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

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

Yayesh Asmerom  1 , Laurel Slater, Danilo S Boskovic, Khaled Bahjri, Megan S Holden, Raylene Phillips, Douglas Deming, Stephen Ashwal, Elba Fayard, Danilyn M Angeles
Affiliations
Randomized Controlled Trial

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

Yayesh Asmerom et al. J Pediatr. 2013 Jul.

Abstract

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.

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Figures

Figure 1
Figure 1
(online): Enrollment flow chart
Figure 2
Figure 2
(online): Study procedure. * Reasons why subjects were not sampled include: Change in acuity or failure to meet study criteria after consent was obtained (n=9); central line will not draw or lipids were being infused preventing sampling (n=5); line was discontinued before sampling could be scheduled (n=6).
Figure 3
Figure 3
A and B, Plasma hypoxanthine and uric acid concentration increased over time in preterm neonates who received oral sucrose before a clinically required heel lance. C, In neonates with minimal pain response (<33% increase in PIPP with heel lance), plasma allantoin concentration increased over time.
Figure 4
Figure 4
Sucrose metabolism
See this image and copyright information in PMC

Comment in

  • Sucrose and oxidants.
    Keshvani AA. Keshvani AA. J Pediatr. 2014 Jan;164(1):220. doi: 10.1016/j.jpeds.2013.09.028. Epub 2013 Oct 18. J Pediatr. 2014. PMID: 24144392 No abstract available.
  • Reply: To PMID 23415615.
    Angeles DM, Boskovic DS, Deming D. Angeles DM, et al. J Pediatr. 2014 Jan;164(1):220-1. doi: 10.1016/j.jpeds.2013.09.035. Epub 2013 Oct 22. J Pediatr. 2014. PMID: 24161219 Free PMC article. No abstract available.

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