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.