University of Toronto

Abstract

A ll newborns experience pain from medical procedures in the first days after birth. At the very least, newborns receive an intramuscular injection of vitamin K and venipuncture or heel-lance for newborn screening tests. Newborns of diabetic mothers, about 4% of newborns, undergo additional heel-lances for monitoring glucose levels. 1,2 Untreated pain from these procedures can have long-lasting effects. 3,4 We previously reported that newborns of diabetic mothers who received an average of 10 heel-lances within 2 days of birth exhibited a heightened pain response during subsequent venipunctures compared with newborns from nondiabetic mothers. 2 Studies aimed at reducing pain and its consequences in newborns are clinically important. 5-7 Sucrose (table sugar) has great potential for routine use. 6 Sucrose is a naturally occurring sweetener with analgesic effects in newborns. Although not fully understood, the mechanism of action is thought to involve activation of the endogenous opioid system through taste. 8 This is supported by the presence of opioid receptors on the tongue and animal studies showing that analgesia can be reversed by opioid antagonists during noxious stimulation. 9 Moreover, chronic consumption of sweeteners has been shown to negate the analgesic effects of opioids. 10 In systematic reviews, single doses of sucrose have been reported to reduce pain in newborns undergoing commonly performed medical procedures, including heel-lancing and venipuncture. 11,12 Based on these data, national and international pain management guidelines promote the widespread use of sucrose. 13-16 However, sucrose has not been evaluated for all commonly performed procedures in healthy term new-borns, and there are concerns that sucrose may raise blood glucose levels in newborns of diabetic mothers. It is necessary to demonstrate that sucrose is effective and safe for varied procedures, repeated use and diverse infant populations. We sought to evaluate the effectiveness and safety of su-crose in newborns of diabetic mothers and nondiabetic moth