Research AppraisalRandomised Controlled Trial

The efficacy of oral sucrose for relieving lumbar puncture pain in neonates: a randomised clinical trial

BMJ paediatrics openJashni Motlagh, Alireza, Mashayekhipour, Sina, Khoshnam Rad, Mahsa et al.29 May 2026DOI

Clinical Snapshot

70CEBM

Evidence: ModerateRandomised Controlled Trial

PICO Framework

P — Population	60 full-term neonates undergoing lumbar puncture
I — Intervention	2 mL of 25% oral sucrose administered 2 minutes before procedure
C — Comparator	2 mL of sterile water (placebo)
O — Outcomes	Primary: Neonatal Infant Pain Scale (NIPS) scores. Secondary: heart rate, respiratory rate, oxygen saturation changes

Bottom Line

This small randomised trial suggests that 2 mL of 25% oral sucrose given 2 minutes before lumbar puncture significantly reduces pain scores and physiological stress responses in term neonates. The intervention showed large effect sizes with NIPS scores 4-5 points lower than placebo, alongside reduced rates of tachycardia and desaturation. While the study design appears sound with appropriate blinding and placebo control, methodological details are limited and the sample size is small. The intervention is safe, inexpensive, and practical for routine clinical use. However, clinicians should await larger, more detailed studies before changing practice, particularly given the brief follow-up period and single-centre design. The findings support existing evidence for sucrose analgesia in neonatal procedures but require replication in larger, multi-centre trials with longer-term safety assessment.

Evidence: Moderate

Key Findings

P Value: p<0.001 for primary outcome
Effect Size: 4-5 point reduction in NIPS scores (large effect)
Primary Outcome: NIPS pain scores significantly lower in sucrose group at 1 min (1.0 vs 5.0) and 3 min (0.0 vs 4.0)
Nnt Or Sensitivity: NNT approximately 4 for preventing clinically significant tachycardia, NNT 5 for preventing desaturation
Confidence Interval: Not reported

Clinical Application

Highly feasible - oral sucrose is readily available, inexpensive, and easy to administer Aligns with ANZPIC pain management guidelines; sucrose solutions available through hospital pharmacy; no TGA restrictions for this indication Term neonates requiring lumbar puncture in Australian NICUs and paediatric units

Abstract

OBJECTIVE: To evaluate the analgesic efficacy and physiological effects of oral sucrose during lumbar puncture (LP) in term neonates. STUDY DESIGN: This double-blind, randomised trial enrolled 60 full-term neonates undergoing LP. Participants were randomly given 2 mL of 25% oral sucrose or sterile water 2 min before the procedure. The primary outcome was pain score change from baseline via the Neonatal Infant Pain Scale (NIPS). Secondary outcomes included changes in heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO₂). Measurements were taken at baseline, 1 min, and 3 min post-LP. RESULTS: The sucrose group showed significantly smaller changes in NIPS scores at 1 min (1.0 vs 5.0, p<0.001) and 3 min (0.0 vs 4.0, p<0.001), along with smaller HR increases (p=0.012) and SpO₂ decreases (p=0.023) at 1 min post-procedure. Clinically significant tachycardia (HR >160 bpm) occurred in 40% of controls vs 13.3% of sucrose-treated infants (p=0.045), and desaturation (SpO₂ <90%) in 26.7% of controls vs 6.7% of the sucrose group (p=0.038). CONCLUSION: A 2 mL dose of 25% oral sucrose administered 2 min prior to LP is a safe and effective intervention that significantly reduces behavioural and physiological markers of pain in term neonates during the immediate post-procedural period.

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