I have work with VLBW long enough but never really heard about using glucose for procedural pain. If you really talk about VLBW in the first week of life then pacifier can not be easily put into their mouth. For really painful procedure you probably better off using narcotics. For minor procedure, say like circumcision, in late preterm or term neonates we use 20% sucrose or glucose and dip pacifier into the container before putting into baby's mouth. You may even try to use expressed breast milk which may give you similar effect. EMLA topical application may be another option.

Thank you for answer. We usually use sugar solutions even in ELBWI ( from 24-25 weekers ) as prevention of painful procedures ( heel lancing, blood sampling, removing adhesive taps et. ). Of course for surgery, mechanical ventilation we definitely use opioids. But I´m not sure, which type, amount and concentration of sweet solution is really suitable for babies. We use sucrose 25% and glucose 20 or 40%. Only rarely I saw transient hyperglycaemia. In tiny babies we donť use pacifiers, but small cotton sticks. It works. Expressed milk usually doesn´t work as good as sugar, probably because limited alangesic effect of lactose.

Consider that hyperosmolar solutions are discouraged in very preterm babies, and that the analgesic effect of oral sugar is amplified if you add other stimulations such as talk and touch (it is the so-called "sensorial saturation"). Also remember that oral glucose cannot interfere with glycemia assessment if you give oral glucose to relieve pain in a test for pìglycaemia, because oral mucosa cannot absorb hydrophobic molecules such as glucose.

Hi Carlo,

I absolutely agree, we don´t use just sweet solutions, always together with other methods of sensorial saturation. I´m not sure about side effects of hyperosmotic solutions given orally in preterm babies. Only one paper ( not randomised ) described increased incidence of NEC , only in group of extremely premature babies ( 24 - 26 wg ).

Jozef

We do not use glucose or sucrose is it necassary

You are absolutely right. There are not universal guidelines for sucrose or glucose dosage. Many topics referred different amount of sweet solution given orally as procedural pain prevention. We usually use volume regarding to body weight. 0,1ml per dose for babies below 1kg, 0,2 ml per dose for babies below 2 kg etcetera. Maximum dose per day is about 2,5 ml. Currently we use 25% of sucrose, but it seems, that glucose or sucrose in lower concentration can be equally efficient. We have some not published data for sucrose 25 and 50% and glucose 10 and 20%. We tried to find out analgesic effectiveness by measuring electrical skin conductance before and during painful procedures.

Please find below a study that might be helpful

Pediatr Res. 1995 Sep;38(3):332-5.

Sucrose reduces pain reaction to heel lancing in preterm infants: a placebo-controlled, randomized and masked study.

Bucher HU, Moser T, von Siebenthal K, Keel M, Wolf M, Duc G.

Author information

Abstract

In term infants sucrose given by mouth has been reported to reduce duration of crying after a heel prick. This study was designed primarily to investigate the effect of sucrose administered orally immediately before heel lancing on the nociceptive reaction in preterm infants as assessed by change in heart rate and duration of crying. A secondary objective was to document changes in cerebral blood volume during acute pain. We used a randomized, masked, placebo-controlled, crossover trial in a neonatal intermediate care unit in a level 3 perinatal center. The patients studied were 16 preterm infants; birth weight, 900-1900 g; gestational wk, 27-34; corrected postmenstrual age at time of investigation, 33-36 wk. Each infant was assessed twice receiving 2 mL of sucrose 50% or 2 mL of distilled water in random order immediately before heel lance. Heart rate, thoracic movements, and transcutaneous blood gases were monitored continuously. Crying during the procedure was documented by a video-camera. A change in cerebral blood volume was assessed by near-infrared spectroscopy. We found the heart increased by a mean of 35 beats/min (bpm) after sucrose and 51 bpm after placebo (median difference 16 bpm, interquartile range 1-30 bpm, p = 0.005). Infants cried 67% of time after sucrose and 88% after placebo (median difference 10%, interquartile range 3-33%, p = 0.002). Cerebral blood volume decreased in 5 of 14 infants after sucrose and in 6 of 14 infants after placebo (difference not significant).