19.

Sucrose (24%) by syringe + swaddled +pacifier compared with water by syringe + swaddled + pacifier for pain/distress associated with retinopathy of prematurity (ROP) examination
Patient or population: neonates with pain/distress associated with ROP examination Settings: hospital Intervention: sucrose (24%) by syringe + swaddled + pacifier Comparison: water by syringe + swaddled + soother
Outcomes	Illustrative comparative risks* (95% CI)		No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Water by syringe + swaddled + pacifier	Sucrose (24%) by syringe + swaddled +pacifier
PIPP during exam 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 was 14 in the control group.	The mean PIPP score in the intervention group was neither lower nor higher than in the control group: 0.00 (95% CI ‐2.08 to 2.08	32 (1)	⊕⊕⊝⊝ low	Bias: the authors did not describe how the random sequence was generated, nor did they describe how allocation concealment was achieved Consistency: as this was the only study concerns about consistency were N/A Precision: this was a small study and the CI were wide around the point estimate Directness: the study was conducted in the target population ‐ no concerns 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 scores with its 95% CI'. CI: confidence interval; N/A not applicable; PIPP: Premature Infant Pain Profile; PMA: postmenstrual age; ROP: retinopathy of prematurity examination
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.