Sucrose for procedural pain in neonates

Please note that some guidelines may be passed their review date. The review process is currently paused. It is recommended that you also refer to more contemporaneous evidence.

Newborns, including the very preterm, are capable of feeling pain. Pain is often unrecognised and under treated in infants.

Sick infants are exposed to numerous painful procedures over the course of their hospitalisation. It is important for all caregivers to recognise sources of pain and to implement appropriate pain reduction strategies.

Non-pharmacological measures to reduce pain:

• reduction of noxious environmental stimuli
• reduce multisensory stimulation
• skin-to-skin contact
• swaddling
• non-nutritive sucking
• breastfeeding.

Contraindications:

• neonates/infants with known sucrose or fructose intolerance.

Oral sucrose 

Oral sucrose or other sweet tasting solutions in small volumes (0.05-1 mL) combined with non-nutritive sucking is effective in reducing pain in infants during minor procedures.

The concentrations of oral sucrose commonly used range from 24 to 33 per cent.

The mechanism is an orally mediated increase in endogenous opioids. There is no analgesic effect if sucrose is given directly into the stomach via a nasogastric tube. Sucrose is more effective if given with a dummy as the dummy promotes non-nutritional sucking, which contributes to calming.

Sucrose should be used in addition to other supportive non-pharmacological measures. Breastfeeding, skin-to-skin contact, cuddling or swaddling during procedures may be feasible depending on the condition of the infant and the nature of the procedure. 

Oral sucrose may be administered for minor painful procedures such as heel lance, venepuncture, intravenous catheter insertion, arterial puncture, eye examination, and lumbar puncture, intramuscular or subcutaneous injections.

Maximum dose administered per procedure

Note: The concentration of the sucrose product 24-33 per cent does not alter the recommended volume to be administered.

Administration of sucrose

Follow these guidelines when administering sucrose:

• Two minutes prior to the procedure, administer a small amount (from 0.05 mL if infant is nil orally up to 0.25 mL) of sucrose onto the infant's tongue.
• Offer a dummy if this is part of the infants care.
• Repeat dose upon commencement of the procedure.
• Continue to administer small volumes every two minutes.
• Document administration of sucrose on medication chart.
• Analgesic effects of oral sucrose last for only five to eight minutes.

Other forms of analgesia

Additional pharmacological therapy is required for minor procedures if the infant is critically ill, or when oral sucrose combined with non-nutritive sucking is insufficient to reduce pain. 

For a crying, irritable infant not undergoing painful procedures, who cannot be comforted by routine nursing measures, oral sucrose may be given and the response assessed.

Possible causes of pain and distress need to be sought and alternative pain and stress reduction strategies evaluated including use of the principals of developmental care.