Premature Infant Pain Profile Scores Research Articles

The Premature Infant Pain Profile-Revised (PIPP-R)

To describe revisions to the Premature Infant Pain Profile (PIPP) and initial construct validation and feasibility of the Premature Infant Pain Profile-Revised (PIPP-R). The PIPP was revised to enhance validity and feasibility. To validate the PIPP-R, data from 2 randomized cross-over studies were utilized to: (1) calculate and compare PIPP and PIPP-R scores in extremely low gestational age infants undergoing a painful and nonpainful event (N=52; dataset #1) and (2) calculate and compare PIPP and PIPP-R scores in assessing the effectiveness of (a) sucrose, (b) non-nutritive sucking (NNS)+sucrose, and (c) facilitated tucking+NNS+sucrose during heel lance (N = 85; dataset #2). Pearson correlations between PIPP and PIPP-R scores were calculated, and Student t tests and 1-way analysis of variance were used to determine construct validity during painful and nonpainful events. To establish feasibility, a survey of 31 Neonatal Intensive Care Unit nurses was conducted. PIPP-R scores were significantly lower during nonpainful (mean, 8.3; SD = 2.9) compared with painful (mean, 9.9; SD=3.1; t95 = 4.51, P = 0.036) events in extremely low gestational age infants in dataset #1. In dataset #2, PIPP-R scores were significantly lower in infants 25 to 41 weeks gestation in the group receiving NNS+sucrose compared with the other 2 groups (F2,79 = 2.9, P<0.05). Overall, nurses rated the PIPP-R as feasible. Initial construct validation and feasibility of the PIPP-R was demonstrated. Further testing with infants of varying gestational ages, diagnoses, and pain conditions is required; as is exploration of PIPP-R in relation to other types of physiological and cognitive responses.

Oral sucrose and non-nutritive sucking goes some way to reducing pain during retinopathy of prematurity eye examinations.

To evaluate the efficacy of oral sucrose combined with non-nutritive sucking for reducing pain associated with retinopathy of prematurity screening. This was a randomised controlled study of 64 infants undergoing eye examination for retinopathy of prematurity screening. Topical anaesthetic (Proparacaine; Alcaine(®) drop 0.5%: ALCON CANADA Inc., Mississauga, Canada) was applied 30 sec before the eye examination in all infants. The infants in intervention group (Group 1, n = 32) received 0.5 mL/kg of 24% sucrose with a pacifier. The control group (Group 2, n = 32) received 0.5 mL/kg of sterile water with a pacifier. The groups had similar gestational ages (28.5 ± 2.8 weeks), mean birthweight (1304 ± 466 g) or corrected gestational age (35.4 ± 3.7 weeks) at examination. The intervention group had a significantly lower mean Premature Infant Pain Profile score during examination of the first eye, following insertion of the speculum (Group 1:13.7 ± 2.1 vs. Group 2:16.4 ± 1.8, p = 0.001). Although sucrose combined with non-nutritive sucking modestly reduces pain scores during eye examinations, there is need to further studies to explore significant pain relief for infants undergoing retinopathy of prematurity screening.

Oral dextrose for analgesia in neonates during nasogastric tube insertion: A randomised controlled trial

This study aims to determine if oral dextrose solution can mitigate the pain response to nasogastric tube (NGT) insertion in neonates. The study was a double-blinded, placebo-controlled, randomised controlled trial. One hundred and fifty consecutive neonates were randomised into three groups to receive 25% dextrose (D25), or 10% dextrose (D10) or placebo (distilled water). An NGT was inserted after giving 2 mL of one of the solutions orally. Pain response was assessed using the Premature Infant Pain Profile (PIPP), and the duration of cry was noted within 60 s of the intervention. Total PIPP score, duration of cry, change in heart rate and oxygen saturation (SpO2 ) were compared among the three groups. Neonates who received D25 had significantly lesser pain response to NGT insertion in terms of lower PIPP score (P < 0.05) and duration of cry (P = 0.001) compared to D10. There was a significantly smaller increase in heart rate and decrease in SpO2 (P < 0.05). In comparison with placebo, D10 significantly decreased duration of cry (P < 0.05) but not PIPP score. Oral D25 was effective in reducing the pain response during NGT insertion in neonates when compared with oral D10 and placebo. Oral D10 was not found to have a potent analgesic effect for the same.

Therapeutic Touch Is Not Therapeutic for Procedural Pain in Very Preterm Neonates

Preterm neonates below 30 weeks' gestational age undergo numerous painful procedures. Many management approaches are not appropriate for this population. Therapeutic Touch, an alternative approach based on the theory of energy medicine, has been shown to promote physiological stability in preterm neonates and reduce pain in some adult studies. The objective was to determine whether Therapeutic Touch is efficacious in decreasing pain in preterm neonates. Infants < 30 weeks' gestational age participated in a randomized control trial in 2 level III neonatal intensive care units. All evaluations, analyses, and heel lance procedure were conducted with only the therapist knowing the group assignment. Immediately before and after the heel lance procedure, the therapist performed nontactile Therapeutic Touch (n = 27) with infant behind curtains, leaving the curtained area for the heel lance, performed by another. In the sham condition (n = 28), the therapist stood by the incubator with hands by her side. The Premature Infant Pain Profile was used for pain response and time for heart rate to return to baseline for recovery. Heart rate variability and stress response were secondary outcomes. There were no group differences in any of the outcomes. Mean Premature Infant Pain Profile scores across 2 minutes of heel lance procedure in 30-second blocks ranged from 7.92 to 8.98 in the Therapeutic Touch group and 7.64 to 8.46 in the sham group. Therapeutic Touch given immediately before and after heel lance has no comforting effect in preterm neonates. Other effective strategies involving actual touch should be considered.

Safety of Noninvasive Electrical Stimulation of Acupuncture Points During a Routine Neonatal Heel Stick.

Hospitalized infants may undergo frequent painful procedures with inadequate pain relief. Alternative pain relief interventions are needed. The aim of this research was to determine the safety of noninvasive electrical stimulation of acupuncture points (NESAP) in neonates who were receiving routine heel sticks. This was a descriptive study performed to assess the safety of using a transcutaneous electrical nerve stimulation (TENS) unit to deliver NESAP to neonates. The subjects were healthy newborn infants<3 days old before hospital discharge. The intervention was NESAP delivered via a TENS unit, administered before, during, and after heel stick. The electrodes of the TENS unit were applied at four acupuncture points. Settings were gradually increased: 6 infants received 1.0 mA, 2 Hz; the second 6 infants received 2.0 mA, 10 Hz; and the last 18 infants received 3.5 mA, 10 Hz. THREE MAIN MEASURES WERE USED: (1) skin assessment (2) vital signs; (3) pain scores using the Premature Infant Pain Profile (PIPP). There were no significant changes in vital signs during and after NESAP. There were no changes in PIPP scores in the first 12 infants after initiation of NESAP. A slight but nonsignificant increase in PIPP scores (from 2.65 to 3.5 on a scale of 0-18) occurred in the last 18 infants. There were no adverse events during or after NESAP. NESAP is safe for infants with low settings on a TENS unit.

Effect of Kangaroo mother care in reducing pain due to heel prick among preterm neonates: a crossover trial

Background: Preterm neonates undergo several painful procedures in NICU including heel prick for blood sugar monitoring. Nonpharmacological interventions have been tried to decrease this procedural pain. There are only few studies on Kangaroo mother care (KMC) in reducing pain among preterm neonates.Method: This crossover trial was conducted at a tertiary care teaching hospital in south India. Premature Infant Pain Profile (PIPP) related to heel prick was assessed in 50 preterm neonates undergoing KMC and compared with 50 preterm babies without KMC.Results: PIPP scores at 15 minutes and 30 minutes after heel prick were significantly less in KMC group compared to control group. Mean PIPP difference between baseline and 30 minutes after heel prick was also significantly low in KMC group compared to control group.Conclusion: KMC is effective in reducing pain due to heel prick among preterm babies.

The Calming Effect of Maternal Breast Milk Odor on Premature Infants

To compare the effectiveness of maternal breast milk odor and formula milk odor in soothing premature infants undergoing heel lancing. Fifty preterm infants born between 32 weeks and 37 weeks gestation were randomly assigned into two groups. During heel lancing, we used formula milk odor for the first group and breast milk odor for the second group. A filter paper (containing either formula or breast milk) was placed near the infant's nose from 3 minutes prior to and up to 9 minutes after the heel blood sampling. The pain score was measured using premature infant pain profile (PIPP) score. We also evaluated crying duration and salivary cortisol prior to and after heel lancing. After the heel lancing, the PIPP score was found to be significantly lower in the breast milk group than the formula milk group (5.4 compared to 9 with p < 0.001). Also, the level of salivary cortisol had significantly increased in the formula milk group, but not in the breast milk group (25.3 nmol/L compared to 17.7 nmol/L (p < 0.001). Breast milk odor has an analgesic effect in preterm newborns and can be used as a safe method for pain relief.

Effect of kangaroo mother care Vs expressed breast milk administration on pain associated with removal of adhesive tape in very low birth weight neonates: A randomized controlled trial

To compare the pain relief effect of Kangaroo Mother Care (KMC) and Expressed Breast Milk (EBM) on the pain associated with adhesive tape removal in very low birth weight (VLBW) neonates. Randomized Controlled Trial. Neonatal intensive care unit of a tertiary care teaching hospital. 15 VLBW neonates who needed adhesive tape removal for the first part and 50 VLBW neonates needing adhesive tape removal for the second part. In first stage of the study, we studied whether adhesive tape removal in VLBW neonates was painful. In the second stage, eligible VLBW neonates were randomised to compare the efficacy of KMC and EBM in reducing the pain during the procedure of adhesive tape removal. Premature Infant Pain Profile (PIPP) Score, heart rate, oxygen saturation. There was significant increase in pain associated with the removal of adhesive tape (Mean pre-procedure PIPP score 3.47 ± 0.74; post-procedure mean PIPP score 12.13 ± 2.59; P<0.0001). The post intervention mean PIPP pain score was not significantly different between the KMC and EBM groups (P= 0.62). Removal of adhesive tape is a painful procedure for VLBW neonates. There was no difference between KMC and EBM in relieving pain associated with adhesive tape removal.

Efficacy and Safety of Continuous Infusion of Fentanyl for Pain Control in Preterm Newborns on Mechanical Ventilation

To evaluate the analgesic superiority and the safety equivalence of continuous fentanyl infusions versus fentanyl boluses in preterm infants on mechanical ventilation. In this multicenter, double-blind, randomized controlled trial, mechanically ventilated newborns (≤ 32(+6) weeks gestational age) were randomized to fentanyl (continuous infusion of fentanyl plus open-label boluses of fentanyl) or placebo (continuous infusion of placebo plus open-label boluses of fentanyl). The primary endpoint was analgesic efficacy, as evaluated by the Echelle Douleur Inconfort Nouveau-Né (EDIN) and Premature Infant Pain Profile scales. Safety variables were evaluated as well. Sixty-four infants were allocated to the fentanyl group, and 67 were allocated to the placebo group. The need for open-label boluses of fentanyl was similar in the 2 groups (P = .949). EDIN scores were comparable in the 2 groups; 65 of 961 (6.8%) EDIN scores were >6 in the fentanyl group and 91 of 857 (10.6%) in the placebo group (P = .003). The median Premature Infant Pain Profile score was clinically and statistically higher in the placebo group compared with the fentanyl group on days 1, 2, and 3 of treatment (P < .05). Mechanical ventilation at age 1 week was required in 27 of 64 infants in the fentanyl group (42.2%), compared with 17 of 67 infants in the placebo group (25.4%) (P = .042). The first cycle of mechanical ventilation was longer and the first meconium passage occurred later in the fentanyl group (P = .019 and .027, respectively). In very preterm infants on mechanical ventilation, continuous fentanyl infusion plus open-label boluses of fentanyl does not reduce prolonged pain, but does reduce acute pain and increase side effects compared with open-label boluses of fentanyl alone.

The Use of Oral Sucrose to Relieve Minor Procedural Pain in Neonates

Objective: To evaluate the effectiveness of oral sucrose as analgesic for minor painful procedures in neonates. Methods: A case control study was conducted in the neonatal intensive care unit at King Hussein Medical Center during the period between June 1 and December 30, 2009. A total of 100 preterm and term neonates with postnatal ages ranging from one to 20 days, who underwent heel pricks for collection of blood for bilirubin estimation were randomly assigned into two groups. The treatment group received 24% sucrose solution two minutes before heel prick and the control group did not receive sucrose solution. The pain was assessed using the Premature Infant Pain Profile which is a multidimensional acute pain rating scale with scores ranging from 0 (no pain) to 21 (maximum pain). The exclusion criteria included the following: age less than 30 weeks gestational age, newborns on ventilators, newborns with major congenital or neurologic anomalies or clinical diagnosis of birth asphyxia or seizures, those on analgesics or sedatives and sick newborns with unstable vital signs. The student's t test was used to compare the relevant data. P value less than 0.05 was considered to indicate statistical significance. Results: A total of 100 newborns, who were born with 30 weeks and above gestational age, were included in the study and divided into treatment and control groups in equal numbers. The mean Premature Infant Pain Profile scores were significantly lower in the treatment group, than in the control. Conclusion: Our study suggests that sucrose is an effective non-pharmacological analgesic for minor painful procedures in neonates.

Facilitated tucking on pain in pre-term newborns during neonatal intensive care: A single blinded randomized controlled cross-over pilot trial

To determine the effect of facilitated tucking (FT) on pain in preterm newborns during heel stick procedure done as a part of neonatal intensive care. This randomized controlled cross-over pilot study included 20 preterm newborns of both sexes between gestational ages (GA) of 28 and 36 weeks based upon the eligibility criteria. Pain was measured using Premature Infant Pain Profile (PIPP) following both heel stick with FT and without FT. The newborns had a lower PIPP score at 30 seconds (Mean, SD: 8.80, 3.82), 60 seconds (Mean, SD: 7.55, 3.28), 90 seconds (Mean, SD: 7.25, 3.06) and 120 seconds (Mean, SD: 6.65, 3.05) when heel stick was done with FT compared to the same procedure done without FT at 30 seconds (Mean, SD: 11.20, 3.44), 60 seconds (Mean, SD: 10.75, 3.24), 90 seconds (Mean, SD: 10.60, 3.22) and 120 seconds (Mean, SD: 10.50, 3.15). A (2 X 4) factorial ANOVA showed a statistically significant difference between these two procedures in all the time periods viz., 30 seconds (p=0.044), 60 seconds (p=0.004), 90 seconds (p=0.002) and 120 seconds (p< 0.0001) at 0.05 level in PIPP score and favoring FT. FT is an effective non-pharmacological pain management in preterm newborns during routine neonatal intensive care.

Remifentanil for endotracheal intubation in premature infants: A randomized controlled trial.

Objective:Endotracheal intubation is a common procedure in neonatal care. The objective of this study was to determine whether the premedication with remifentanil before intubation has analgesic effects in newborn infants.Methods:A total of 40 premature infants who needed endotracheal intubation for intubation-surfactant-extubation method were randomly assigned in two groups of an equal number at two university hospitals. The control group was given 10 μg/kg atropine IV infusions in 1 min and then 2 ml normal saline. In the case group, the atropine was given with the same method and then remifentanil was administered 2 μg/kg IV infusions in 2 min.Findings:For remifentanil and control groups, the mean birth weight were 1761 ± 64 and 1447 ± 63 grams (P = 0.29), and the mean gestational ages were 31.69 ± 3.5 and 30.56 ± 2.8 weeks (P = 0.28), respectively. Using premature infant pain profile score, infants who received remifentanil felt significantly less pain than the control group (15.1 ± 1.6 vs. 7.5 ± 1.4; P < 0.001). There were no significant differences in the duration of endotracheal intubation procedure (20.8 ± 6 vs. 22.8 ± 7.3 s; P = 0.33), the number of attempts for successful intubation and oxygen desaturation between groups.Conclusion:Premedication with remifentanil has good analgesic effects for endotracheal intubation in premature infants without significant derangements in mean blood pressure and oxygen saturation.

A Systematic Review and Meta‐Analyses of Nonsucrose Sweet Solutions for Pain Relief in Neonates

Sucrose has been demonstrated to provide analgesia for minor painful procedures in infants. However, results of trials investigating other sweet solutions for neonatal pain relief have not yet been synthesized. To establish the efficacy of nonsucrose sweet-tasting solutions for pain relief during painful procedures in neonates. The present article is a systematic review and meta-analyses of the literature. Standard methods of the Cochrane Neonatal Collaborative Review Group were used. Literature searches were reviewed for randomized controlled trials investigating the use of sweet solutions, except sucrose, for procedural pain management in neonates. Outcomes assessed included validated pain measures and behavioural and physiological indicators. Thirty-eight studies (3785 neonates) were included, 35 of which investigated glucose. Heel lancing was performed in 21⁄38 studies and venipuncture in 11⁄38 studies. A 3.6-point reduction in Premature Infant Pain Profile scores during heel lances was observed in studies comparing 20% to 30% glucose with no intervention (two studies, 124 neonates; mean difference -3.6 [95% CI -4.6 to -2.6]; P<0.001; I2=54%). A significant reduction in the incidence of cry after venipuncture for infants receiving 25% to 30% glucose versus water or no intervention was observed (three studies, 130 infants; risk difference -0.18 [95% CI -0.31 to -0.05]; P=0.008, number needed to treat = 6 [95% CI 3 to 20]; I2=63%). The present systematic review and meta-analyses demonstrate that glucose reduces pain scores and crying during single heel lances and venipunctures. Results indicate that 20% to 30% glucose solutions have analgesic effects and can be recommended as an alternative to sucrose for procedural pain reduction in healthy term and preterm neonates.

Reduction of Neonatal Pain Following Administration of 25% Lingual Dextrose: A Randomized Control Trial

Neonates experience painful procedures during routine care. Orally administered, sweet tasting solutions are commonly used in management of neonatal pain. We conducted a double-blind randomized control trial in neonates admitted to Neonatal Intensive Care Unit of Shri Krishna Hospital, Karamsad-Gujarat-India, of lingual administration of 25% dextrose vs. no intervention, to evaluate reduction of pain following oropharyngeal infant feeding tube insertions. Pain was assessed using Premature Infant Pain Profile score. Almost all the patients in the control group (98%) experienced moderate-to-severe pain as compared with the intervention group (71%). Mean Premature Infant Pain Profile score was statistically significantly lower in the intervention group (8.21) as compared with control group (10.31). (p < 0.001, 95% CI 1.090-3.102). Lingual 25% dextrose is an effective analgesic for relieving pain during orogastric tube insertion.

The pain response to mydriatic eyedrops in preterm infants

ObjectiveEvaluate physiologic and behavioral pain responses of premature infants following instillation of mydriatic eye drops for ROP examinations. While burning and stinging occurs in older patients, the infant pain response is not well characterized.Study DesignVital sign and video monitor recorded infant responses before, during, and after mydriatic (tropicamide 1%, phenylephrine 2.5%) administration upon first ROP exam. Two masked observers graded Premature Infant Pain Profile (PIPP) scores immediately prior and following eye drop administration. Scores <7 indicate no/minimal pain, 7-12 slight/moderate, >12 severe.ResultsTwenty infants had mean pre-mydriatic PIPP score 3.6 (SD 1.6), mean post-mydriatic score 5.7 (SD 3.4), mean change 2.1 (SD 3.4)(p=0.01). One (5%) had pre-mydriatic PIPP score ≥7, seven (35%) post scores ≥7 (p=0.07) with one >12.ConclusionsMydriatic drops cause a clinically significant pain response in one third of infants. Non-pharmacologic supportive measures are recommended for all infants until predictive factors are defined.

190 Predicting The Efficacy of Oral Sucrose in Reducing Pain During Ophtalmological Examination for Retinopathy of Prematurity: A Prospective Randomised Study

Background and aimRetinopathy of prematurity (ROP) is one of the major morbidity among preterm infants. Although, local anesthetics reduce pain to some extent, eye examination still remains as a painful...

Expressed breast milk vs 25% Dextrose in procedural pain in neonates: A double blind randomized controlled trial

To compare the effect of expressed breast milk (EBM), 25% dextrose (25 D) and sterile water (SW) on procedural pain in neonates as assessed by the premature infant pain profile (PIPP), changes in heart rate (HR), oxygen saturation (SpO2) and duration of crying. Prospective, double blind, randomized controlled trial. Postnatal ward of a tertiary-care hospital. 210 babies who required venipuncture for blood sampling and who were on oral feeds were recruited into the study after parental informed consent. The enrolled babies were randomized into intervention groups (EBM, 25% dextrose) and control group (sterile water). Two ml of test solution was given to baby by paladay (a traditional cup with a spout) 2 min before venipuncture. The face and crying of baby were video graphed by an independent, blinded observer. The facial response to pain (brow bulge, eye squeeze, nasolabial furrow) was analysed from the video. Maximum HR and minimum SpO2 were recorded during, and 1, 3 and 5 min after venipuncture by another blinded observer. PIPP score, HR, SpO2 and crying time at 0/1/3/5 min after sampling. 160 babies were considered for final analysis with 50 in 25 D, 62 in EBM and 48 in SW group. The mean PIPP score in the 3 groups were 5.22, 6.84 and 11.22 at 0-30 sec after venipuncture; 4.52, 6.34, and 10.88 at 1-1½ min; 3.96, 6.15 and 9.35 at 3-3½ min; and 3.12, 4.68 and 7.83 at 5-5½ min; respectively (P<0.001). The median crying time was 10, 37.5 and 162 seconds in 25 D, EBM and SW groups, respectively (P<0.001). EBM significantly reduces procedural pain in neonates though to a lesser extent as compared to 25% dextrose.

Kangaroo Mother Care in Reducing Pain in Preterm Neonates on Heel Prick

To determine the effect of Kangaroo Mother Care (KMC) of small duration of 15 min in decreasing pain in preterm neonates between 32-36 wk 6 d on heel prick by a 26 gauge needle. Randomized controlled double masked crossover trial involving 50 neonates, between 32 wk and 36 wk 6 d gestation and weighing less than 2500 g, within 10 d of birth, vitally stable, breathing without assistance or on Continuous positive airway pressure (CPAP), without any clinically evident neurological signs, not having received analgesics/sedatives within last 24 h and not fed within last 30 min and requiring heel pricking were eligible. Outcome measured was the Premature Infant Pain Profile (PIPP). Analysis was done using independent sample t test, with Bonferroni correction applied for comparing individual components of PIPP score. The heart rate, behaviour and facial scores were statistically significant and lower in KMC group. But there was no statistically significant difference in oxygen saturation (SpO(2)). The difference(4.85) in PIPP score was clinically and statistically significant (p < 0.0001). The findings suggest that short duration KMC (15 min) has stress reducing benefits. Preterm neonates above 32 wk gestational age can benefit from KMC to decrease pain from heel prick procedure.

Procedural Pain and Oxidative Stress in Premature Neonates

Preterm neonates exposed to painful procedures in the neonatal intensive care unit exhibit increased pain scores and alterations in oxygenation and heart rate. It is unclear whether these physiological responses increase the risk of oxidative stress. Using a prospective study design, we examined the relationship between a tissue-damaging procedure (TDP; tape removal during discontinuation of an indwelling central arterial or venous catheter) and oxidative stress in 80 preterm neonates. Oxidative stress was quantified by measuring uric acid (UA) and malondialdehyde (MDA) concentration in plasma before and after neonates (n = 38) experienced a TDP compared to those not experiencing any TDP (control group, n = 42). Pain was measured before and during the TDP using the Premature Infant Pain Profile (PIPP). We found that pain scores were higher in the TDP group compared to the control group (median scores, 11 and 5, respectively; P < .001). UA significantly decreased over time in control neonates but remained stable in TDP neonates (132.76 to 123.23 μM versus 140.50 to 138.9 μM; P = .002). MDA levels decreased over time in control neonates but increased in TDP neonates (2.07 to 1.81 μM versus 2.07 to 2.21 μM, P = .01). We found significant positive correlations between PIPP scores and MDA. Our data suggest a significant relationship between procedural pain and oxidative stress in preterm neonates. PerspectiveThis article presents data describing a significant relationship between physiological markers of neonatal pain and oxidative stress. The method described in this paper can potentially be used to assess the direct cellular effects of procedural pain as well the effectiveness of interventions performed to decrease pain.

Analgesic Effect of Breast Milk Versus Sucrose for Analgesia During Heel Lance in Late Preterm Infants

The purpose of this trial was to investigate whether breast milk (either breastfed or bottle-fed) has a better analgesic effect than sucrose in newborns born at a postmenstrual age between 32 and 37 weeks. We conducted a randomized controlled trial at a secondary care neonatal unit in the Netherlands on 71 preterm neonates (postmenstrual age at birth 32-37 weeks), undergoing heel lance with an automated piercing device. Newborns were randomly assigned to breast milk (either breastfed or bottle-fed) administered during heel lance or oral sucrose administered before heel lance. We assessed the Premature Infant Pain Profile (PIPP) score (range, 0-21) to investigate whether there was a difference in pain score between neonates receiving breast milk and those receiving sucrose solution. There was no significant difference in mean PIPP score between neonates receiving breast milk (6.1) and those receiving sucrose (5.5), with a mean difference of 0.6 (95% confidence interval -1.6 to 2.8; P = .58). From this study, it cannot be concluded that breast milk has a better analgesic effect than sucrose in late preterm infants. From the results, it follows with 95% confidence that the analgesic effect of breast milk is not >1.6 points better and not > 2.8 points worse on the PIPP scale (SD 3.7) than the analgesic effect of sucrose in late preterm infants.