News release

From: Cochrane Reviews

Sugar comforts newborn babies during painful procedures

A new Cochrane review has found that sucrose can help with pain relief in newborn babies during common hospital procedures, such as venepuncture. This involves drawing blood with a needle, typically for testing.

Newborns, especially preterm infants in neonatal intensive care units (NICUs), undergo numerous painful procedures. Because of their immature pain regulation, they can experience these procedures intensely. Preventing and treating procedural pain in hospitalised newborns is important, as repeated untreated pain has been associated with poorer physical growth and potential effects on brain development.

Accessible, low-cost solutions such as sucrose — a sweet sugar solution placed in a baby’s mouth shortly before needle procedures — have been used for decades. However, evidence specific to some procedures, such as venepuncture, has been limited.

Despite sucrose being recommended in multiple guidelines for procedural pain relief in infants, its use in clinical settings remains inconsistent.

Low-cost, safe intervention

The new review examined 29 clinical trials involving more than 2,700 preterm and full-term babies undergoing venepuncture in hospital. It found that sucrose probably reduces pain during and immediately after the needle procedure when compared to no treatment, water or standard care. The findings also suggest that sucrose works especially well when combined with non-nutritive sucking, such as a pacifier or dummy.

“Newborn babies undergo frequent needle procedures in hospital without any pain relief or comforting measures, even though older children and adults rarely have these procedures done without pain care,” said lead author Mariana Bueno from the University of Toronto. “The evidence shows that a small amount of sucrose given just before the procedure is a simple, fast and effective way to reduce that pain. Our review helps clinicians use this evidence more confidently and consistently in practice.”

None of the studies included in the review reported immediate side effects from sucrose when used in the small amounts required for pain relief. However, the studies focused on short-term effects, and more research is needed to understand any potential long-term effects of repeated use in babies who spend extended time in neonatal care.

“Parents may be surprised to learn that something as simple as a few drops of sugar solution can make a real difference to their baby’s comfort during blood tests,” said co-author Ligyana Candido from the University of Ottawa. “This is a low-cost, safe intervention that works within minutes, and it can be especially helpful when other comforting methods like skin-to-skin contact or breastfeeding aren’t possible.”

Treated like other medications

Although sucrose is already widely used in neonatal units, the researchers found considerable variation in how it is given, including differences in dose and timing.

“What stood out to me when doing this review was the wide variation in how sucrose was given to newborns,” Bueno added. The authors suggest the findings can help inform clearer clinical protocols and more consistent practice.

They also highlight that sucrose should be used purposefully for painful procedures and documented appropriately, rather than being given routinely to settle a crying baby.

“To ensure safety and clinical consistency, sucrose must be administered under formal medication protocols that define specific timing and dosage for painful procedures,” said co-author Jiale Hu from Virginia Commonwealth University.

The review authors say future research should focus on comparing effective comfort measures such as skin-to-skin contact, breastfeeding and sucrose with each other, rather than continuing to compare them to no treatment, and on understanding any potential long-term effects of repeated use in babies who spend extended time in neonatal care.