Oral Sucrose and Pain Relief for Preterm Infants

Anita Mitchell, RN, PhD, Patricia A. Waltman, RNC, EdD, NNP

Disclosures

Pain Manag Nurs. 2003;4(2) 

In This Article

Recommendations for Using Sucrose to Provide Pain Relief for Preterm Infants

The International Evidence-Based Group for Neonatal Pain has published a consensus statement for the prevention and management of pain in the newborn. This interdisciplinary, international group was made up of infant pain experts from various practice settings. Faculty members reached a consensus and presented guidelines for the management of pain in infants after performing a thorough systematic literature review, analyzing and critiquing randomized controlled trials (RCTs), and performing meta-analyses. Evidence-based guidelines in this statement recommend interventions that prevent and manage pain for a wide variety of painful procedures performed on newborn infants (Anand, Phil, & the International Evidence-Based Group for Neonatal Pain, 2001).

(Anand and Phil (2001) recommend the use of a pacifier with 12% to 24% sucrose as a pain relief measure. The recommended dose of sucrose solution for the preterm infant is .1 to .4 ml, and the recommended dose for the term neonate is 2 ml. Guidelines in the consensus statement encourage the combination of a variety of behavioral and pharmacologic interventions during painful procedures to give an additive or synergistic effect. Therefore, offering an infant a pacifier with sucrose may be one of several interventions, combined with comfort measures such as swaddling and analgesic medications.

The Cochrane Collaboration is an international, interdisciplinary organization that performs systematic reviews and meta-analyses of RTCs, and provides evidence-based information for healthcare professionals who are making practice decisions. One systematic review provided by the Cochrane Collaboration examined the use of sucrose during painful procedures performed on preterm and term infants. This review recommended the use of oral sucrose to relieve pain in both term and preterm infants during single painful procedures such as heelsticks or venipunctures. Effective doses for preterm infants ranged from .012 g (.05 ml 24% solution) to .12 g (.5 ml 24% solution) sucrose given 2 minutes before heelsticks. It was also recommended that additional pain relief measures be used in combination with the sucrose (Stevens, Yamada, & Ohlsson, 2002). Sucrose is given two minutes before a painful procedure, and its action lasts approximately five minutes (Barr et al., 1995; Blass, 1994).

Ohlsson, Taddio, Jadad, & Stevens (2000) used a systematic review to make decisions on a variety of clinical practice questions pertaining to pain relief for infants. Using evidence-based guidelines, these researchers concluded that sucrose and alternative sweet liquids such as 30% glucose or Calpol (i.e., hydrogenated glucose) are effective in relieving pain during heelsticks.

A systematic review and meta-analysis of sucrose by Stevens, Taddio, Ohlsson, & Einarson (1997) summarized and critically analyzed those sucrose studies that utilized varying concentrations and doses of sucrose for pain management studies with infants. According to this meta-analysis, the concentration of sucrose for use in infant pain management typically varies between 12% and 24%, and the volume varies from .05 ml for preterm infants to 2 ml for term infants. The sucrose may be administered to preterm infants by dipping a pacifier into the sucrose solution. The volume of sucrose on a dipped Wee Thumbie pacifier (Children's Medical Ventures, Norwell, Massachusetts) is approximately .1 ml (Stevens et al., 1999).

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