Do you remember being a child and being given a spoonful of sugar after a nasty cough medicine, or before it, to sweeten the taste? When Joseph was in special care I was quite stunned that I was asked to give consent to using sucrose solution before medical procedures. I had never heard of this before. At first, I consented. Most commonly it was done before heel pricks, and putting in lines. It was explained to me that the sweet taste would distract him, in truth, its administered as a mild analgesic.
However after this had been administered a few times, I noticed Joseph would become agitated at the taste of the sugar, like he knew that the sweet taste would be followed by something nasty. I was unconvinced about the use of sucrose. Of course, as mentioned before, I had a no Google rule during Joseph’s stay so I hadn’t questioned it. I should have realised that it wasn’t run of the mill when it was in a locked cupboard and two nurses had to sign for it. Imagine my suprise when I discovered that my scepticism about the use of sucrose was not unfounded, and that doctors and researchers have expressed concern, and in fact, some of the nurses didn’t like the use of sucrose either.
After a few times, I asked for expressed breast milk to be used instead, and for Joseph this seemed to work much better, and my consent for sucrose was withdrawn. He enjoyed breast milk pipettes at other times as part of his mouth care, so he didn’t feel as suspicious about that! (at this time Joseph was still tube fed)
During my discussions with other mothers of premature babies I have discovered that the use of sucrose in NICU is not widespread around the country, in fact less than half of the mothers I spoke to had had sucrose used during the course of their baby’s care.
There is controversy surrounding the use of sucrose in neo natal care. The studies that have been done are small, one that I read was conducted in Leeds and only had 15 participants, all 32-34 gestation babies.
The theory is that sucrose may have an analgesic effect, but it is highly short-lived, it lasts 5-9 minutes, so must be administered in a timely manner to have any effect. The effect of the sucrose is measured by looking at the heart rate and the baby’s facial expressions.
There are a number of concerns about the use of sucrose. The majority of the concern surrounds the research. None of the studies have looked at the whole NICU stay, just instances of administering the sucrose and analysing the baby’s response to the procedure following. For a baby like Joseph, this is obviously a concern, during his initial weeks Joseph had several procedures daily.
There is concern that the long term neurological impact of using sucrose is not known, as there have been no studies, that I can locate, that have followed up these babies. The conclusion that all researchers have come too, and those analysing the research, is that much more research is required, in terms of long term ramifications of the use of sucrose, as well as more research in terms of extremely premature babies.
Since reading about this issue today, I have become upset and a little annoyed. I had a lot of issues when Joseph was in hospital, because I feel that I was not able to give informed consent. I was asked, but I didn’t know what I was agreeing to, I had no idea about the research or the controversy. I felt I wasn’t really given a choice, and am disappointed that there isn’t more quickly accessible information given to parents about the administration of sucrose. Of course, anything that made Joseph’s treatment better and more bearable, I was all for, but to me, there isn’t sufficient evidence that it is effective for repeated use over a number of weeks . Sucrose is safe, its cheap, and its readily available. It also is not “owned” by a drug company, and doesn’t require the same sort of licensing, and thus testing a drug would have to go through.
One of the problems in Neonatal care, it would appear, is that there is a limit to the pain relief options open to neonatologists in the case of very small and extremely premautre babies. Morphine is used for neonates, but none of the topical analgesics (that is, those applied to the skin) have been tested for the use in neonatal care.
I am grateful, however, that now it is widely known and accepted that babies from 24 weeks gestation have defined neurological pathways, and feel and can process pain, and that research is ongoing into this field. As a mother, I am so grateful that doctors and researchers care about pain management, and looking after our tiny vulnerable babies.
I am also heartened that the following are recommended for pain management of infants as well as or instead of the sucrose:
Comfort suckling – on a dummy or breastfeeding
Procedures being “clustered” and done all at once where possible
Procedures being carried out by highly experienced staff
Kangaroo cuddles with the parents.
Just a note: I did conduct research for this blog, I have not referenced it here, for a few reasons, first of all, this is a blog, its not a scholarly piece of work. Secondly, the works I have read are intended for doctors and scientists, not parents.
If you are intersted further, these are the pieces of research I found that were freely available
Avery's neonatology: pathophysiology & management of the newborn - available free on Google Books - and the best I have read on the topic