeding or Breastmilk to Alleviate Procedural Pain in Neonates: A Systematic Review

Objectives: To (1) compare breastfeeding with control (placebo, no treatment, sucrose, glucose, pacifiers, or positioning) and (2) compare breastmilk with control for procedural pain in neonates. Methods: Systematic review and meta-analyses of randomized and quasi-randomized trials of breastfeeding or supplemental breastmilk for procedural pain in neonates was carried out on studies identified from electronic databases and hand searches without language restrictions. The methodological quality of the trials was assessed according to the Neonatal Review Group of Cochrane Collaboration. Results: Eleven eligible studies were identified. Marked heterogeneity in control intervention and pain assessment measures was noted. The breastfeeding group had significantly less increase in the heart rate, reduced proportion of crying time and reduced duration of crying compared to the swaddled or pacifier group. Premature Infant Pain Profile scores were lower in the breastfeeding group when compared to the placebo and the group positioned in mother's arms, but were not different compared to the no-treatment and the glucose groups. Neonates in the supplemental breastmilk group had a significantly less increase in the heart rate and Neonatal Facial Coding Score but no significant difference in the duration of crying time and oxygen saturation change compared to the placebo. Conclusions: If available, breastfeeding or breastmilk should be used to alleviate pain in neonates undergoing painful procedure compared to placebo, positioning, or no intervention. Administration of glucose/sucrose had a similar effectiveness as breastfeeding for reducing pain. The effectiveness of breastmilk for repeated painful procedures is not established, and further research is needed.