Sucrose water (24%) for analgesia

VUMC Policy Click Here

The taste of a concentrated sucrose solution placed in the mouth of preterm and newborn infants has been shown to have analgesic effect. 24% sucrose should be administered to NICU patients to diminish minor pain associated with necessary medical procedures.

A recent abstract presented at the 2002 SPR conference suggest that smaller doses than we had been using are equally effective.  We are now instituting a policy to use these smaller recommended doses less frequently and reminding care-takers to treat 24% sucrose as a pharmacologic intervention and document it appropriately.

Procedures which cause discomfort and should be accompanied by 24% sucrose administration include: heel-lancing, an iv start, a venous or arterial blood draw, an IM injection, LP, suprapubic tap, and dressing changes or extensive tape removal. Suctioning and urinary catheterization are also unpleasant.

24% sucrose is delivered daily to the NICU and placed in the formula refrigerator in the large step-down nursery. An individual dose of 24% sucrose should be obtained with a sterile oral syringe and should not be left at room temperature for more than 12 hours.

Doses:

• Intubated infants:  0.05mL
• Infants < 1000g: 0.05mL
• Infants < 28 weeks:  0.05mL
• Infants 1001-2000g:  0.05mL - 0.2mL
• Infants > 2000g:  0.05mL - 0.5mL

Sucrose should be dispensed slowly into the side of the infant’s mouth onto the anterior tongue 2 minutes prior to the painful intervention.

24% sucrose should only be used once in an hour and no more than 4 times in a 24 hour period.

Contraindications:

Do not give 24% sucrose to infants with:

High risk for NEC: (asphyxia, congenital heart disease, or feeding intolerance)

Surgical issues (esophageal atresia, TEF, or any intestinal obstruction pre- or post-op)

High risk for aspiration (sedation, asphyxia, neuromotor problems)

Hyperglycemia

Non-pain related irritability

Nurses should document the administration of 24% sucrose on the nursing flow sheet in the intervention box under pain assessment. Nurses should also note and report any perceived adverse effects of 24% sucrose including glucose intolerance or apnea.

Anand KJS, et al. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001;155:173-180.

Stevens B, Ohlsson A. Sucrose in neonates undergoing painful procedures. Cochrane Database of Systematic Reviews 2000;2:DC001069.  http://www.nichd.nih.gov/cochrane/Stevens/Stevens.HTM