Background

Nonpharmacologic approaches are established for the treatment of painful procedures in preterms, but evidence if multiple doses of sucrose might be more effective than a standard dose is lacking.

Objectives

Testing the efficacy of 24%-oral-sucrose in single versus double dose during heel prick in preterms.

Methods

Single centre, double-blind, randomized, controlled trial conducted at III Level Neonatal Intensive Care Unit of Padua University.

We enrolled preterm infants 24-36 gestational weeks needing heel prick procedure to receive a single standard dose of sucrose 2' before or a double dose 2' before and 30" after heel prick in association with non-nutritive sucking and facilitated tucking.

Primary outcome was the efficacy of the two interventions tested by PIPP scale obtained at 30", 60" and 120" after the heel prick. Secondary outcome was the evaluation of the concordance between PIPP scale and others pain scores (NIPS, FLACC and indirect VAS) more feasible in clinical practice.

Results

Seventy-two infants were randomized. No difference in pain perception as measured by PIPP score was found between the two 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”; 6.0(IQR 4.0-7.0)vs 5.0(IQR 4.0-8.5) at 60” and 5.0(IQR 4.0-7.0)vs 5.0(IQR 4.0-7.5) at 120”, in the experimental and standard treatment groups respectively(p=0.9020). There was no correlation between PIPP scores and other pain scales.

Conclusion

Preterms treated with two doses of sucrose 24% did not experience less pain than infants treated with a single standard dose. We do not recommend using other pain scale rather than PIPP.