Use of Oral Sucrose 08

Administration of oral sucrose to neonates
(Based on Neonatal Guideline G6)
Bhupendra Singh, SpR

July 2008
Clinical guidelines and self directed learning packages are
for guidance only.
Their interpretation and application remains the

responsibility of the individual clinician.
If in doubt always contact a senior colleague.
Caution is advised when using guidelines after a review

date.
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No changes may be made to these files.
All material COPYRIGHT Nottingham Neonatal Service,

July 2008
© Nottingham Neonatal Service

Overview
• Introduction
• Aims and objectives
• Indications and contraindications
• Prescription and administration

Introduction
What is pain: ‘An unpleasant sensory and emotional
experience associated with actual or potential tissue
damage or described in terms of such damage’.
Repeated painful stimuli can lower the pain threshold.

Neonatal pain causes both physiological and
psychological consequences, provoking hypoxaemia,
hypertension, tachycardia and intracranial pressure
which could cause brain damage.
Introduction
Oral sucrose solution relieves pain by releasing endorphins

in the brain.
A Cochrane review (meta-analysis) has shown that oral

sucrose offers a useful, prompt and short-term analgesic
effect for the newborn during painful procedures,
reducing crying, grimacing and heart rate by up to 70%.
Aims and objectives
• To emphasise importance of minimising /
alleviating pain in neonates
• To be able to prescribe and use oral

sucrose solution for analgesia in neonates.
When to use?
Oral sucrose should only be used in babies
≥ 32 weeks corrected gestation
• Heel prick blood sampling • Lumber puncture
• Venepuncture • Long line insertion
• Arterial stabs • Intramuscular or subcutaneous

injections
• Areterial or venous cannulation
• ROP examinations
• Suture removal
• SPA for urine collection
• Wound dressings
• Urinary catheterisation
Always also consider other options such as

non-nutritive sucking, cuddling, wrapping
When not to use?
(Contraindications)
• Infants < 32 weeks of corrected gestational age
• Infants of opiate dependent mothers- analgesic effect of sucrose

reduced or absent
• Known fructose intolerance (sucrose is composed of Glucose +

Fructose)
• Parental objection
• Be cautious in hyperglycaemic and neonates at high risk of NEC-

consider NBM dose (0.5 ml).
Always also consider other options such as

non-nutritive sucking, cuddling, wrapping, pharmacological options
Dosage and prescription
< 1500 gram and on feeds = 1 ml
≥ 1500 gram and on feeds = 2 ml
Concentration (24%) need to be specified
04/7
Dosage and prescription
<1500 gram and NBM- 0.2 ml
≥ 1500 gram and NBM- 0.5 ml
Administration
Administration
using a pacifier
• Take required volume into a sterile galipot
• Dip pacifier into sucrose
• Place into mouth
• Repeat until total volume is given
• Give 2 minutes before procedure
• Leave for no longer than 8 minutes
• If delay is anticipated (difficult arterial lines), divide the dose and

administer at 1 min intervals.
Administration
using a Syringe
• Draw up required volume of the sucrose solution
• Administer slowly onto anterior tongue
• Offer pacifier if available
• Give 2 minutes before procedure
• Do not leave longer than 8 minutes
• If delay anticipated (difficult IV cannulation) , divide the dose and

administer at 1 min intervals.
Caution!
• Should be used only in ≥ 32 weeks corrected gestation
babies.
• Sucrose is ineffective if administered via nasogastric

tube.
• Needs to be checked and signed on the prescription

chart like any other medication
• If contraindicated, consider other methods of pain relief.

References
• Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants

undergoing painful procedures. The Cochrane Database of systematic reviews 2004
issue 3
• American Academy of Paediatrics, Canadian Paediatric Society (2000) Prevention

and management of pain and stress in neonates. Paediatrics 105 (2) 454 – 461.
• Does oral sucrose reduce the pain of neonatal procedures. Horwitz N. Arch of Dis
child 2002; 87 : 80 – 81.
• Beta-endorphin concentration after administration of sucrose in preterm infants. Anna

Taddio, Vibhuti Shah, Joel Katz. Arch Pediatr Adolesc Med. 2003; 157: 1071 – 1074.
• Does Sucrose Analgesia Promote Physiologic Stability in Preterm Neonates? Boyer

K et al. Biol Neonate 2004;85:26-31.
No changes may be made to these files.
All material COPYRIGHT Nottingham Neonatal Service,

July 2008
© Nottingham Neonatal Service

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Administration of oral sucrose to neonates

(Based on Neonatal Guideline G6)

Bhupendra Singh, SpR

Their interpretation and application remains the

Caution is advised when using guidelines after a review

To view these files a PDF file reader is required such as

No changes may be made to these files.

All material COPYRIGHT Nottingham Neonatal Service,

© Nottingham Neonatal Service

• Aims and objectives

• Indications and contraindications

• Prescription and administration

Repeated painful stimuli can lower the pain threshold.

Oral sucrose solution relieves pain by releasing endorphins

A Cochrane review (meta-analysis) has shown that oral

• To be able to prescribe and use oral

• Heel prick blood sampling • Lumber puncture

• Venepuncture • Long line insertion

• Arterial stabs • Intramuscular or subcutaneous

Always also consider other options such as

• Infants of opiate dependent mothers- analgesic effect of sucrose

• Known fructose intolerance (sucrose is composed of Glucose +

• Be cautious in hyperglycaemic and neonates at high risk of NEC-

Always also consider other options such as

Concentration (24%) need to be specified

• Dip pacifier into sucrose

• Place into mouth

• Repeat until total volume is given

• Give 2 minutes before procedure

• Leave for no longer than 8 minutes

• If delay is anticipated (difficult arterial lines), divide the dose and

• Draw up required volume of the sucrose solution

• Administer slowly onto anterior tongue

• Offer pacifier if available

• Give 2 minutes before procedure

• Do not leave longer than 8 minutes

• If delay anticipated (difficult IV cannulation) , divide the dose and

• Sucrose is ineffective if administered via nasogastric

• Needs to be checked and signed on the prescription

• If contraindicated, consider other methods of pain relief.

• Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants

• American Academy of Paediatrics, Canadian Paediatric Society (2000) Prevention

• Beta-endorphin concentration after administration of sucrose in preterm infants. Anna

• Does Sucrose Analgesia Promote Physiologic Stability in Preterm Neonates? Boyer

All material COPYRIGHT Nottingham Neonatal Service,

© Nottingham Neonatal Service

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