title: Oral sucrose for heel lance enhances adenosine triphosphate use in preterm neonates with respiratory distress.
abstract: OBJECTIVE
  To examine the effects of oral sucrose on procedural pain, and on biochemical markers of adenosine triphosphate utilization and oxidative stress in preterm neonates with mild to moderate respiratory distress.
  
  
  METHODS
  Preterm neonates with a clinically required heel lance that met study criteria (n = 49) were randomized into three groups: (1) control (n = 24), (2) heel lance treated with placebo and non-nutritive sucking (n = 15) and (3) heel lance treated with sucrose and non-nutritive sucking (n = 10). Plasma markers of adenosine triphosphate degradation (hypoxanthine, xanthine and uric acid) and oxidative stress (allantoin) were measured before and after the heel lance. Pain was measured using the Premature Infant Pain Profile. Data were analyzed using repeated measures analysis of variance, chi-square and one-way analysis of variance.
  
  
  RESULTS
  We found that in preterm neonates who were intubated and/or were receiving ⩾30% FiO2, a single dose of oral sucrose given before a heel lance significantly increased markers of adenosine triphosphate use.
  
  
  CONCLUSIONS
  We found that oral sucrose enhanced adenosine triphosphate use in neonates who were intubated and/or were receiving ⩾30% FiO2. Although oral sucrose decreased pain scores, our data suggest that it also increased energy use as evidenced by increased plasma markers of adenosine triphosphate utilization. These effects of sucrose, specifically the fructose component, on adenosine triphosphate metabolism warrant further investigation.
authors.affiliation: Division of Physiology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA; Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Danilyn M
authors.initials: DM
authors.lastname: Angeles
authors.affiliation: Division of Physiology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Yayesh
authors.initials: Y
authors.lastname: Asmerom
authors.affiliation: Division of Biochemistry, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Danilo S
authors.initials: DS
authors.lastname: Boskovic
authors.affiliation: Division of Physiology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Laurel
authors.initials: L
authors.lastname: Slater
authors.affiliation: Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA, USA; Riverside University Health Care Systems, Moreno Valley, CA, USA.
authors.forename: Sharon
authors.initials: S
authors.lastname: Bacot-Carter
authors.affiliation: Riverside University Health Care Systems, Moreno Valley, CA, USA; Department of Biostatistics, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Khaled
authors.initials: K
authors.lastname: Bahjri
authors.affiliation: Riverside University Health Care Systems, Moreno Valley, CA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Mukasa
authors.affiliation: Division of Physiology, Department of Basic Sciences, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Megan
authors.initials: M
authors.lastname: Holden
authors.affiliation: Department of Pediatrics, School of Medicine, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Elba
authors.initials: E
authors.lastname: Fayard
keywords: Anesthesia/pain; critical care/emergency medicine; nursing