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Randomized Placebo-controlled Trial of Sucrose Analgesia on Neonatal Skin Blood Flow and Pain Response During Heel Lance

Tutag Lehr, Victoria BS Pharm, PharmD*,†; Cortez, Josef MD; Grever, William PhD; Cepeda, Eugene MD; Thomas, Ron PhD§; Aranda, Jacob V. MD, PhD†,‡,∥

doi: 10.1097/AJP.0000000000000126
Original Articles

Objectives: To evaluate the effect of oral sucrose on skin blood flow (SBF; perfusion units; PU) measured by Laser Doppler Imager (LDI) in term newborns and pain response (Neonatal Infant Pain Scale score; NIPS score) during heel lance; (2) determine SBF changes during heel lance; and (3) the relationship between SBF and NIPS.

Materials and Methods: Term infants ≤7 days old (n=56) undergoing routine heel lance were randomized to pretreatment with 2.0 mL oral 24% sucrose (n=29) or sterile water (n=27) in a double-blinded, placebo-controlled trial. SBF was assessed by LDI scans and NIPS scores at 10 minutes before lance, immediately after lancing, and 5 minutes after blood extraction. Mean SBF and median NIPS scores were compared between groups using General Linear Model or Kruskal-Wallis. Regressions examined the relationship between SBF immediately after heel lance and NIPS score.

Results: Mean SBF and median NIPS scores immediately after heel lance were lower in sucrose-treated infants (167.9±15.5 vs. 205.4±16.0 PU, P=0.09; NIPS 1 [interquartile range 0 to 4] vs. NIPS 3 [interquartile range 0 to 6], P=0.02), although no significant difference in mean SBF. During heel lance NIPS score was predictive of SBF. An increase of 1 in NIPS score was associated with 11 PU increase in SBF (R2=0.21; P=0.09) for sucrose, and 16 PU increase for placebo-treated infants (R2=0.20; P=0.014).

Conclusions: Increased SBF assessed by LDI is a pain response among term neonates after routine heel lance, which was not completely attenuated by oral sucrose administration. Increased SBF is associated with NIPS scores. Sucrose analgesic efficacy evidenced by decreased NIPS scores for the sucrose group. Association of SBF with NIPS scores suggests that LDI is potentially useful for assessing newborn procedural pain.

*Department of Pharmacy Practice, The Eugene Applebaum College of Pharmacy & Health Sciences, Wayne State University

Pediatric Pharmacology Research Unit, Division of Clinical Pharmacology and Toxicology, Children’s Hospital of Michigan

Department of Pediatrics, Division of Neonatal and Perinatal Medicine, Hutzel Women’s Hospital and Children’s Hospital of Michigan

§Department of Pediatrics, Children’s Research Center of Michigan, Wayne State University School of Medicine, Detroit, MI

Division of Neonatology and Neonatal Translational Research Laboratory, SUNY Downstate Medical Center, Brooklyn, NY Identifier NCT 00694174.

Supported by The Gerber Foundation, Fremont, MI. The authors declare no conflict of interest.

Reprints: Victoria Tutag Lehr, BS Pharm, PharmD, Pharmacy Practice, 259 Mack, Suite 4144, Detroit, MI 48201 (e-mail:

Received August 19, 2013

Received in revised form July 14, 2014

Accepted May 30, 2014

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.