Gradin M, Eriksson M, Holmqvist G, Holstein A, Schollin J. Pain reduction at venipuncture in newborns: oral glucose compared with local anesthetic cream. Pediatrics. 2002; 110:1053-1057.

Researchers in Sweden compared the effectiveness of the use of EMLA local anesthetic cream to oral glucose for the prevention of pain in neonates. The sample included 201 newborns (>36 weeks gestational age and older than 24 hours) who were randomly assigned to one of two groups:

1. those who had EMLA cream applied to the skin 60 minutes before a venipuncture was performed plus 1 cc of sterile water placebo orally (EMLA Group)

2. those who received 1 cc of 30% glucose water orally plus a placebo cream applied to the skin (Glucose Group) prior to the venipuncture.

Because the applications were double-blind, none of the researchers knew which intervention the infants received. All infants were also offered pacifiers or the chance to suck on the parents' or nurse's finger during the procedure.

Assessment of the newborns' pain responses to the regularly scheduled venipuncture were gathered via the Premature Infant Pain Profile (PIPP). This tool rated facial expressions, heart rate, and oxygenation saturation levels before, during, and after the venipuncture was performed. Data were also gathered on the duration of the neonate's crying.

The PIPP results showed that only 19.3% in the glucose group experienced pain versus 41.7% of the EMLA group. There was also less crying in the glucose group. There were no differences in the groups related to heart rate changes.

The researchers noted that the results were impressive related to the reduction of pain in the glucose group. However, they proposed that the sucking behavior in the group could have been enhanced by the glucose causing the nonnutritive sucking to also be of analgesic benefit. More research needs to be done in the area of pain reduction in newborns.