24.

Sucrose (24%) compared with water for potentially painful procedures for a period of seven days
Patient or population: neonates with pain associated with potentially painful procedures for 7 days Settings: hospital Intervention: sucrose (24%) Comparison: water
Outcomes	Illustrative comparative risks* (95% CI)		No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Water	Sucrose (24%)
Motor development and vigor (MDV) domain of the NAPI tool Normative mean and SD at 36 weeks PMA 63 (14.5) Higher scores are associated with more mature behaviour (Snider 2005)	The mean MDV score at 40 weeks PMA was 76.48 in the control group	The mean MDV score at 40 weeks PMA in the intervention group was lower than in the control group: ‐1.83 (95% CI ‐8.59 to 4.93)	93 (1)	⊕⊕⊕⊕ high	Bias: there were no concerns about bias in this study Consistency: as this was a single study concerns about consistency were N/A Precision: this was a moderately sized study and the CI was narrow around the point estimate Directness: the study was conducted in the target population ‐ no concerns about indirectness
Alertness and orientation (AO) domain of the NAPI tool Normative mean and SD at 36 weeks PMA 54 (19.4) Higher scores are associated with more mature behaviour (Snider 2005)	The mean AO score at 40 weeks PMA was 67.77 in the control group	The mean AO score at 40 weeks PMA in the intervention group was higher than in the control group: 3.09 (95% CI ‐6.49 to 12.67)	93 (1)	⊕⊕⊕⊕ high	Bias: there were no concerns about bias in this study Consistency: as this was a single study concerns about consistency was N/A Precision: this was a moderately sized study and the CI was narrow 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 MDV and the mean AO scores in the control group according to the values reported in the Assumed risk column. The corresponding risk was the means in the intervention groups for the MDV and AO scores with their 95% CI'. AO: 'alertness and orientation' CI: confidence interval; MDV: 'motor development and vigor'; N/A: not applicable; PMA post menstrual age; SD: standard deviation
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.