Variability in clinical practice guidelines for sweetening agents in newborn infants undergoing painful procedures

Abstract

Objective: Sweetening agents have been recommended in position statements and consensus documents for procedural pain management in neonates; however, it is not clear if this has resulted in widespread adoption in clinical practice. The objective of this study was to investigate unit-specific protocols for the use of sweetening agents.

Methods: Structured telephone survey with qualified personnel in special care (level II) nurseries and neonatal intensive care (level III) units across Canada. The frequency and pattern of recommended use of sweetening agents was documented.

Results: Eighty-six of 92 units (93.5%) participated. Sixty-four percent recommended sucrose and 2.3% recommended glucose for procedural pain management; 87.7% had a guideline. Sweetening agents were most commonly recommended for venipuncture/venous cannulation (91.2% for both), lumbar puncture (87.7%), and heel lance (82.5%). Dosing guidelines ranged from 0.05 mL of 24% sucrose solution to 3 mL of 25% sucrose solution. Sweeteners were not recommended for infants with necrotizing enterocolitis (77.2%) or those who were nil per os (75%).

Conclusions: Sweetening agents were recommended for procedural pain management in two-thirds of special care nurseries and neonatal intensive care units across Canada with extensive variability in specific dosing guidelines. Audits of pain management practices should therefore account for unit-specific practice guidelines.