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Editor,—The work of Lewindon et al has highlighted an important and a simple way of relieving the pain of common procedures in infants.1 The use of sucrose solution seems to be a safe, cheap, and effective alternative to the use of conventional analgesics. However, using a highly concentrated solution of sucrose (75%) may only be possible in a research setting. Its use in a clinical context may be associated with important complications relating to the storage of the solution and the risk of bacterial contamination. Currently, we are involved in a similar study evaluating the effectiveness of a concentrated sucrose solution as an analgesic in infants. The risk of bacterial contamination has emerged as a major problem that could impede the routine use of sucrose solutions on a busy clinical ward. We found that the 10% solution sucrose prepared and stored in the usual way for oral medications has a very short shelf life. Significant bacterial contamination was noted only 24 hours after the preparation when solutions were stored in the normal ward refrigerator. The significant level of unwanted bacterial growth has made it necessary for the sucrose solution to be prepared on the same day of use.
These problems imposed a great restriction in the successful use of such solutions in the clinical setting. For the purposes of research, the daily preparation of sucrose solutions may interfere with the strict blinding of the operators unless special precautions are taken. It would be very useful to know whether these problems were encountered by Lewindon et al and what precautions were taken to reduce the risk of bacterial contamination and to ensure the complete blinding of the operators. For the clinical application of the research data and before recommendations can be made regarding the use of concentrated sucrose solutions in infants to relieve pain, the issues of the safety and prevention of bacterial contamination need to be addressed. In particular, it is necessary to evaluate and test the methods of preparing and storing the solutions and the use of preservatives, if any, before any definitive recommendations can made.
Dr Lewindon comments:
Abu-Arafeh and colleagues highlight the importance of microbiological safety of solutions recommended for administration to infants. In our study the solutions were prepared daily by one of the investigators not involved in the immunisation process; the issue of bacterial contamination was not addressed. However, the food industry can verify that carbohydrate solutions in excess of 48% (wt/vol) will inhibit bacteriological growth1-1 giving such solutions a reasonable shelf life. Only osmotolerant yeasts and molds could be expected to survive the high osmotic environment of a 75% solution and even these would not expect to thrive in such concentrations.1-1 The careful preparation (with sterile water) and subsequent handling of this solution should permit researchers and clinicians to use a “stock” solution with a shelf life of at least one week and probably longer. This latter supposition is certainly in need of further clarification and I thank Abu-Arafehet al for highlighting this neglected aspect of our recommendation.
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