The use of sucrose in NICU please respond:

[cajrio]

I am looking at making some changes in our unit's policy and I would ask those who work in other NICU's to please answer these questions. Thanks:

Do your unit use sucrose and if so do you need an MD order?

What age preemies can receive the benefit of the sucrose? (ex 24wks,30wks etc)

Can intubated infant still use the sucrose?

Has your unit noticed an increase in NEC since the use of sucrose?

Please if possible list the state and level,

thanks again.

[skysurfer]

Hello cajrio,

We are using sucrose(glucose 20%) for pain relief in Infants 0-1yrs.

The Infant has to be on enteral feeding, has to have a normal sucking behaviour, and a normal sip reflex.

Contraindications are as follows:

1. NEC, confirmed or estimated
   
2. Sedated or relaxed child
   
3. No enteral feeding
   
4. No suck or sip reflexes
   
5. Severely ill child, intubated and ventilated, as the sucrose is only given for small interventions like IV-Line placement, Heel Stick, small interventions like removing tapes on skin etc. Severely ill children have to receive pain treatment with other, stronger medications.

The maximum ammount of glucose administered per intervention is ruled by the childs weight as follows:

1.500 – 2.500g: 3x 0.4 ml

> 2.500g: 3x 0.6 ml

We haven´t noticed an increasing number of NEC in our Unit. Numbers are stable since we first introduced this system.

The glucose is applied by a small syringe at the front part of the tongue and then, a pacifier is given, because there is evidence that sucking reduces stress......Giving glucose is under authority of the RN´s. If reached the maximum dosage for the childs weight, we go on with other Medications like Nubain....Paracetamol... for further information pls see http://www.medscape.com/viewarticle/458592

hope that helps

[Kalico]

I was wondering where you work in NC. I am interviewing with Carolina's Medical Center in Charlotte. I was wondering if you knew anything about them.

[SteveNNP, MSN, NP]

I don't think we have a specific policy, but this is what we usually go by when using oral sucrose. We do not need an order.

Never intubated,

no other ordered pain meds, eg morphine [except tylenol]

Usually if they are not intubated and not on IV pain meds they are >29-30 weeks. I usually won't give it unless they are on some kind of enteral feeds or are a term baby. Our sucrose comes in little cups [sweet-ease] which we dip the paci's in. I sometimes give them sucrose/pacis while OG feeding to teach oral motor skills. If they're on enteral feeds, NEC risk should be the same with or without sucrose.

[RN4BABES]

Amazing how different things are everywhere. We use sucrose 25%, 0.5 ml to a max of BID for painful procedures. We certainly use it on intubated babies unless the particular baby is already on a drip of Fentanyl or the like. We follow the administarion with a soother as well. The baby has to be feeding at least 1cc Q2h, not okay for induction feeders. Contraindicated in hyperglycemic babes and query NEC's. We do need a doctor's order although it is a "stamped" order that's pretty much standard once the baby is feeding.

Toronto, CAN

[skysurfer]

We certainly use it on intubated babies unless the particular baby is already on a drip of Fentanyl or the like. Contraindicated in hyperglycemic babes and query NEC's.

Bucher et al 1995 showed in a study that sucrose in such small doses has not been shown to cause hyperglycemia.....:thankya:

In intubated children i´d bee very careful because of possible aspiration of the fluid.

[Sweden]

We use sucrose 30% for all painful prodedures (there is a written policy but I can´t remember the exact amount of sucrose allowed in each case).

All babies can have it, including intubated (we usually give food in the mouth with feedings anyway) and surgical cases (nec also). They don´t have to be on feedings at all.....

Anna

[cajrio]

Thank you everyone for answering my questions, the more replies I can get the more information I can present to our attendings to help change our policy. If anyone is willing send me their units protocols I can send you my smail address or email address, thanks,

[cajrio]

I was wondering where you work in NC. I am interviewing with Carolina's Medical Center in Charlotte. I was wondering if you knew anything about them.

I work in the Raleigh Durham Trainagle area, one of the "well known" NICU's. I have heard that Carolina has a great facility and that you would are lucky to find a position as often there is a waiting list. Good luck.

[dawngloves, BSN, RN]

Doesn't anyone use Sweetease? We use that, no order needed. One dip q 5 minutes x 3 max. Not on intubated or NPO kids.

http://childrensmedical.respironics.com/Product_Info/productb1e2.html?p=965AE6A0-4C00-4C99-A14A078F5FE26AE2

[prmenrs, RN]

We do, (it's esp good for circs) and did when I worked in Level 3.

[KK7724]

Oh my God,

Y'all make me feel like our NICU is in the stone ages!!!! We don't EVER use it!! I've only ever heard of well-baby using it for circumcisions. God, I"m going to be viewed as a bad nurse when I work outside the state of Alabama obviously! Oh well, I know it's going to be bad for me since at our unit we make ventilator settings changes, give surfactant, intubate, etc etc!!!!!!

~Kristina~