Repeating a dose of sucrose for heel prick procedure in preterms is not effective in reducing pain: a randomised controlled trial

Oral sucrose is included in almost all recommendations for treatment of pain in newborns, but evidence if multiple doses might be more effective than a single standard dose is lacking. We designed a single-centre, double-blind, randomised, controlled trial. We enrolled preterm infants needing the heel prick procedure. Each enrolled infant was randomised to receive a single standard dose of sucrose 2 min before or a double dose of sucrose 2 min before, and 30 s after heel prick. Primary outcome was the efficacy of the two interventions tested by the premature infant pain profile-PIPP scale obtained at 30 s, 60 s, and 120 s after heel prick. Secondary outcome was the evaluation of the concordance between the PIPP scale and other pain scores more feasible in clinical practice. Seventy-two infants were randomised. No difference in pain perception as measured by the PIPP scale was found between the groups: median PIPP values 4.0(IQR 3.0–4.0) vs 3.0(IQR 3.0–4.0) at baseline; 6.0(IQR 5.0–10.0) vs 6.0(IQR 4.0–8.5) at 30 s; 6.0(IQR 4.0–7.0) vs 5.0(IQR 4.0–8.5) at 60 s and 5.0(IQR 4.0-7.0) vs 5.0(IQR 4.0–7.5) at 2 min, in the experimental and standard treatment groups, respectively ( p = 0.9020). There was no correlation between PIPP scores and other pain scales. Conclusion : We do not recommend doubling the dose during heel prick. What is Known: • Oral sucrose is included in almost all international position papers and recommendations for the treatment of mild to moderate pain in newborns, associated with non-nutritive sucking and facilitated tucking • Premature infant pain profile (PIPP) scale is the gold standard for evaluation of pain in preterms but it is difficult to use in clinical practice What is New: • Repeating a dose of 24% sucrose is not effective in reducing pain during the recovery phase of a skin breaking procedure • Other pain scales, easier to use in clinical practice, are not comparable with PIPP for the evaluation of procedural pain in preterms