Oral sucrose for heel lance increases adenosine triphosphate use and oxidative stress in preterm neonates

J Pediatr. 2013 Jul;163(1):29-35.e1. doi: 10.1016/j.jpeds.2012.12.088. Epub 2013 Feb 14.


Objective: To examine the effects of sucrose on pain and biochemical markers of adenosine triphosphate (ATP) degradation and oxidative stress in preterm neonates experiencing a clinically required heel lance.

Study design: Preterm neonates that met study criteria (n = 131) were randomized into 3 groups: (1) control; (2) heel lance treated with placebo and non-nutritive sucking; and (3) heel lance treated with sucrose and non-nutritive sucking. Plasma markers of ATP degradation (hypoxanthine, xanthine, and uric acid) and oxidative stress (allantoin) were measured before and after the heel lance. Pain was measured with the Premature Infant Pain Profile. Data were analyzed by the use of repeated-measures ANOVA and Spearman rho.

Results: We found significant increases in plasma hypoxanthine and uric acid over time in neonates who received sucrose. We also found a significant negative correlation between pain scores and plasma allantoin concentration in a subgroup of neonates who received sucrose.

Conclusion: A single dose of oral sucrose, given before heel lance, significantly increased ATP use and oxidative stress in premature neonates. Because neonates are given multiple doses of sucrose per day, randomized trials are needed to examine the effects of repeated sucrose administration on ATP degradation, oxidative stress, and cell injury.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adenosine Triphosphate / metabolism*
  • Administration, Oral
  • Double-Blind Method
  • Female
  • Heel
  • Humans
  • Infant, Newborn
  • Infant, Premature
  • Male
  • Oxidative Stress*
  • Pain / drug therapy*
  • Pain / etiology
  • Pain / metabolism*
  • Prospective Studies
  • Punctures / adverse effects*
  • Sucrose / administration & dosage*


  • Sucrose
  • Adenosine Triphosphate