Mariana Bueno, PhD, RN, highlights sucrose for newborn pain relief

In neonatal care, implementing sucrose as a formal medication rather than a routine comfort measure requires strict adherence to evidence-based dosing and timing protocols. According to Mariana Bueno, PhD, RN, assistant professor at the University of Toronto, clinical practice guidelines identify 24% sucrose as the safest and most indicated concentration.

While research has investigated concentrations ranging from 10% to 50%, the 24% solution remains the clinical standard for efficacy and safety. Dosing protocols should prioritize small volumes, as amounts as low as 0.1 mL to 0.5 mL are sufficient to provide significant analgesic effects for common painful procedures such as heel punctures or intramuscular injections. Using these minimal amounts allows clinicians the flexibility to administer additional “rescue doses” or drops if the infant continues to show signs of agitation or pain during the procedure.

The timing of administration is equally critical; sucrose must be administered approximately 2 minutes before the start of a procedure. This lead time is necessary because it takes roughly 2 minutes for the sucrose to stimulate the endogenous opioid system and produce the desired analgesic effect.

To maximize the efficacy of pharmacological intervention, clinicians should integrate sucrose with other evidence-based comfort measures. Research indicates a synergistic effect between sucrose and nonnutritive sucking. When a baby is capable of coordinated sucking and breathing, clinicians should administer sucrose drops, followed immediately by a pacifier, to ensure that the infant maintains rhythmic sucking throughout the procedure.

Furthermore, sucrose administration should be viewed within a hierarchy of comfort strategies. Parent-led interventions, such as breastfeeding and skin-to-skin care, should be prioritized whenever the infant’s medical status and the clinical setting allow. If these primary strategies are not feasible—for instance, if the infant cannot be moved from an incubator—sucrose should then be combined with other supportive techniques such as facilitated tucking.

Facilitated tucking involves placing the baby in a side-lying, fetal-like position while providing manual support to the head and limbs. By combining these physical comfort measures with precise sucrose protocols, neonatal units can ensure a more robust, professional approach to pain management, moving away from ad hoc administration toward a standardized, medication-based clinical practice.

This video is part 1 of a 2-part series. Check back tomorrow for part 2.

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Reference

Sugar comforts newborn babies during painful procedures. News release Cochrane. March 3, 2026. Accessed March 9, 2026. https://www.eurekalert.org/news-releases/1117421?