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Oral sucrose for acute pain studied in more than 7000 neonates, but many questions remain
  1. Monique van Dijk1,2,
  2. Dick Tibboel2,
  3. Sinno Simons1
  1. 1Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
  2. 2Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
  1. Correspondence to Monique van Dijk, Department of Pediatric Surgery and Pediatrics, Erasmus MC-Sophia Children's Hospital, Wytemaweg 80, Rotterdam 3015 CN, The Netherlands; m.vandijk.3{at}

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Oral sucrose for infants is not new at all; it is comparable with the ‘sugar tit’ (a pacifier made from cloth wrapped around sugar) that was used as early as the 18th century.

In many neonatal intensive care units neonates are given a few drops of orally administered sucrose (with or without a pacifier) before skin-breaking procedures to relieve pain. Its effectiveness after heel lance, venepuncture and intramuscular injection was confirmed in a recent, updated Cochrane review.1 Most of the reviewed trials used the Premature Infant Pain Profile (PIPP), a composite pain score that takes both behaviour and physiological changes into account.

Seventy-four trials have been performed since 2001 including over 7000 neonates. Are all debateable issues solved by now? The 2016 Cochrane review concludes that (1) the optimal dose is unknown; (2) we need to further study the effectiveness of repeated sucrose administration and also the children's long-term neurodevelopmental outcome; (3) its use in extremely preterm, unstable and ventilated neonates needs to be addressed and (4) the effects of sucrose in combination with pharmacological or non-pharmacological interventions should be studied.

On top of that, the common practice of waiting for 2 min after sucrose administration before starting a skin-breaking procedure is based on only one study in healthy newborns two decades ago.2 Our recent observational study found no influence of the length of waiting time on PIPP score during heel stick procedure.3

Also, Slater et al4 did not find a significant pain-reducing effect of sucrose on nociceptive brain activity measured with EEG and EMG opposed to the PIPP which raises the question of the appropriate primary outcome.

So what to conclude?

Although sucrose has been widely studied and implemented, major knowledge gaps still exist. We propose to only perform studies on sucrose that address the aforementioned research questions. More studies on brain activity during painful procedures and cortical pain circuits in premature neonates are highly needed as well.

By doing so, many questions may have been solved in the 2019 Cochrane update.



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  • Contributors All authors contributed equally.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.