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Sucrose


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Guest lizardcurry

We are updating our sucrose policy and have a few questions.

 

Is there any evidence to support increased incidence of NEC (necrotizing enterocolitis) in infants less than 32 weeks?  If so, could you provide articles?

Do you use Sucrose in infants less than 32 weeks?

Do you use Sucrose for fussy, agitated babies? If so can you provide evidence to support this practice?

 

Thanks,

Elizabeth Curry
 

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Hi,

I work in neonatal unit for babies > 33 hbd so I don't have experience with preemies less then 32 weeeks, but from our annual polish neonatal meetings I know from friends working in NICUs with very small babies, sucrose is used in procedural pain menagement in at least 10 NICUs with good results. I don't remember any  discussions about increased risk of NEC related to sucrose using.

 

And yes we commonly use sucrose for agitated 33 weekers and older neonates during medical procedures - USG examination, heel stics, laboratory blood draws, tape removal, eye examination and others. In my unit we use 20% sucrose and it works. I know, in GB 33% sucrose is used, but we have 20% sucrose in bottles, so we tried this solution and it worked. Treatment starts 2 minutes before painful procedure. 1-2 drops of solution is administered oraly (preferably on tongue) every 30 second before, and during procedure. It is important to use no more than 1-2 drops at once, because we noticed that if procedure was extended, our patients were after so happy and sweet that they didn't want to suck their mothers for few hours, despite the fact that in every case serum glucose level was normal.

In USG exams we use sucrose with the same protocol, but we don't start it before exam, but only if baby is fussy or agitated during exam. Usually few drops is enough to finish exam in peace :).

 

1.Gal P, et al.: Efficacy of sucrose to reduce pain in premature infants during eye examinations for retinopathy of prematurity. Ann Pharmacother. 39:1029 2005

 

2. R. Slater, L. Cornelissen, L. Fabrizi, et al.: Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomized controlled trial. Lancet. 376:1225 2010

 

There are more articles at: http://www.ncbi.nlm.nih.gov/pubmed/?term=sucrose+pain

 

best,

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Hi Elizabeth

We use sucrose in all our babies. For babies less than 1500g we give 0.1mL sucrose 24% up to 3 doses per procedure. The sucrose we use, this equates to 3 drops. The most inportant thing for those tiny babies is not to give the dose all at once as there is a risk of apnoea / bradycardia. We have being using sucrose in all our babies (24weeks +) since 2009 and we haven't had an increase in NEC. We do limit the number of doses per 24 hours. We used to give up to 10 doses per 24 hours but in 2012 our state guidelines changed to up to 3 doses per procedure and 5 procedures per 24 hours - not sure why they chose this!

Regards Nettie

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