Sucrose analgesia for heel‐lance procedures in neonates

Background Sucrose has been examined for calming and pain‐relieving effects in neonates for invasive procedures such as heel lance. Objectives To assess the effectiveness of sucrose for relieving pain from heel lance in neonates in terms of immediate and long‐term outcomes Search methods We searched (February 2022): CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and three trial registries. Selection criteria We included randomised controlled trials where term and/or preterm neonates received sucrose for heel lances. Comparison treatments included water/placebo/no intervention, non‐nutritive sucking (NNS), glucose, breastfeeding, breast milk, music, acupuncture, facilitated tucking, and skin‐to‐skin care. Data collection and analysis We used standard Cochrane methods. We reported mean differences (MD) with 95% confidence intervals (CI) using the fixed‐effect model for continuous outcome measures. We assessed heterogeneity by the I2 test. We used GRADE to assess certainty of evidence. Main results We included 55 trials (6273 infants): 29 included term neonates, 22 included preterm neonates, and four included both. Heel lance was investigated in 50 trials; 15 investigated other minor painful procedures in addition to lancing. Sucrose vs control The evidence suggests that sucrose probably results in a reduction in PIPP scores compared to the control group at 30 seconds (MD ‐1.74 (95% CI ‐2.11 to ‐1.37); I2 = 62%; moderate‐certainty evidence) and 60 seconds after lancing (MD ‐2.14, 95% CI ‐3.34 to ‐0.94; I2 = 0%; moderate‐certainty evidence). The evidence is very uncertain about the effects of sucrose on DAN scores compared to water at 30 seconds after lancing (MD ‐1.90, 95% CI ‐8.58 to 4.78; heterogeneity not applicable (N/A); very low‐certainty evidence). The evidence suggests that sucrose probably results in a reduction in NIPS scores compared to water immediately after lancing (MD ‐2.00, 95% CI ‐2.42 to ‐1.58; heterogeneity N/A; moderate‐certainty evidence). Sucrose vs NNS The evidence is very uncertain about the effect of sucrose on PIPP scores compared to NNS during the recovery period after lancing (MD 0.60, 95% CI ‐0.30 to 1.50; heterogeneity not applicable; very low‐certainty evidence) and on DAN scores at 30 seconds after lancing (MD ‐1.20, 95% CI ‐7.87 to 5.47; heterogeneity N/A; very low‐certainty evidence). Sucrose + NNS vs NNS The evidence is very uncertain about the effect of sucrose + NNS on PIPP scores compared to NNS during lancin