The physiological effects of oral sucrose and non-nutritive sucking are thought to be mediated by both endogenous opioid and non-opioid systems (Blass 1999). The most common adverse reaction is constipation. Studies conducted to date on children older than 12 months have failed to provide consistent evidence of pain reduction. For optimal results, oral sucrose should be administered with supportive interventions like non-nutritive sucking (NNS) (pacifier dipped in sucrose where parents have agreed to use pacifier). Use of maternal breast milk/breast feeding  should be considered where available for pain relief prior to minor procedure. Consistent management of repeated procedural pain with sucrose in preterm neonates: Is it effective and safe for repeated use over time? an indwelling arterial line for infants requiring frequent blood sampling. Bloating or swelling of the face, arms, hands, lower legs, or feet Adverse effects were described as those that occurred immediately after administration of the solution, such as choking, coughing, or vomiting; sustained tachycardia, or bradycardia. Barr et al (1999) in an early study reviewed sucrose administration during immunisation. Alternative strategies should be considered for babies undergoing frequent procedures, e.g. The study sample consisted of 43 preterm neonates divided into two groups: a sucrose group (SG, n=18) and a control group (CG, n=25) in which no sucrose was administered. Acute pain relief services protocol (APRS). The SG received 0.5 mL/kg 25% oral sucrose for 2 min prior to all acute painful procedures during three consecutive days. Neonates routinely experience pain and discomfort from both invasive and non-invasive procedures in the neonatal unit. RARE side effects A Significant Type Of Allergic Reaction Called Anaphylaxis A Skin Rash A Stuffy And Runny Nose Blockage Of The Esophagus Blockage Of The Stomach Or Intestine Bronchospasm Hives Inflammation Of The Skin Due To An Allergy Itching Pink Eye Stool Blockage Of The Intestine Admission criteria: Neonatal Unit & Transitional Care, Antibiotic guidelines for the neonatal unit, Congenital hypothyroidism in Scotland, guidelines for the management of, Cranial ultrasound: a guideline for the performance of routine cranial USS for preterm infants, Criteria for attendance at delivery by neonatal staff, Early onset sepsis in the neonate: prevention and treatment, Expressed breast milk (maternal and donor), Eye infections in the neonate: Ophthalmia Neonatorum and the management of systemic Gonococcal and Chlamydial infections, Heart murmurs in the neonate: an approach to the neonate with a heart murmur, Intubation and premedication for neonates, Jaundice management on the postnatal wards, Less Invasive Surfactant Administration (LISA), neonatal guideline, Management of infants born to HIV positive mothers, Management of the difficult airway, neonates, Oesophageal atresia and tracheo-oesophageal fistula, Palliative care resource folder (Neonatal & Children's Services) [Staffnet], Patent ductus arteriosus (PDA) : medical treatment and indications for surgical closure, Peripheral arterial lines: insertion and care, Peripherally inserted central catheters (PICC Lines) - Neonatology guideline, Renal anomalies detected or suspected antenatally, Respiratory management of preterm infants: primary respiratory therapy with CPAP or intubation and surfactant, Seldinger chest drain insertion and management, Transcutaneous bilirubinometry in the Community, Enoxaparin use in neonatal and paediatric critical care, Virological assessment of fetuses and neonates, Humidified High Flow Nasal Cannulae (HHFNC), Epidermolysis Bullosa (EB) Care of Neonates, Cytomegalovirus (CMV) - congenital infection, Cardiac genetics pathway for infants with congenital heart disease and the appropriate utilisation of irradiated blood products, Anti-Ro & Anti-La antibodies : Guideline for the management of babies born to mothers with systemic lupus erythematosus (SLE) and other autoimmune disorders, Passage of a nasogastric or orogastric feeding tube (neonatal guideline), Confirming the position of a naso-gastric / oro-gastric tube in neonates, WoSPGHAN enteral tube feeding information pack for healthcare professionals, Extravasation injuries: prevention and management (neonatal guideline), Management of infants born to mothers with Hepatitis C, Perinatal management of extreme preterm birth before 27 weeks of gestation: a framework for practice, Sampling from arterial peripheral / umbilical lines : neonatal guideline, Arterial lines: priming & calibration using the Kids Kit ™ closed blood sampling system : neonatal guideline, Volume Targeted Ventilation: indication and use in the Neonatal Unit, Persistent or refractory hypoglycaemia in the neonate : a guideline for management, Postnatal management of fetal arrhythmias, Disorders of Sex Development (DSD): Management of Atypical Genitalia & Suspected DSD in the Neonate, Congenital syphilis : management of babies born to mothers with syphilis infection, Cooling mattress : Tecotherm Neo Instructions, Developmental dysplasia of the hips (DDH) and congenital foot deformities, High Frequency Oscillatory Ventilation (HFOV) : a guide to the use of HFOV in the neonate, Surfactant Administration via Laryngeal Mask Airway (LMA) Standard Operating Procedure, West of Scotland Critical Care Guidelines, Venepuncture /arterial puncture/heel stab, Eye examination e.g. RESULTS While a comparable increase in hemoglobin was observed for both administration routes (median increase 0.25 g/L in the intravenous group vs 0.21 g/L in the oral group), only iron sucrose led to … Concerns about neurodevelopment in the long term were raised by old research although more recent evidence refutes this. Selected from data included with permission and copyrighted by First Databank, Inc. However recent studies dispel this theory by highlighting that acute pain activates the sensory cortex in even the extreme preterm neonate (Bartocci et al, 2005, Fitzgerald, 2005). Ramenghi LA, Evans DJ, Levene MI. It is safe to use for all babies 12 months and younger, except babies who are premature, and with low birth weight, and unstable sugar levels. Oral sucrose is safe and effective for reducing minor procedural pain from single events like heel prick, intramuscular injection and venepuncture. However, the cry time was significantly reduced. The authors reported that sucrose was less effective in infants older than 3 months. Oral sucrose did not significantly reduce pain scores during ROP examinations, and withholding feeding before the examination was not beneficial. Further concerns in relation to possible adverse effects have been alterations in glucose homeostasis and necrotising enterocolitis. Documentation however, is required, to maintain a record of administration and to ensure that excessive amount is not given especially in preterm babies less than 32 weeks in first week of life. This can increase your risk for serious side effects or may cause your medications not to work correctly. (1) The research has come under fire from numerous quarters including unsurprisingly the manufacturers of … Carbajal (2002) and Gibbons et al (2002) reported that sucrose can be effective in neonates as young as 25 weeks gestation. (1998) Psychometric Issues in the Measure of Pain, in: Measurement of Pain in Infants and Children, Progress in Pain Research and Management, Vol 10, Finley, G.A., McGrath, P.J. Hypophosphatemia The peak action is 2 minutesThe duration of action is 5-10 minutesObserve for gagging, choking, coughing and vomiting, If an inadequate analgesic effect is achieved consider additional therapies. It seems reasonable to offer sucrose to infants up to 12 months old, whilst being aware the effects are not as profound or reliable as following its administration in neonates. Do not exceed 4 doses per procedure. Other Professionals Consulted: Dr G. Bell Consultant Anaesthetist, RHSC; Stephen Bowhay Pharmacist GG&C, Literature Review/Evidence base background. However it is not the volume but the sweet substance that produces the analgesic effect, therefore studies report 0.05ml to 0.5ml of 24% to 25% sucrose as an adequate volume (Stevens et al, 2004, Stevens et al 2010). Keywords Ferrous sulphate, intravenous iron sucrose, postpartum anaemia. The onset of action is reportedly 10 seconds, and is therefore so rapid that there is not enough time for absorption to occur (Blass and Shah, 1995). Weight Gain and Insulin Resistance. Consensus statement for the prevention and management of pain in the newborn, Sucrose analgesia and Diptheria-pertussis-tetanus immunisations at 2 and 4 months, The response of crying newborns to sucrose: is it a “sweetness” effect, Suckling- and sucrose-induced analgesia in human newborns, Analgesic effect of breast feeding in term neonates: randomised controlled trial, Sucrose analgesia: identifying potentially better practices, Randomised controlled trial of sucrose by mouth for the relief of infant crying after immunisation. However there have been concerns surrounding developmental outcomes in infants less than 32 weeks corrected gestational age (Stevens 2004). The benefits of sucrose administration during heel lance and venepuncture has been well documented (Carbajal, 2003, Abad et al, 1996, Johnston, 1998). Cochrane review 2016: There was high-quality evidence for the beneficial effect of sucrose (24%) with non-nutritive sucking (pacifier dipped in sucrose) or 0.5 mL of sucrose orally in preterm and term infants: There was high-quality evidence to support  the use of 2 mL 24% sucrose prior to venepuncture: and intramuscular injections: Ramenghi et al (1999) reported that the administration of sucrose to the stomach by nasogastric tube was not an effective analgesia. Use “medication” to document administration of “Oral Sucrose” and mention the dose given. Fitzgerald and Howard (2003) reflect that early periods of development are particularly vulnerable to the effects of acute or repetitive pain exposures. There is insufficient evidence to recommend optimum dosing and age parameters for sucrose administration (Stevens et al, 2004). Slow heartbeat . Early repetitive pain in preterm infants in relation to the developing brain, Oral sweet solution reduces painrelated behavior in preterm infants, International Evidence-Based Group for Neonatal Pain. Emphasis should also be placed on the 2- minute peak effectiveness and the fact that the duration of sucrose action is temporary and the analgesic not sedative for the irritable infant (Lefrak et al 2007). IASP Press, Seattle. Pharmacological pain management can be difficult because of the medication side effects that can occur with these tiny humans, thus nonpharmacological pain management has become the ideal. The combination of 2 NPIs (eg, oral sucrose and FT) may have additive effects by stimulating infants in a multisensorial way to cope with the painful experience. An assistant may be required to administer sucrose during the procedure. © 2005 - 2019 WebMD LLC. Pain responses in preterm neonates were thought to be largely sub cortical, with functional maturation of higher brain centres being required to produce a pain experience. Go to the “Summary of care” for the Baby, click on the red + sign on top left side, it would open a drop down list. 18, 37, 38. Geriatric . The use of sucrose in addition to pharmacological measures has been recommended in more invasive procedures such as central catheter placement, lumbar puncture and chest tube insertion (Anand, 2001). It is also recommended that the effect of sucrose could be further enhanced by utilising other comfort measures such as facilitated tuck, swaddling kangaroo care. Important Safety Information for Sucraid ® (sacrosidase) Oral Solution Sucraid ® may cause a serious allergic reaction. Myalgia side effects can occur up to one or two days after the treatment takes place. Oral sucrose is safe and effective for reducing procedural pain from a single event. ORAL SUCROSE for Procedural pain VIDEO link: https://www.youtube.com/watch?v=0A2YuE-5K1U. Adverse effects were noted in most often in the immature infant (4 of 23). There is now extensive evidence in support of the administration of sucrose for procedural pain, frequently in conjunction with both pharmacological and non-pharmacological interventions (Anand, 2001).Further clinical indications for the administration of sucrose include eye examinations, oral suctioning, subcutaneous or intramuscular injection, nasogastric or orogastric tube insertion (Anand, 2001). (2003). Staff should also be aware of the appropriate pharmacy monograph. Mirka, I have also been exposed to the use of oral sucrose during painful procedures to decrease infant pain. If experienced, these tend to have a Severe expression. The Administration of Sucrose as a Method of Pain Management. There is a 2- minute peak effectiveness following administration which will provide short term pain management.The effect may be prolonged by administering 2 or three repeat doses at 2 minute intervals during the procedure. Patients may experience pains and aches of the muscles, specifically in areas near the spine. The investigators will also measure the number of successful venipunctures at the first attempt. 1 minute after IV cannulation were similar in both groups (16 4 beats/min for sucrose vs. 18 4 beats/ min for placebo, p = 0.74). If you are worried about using sucrose with your baby call your primary physician for their recommendations. Be dependent on the infant 's tongue to reduce procedural pain with sucrose in neonates. Product and does not need prescription prior to all acute painful procedures lasting longer than this and alternative should! Is given directly into the stomach via nasogastric tube unsurprisingly the manufacturers of … side effects similar. 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