The newborn screening is a blood test done to help identify certain health issues that would not otherwise be seen as early in newborns. Unfortunately, this screening requires that blood be drawn. A heelstick was the common method to withdraw blood, but venipuncture (from the back of the hand) has become a more common approach because it is associated with less discomfort for the newborn. However, venipuncture still causes some unhappiness. Making a newborn cry is bad enough but early negative experiences can also lead to higher anxiety and pain with future medical tests. Oral sucrose, a sugar solution, has been found to have a pain-relieving and calming effect with infants receiving vaccinations.
Researchers from Canada examined steps to reduce discomfort for infants including a topical medication lidocaine, a sucrose solution, or sucrose plus lidocaine. The study, published in Pediatrics, found that oral sucrose was effective at reducing pain in infants during venipuncture.
The study was a randomized trial that included 330 healthy full-term newborns. Before their venipuncture, the infants were given one of three treatments to decrease pain:
- 2 milliliters of 24% sucrose solution, administered by mouth using a syringe over 1 to 2 minutes
- 1 gram of liposomal lidocaine 4% cream to the dorsum of the hand
- Both sucrose and lidocaine
The infants were also swaddled and held by a nurse during the venipuncture.
A facial grimace scale assessed pain with scores ranging from 0-100. The average grimace score during venipuncture was:
- 14 with sucrose solution
- 42 with liposomal lidocaine
- 19 with sucrose and lidocaine
Both groups with sucrose were significantly lower than lidocaine alone. There was no significant difference between sucrose or sucrose and lidocaine.
Randomized trials are considered a very reliable form of research trial. Although no trial can be perfect this trial was well-done and the results are likely to be true. The lidocaine, which is often used for pain reduction in medical procedures, appeared less effective at reducing pain during venipuncture compared to sucrose.
It is not clear if the sucrose directly affects pain levels or if it is simply a happy distraction, but it appears effective in decreasing the stress. The small sucrose delivered was not associated with adverse events, so it may be a safe way to make venipuncture a little less distressing for newborns.
Taddio A, Shah V, Stephens D, et al.
Effect of liposomal lidocaine and sucrose alone and in combination for venipuncture pain in newborns.
Pediatrics. 2011 Apr;127(4):e940-947.
Last reviewed July 2011 by Brian P. Randall, MD
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