Browser Not Supported

It looks like you're using an outdated browser. To view this site properly, please switch to a more modern browser such as Chrome,Firefox, or Edge.

CLINICAL GUIDELINESWORK AT STARSHIPCONTACTSMY SHORTLIST
Health Professionals
Starship Child HealthNewborn intensive careClinical Guideline

Sucrose 25% for analgesia in neonates

Date last published:

Short term analgesia for procedural pain in neonates

This document is only valid for the day on which it is accessed. Please read our .
Newborn intensive care

Dose and administration

Oral sucrose liquid (25%)

Gestational Age (weeks)DoseDaily maximum
< 320.2 mL1 mL
32 - 400.2 - 0.5 mL2.5 mL
40 - 440.2 - 1 mL5 mL
Infants 1 - 18 months postnatal age1 - 2 mL5 mL

* for <32 weeks use a swab to administer sucrose.

Robust evidence to guide the exact dose or the maximum amount to be given in a 24-hour period is lacking. Research supports small volumes, dosing to effect and repeating only as required. If the infant requires more than the recommend doses in 24 hours, consider alternative pain management options.

Indications

  • Simple analgesia for procedural pain and/or distress

  • Adjunct to other analgesics and topical or local anaesthetic during invasive or distressing procedures (e.g., chest drain insertion, laser therapy and ROP examination)

Oral sucrose should be offered to all preterm and term infants, if breast milk is not available, during a painful procedure.

Oral Sucrose is not appropriate for the management of continuing pain or distress.

Precautions

  • Neonates who are intubated and/or muscle relaxed, have confirmed or suspected necrotising enterocolitis, altered or impaired gag and swallow reflexes or are nil by mouth – Use doses as per <32 weeks, and apply to infant’s tongue using a swab.

  • Requiring investigations for hypoglycaemia and inborn errors of metabolism – confirm use of sucrose is clinically appropriate to condition before administration.

Contraindications

Infants with known intolerance to sucrose or fructose.

Clinical pharmacology

In infants, the taste of sucrose results in the release of endogenous opioids, resulting in a short-term decrease in pain and distress. Peak effect is typically seen at 2 minutes, with the effect lasting 4—8 minutes.

Possible adverse effects

Sucrose is generally well tolerated. Administration may be associated with minor oxygen desaturation, choking, bradycardia and brief apnoea.

Special considerations

  • Breastfeeding (or EBM if breastfeeding is not possible) are alternative short-term analgesics. Sucrose should be used if these options are unavailable.

  • Other non-pharmacological measures should be used alongside oral sucrose to increase the effectiveness, such as non-nutritive sucking, swaddling, containment holding, kangaroo care etc. Oral sucrose is more effective if administered alongside non-nutritive sucking.

  • There is no analgesic effect if sucrose is given directly into the stomach via a gastric tube.

  • Procedures which are known to cause pain and/ or distress in infants may include:

    • Blood tests - heel pricks, venepuncture or arterial stab

    • Intravenous catheter (IVC) & line insertion

    • Lumbar puncture

    • Dressings - wound/ stoma / removal of adhesive tape & sutures

    • Treatment of IVC extravasation, excoriated or broken skin

    • Indwelling Urinary Catheter (IDC) & Nasal gastric (NGT)/ Oral gastric tube(OGT) insertion

    • Intramuscular (IM), subcutaneous (SC) injection

    • Eye examination

    • Tracheostomy care

    • Bowel washout

    • Echocardiogram (Echo)

    • Endotracheal tube (ETT) re-tape (use NBM dosing)

Management of sucrose administration

Description

Clear, colourless solution for oral administration containing 25% sucrose.

Prescription

  • If appropriate, stat dose to be charted on ONCE ONLY page of prescription chart in mL/dose.

  • PRN doses are charted on the REGULAR page of prescription chart in mL/dose.

Administration

  • Prepare the infant for the procedure using supportive measures.

  • Prepare the amount of oral sucrose – see table above.

  • The dose is to be administered slowly on to the anterior of the tongue.

  • Give ¼ or less (of the total amount) of oral sucrose 2 minutes prior to the start of the procedure.

  • Offer a pacifier if this is a normal part of the infant’s care.

  • Give a further ¼ of the total dose of sucrose at the start of the procedure, and repeat incrementally throughout the procedure as required. Analgesic effect may last 5-8 minutes from first administration; observe and dose to effect.

  • Consult the medical team if the oral sucrose is ineffective or if the recommended amount is reached, rest the patient and reassess the pain management plan.

Nursing considerations

Observe for signs of adverse effects.

Storage

  • Store at room temperature <25°C until opened.

  • Once opened, store in the refrigerator and use within 7 days.

  • Discard any unused solution 7 days after opening.

 

References

  • Acharya A.B, Annamali S, Taub N.A, Field D.Oral sucrose analgesia for preterm infant venepuncture. Arch Dis Child Fetal Neonatal Ed.2004;89:F17-F18

  • Bucher H-U, Von Siebenthal K, Keel M, Wolf M, Duc G. Sucrose reduces pain reaction to heel lancing in preterm infants: a placebo-controlled, randomized and masked study. Pediatric research. 1995;38(3):332-5.

  • Haouari N, Wood C, Griffiths G, Levene M. The analgesic effect of sucrose in full term infants: a randomised controlled trial. Bmj. 1995; 310(6993):1498-500.

  • Harrison,D.M. Oral sucrose for pain management in infants: Myths and misconceptions. Journal of Neonatal Nursing 2008,14, 39-46

  • Hatfield L, et al. Analgesic properties of oral sucrose during routine immnunisations at 2 and 4 months of age. Pediatrics 2008; 121;e327-e334

  • Johnston CC, Filion F, Snider L,et al. Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks' post-conceptional age. Pediatrics 2002;110:523-528.

  • Johnston CC, Stremler R, Horton L, Friedman A. Effect of repeated doses of sucrose during heel stick procedure in preterm neonates. Neonatology. 1999; 75(3):160-6.

  • Lefrak L, et al. Sucrose Analgesia: Identifying Potentially Better Practices. Pediatrics. 2006; 118 (Supp 2), S197-202

  • Ramenghi LA, Griffith GC, Wood CM, Levene MI. Effect of non-sucrose sweet tasting solution on neonatal heel prick responses. Archives of Disease in Childhood-Fetal and Neonatal Edition. 1996; 74(2):F129-F31.

  • Shah PS, Herbozo C, Aliwalas LL, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database of Systematic Reviews. 2012(12).

  • Stevens B, Yamada J, Beyene J, Gibbins S, Petryshen P, Stinson J, et al. Consistent management of repeated procedural pain with sucrose in preterm neonates: is it effective and safe for repeated use over time? The Clinical journal of pain. 2005;21(6):543-8.

  • Stevens B, Yamada J, Campbell-Yeo M, Gibbins S, Harrison D, Dionne K, et al. The minimally effective dose of sucrose for procedural pain relief in neonates: a randomized controlled trial. BMC Pediatrics. 2018;18(1):85.

  • Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane database of systematic reviews. 2016(7).

  • Sucrose (oral) for procedural pain management in infants. The Royal Childrens Hospital Melbourne Clinical Guidelines

  • Thakkar P, Arora K, Goyal K, Das R, Javadekar B, Aiyer S, et al. To evaluate and compare the efficacy of combined sucrose and non-nutritive sucking for analgesia in newborns undergoing minor painful procedure: a randomized controlled trial. Journal of Perinatology. 2016; 36(1):67-70.

 

Document Control

Clinical Guideline
Starship Child Health
2 year(s)
Newborn Services Clinical Practice Committee
Newborn Services Clinical Practice Committee
Sarah Bellhouse

Guideline Feedback

Tools