NICU Procedures Are Getting Sweeter: Development of a Sucrose Protocol for Neonatal Procedural Pain

Abstract

Neonates in the neonatal intensive care nursery experience multiple, painful, tissue-damaging procedures daily. Pain among neonates is often underestimated and untreated, producing untoward consequences. A literature review established strong evidence supporting the use of sucrose as an analgesic for minor procedural pain among neonates. A review of unit practices and nurses' experiential evidence initiated the production of a standardized protocol in our unit at the University of Washington Medical Center NICU in Seattle.Nursing practices surrounding sucrose use differed widely in dose, timing, and patient application. We carefully evaluated evidence documenting the effectiveness as well as the safety of sucrose administration and wrote a protocol and practice standards for our primarily premature patient population. This article describes the development and execution of a standardized, nurse-implemented, sucrose protocol to reduce procedural pain.

Pediatric Clinical Practice Guidelines for Acute Procedural Pain: A Systematic Review

“…Of the 18 guidelines, 7 focused on neonates or infants only, [21][22][23][24][25][26][27] and 11 included infants and children 0 to 18 years old. [28][29][30][31][32][33][34][35][36][37][38] …”

“…The overall mean domain score was 85.7% 6 15.4%. Twelve guidelines [21][22][23][24][25][26][27]29,31,34,37,38 (66.7%) received .85.0% in the domain score. Key recommendations were easily identifiable in the guidelines.…”

“…16 The average domain score rating was 25.5% 6 33.7%. Fourteen guidelines [21][22][23][24][25]27,28,[30][31][32][33]35,36,38 (77%) scored below 50% for this domain. These guidelines did not indicate how the guideline recommendations could be translated into clinical practice.…”

“…This finding attests to the importance of using a systematic method to synthesize and present findings. 25,26,29,34,37 The scope and purpose domain received the second highest scores, suggesting that most guideline developers have comprehensively reported the target population and research questions for the guidelines. This is vital for guideline developers, because busy clinicians need to be able to efficiently identify guidelines for pain assessment and management that are relevant and feasible in their clinical practice setting.…”

Stress : Clinical and Developmental Aspects of Salivary Cortisol in Infants

“…NPS is considered both stressful and painful, and is associated with the physiological responses that accompany other painful interventions [167,168].…”