Sucrose May Offer Analgesic Benefit for Preterm Infants in NICU

Among preterm infants hospitalized in a neonatal intensive care unit (NICU), repeated sucrose administration was found to have analgesic effects when administered during skin-breaking procedures. These findings were published in Frontiers in Pain Research.

This longitudinal observational study was conducted at 4 university-affiliated NICUs in Canada. Infants (N=172) born at less than 32 weeks’ gestation and expected to undergo heel lance procedures were recruited for this study in the first 10 days of life. Nurses administered a single drop (~0.12 mL) of 24% sucrose onto the anterior surface of the tongue 2 minutes prior to every skin-breaking or potentially skin-breaking painful procedure. Sucrose was delivered again if the procedure lasted longer than 1 minute or if the infant showed signs of distress. Pain outcomes were evaluated using the Premature Infant Pain Profile-Revised (PIPP-R) instrument every 30 seconds after the procedure.

A total of 153 infants underwent 418 pain assessments. Most painful procedures (94.2%) were heel lances.

The PIPP-R scores did not differ between assessment at time points 1 to 4 (F, 1.80; P =.15). The average scores were 6.11 (SD, 3.68) points at time point 1, followed by 5.76 (SD, 3.41), 6.48 (SD, 3.67), and 6.81 (SD, 3.69) points at time points 2, 3, and 4, respectively.

In general, pain scores did not differ over time by site or by time, but there was a significant difference by site, in which scores at time 1 were higher at sites 1 (mean, 8.0 points) and 3 (mean, 7.25 points) compared with sites 4 (mean, 6.36 points) or 2 (mean, 5.04 points).

Overall, pain scores at 30 and 60 seconds were approximately 6 points on the 21-point PIPP-R scale, indicating a minimal level of pain, and the administration of sucrose continued to be effective for the procedures over time.

A major limitation of this study was the fidelity of evaluating pain in preterm infants.

Study authors concluded, “Consistently low PIPP-R scores were reported for skin breaking procedures over the NICU stay, confirming sustained analgesic effectiveness of a minimal amount sucrose for repeated painful procedures in the NICU. However, mild pain was still assessed. We used the established minimally effective dose of sucrose for neonates so that infants would receive the smallest cumulative amount of sucrose possible throughout the NICU stay.”