Ben Vandermeer

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A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venipuncture in a pediatric emergency department

BMC Pediatrics (2007)

Sarah Curtis Hsing Jou Samina Ali Ben Vandermeer Terry P. Klassen

Although sucrose has been accepted as an effective analgesic agent for procedural pain in neonates, previous studies are largely in the NICU population using the procedure of heel lance. This is the first report of the effect of sucrose, pacifier or the combination thereof for the procedural pain of venipuncture in infants in the pediatric emergency department population. The study design was a double (sucrose) and single blind (pacifier), placebo-controlled randomized trial – factorial design carried out in a pediatric emergency department. The study population was infants, aged 0 – 6 months. Eighty-four patients were randomly assigned to one of four groups: a) sucrose b) sucrose & pacifier c) control d) control & pacifier. Each child received 2 ml of either 44% sucrose or sterile water, by mouth. The primary outcome measure: FLACC pain scale score change from baseline. Secondary outcome measures: crying time and heart rate change from baseline. Sucrose did not significantly reduce the FLACC score, crying time or heart rate. However sub-group analysis revealed that sucrose had a much greater effect in the younger groups. Pacifier use reduced FLACC score (not statistically significant), crying times (statistically significant) but not heart rate. Subgroup analysis revealed a mean crying time difference of 76.52 seconds (p < 0.0171) (0–1 month) and 123.9 seconds (p < 0.0029) (1–3 month). For subgroup age > 3 months pacifier did not have any significant effect on crying time. Age adjusted regression analysis revealed that both sucrose and pacifier had significant effects on crying time. Crying time increased with both increasing age and increasing gestational age. Pacifiers are inexpensive, effective analgesics and are easy to use in the PED for venipuncture in infants aged 0–3 months. The benefits of sucrose alone as an analgesic require further investigation in the older infant, but sucrose does appear to provide additional benefit when used with a pacifier in this age group. Current Controlled Trials ISRCTN15819627

Pacifier

Venipuncture

FLACC scale

10.1186/1471-2431-7-27

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Citations (105)

Studies Investigating Mast Cell Stabilizing Agents

Donna M Dryden Carol H Spooner Michael K. Stickland Ben Vandermeer Lisa Tjosvold

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Manifestations and Management of Chronic Insomnia in Adults: Summary

Nina Buscemi Ben Vandermeer Carol A. Friesen Liza Bialy Michelle Tubman

Chronic Insomnia

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Screening Tests for Gestational Diabetes: A Systematic Review for the U.S. Preventive Services Task Force

Annals of Internal Medicine (2013)

Lois Donovan Lisa Hartling Melanie Muise Alyssa Guthrie Ben Vandermeer

A 50-g oral glucose challenge test (OGCT) is a widely accepted screening method for gestational diabetes mellitus (GDM), but other options are being considered.To systematically review the test characteristics of various screening methods for GDM across a range of recommended diagnostic glucose thresholds.15 electronic databases from 1995 to May 2012, reference lists, Web sites of relevant organizations, and gray literature.Two reviewers independently identified English-language prospective studies that compared any screening test for GDM with any reference standard.One reviewer extracted and a second reviewer verified data from 51 cohort studies. Two reviewers independently assessed methodological quality.The sensitivity, specificity, and positive and negative likelihood ratios for the OGCT at a threshold of 7.8 mmol/L (140 mg/dL) were 70% to 88%, 69% to 89%, 2.6 to 6.5, and 0.16 to 0.33, respectively. At a threshold of 7.2 mmol/L (130 mg/dL), the test characteristics were 88% to 99%, 66% to 77%, 2.7 to 4.2, and 0.02 to 0.14, respectively. For a fasting plasma glucose threshold of 4.7 mmol/L (85 mg/dL), they were 87%, 52%, 1.8, and 0.25, respectively. Glycated hemoglobin level had poorer test characteristics than fasting plasma glucose level or the OGCT. No studies compared the OGCT with International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria.The lack of a gold standard for confirming GDM limits comparisons. Few data exist for screening tests before 24 weeks' gestation.The OGCT and fasting plasma glucose level (at a threshold of 4.7 mmol/L [85 mg/dL]) by 24 weeks' gestation are good at identifying women who do not have GDM. The OGCT is better at identifying women who have GDM. The OGCT has not been validated for the IADPSG diagnostic criteria.

Glycated hemoglobin

Gold standard (test)

Reference range

10.7326/0003-4819-159-2-201307160-00657

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Citations (118)

Table 8, Examples of sources of disagreement for the Risk of Bias tool

Lisa Hartling Michele P Hamm Andrea Milne Ben Vandermeer Pasqualina Santaguida

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