Is using sucrose in neonates a good idea?

RNIBCLC · Sep 12, 2014

There are many good studies that praise sucrose pain relief. What is often misunderstood is that it takes about 10 minutes for infants to feel the intended pain relief. Sucking in addition to sucrose provides the best pain relief. All infants in my facility are provided with a pacifier dipped in sucrose for painful procedures. The amount of sucrose is very small in these situations. The pacifier is then thrown away after the procedure.

Bortaz, MSN, RN · Sep 13, 2014

Sucrose causes endogenous opioid release in infants. In small doses, it's a great tool. The usual suggested dose is 0.2-0.5 ml. The problem is that most nurses use it for crying, fussiness, I've even seen it given to crying NPO kids. And so many nurses give way too much of it. I've seen them use 10 ml syringes full of it.

also, importantly, it is contraindicated in babies with gastro issues. Which are of course the babies I've seen it most used for. So many nurses used to pump our gastroschisis babies full of it, trying to make them stop crying.

i fought to have it removed from my NICU due to the rampant misuse, but of course the nurses wanted to keep it for their crybabies, and fought my efforts.

NicuGal, MSN, RN · Sep 13, 2014

We have an overuse also but we have to now take it out of the Pyxis and sign it off. We do not give it to any withdrawal or gut kids, think about how your gut feels after you eat/drink a bunch of sugary stuff...blah!

HyperSaurus, RN, BSN · Sep 13, 2014

I try not to use it (some of my coworkers are a big fan), but if they are stable and eating, and really crying while I am assessing, I will sometimes give them 0.1mL to get through the assess. I prefer however, if there is breast milk available, to give that.

katierobin23 · Sep 13, 2014

Sucrose causes endogenous opioid release in infants. In small doses, it's a great tool. The usual suggested dose is 0.2-0.5 ml. The problem is that most nurses use it for crying, fussiness, I've even seen it given to crying NPO kids. And so many nurses give way too much of it. I've seen them use 10 ml syringes full of it.
also, importantly, it is contraindicated in babies with gastro issues. Which are of course the babies I've seen it most used for. So many nurses used to pump our gastroschisis babies full of it, trying to make them stop crying.
i fought to have it removed from my NICU due to the rampant misuse, but of course the nurses wanted to keep it for their crybabies, and fought my efforts.

All of this. I'm getting so tired of seeing huge syringes of it at kids's bedsides who are NPO for belly issues or are NAS babies...the most I've accomplished is getting a flyer posted about when and when not to use it. It's supposed to be moved to the Pyxis in 3ml containers soon (rather than in the stock room in 11ml containers as it is now), but I'm not seeing that happen anytime soon.

champagnesupeRNova · Sep 13, 2014

I did a research report on the use of oral sucrose in neonates in nursing school and read the Cochrane review. All of the studies on this subject concluded that oral sucrose use before minor painful procedures (such as heelsticks and IV starts) reduces pain behaviors in neonates.

There were two studies in the Cochrane review that also monitored brain activity as the neonates were getting heel sticks. Interestingly, the studies concluded that brain activity is the same in neonates who do or do not get oral sucrose before a painful procedure, but their pain behaviors (such as crying, heel retraction, brow furrow, etc.) were significantly reduced in those that did receive it. Simply put, their brains were responding to the pain at the same level in both testing groups, but their pain behaviors were significantly different. (By the way, they did not just go around poking babies for research. The testing was done in various hospitals on babies that actually needed lab draws :up: )

On the unit I work on, we have little one-time use droppers of sucrose stocked in the bedside cart so it's convenient to use for lab draws and things like that. I have only seen it being overused in our withdrawal kids, but even then it's not as bad as people having syringes full of it! Here's a pic of it. Ignore creepy doll:

NicuGal, MSN, RN · Sep 13, 2014

That's what we have and you would find about 20 empty ones scattered at kids bedsides...no joking! So now it is in the Pyxis and signed off.

labordude, BSN, RN · Sep 17, 2014

Also remember that delivery of sucrose via sucking is the preferred method. The research supports this method of administration as compared to squirting the liquid in their mouth with an oral syringe. The one (older study, with a small n) that I remember off the top of my head is by Greenberg that looked at differences in method of administration.