Comparison of analgesic effect of 24% sucrose and breast milk in healthy infants less than 2 months of age

Saiprasad Kavthekar, Rahul Patil, Anil Kurane, Hemant Bharati


Background: Many newborns undergo painful procedures like heel pricks, venepuncture and intramuscular injection for immunization. The medical and paramedical staffs usually ignore pain felt during these procedures. The aim of this study was to compare analgesic activity of 24% sucrose solution with breast milk during 1st DPT vaccination using sterile water as placebo.

Methods: This double blind, randomized placebo controlled trial was conducted in 150 healthy infants undergoing for their 1st DPT vaccination. Infants were randomized in to three groups of 50 each and received sterile water, 24% sucrose and breast milk 2 minutes prior to vaccination. The outcome variables were total duration of cry, first cry, change in heart rate and modified facial coding score (MFCS).

Results: Mean total cry was significantly lower in 24% sucrose babies 36.3 (25.34) seconds and breast milk babies 42.1 (26.13) seconds as compared to sterile water 137.2 (20.31) seconds. Mean first cry was significantly lower in 24% sucrose 18.2 (14.12) seconds and breast milk babies 25.1 (13.67) seconds as compared to sterile water 94.3 (23.26) seconds. Mean rise in heart rate (beats/min) at 3 minutes was significantly lower with 24% sucrose 3 (2.3)and breast milk 7.4 (4.6) as compared to sterile water 18.2 (4.61).Change in MFCS at 1min and 3 min was significantly lower in 24% sucrose and breast milkĀ  babies. Maximum reduction in total cry, first cry, lower rise in heart rate and low MFCS was with 24% sucrose as compared to breast milk group.

Conclusions: 24% sucrose and breast milk had analgesic activity in infants less than two months of age undergoing DPT vaccination. The analgesic effect was better for 24% sucrose as compared to breast milk.


Analgesia, Breast milk, Infants, 24% Sucrose

Full Text:



Anand KJS, Hickey PR. Pain and its effect in human neonate and fetus. N Engl J Med. 1987;317:1321-9.

Committee on fetus and newborn, committee on drugs, section on Anesthiology, section on surgery. Prevention and management of pain and stress in neonates. Pediatrics. 2000;105(2):415-61.

Grunau RVE, Graig KD. Pain expression in neonates, facial action and cry. Pain. 1987;28:395-410.

Batton DG, Barrington KJ, Wallmanc. Prevention and management of pain in the neonate an update. Pediatrics. 2006;118:2231-41.

Harrison D, Beggs S, Stevens B. Sucrose for procedural pain management in infants. Pediatrics. 2012;130(5):1-8.

Stevens B, Yamanda J, Lee GY, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Rev. 2013;1:CD001069.

Taddio A, Shah V, Hancock R, Smith RW, Stephens D, Atenafu E et al. Effectiveness of sucrose analgesic in newborns undergoing painful medical procedures. Canadian Med Asso J. 2008;179:34-43.

Haourai N, Wood C, Criffiths G, Levene M. The analgesic effect of sucrose in full term infants. A randomised controlled trial. British Med J. 1995;310:1499-500.

Hatfield LA, Gusie ME, Dyer A, Polomano RC. Analgesic properties of oral sucrose during routine immunizations at 2 and 4 months of age. Pediatrics. 2008;121:327-34.

Blass EM, Hoffmeyr LB. Sucrose as analgesic for newborn infants. Pediatrics. 1991;87:215-8.

Ramenghi L, Wood CM, Griffiths GC, Levene MI. Reduction of pain response in premature infants using intraoral sucrose. Arch Dis Child. 1993;69:388-9.

Nimbalkar S, Sinojia A , Dongara A. Reduction of neonatal pain following administration of 25% lingual Dextrose. A randomized control trial. J Trop Paediatr. 2013;59:223-5.

Yang MC, Chen H, Chen CC, Chung MY, Chen FS, Huang HC. Expressed breast milk procedural pain in preterm neonates: a randomized, double blind, placebo controlled trial. Acta Pedia. 2013;102:15-21.

Shah PS, Herbozoc, Aliwales LL, Shah VS. Breast feeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev. 2012;12:CD004950.

Upadhyay A, Aggarwal R, Narayan S, Joshi M, Paul VK, Deorari AK. Analgesic effect of expressed breast milk in procedural pain in term neonates: a randomized, placebo controlled, double-blind trial. Acta Pediatr. 2004;93:518-22.

Osinaike BB, Oyedeji AO, Adeoye OT, Dairo MD, Aderinto DA. Effect of breastfeeding during venepuncture in neonates. Ann Trop Paediatr. 2007;27:201-5.

Singh VB, Mishra SK, Singh T, Upadhyay A. Antinociceptive effect of exclusive breastfeeding in healthy term infants during vaccination. Early Human Development. 2008;84:50-1.

Goldman RD, Korean G. Biological markers of pain in the vulnerable infant. Clin Perinatol. 2002;29:415-25.

Gaurav G, Upadhyay A, Gupta NK, Chaudhry R, Deepak C, Sreenivas V. Comparison of analgesic effect of direct breastfeeding, oral 25% dextrose solution and placebo during 1st DPT vaccination in healthy term infants: a randomized, placebo controlled trial. Indian Pedia. 2013;50:649-53.

Thakkar P, Arora A, Goyal K, Das RR, Javadekar B, Aiyer S, Paingrahi SK. To evaluate and compare the efficacy of combined sucrose and non-nutritive sucking for analgesia in newborns undergoing minor painful procedures, a randomized controlled trial. J Perinatol. 2016;36:67-70.

Barr RG, Pantel MS, Young MS, Young SN, Wright JH et al. The response of crying newborn to sucrose. Physiol Behaviour. 1999;66:409-17.

Blass EM, Shah A. Pain reducing properties of sucrose in human newborn. Chem Senses. 1995;20(1):29-35.

Efe E, Ozer ZC. The use of breastfeeding for pain relief during neonatal immunization injections. Appl Nurs Res. 2007;20:10-6.

Gray L, Watt L, Blass E. Skin-to-skin contact is analgesic in healthy newborns. Pediatrics. 2000;105:252-7.