We read with much interest the paper by Codipietro and colleagues,
[1] who compared the efficacy of breastfeeding versus orally administered
sucrose solution in reducing pain response during blood sampling through
heel lance in healthy term neonates. They found that breastfeeding
provides superior analgesia to oral sucrose, while the heart rate
increase, oxygen saturation decrease, and crying behavior that normally
accompany this procedure were significantly lower in the breastfeeding
group as compared with the sucrose group.
This is relevant, considering that pain relief by sweet solutions is
usually attributed to an endogenous opioid mechanism. However, this
hypothesis is not confirmed in human newborns and at the present time, we
are far from identifying the analgesic mechanisms ( skin-to skin contact,
holding, orotactile stimulation because of oral liquid, or orogustatory
stimulation …) behind the analgesic effect of sweet solutions. [2]
Nevertheless, we are puzzled by the lack of reference to the colostral
opioid galactopoiesis. Beta-Endorphin levels of colostral milk are
approximately two-fold higher than in plasma of lactating women, in who
concentrations peak at term, after the first and second stages of labor
and natural delivery. [3,4] The source and regulatory mechanisms that
elevate beta-Endorphin in the colostrum of lactating mothers are still
unknown, but it is suggested that increased bioavailability may help the
newborn overcome the stressful perinatal events. [5,6] These milk-borne
peptides are absorbed intact [7] and may play important roles in the
perinatal period, such as analgesia, steroidogenesis, cardiovascular and
endocrine functions, neuroimmunomodulation, [8]
The authors should be congratulated on showing very clearly, that the
analgesic superiority of breastfeeding versus oral sucrose solution, into
an area in which changes in neonatal care have shown to have clinical
significance. Nevertheless, it would be of interest to me to know if the
analgesic superiority of breastfeeding during a neonatal minor pain
procedure may be influenced by vaginal or elective delivery.
Vincenzo Zanardo, MD
Arturo Giustardi, MD
Daniele Trevisanuto, MD
REFERENCES
1. Codipietro L, Ceccarelli M, Alberto Ponzone A. Breastfeeding or
Oral Sucrose Solution in Term Neonates Receiving Heel Lance: A Randomized,
Controlled Trial. Pediatrics 2008; 122:e716–e721
2. Gradin M, Schollin J. The role of endogenous opioids in mediating
pain reduction by orally administered glucose among newborns. Pediatrics
2005;115:1004-10007
3. Franceschini R, Venturini PL, Cataldi A, Barreca T, Ragni N,
Rolandi E. Plasma beta-endorphin concentrations during suckling in
lactating women. BJOG 1989;96:711–713
4. Ferrando T, Rainero I, De Gennaro T et al. Beta-endorphin-like and
a-MSHlike immunoreactivities in human milk. Life Sci 1990;47: 633– 635
5. Zanardo V, Nicolussi S, Giacomin C, Marzari F, Faggian D, Favaro
F, Plebani M. Beta endorphin concentrations in human milk. J Pediatr
Gastroenterol Nutr 2001;33:160-164
6. Zanardo V, Nicolussi S, Giacomin C, Faggian D, Favaro F, Plebani
M. Labor pain effects on colostral milk beta-endorphin concentrations of
lactating mothers. Biol Neonate 2001;79:87-90
7. Banks W.A, Kastin AJ, Coy DH. DSIP crosses the gastrointestinal
tract in neonatal rats. Life Sci 1983; 33:1587–159
8. Foley KM, Kourides IA, Inturrisi CE et al. b-Endorphin: analgesic
and hormonal effects in humans. Proceedings of the National Academy of
Science USA 1979;78: 5377–5381
Conflict of Interest:
None declared
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