63 Repeated Administration of Sucrose in Hospitalized Preterm Infants and Neurodevelopment at 18 Months
Authors: Bueno Mariana , Stevens Bonnie , Ballantyne Marilyn , Campbell-Yeo Marsha , Estabrooks Carole , Gibbins Sharyn , Harrison Denise , McNair Carol , Riahi Shirine , Squires Janet , Synnes Anne , Taddio Anna , Victor Charles , Yamada Janet 
Published: September 2023

Abstract

Background
Preterm neonates, often hospitalized in the neonatal intensive care units (NICU), undergo multiple skin-breaking procedures. To minimize procedural pain, these infants frequently receive repeated administration of sucrose of varying concentrations and doses. Repetitive procedural pain has been associated with neurodevelopmental consequences, but long-term effects of repeated sucrose administration and volume are unknown.

Objectives
Our goal was to examine the association of total volume of sucrose over the NICU stay and neurodevelopment of preterm neonates at 18 months corrected gestational age (CGA).

Design/Methods
A prospective longitudinal observational study was conducted in four level-III Canadian NICUs. Infants &lt;32 weeks of gestational age (GA) at birth and &lt;10 days of life at enrollment were included. The minimally effective dose of 24% sucrose (0.1 ml) was administered prior to all skin-breaking procedures during the NICU stay. Total volume of sucrose administered for painful procedures was calculated for the full hospitalization. Infants were assessed at 18 months CGA by a trained observer using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). The standardized mean score for each Bayley-III component was reported out of 100 (±15). Scores ≥85 are considered within normal limits. The association between sucrose and 18-month composite development scores, adjusting for birthweight and maternal use of medication for depression, were conducted using GEE models accounting for NICU site.

Results
Of the 168 infants enrolled in the study, 118 completed the Bayley-III assessment at 18 months (60% male, mean GA at birth 28.3 [±2.2] weeks, mean birth weight [1092 (±354) grams]). Infants received an average of 5.92 (±5.59) ml of sucrose during the hospitalization for an average of 58 (±70) skin-breaking painful procedures. The mean Bayley-III scores were within normal limits; cognitive 91 (±17), language 86 (±18), motor 88 (±17). There was no statistically significant association between total sucrose volume administered and cognitive (p=0.98), language (p=0.68), and motor (p=0.29) Bayley-III scores in the adjusted analyses.

Conclusion
Results do not generally indicate neurodevelopmental delay in preterm infants assessed at 18 months of CGA. The association between total sucrose volume administered for painful procedures and neurodevelopment requires more research as the infant matures, to better understand the impact of sucrose on long-term neurodevelopmental outcomes and with attention to potential confounders. The relationship between the combination of sucrose and other evidence-supported interventions (e.g., skin-to-skin care, breastfeeding) for all painful procedures during the NICU and neurodevelopment also requires further investigation.