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Sucrose (24%) compared with EMLA + sucrose (24%) for pain associated with circumcision
Patient or population: neonates undergoing circumcision Settings: hospital Intervention: sucrose (24%) Comparison: EMLA + sucrose (24%)
Outcomes	Illustrative comparative risks* (95% CI)		No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	EMLA + sucrose (24%)	Sucrose (24%)
N‐PASS score during circumcision Range 0‐13 A lower score = less pain (Hummel 2010)	The mean N‐PASS score in the control group was 5.2	The mean N‐PASS score in the intervention group was higher: MD 3.00 (95% CI 2.42 to 3.58)	60 (1)	⊕⊕⊝⊝ low	Bias: there were concerns about risk of bias in this study for random sequence generation (unclear risk) and high risk of performance and detection bias Consistency: as this was the only study concerns about consistency were N/A Precision: this was a small study and the CI was wide around the point estimate Directness: the study was conducted in the target population ‐ no concerns about indirectness
N‐PASS score after 5 min Range 0‐13 A lower score = less pain (Hummel 2010)	The mean N‐PASS score in the control group was 3.3	The mean N‐PASS score in the intervention group was higher: MD 1.20 (95% CI 0.49 to 1.91)	60 (1)	⊕⊕⊝⊝ low	Bias: there were concerns about risk of bias in this study for random sequence generation (unclear risk) and high risk of performance and detection bias Consistency: as this was the only study concerns about consistency were N/A Precision: this was a small study and the CI was 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 N‐PASS 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 N‐PASS score with its 95% CI'. CI: confidence interval; EMLA: eutectic mixture of local anaesthetic; MD mean difference; N/A not applicable; N‐PASS: Neonatal Pain Agitation and Sedation Scale
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.