9.

Sucrose (24%) compared with sucrose (24%) + NNS + swaddling for pain associated with heel lance
Patient or population: neonates with pain associated with heel lance Settings: hospital Intervention: sucrose (24%) Comparison: sucrose (24%) + NNS + swaddling
Outcomes	Illustrative comparative risks* (95% CI)		No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Sucrose (24%) + NNS + swaddling	Sucrose (24%)
Revised NFCS Range of scale 0‐10 in term infants 0‐9 in preterm infants A lower score = less pain Grunau 1987	The mean NFCS score in the sucrose (24%) + NNS + swaddling group was 0.02	The mean NFCS score in the sucrose (24%) group was higher than in the sucrose (24%) + NNS + swaddling group: 0.43 (95% CI 0.23 to 0.63)	337 (1)	⊕⊕⊕⊝ moderate	Bias: there was a risk of performance and detection bias in this study as the coder could have distinguished the different groups Consistency: as this was a single study a rating of consistency was N/A Precision: this study had a very large sample size with a narrow 95% CI (no concerns about precision) Directness: the study was conducted in the target population ‐ no concerns about indirectness
*The basis for the assumed risk was 'The mean NFCS 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 NFCS score with its 95% CI'. CI: confidence interval; N/A: not applicable; NFCS: Neonatal Facial Coding System; 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.