A Systematic Review and Meta-Analysis of the Effectiveness of Physical Interventions Administered Orally for Infants for Reducing Distress During Vaccine Injections.

BACKGROUND

Infants experience distress from repeated vaccine injections in the first year of life. This systematic review evaluated oral nutritive and non-nutritive interventions to reduce distress including: breastfeeding (pre-injection and during), bottle-feeding, sucrose solution, glucose/dextrose solutions, other sweet-tasting oral liquids, and non-nutritive sucking.

DESIGN/

METHODS

Cochrane methodology and GRADE were used. Searches were conducted in MEDLINE, EMBASE, APA PsycINFO, CINAHL, and ProQuest Dissertations to identify relevant randomized and quasi-randomized controlled trials. Distress was the critical outcome. Placebo-controlled trials were prioritized when possible. Eligible studies were reviewed and data extracted by at least 2 reviewers. A random-effects model was used to pool the data; results are presented as standardized mean differences (SMDs) with 95% CIs. The certainty of evidence (graded from high, moderate, low, to very low) and the magnitude of effect were used to develop summary statements.

RESULTS

Fifty-nine distinctive studies were included, with certainty of evidence ranging from moderate to very low. The magnitude of effect exceeded the minimum threshold (SMD ≥0.2) for all interventions. Breastfeeding during vaccinations likely results in a large reduction in distress (SMD=-2.38, moderate certainty). Breastfeeding pre-injection (SMD=-1.19, low certainty) and bottle-feeding (SMD=-1.65, low certainty) may both result in a large reduction in distress. Evidence from placebo-controlled trials shows that sucrose solution likely results in a large decrease in distress (SMD=-1.02, moderate certainty) and glucose/dextrose solutions likely reduce distress (SMD=-0.78, moderate certainty). Other sweet-tasting oral liquids likely result in a large decrease in distress (SMD=-1.47, moderate certainty). Non-nutritive sucking may reduce distress, but the evidence is very uncertain (SMD=-1.98, very low certainty).

CONCLUSIONS

In infants, breastfeeding, sweet-tasting solutions, and other oral sweet-tasting liquids are preferred oral interventions to reduce vaccine injection-related distress.