5.

Sucrose (24%) + NNS + NIDCAP support compared with breast milk (by syringe) for heel lance‐associated pain
Patient or population: neonates with heel lance‐associated pain Settings: hospital Intervention: sucrose (24%) + NNS + NIDCAP support Comparison: breast milk (by syringe)
Outcomes	Illustrative comparative risks* (95% CI)		No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Breast milk (by syringe)	Sucrose (24%) + NNS + NIDCAP support
PIPP score Range of scale 0‐21 for infants < 28 weeks PMA and 0‐18 for infants > 36 weeks PMA A lower score = less pain (Stevens 1996; Stevens 2014a)	The mean PIPP score in the breast milk (by syringe) group was 5.38	The mean PIPP score in the sucrose (24%) + NNS + NIDCAP support group was lower than in the control group: ‐0.13 (95% CI ‐2.41 to 2.15)	47 (1)	⊕⊕⊝⊝ low	Bias: there was a high risk of performance and detection bias as the interventions could not be blinded Consistency: as there was only one study in this analysis concern about consistency was N/A Precision: small sample size (lack of precision) Indirectness: the study was conducted in the target population (no concern about indirectness)
*The basis for the assumed risk was 'The mean PIPP score in the control group according to the value reported in the Assumed risk column. The corresponding risk was the mean in the intervention group for the PIPP score with its 95% CI'. CI: confidence interval; PIPP: Premature Infant Pain Profile; PMA: postmenstrual age; N/A not applicable; NIDCAP: Newborn Individualized Developmental Care and Assessment Program;NNS: non‐nutritive sucking
GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate.