Does giving newborns sugar water during needle procedures reduce their pain?

Key messages

• Newborn babies given sucrose (sugar water) when undergoing a needle procedure probably have less pain during and shortly after the procedure than babies given nothing, water, or standard comfort measures.

• Sucrose seems to reduce pain more than pacifiers. We do not have good evidence about the effect of sucrose compared to skin-to-skin care.

• No studies reported on harmful side effects, such as gagging or apnoea (a temporary pause in breathing).

What is sucrose analgesia (pain relief)?

Sucrose is table sugar. When mixed with water, and in very small amounts, it can be used for pain relief in newborn babies. Sucrose is dropped on a baby's tongue about two minutes before and/or immediately before venepuncture, when a needle is put into a vein to take blood or give treatment.

Why is pain relief important for newborn babies who are in hospital?

Hospitalised preterm babies (i.e. born early) and term babies (i.e. born at the normal time) are exposed to many painful procedures to give them medicine and to diagnose problems. Pain has many consequences for newborn babies. It can contribute to poor physical growth and affect brain development. Therefore, it is important to reduce babies' experience of pain as much as possible to ensure health as they grow.

What did we want to find out?

We wanted to find out how well sucrose worked to relieve pain in newborn babies during and shortly after needle punctures. We wanted to know how sucrose compared to other pain relief methods such as pacifier sucking, breastfeeding, or being held next to a mother or father's skin (skin-to-skin care). We also wanted to find out if sucrose caused negative effects.

What did we do?

We searched for studies that investigated the pain-relief effects of sucrose compared to other methods (e.g. breastfeeding, pacifiers, holding). We summarised the results and rated our confidence in the evidence based on factors such as the number of infants treated and the quality of the methods used in the studies.

What did we find?

We found 29 studies that included 2764 newborn babies. The studies used different doses of sucrose and gave the sucrose to the babies in different ways. The studies were conducted worldwide. Most were carried out in Asia, with additional studies from Europe, North America, and South America. All the studies were randomised controlled trials, in which infants were assigned randomly to two or more treatment groups. This is the best way to ensure that the infant groups are similar, and that investigators and parents don’t know who is in which group. None of the studies were supported by the pharmaceutical industry.

Main results

• Sucrose probably reduces babies' pain during and shortly after (30 seconds to 1 minute) the needle insertion compared to no pain relief (such as water).

• Sucrose may make little to no difference to pain during the procedure compared to skin-to-skin care.

• Sucrose probably reduces pain during the needle insertion compared to breastfeeding.

• Sucrose (with pacifier sucking) likely reduces pain during and shortly after (30 seconds to 2 minutes) the needle insertion compared to pacifier sucking alone.

No study reported on harmful effects for any of our comparisons of interest.

What are the limitations of the evidence?

Sucrose versus no intervention or water

We are moderately confident that sucrose probably reduces pain compared to no intervention. However, it is possible that people in the studies were aware of which treatment babies were receiving, and the studies involved small numbers of babies.

Sucrose versus skin-to-skin care

We are not confident that sucrose reduces pain more than skin-to-skin care because the two studies reported very different results. Further research is likely to change these results.

Sucrose versus breastfeeding

We are moderately confident that sucrose probably reduces pain more than breastfeeding. However, the study did not clearly report details of how it was conducted.

Sucrose versus pacifier

We are moderately confident that sucrose with a pacifier probably reduces pain more than pacifiers alone. The studies differed in how sucrose was given, including the amount of sucrose, how it was administered, and whether it was given with or without a pacifier.

How current is this evidence?

This evidence is current to July 2024.