NEW YORK (Reuters Health) – For preterm infants undergoing venipuncture, oral sucrose and application of EMLA cream has a greater analgesic effect than sucrose alone, according to a report in the July issue of Pediatrics.

Dr. Valerie Biran, with Hopital Robert Debre in Paris, France and colleagues point out that while sweet-tasting solutions have been shown to reduce signs of pain in newborns, the effect is usually moderate. “The advantages of combining different analgesic strategies have been stressed in recommendations to alleviate procedural pain in neonates,” they explain.

The team hypothesized that the effect of oral sucrose would be additive to the effect of a local anesthetic. To investigate, they conducted a randomized trial in which 76 infants younger than 37 weeks’ gestational age received either sucrose plus application of a placebo cream or sucrose plus EMLA cream before a venipuncture procedure.

Pain was assessed using the Douleur Aigue Nouveau-ne (DAN) behavioral scale. The mean DAN pain scores were 7.7 for the sucrose-only group and 6.4 in the sucrose-plus-EMLA group during venipuncture itself. In the 30 seconds after needle removal, corresponding scores were 7.1 and 5.7, respectively, the authors report.

“Analysis of scores from serial measurements showed a significant time (p=0.047) and treatment (p=0.018) effect in favor of the sucrose + EMLA treatment,” the researchers found.

The Premature Infant Pain Profile (PIPP) scale was used as a secondary outcome measure. Those results were not statistically different between the two groups, according to the report.

There is concern about the safety of the use of EMLA in neonates, Dr. Biran and colleagues note, but they saw no erythema at the site of cream application.

They conclude, “The results of our study add to the current evidence that the combination of EMLA cream and oral sweet solutions is additive to reduce pain during venipuncture in preterm neonates.

Pediatrics 2011;128.