Objective: The aim of this double blind randomisedplacebo controlled trial was to determine whether oralsucrose modifies the pain response to NGT insertion inneonates.Method: Ethical approval was obtained from the regionalethics committee. 20 stable preterm infants who requiredNGT insertion for feeding were recruited and randomised on51 occasions to receive either oral 24% sucrose (n=26) orplacebo (sterile water) (n=25). After baseline measure-ments, the test solution was administered and then theNGT was passed through. A separate observer measuredpain during and after NGT passage by behavioural response(0- to 4-point Neonatal Facial Coding System (NFCS) and bythe presence or absence of cry), and by physiologicalresponse (heart rate (HR), SaO2). Adverse events duringadministration of the test solution, difficulty in passing theNGT, and adverse events during NGT passage wererecorded.Results: Baseline characteristics of the infants in each groupwere comparable. The group who received sucrose demon-strated a significantly lower NFCS during NGT passagecompared to the placebo group ([median (range)] 1 (0–4)vs. 3 (0–4); p=0.004). There was a trend for sucrose treatedinfants to have reduced HR change during NGT passagecompared with the placebo group ([mean (S.D.)] −0.73 (23)vs. +11 (17); p=0.055). Mean SaO2 did not change signifi-cantly. Pain response measurements quickly returned tobaseline after NGT insertion. Adverse effects, such as apnoeaor oxygen desaturation, were few and occurred equally ineach group.Conclusion: NGT insertion induced a pain response compar-able to previously reported responses to heel lance inneonates. Oral sucrose 24% is effective and safe in reducingthe behavioural and physiological pain response to NGTpassage.

doi:10.1016/j.earlhumdev.2006.09.034——————————————————————————————————————————————————————————————

The McCance Lecture, Neonatal Society SpringMeeting 2006

Neonatal pain processing

Maria Fitzgerald

Professor of Developmental Neurobiology, Department ofAnatomy and Developmental Biology, University CollegeLondon, UK

Newborn infants show strong pain behaviour, but the natureof this pain is poorly understood and has, historically, beenundertreated. Research has cast new light on the physiolo-gical and pharmacological processes that shape the newbornpain response and it is evident that infant pain involvesfunctional signalling pathways that are not found in thenormal mature nervous system. This lecture focuses onrecent research upon the underlying organization andstrengthening of nociceptive circuitry in the dorsal hornduring the first postnatal weeks. Furthermore evidence willbe presented to show how this circuitry might be altered byboth noxious and non-noxious sensory inputs in early life andthe mechanisms by which early tissue damage and inflam-mation might affect future pain processing are discussed.The study of developing nociceptive pathways can betranslated into an increased understanding of paediatricpain. Such research should help us to design better strategiesfor the relief of pain in infants and children.References[1] Fitzgerald M. The development of nociceptive circuits.Nat Rev, Neurosci 2005;6:507–20.[2] Slater R, Cantarella A, Gallella S, Worley A, Boyd S, MeekJ, Fitzgerald M. Cortical pain responses in human infants.J Neurosci (in press).

doi:10.1016/j.earlhumdev.2006.09.035——————————————————————————————————————————————————————————————

137Abstracts