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Sucrose and non-nutritive sucking for the relief of pain in screening for retinopathy of prematurity: a randomised controlled trial
  1. E M Boyle1,
  2. Y Freer1,
  3. Z Khan-Orakzai1,
  4. M Watkinson2,
  5. E Wright3,
  6. J R Ainsworth4,
  7. N McIntosh1
  1. 1Neonatal Unit, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK
  2. 2Neonatal Unit, Birmingham Heartlands Hospital, Birmingham, UK
  3. 3Princess Alexandra Eye Pavilion, Edinburgh
  4. 4Department of Ophthalmology, Birmingham Heartlands Hospital
  1. Correspondence to:
    Dr Boyle
    McMaster University Medical Centre, Department of Pediatrics, Room 4G40, 1200 Main Street West, Hamilton, Ontario L8S 4J9, Canada; emboyle{at}


Background: Screening is necessary for infants at risk of retinopathy of prematurity. Despite local anaesthetic drops, infants find eye examinations distressing, displaying behavioural and physiological changes indicating acute pain. Oral sucrose and non-nutritive sucking reduce pain responses associated with invasive procedures.

Objective: To evaluate the use of oral sucrose and/or pacifier for reducing pain responses during eye examinations.

Methods: Forty infants <32 weeks gestation or <1500 g birth weight, in two neonatal units, were randomised to one of four interventions administered two minutes before their first screening examination: 1 ml sterile water as placebo (group 1, n  =  10), 1 ml 33% sucrose solution (group 2, n  =  10), 1 ml sterile water with pacifier (group 3, n  =  9), or 1 ml 33% sucrose solution with pacifier (group 4, n  =  11). Examinations were videotaped. Two observers, blind to the intervention, assessed recordings. Pain responses were scored using the premature infant pain profile (PIPP).

Results: The groups were similar in gestation, birth weight, and age at examination. Mean PIPP scores were 15.3, 14.3, 12.3, and 12.1 for groups 1, 2, 3, and 4 respectively. Analysis of variance showed a significant difference in PIPP score between groups (p  =  0.023). Infants randomised to pacifiers scored lower than those without pacifiers (p  =  0.003). There was no difference between groups receiving sucrose and those receiving water (p  =  0.321).

Conclusions: Non-nutritive sucking reduced distress responses in infants undergoing screening for retinopathy of prematurity. The difference in response was large enough to be detected by a validated assessment tool. No synergistic effect of sucrose and pacifier was apparent in this group.

  • premature
  • retinopathy of prematurity
  • pain
  • sucrose

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  • Published Online First 20 January 2006

  • Competing interests: none declared

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