Despite repeated sucrose doses for pain relief in the NICU, preterm infants showed no signs of delayed neurodevelopment at 18 months, according to a recent study.

The prospective longitudinal study assessed the neurodevelopmental impact of cumulative sucrose exposure in preterm neonates treated for procedural pain in the NICU. Researchers enrolled 172 neonates (<32 weeks gestational age) across four Canadian level III NICUs, with follow-up neurodevelopmental assessments at 18 months corrected age (CA) using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). A total of 118 infants completed the study.

Participants received an average cumulative sucrose dose of 5.96 mL (±5.6) throughout their NICU stay, with each dose comprising 0.1 mL of 24% sucrose administered two minutes prior to commonly performed painful procedures. Bayley-III composite scores—standardized to a mean of 100 with a standard deviation of 15—at 18 months CA were 91 (±17) for cognitive, 86 (±18) for language, and 88 (±18) for motor development. Scores remained within normal ranges, and no statistically significant association was observed between cumulative sucrose exposure and developmental outcomes (cognitive: p=0.57, language: p=0.42, motor: p=0.70) after adjusting for known neonatal and maternal developmental factors.

These findings, published in BMJ Paediatrics Open, suggest that while sucrose administration is effective for acute pain relief in neonates, cumulative exposure does not appear to adversely affect neurodevelopment at 18 months CA, nor does it confer neuroprotective effects. Given the potential risks of untreated procedural pain, the study supports minimizing sucrose dosage and incorporating non-pharmacological interventions—such as skin-to-skin contact, non-nutritive sucking, facilitated tucking, and swaddling—to balance effective pain management with neurodevelopmental outcomes.

The study’s findings align with existing evidence on safe pain management practices in preterm neonates. Further research could explore neurodevelopmental outcomes beyond 18 months and identify optimal combinations of pain relief interventions for this population.

Full disclosures can be found in the published study.