Conclusions: Administration of an oral sucrose solution in infants 1 to 3 months of age during IV 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. Procedural pain and brain development in premature newborns. This study compared the impact of sucrose and FT alone and in combination on pain reactivity across multiple painful procedures. • While oral sucrose is most effective in the neonatal population, evidence suggests it may provide some analgesia and calming Sucrose is indicated for procedural pain from minor procedures.In the Neonatal Unit it should always be used in conjunction with developmentally supportive care (see Developmental Care Guideline).If maternal EBM is available this may be an alternative. Caution advised in such cases if >10 doses/day are required. Myalgia side effects can occur up to one or two days after the treatment takes place. Weight Gain and Insulin Resistance. Stevens,  B.J., Riddell, R.R.P., Oberlander, T.E., Gibbins, S. (2007) Assessment of Pain in Neonates and Infants, In: Pain in Neonates and Infants, Anand, K.J.S., Stevens, B.J., McGrath, P.J. RESULTS: Most studies supported the use of topical proparacaine, which marginally decreased pain without any side effects. Sucrose may be inadequate for painful procedures lasting longer than this and alternative analgesia should be considered. Use of dextrose oral gel is not recommended in children younger than 2 years of age. 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 In units with no maternity badger, the administration should be recorded in the baby’s record according to local guidance. The most common adverse reaction is constipation. Procedures known to cause pain and discomfort include: Sucrose can be used before checking glucose level. Iron sucrose can cause a decrease in the absorption of Technetium Tc-99m oxidronate resulting in a reduced serum concentration and potentially a decrease in efficacy. If maternal breast milk is not available then small amounts of oral sucrose solution have also been shown to reduce procedural pain. Side effects were similar for both groups and no adverse events were reported. Neonates routinely experience pain and discomfort from both invasive and non-invasive procedures in the neonatal unit. Sucraid ® does not break down some sugars that come from the digestion of starch. SIDE EFFECTS. On top of the other side effects already mentioned in this article, there has recently been quite a bit of controversy following Italian research into potential cancer-causing effects of sucralose. Oral iron (OI) supplements were associated with more side effects and anaphylactic reactions and IV iron sucrose can overcome the shortcomings of OI therapy. Eds. fever, cold or flu symptoms (sore throat, cough, stuffy nose, sneezing); Author(s): Review authors: Tayyaba Yasmeen - LAT, DGRI, Dumfries; Asma Yasmeen - Specialty Doctor, NNU, PRMH, Glasgow, Co-Author(s): Original authors: L. Raeside ANNP RHSC/SGH; K. Trower Specialist in Pain Management, RHSC. This dramatic change in temperature may prompt other side effects such as chest pain, irregular breathing and muscles aches and pains. There is insufficient evidence to recommend optimum dosing and age parameters for sucrose administration (Stevens et al, 2004). The investigators will also measure the number of successful venipunctures at the first attempt. The serum concentration of Tetracycline can be decreased when it … • Adverse effects were described as those that occurred immediately after administration of the solution, such as choking, coughing, or vomiting; sustained tachycardia, or bradycardia. Chest pain or pressure. Important Safety Information for Sucraid ® (sacrosidase) Oral Solution Sucraid ® may cause a serious allergic reaction. Sucrose for analgesia in newborn infants undergoing painful procedures. Oral sucrose is safe and effective for reducing minor procedural pain from single events like heel prick, intramuscular injection and venepuncture. Administer sucrose solution (Appendix 1) on to anterior aspect of tongue or inside cheek, or dip dummy/pacifier into sucrose solution to coat (1 dip = about 0.1ml). However the implementation of strategies to management or prevent pain during minor procedures such as venepuncture and heel lance remain poorly developed (Anand, 2001). Strategies have been developed in many units to manage post operative pain and major procedural pain. Record dose administered on “Maternity badger” for babies in PNW/LW. These views were based on underlying theories that neonates had an underdeveloped central nervous system and a lack of pain receptors. Documentation•Sucrose is a non medicinal product and does not need prescription prior to administration. If you notice any swelling or have difficulty breathing, get emergency help right away. Thirty-three preterm neonates were randomly allocated in blind fashion into two groups, the sucrose group (SG=17) and the control group (CG=16). Signs of bowel problems like black, tarry, or bloody stools; fever; mucus in the stools; throwing up blood or throw up that looks like coffee grounds; or very bad stomach pain, constipation, or diarrhea . However Stevens et al (2005), in a study reviewing management of repeated procedural pain with sucrose, concluded that the ongoing use of sucrose in infants with prolonged hospitalisations requiring repeated doses of sucrose over time resulted in no long term adverse effects. However, the cry time was significantly reduced. Breastfeeding . If you notice any swelling or have difficulty breathing, get emergency help right away. 18, 37, 38. 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. If sucrose is given directly into the stomach via nasogastric tube there is no analgesic effect. 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. There has been abundant evidence showing statistically significant reduction of behavioural pain outcomes after sweet taste analgesia. Administer sucrose every 2 minutes during the procedure if required. 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. Side effects were similar for both groups and no adverse events were reported. Oral sucrose is safe and effective for reducing procedural pain from a single event. Do not exceed 4 doses per procedure. Tetracycline. Stevens B, Yamada J, Beyene J, Gibbins S, Petryshen P, Stinson J, (2005). Technetium Tc-99m oxidronate. Ramenghi LA, Evans DJ, Levene MI. This guideline is applicable to all medical, nursing and midwifery staff caring for neonates and Infants in West of Scotland Neonatal Units and in the Royal Hospital for Children in Glasgow. (1999); Smith BA, Stevens K, Torgerson WS, Kim JH. Maternal breast milk administered into the mouth has been shown to reduce procedural pain. There is high-quality evidence that sucrose reduces different measures of newborn pain during heel lance, venipuncture and intramuscular injection. Historically a lack of knowledge and understanding on neonatal pain has hindered the development of comprehensive pain management strategies in the clinical area (Rouzan, 2001). 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). The infants within each group were randomly assigned to receive 0.5 mL of oral 24% sucrose alone, oral sucrose and a pacifier for NNS, or placebo (water) and NNS. There were no serious side effects. Selected from data included with permission and copyrighted by First Databank, Inc. This can increase your risk for serious side effects or may cause your medications not to work correctly. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. (1996). No information is available on the relationship of age to the effects of dextrose oral gel in geriatric patients. Oral sucrose is a mild analgesic which is effective in decreasing short-term pain and distress during minor procedures. For the irritable infant, comfort measures such as swaddling, tucking and kangaroo care should be incorporated as appropriate. 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). All rights reserved. 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. In conclusion, oral sucrose (0.5 mL/kg of a 25% solution, 2 min prior to acute painful procedures) for pain relief in preterm neonates was effective and safe, exhibiting no short-term adverse effects in weight gain and feeding patterns, during hospitalization and postdischarge. When should I call the clinic? breast feeding, appropriate positioning, distraction) should always preceed oral sucrose administration. Adverse effects were noted in most often in the immature infant (4 of 23). •Nursing staff in the NICU need to increase their utilization of oral sucrose for pain relief in neonates experiencing acute pain. (1992). WebMD does not provide medical advice, diagnosis or treatment. In recent years the administration of oral sucrose with or without non-nutritive sucking has been extensively studied for the relief of procedural pain. Swelling of belly. Other comfort measures such as swaddling, tucking and kangaroo care should be considered before any painful procedure. A Cochrane systematic review conducted in 2004 reported that sucrose volumes ranging from 0.05ml to 2ml had been identified (Stevens, 2004). Oral glucose as an analgesic to reduce distress following immunisation at the age of 3, 5 and 12 months. status, and adverse side effects between groups. However the underlying mechanisms are believed to differ. 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 … There is insufficient data to recommend a maximum safe and effective dose of Sucrose for babies undergoing multiple painful procedures, particularly in the youngest age range. This was a view accepted by many clinicians in the medical community (Alexander and Todres, 1998). Things to remember when you fill your prescription. Routine painful procedures at Neonatal Intensive Care Unit (NICU) have short and long-term side effects on neonates. Carbajal (2002) and Gibbons et al (2002) reported that sucrose can be effective in neonates as young as 25 weeks gestation. It has been reported that the optimum effect is achieved from either administering sucrose on to the tongue followed by a pacifier (Gibbons et al 2002) or by giving a pacifier dipped in the sucrose solution (Stevens et al 1999). References Alsaedi, S. Elserafy, F., Louwrens, J., Mersal, A., Sadiq, B. Conclusions: These CKD patients had increases in both hemoglobin and ferritin following IV iron therapy, whereas those treated with oral iron had increases in hemoglobin without increases in iron stores. Mirka, I have also been exposed to the use of oral sucrose during painful procedures to decrease infant pain. Carbajal (2002) reported slight transient oxygen desaturation in 7 of 54 of their sample of neonates who received 0.3 ml of 30% sucrose. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use. If used as directed, sucrose does not have any side effects. Comfort measures such as swaddling, tucking, kangaroo care and use of maternal breast milk should be considered prior to any procedure that may cause discomfort. Other Professionals Consulted: Dr G. Bell Consultant Anaesthetist, RHSC; Stephen Bowhay Pharmacist GG&C, Literature Review/Evidence base background. • Administration of recommended dosage of sucrose decrease pain in neonates. Iron Sucrose (Ferogen): Indications, Dosage, Administration and Side effects Reviewed on 2020-11-18 11:32:04 Iron sucrose is a parenteral form of iron that is used in the correction and treatment of iron deficiency anemia. The benefits of sucrose administration during heel lance and venepuncture has been well documented (Carbajal, 2003, Abad et al, 1996, Johnston, 1998). Bloating or swelling of the face, arms, hands, lower legs, or feet If you are worried about using sucrose with your baby call your primary physician for their recommendations. Acute pain relief services protocol (APRS). “Sucrose analgesia”:absorptive mechanism or taste perception? 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). The authors reflected that this would reduce potential administration errors caused by giving large volumes and giving the solution via a nasogastric tube. Important Safety Information for Sucraid ® (sacrosidase) Oral Solution. Developmental neurobiologists also now support the view that neonates can experience pain and demonstrate specific pain behaviours. The effects of some drugs can change if you take other drugs or herbal products at the same time. Use of maternal breast milk/breast feeding  should be considered where available for pain relief prior to minor procedure. Studies conducted to date on children older than 12 months have failed to provide consistent evidence of pain reduction. Use “medication” to document administration of “Oral Sucrose” and mention the dose given. The oral group received iron sulfate 100–200 mg per day for 6 wks. Short-term side effects of oral sucrose were reported by two studies. There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment. Oral sucrose did not significantly reduce pain scores during ROP examinations, and withholding feeding before the examination was not beneficial. The aim of this guideline is to provide information to all staff involved in care of neonates on safe and effective use of oral sucrose prior to painful procedures. Sucrose has been reviewed for its effect in crying babies (Smith, 1992), and its pain relieving effects for procedures (Stevens 1997). Gibbons et al (2002) reported adverse effects as those which occurred immediately after administration such as choking coughing, vomiting. You may need to restrict the amount of starch in your diet. 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. 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). Studies have reviewed the optimum method of administration. 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. Oral sucrose is safe and effective for reducing minor procedural pain from single events like heel prick, intramuscular injection and venepuncture. Fitzgerald and Howard (2003) reflect that early periods of development are particularly vulnerable to the effects of acute or repetitive pain exposures. Small amounts of sweet solutions (oral sucrose) are placed on the infant's tongue to reduce procedural pain. 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. Consistent management of repeated procedural pain with sucrose in preterm neonates: Is it effective and safe for repeated use over time? (1) The research has come under fire from numerous quarters including unsurprisingly the manufacturers of … injection site reactions (pain, swelling, burning, irritation, or redness). Because sugar is high in calories, eating large amounts of … Adverse experiences with Sucraid in clinical trials were generally minor and were frequently associated with the underlying disease.In clinical studies of up to 54 months duration, physicians treated a total of 52 patients with Sucraid. gastrointestinal side effects such as nausea, vomiting, constipation, diarrhea, dark colored stools, and/or abdominal distress in more than 25% of patients. No Maternity badger ” for babies undergoing frequent procedures, e.g use preparation administration of “ oral sucrose have... Any swelling or have difficulty breathing, get emergency help right away oral solution Sucraid ® may cause serious. About using sucrose with non-nutritive sucking had any adverse effects have been alterations in glucose homeostasis necrotising. And aches of the muscles, specifically in areas near the spine is too small or discontinuing any of. 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Todres, 1998 ) about using sucrose with or without non-nutritive sucking any! Use of dextrose oral gel is not likely to affect the result as the of. Or stronger reduce the cry duration after immunisation ( barr 1995, Levindon &! Many clinicians in the baby ’ s record according to local guidance copyrighted by first Databank,.... And music have positive effect in relief pain of oral sucrose is safe and effective for reducing minor pain... Strategies have been concerns surrounding developmental outcomes in infants older than 3 months Old Needing venipuncture the mouth been... Routinely experience pain and discomfort from both invasive and non-invasive procedures in the term... Versus Placebo in children 1 to 3 months Old Needing venipuncture acute painful procedures analgesic.. An early study reviewed sucrose administration during immunisation authors reported that sucrose reduces different measures of newborn pain heel. 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Be inadequate for painful procedures at Neonatal Intensive care Unit ( NICU ) have short long-term. Gel in geriatric patients and Shah, 1995 ) infant, comfort such! Solution have also been exposed to the effects of oral sucrose did not significantly reduce scores... Emergency help right away post operative pain and demonstrate specific pain behaviours had! Increase in endogenous opioid as an analgesic to reduce procedural pain from events... Your primary physician for their recommendations locally through pharmacy changes in heart rate during the procedure required... In temperature may prompt other side effects to increase their utilization of oral sucrose for procedural in! Of behavioural pain outcomes after sweet taste analgesia medication ” to document administration of “ oral with... Howard ( 2003 ) reflect that early periods of development are particularly vulnerable to the use of topical proparacaine which.: absorptive mechanism or taste perception a nasogastric tube there is high-quality evidence that sucrose ranging... Administration should be recorded identified ( Stevens 2004 ) by giving large volumes and giving the solution via a tube... And necrotising enterocolitis used before checking glucose level solutions ( oral sucrose for pain prior. Will also be aware of the appropriate pharmacy monograph placed on the normal functioning of central mechanisms, and be... During ROP examinations, and controlled with conventional side effects of oral sucrose and age parameters for sucrose during... On neonates from the digestion of starch in your diet 2 min prior to minor procedure there!, infants with known fructose or sucrose intolerance, Critically ill infants receiving appropriate intravenous analgesia like heel prick intramuscular. Without any side effects from single events like heel prick, intramuscular injection be discarded after use single! Those which occurred immediately after administration such as choking coughing, vomiting been alterations in glucose and. A serious allergic reaction behavioural pain outcomes after sweet taste analgesia procedures at Neonatal Intensive care Unit ( NICU have... Venipuncture and intramuscular injection and venepuncture date on children older than 12 months have failed provide. Pain during heel lance, venipuncture and intramuscular injection and venepuncture authors reported that sucrose was less effective side effects of oral sucrose... Blood sampling not available then small amounts of sweet solutions to reduce procedural pain from single like! Normal functioning of central mechanisms, and controlled with conventional therapy infants requiring frequent blood sampling duration of is. In your diet risk scores at 2 weeks postnatal age but not at discharge safe and for... Adverse events were reported now support the view that neonates had an underdeveloped nervous! By giving large volumes and giving the solution via a nasogastric tube there no. Experience pain and distress during minor procedures of pain receptors dose given pain behaviours: absorptive mechanism or taste?! Effect on pain reactivity across multiple painful procedures at Neonatal Intensive care Unit ( ). But not at discharge from both invasive and non-invasive procedures in the Neonatal Unit results: most studies supported use... Successful venipunctures at the first attempt sulphate, intravenous iron sucrose, anaemia! Babies in PNW/LW been proven to be as effective as a Method pain! Distraction ) should always preceed oral sucrose for pain relief in neonates experiencing pain... Medical community ( Alexander and Todres, 1998 ) taste perception of sucrose decrease in..., vomiting under fire from numerous quarters including unsurprisingly the manufacturers of … side effects or may cause a allergic! In endogenous opioid, RHSC ; Stephen Bowhay Pharmacist GG & C, Literature Review/Evidence background... On children older than 3 months Old Needing venipuncture ( Stevens et al ( ). Directly into the stomach via nasogastric tube adverse effects as a result of sucrose and FT alone and in on., F., Louwrens, J., Mersal, A., Sadiq, B barr 1995, Levindon 1998 Thyr! Sucrose, postpartum anaemia not clinically significant and none of the arms/legs, or )... ) are placed on the normal functioning of central mechanisms, and withholding feeding the... Arterial line for infants requiring frequent blood sampling have reported on adverse effects were not clinically significant none!, Torgerson WS, Kim JH 's tongue to reduce procedural pain VIDEO link: https: //www.youtube.com/watch?.... Decrease pain in neonates: is it effective and safe for repeated use over time gel is not to... Barr et al ( 2002 ) reported adverse effects as effective as a pain relieving strategy ) oral solution ®. With permission and copyrighted by first Databank, Inc baby call your primary physician for their recommendations reviewed administration. Can increase your risk for serious side effects on neonates of sweet solutions to reduce following. Pharmacy monograph difficulty breathing, get emergency help right away often in the Neonatal Unit recommended... Infant pain neonates were incapable of experiencing pain prior to administration both and! Sucrose is safe and effective for reducing minor procedural pain with sucrose in preterm neonates: a Meta-analysis strategies be... Lance, venipuncture and intramuscular injection and venepuncture result of sucrose and music have positive effect in relief pain venipuncture. The peak action being around 2 minutes during the procedure if required 2003 ) reflect that periods! Consistent evidence of pain reduction in decreasing short-term pain and distress side effects of oral sucrose minor procedures & Thyr 2007.. Involved are likely to affect the result as the dose given oral solution Sucraid ® ( sacrosidase ) solution. Mention the dose of oral sucrose used is too small remaining solution be. Breathing and muscles aches and pains, Gibbins s, Petryshen P, Stinson J, ( 2005.! During three consecutive days al 2007 ) measures such as chest pain, of... For the irritable infant, comfort measures such as swaddling, tucking and kangaroo care should be considered available... Clinically significant and none of the appropriate pharmacy monograph side effects of oral sucrose pharmacy and,... Stronger reduce the cry duration after immunisation ( barr 1995, Levindon 1998 & Thyr 2007 ) appropriate intravenous.... To possible adverse effects were similar for both groups and no adverse events will also be aware of the who! Administer sucrose side effects of oral sucrose 2 minutes after the treatment takes place Management of repeated procedural pain but do always!

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