title: Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial.
abstract: BACKGROUND
  Many infants admitted to hospital undergo repeated invasive procedures. Oral sucrose is frequently given to relieve procedural pain in neonates on the basis of its effect on behavioural and physiological pain scores. We assessed whether sucrose administration reduces pain-specific brain and spinal cord activity after an acute noxious procedure in newborn infants.
  
  
  METHODS
  In this double-blind, randomised controlled trial, 59 newborn infants at University College Hospital (London, UK) were randomly assigned to receive 0·5 mL 24% sucrose solution or 0·5 mL sterile water 2 min before undergoing a clinically required heel lance. Randomisation was by a computer-generated randomisation code, and researchers, clinicians, participants, and parents were masked to the identity of the solutions. The primary outcome was pain-specific brain activity evoked by one time-locked heel lance, recorded with electroencephalography and identified by principal component analysis. Secondary measures were baseline behavioural and physiological measures, observational pain scores (PIPP), and spinal nociceptive reflex withdrawal activity. Data were analysed per protocol. This study is registered, number ISRCTN78390996.
  
  
  RESULTS
  29 infants were assigned to receive sucrose and 30 to sterilised water; 20 and 24 infants, respectively, were included in the analysis of the primary outcome measure. Nociceptive brain activity after the noxious heel lance did not differ significantly between infants who received sucrose and those who received sterile water (sucrose: mean 0·10, 95% CI 0·04-0·16; sterile water: mean 0·08, 0·04-0·12; p=0·46). No significant difference was recorded between the sucrose and sterile water groups in the magnitude or latency of the spinal nociceptive reflex withdrawal recorded from the biceps femoris of the stimulated leg. The PIPP score was significantly lower in infants given sucrose than in those given sterile water (mean 5·8, 95% CI 3·7-7·8 vs 8·5, 7·3-9·8; p=0·02) and significantly more infants had no change in facial expression after sucrose administration (seven of 20 [35%] vs none of 24; p<0·0001).
  
  
  CONCLUSIONS
  Our data suggest that oral sucrose does not significantly affect activity in neonatal brain or spinal cord nociceptive circuits, and therefore might not be an effective analgesic drug. The ability of sucrose to reduce clinical observational scores after noxious events in newborn infants should not be interpreted as pain relief.
  
  
  BACKGROUND
  Medical Research Council.
authors.affiliation: Nuffield Department of Anaesthetics, University of Oxford, Oxford, UK. r.slater@ucl.ac.uk
authors.forename: Rebeccah
authors.initials: R
authors.lastname: Slater
authors.forename: Laura
authors.initials: L
authors.lastname: Cornelissen
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fabrizi
authors.forename: Debbie
authors.initials: D
authors.lastname: Patten
authors.forename: Jan
authors.initials: J
authors.lastname: Yoxen
authors.forename: Alan
authors.initials: A
authors.lastname: Worley
authors.forename: Stewart
authors.initials: S
authors.lastname: Boyd
authors.forename: Judith
authors.initials: J
authors.lastname: Meek
authors.forename: Maria
authors.initials: M
authors.lastname: Fitzgerald
mesh_terms: D000284:Administration, Oral; D000698:Analgesia; D001800:Blood Specimen Collection; D001921:Brain / Q000502:physiology; D004311:Double-Blind Method; D004569:Electroencephalography; D004576:Electromyography; D005071:Evoked Potentials; D005149:Facial Expression; D005260:Female; D006339:Heart Rate; D006801:Humans; D018730:Infant Behavior; D007231:Infant, Newborn; D008297:Male; D010100:Oxygen / Q000097:blood; D010147:Pain Measurement; D013131:Spine / Q000502:physiology; D013395:Sucrose / Q000008:administration & dosage*; D014867:Water / Q000008:administration & dosage
chemical_list: D014867:Water; D013395:Sucrose; D010100:Oxygen
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