Britney Benoit1, Ruth Martin-Misener1, Margot Latimer1, Marsha Campbell-Yeo1
Background: Untreated pain is associated with adverse consequences in full term and preterm infants. International guidelines recommend breastfeeding as a pain relieving intervention during acute procedures, however, an updated synthesis of the state of evidence is needed to make recommendations for research and clinical practice.
Aim: To review the current state of evidence for the effectiveness of breastfeeding and expressed breast milk in reducing procedural pain in full term and preterm infants.
Methods: A systematic search of key electronic databases (PubMed, CINAHL, EMBASE) was completed from the date of the most recent Cochrane review search on this topic (January 1, 2011) to December 22, 2016. The search strategy included key terms for infant, breastfeeding, breast milk, and pain. Inclusion criteria required that studies be 1) an empirical investigation examining the use of breastfeeding as a pain relieving intervention, 2) include a sample of full term or preterm born infants, and 3) be published in English in a peer-reviewed journal. Risk of bias was scored using using Cochrane tools.
Results: Of the 1032 abstracts screened, 21 were found eligible for inclusion. Fifteen studies reported on the use of breastfeeding or expressed breast milk in full term infants (n = 1908) and six reported on preterm infants (n = 428). Direct breastfeeding was more effective than maternal holding, maternal skin-to-skin contact, topical anesthetics, and music therapy; and was as or more effective than sweet tasting solutions in full term infants. Expressed breast milk was not consistently found to reduce pain responding in full term or preterm infants. Studies generally had moderate to high risk of bias.
Conclusion: While there is sufficient evidence to recommend direct breastfeeding as the preferred first line analgesic intervention for procedural pain management in full term infants, expressed breast milk alone should not be considered an adequate intervention.