Analgesia (mild), minor procedures: Limited data available, optimal dose not established: Oral: 0.1 to 0.2 mL of 24% solution placed on the tongue or buccal surface (via oral syringe or pacifier) 2 minutes prior to procedure; various regimens reported (Stevens 2016; Stevens 2018). Some regimens suggest that lower doses (0.1 mL) may be repeated after 2 minutes for longer procedures; doses should be limited to <10 doses/day (Johnston 2002; Johnston 2007). Some experts have recommended doses in pre-term infants of 0.1 to 0.4 mL and in term infants of 2 mL (Anand 2001). Some studies have found that sucrose used in combination with non-nutritive sucking is more effective than sucrose alone when administered to full-term neonates prior to heel lance (Thakkar 2016).
Age-directed dosing (LeFrak 2006): Oral: Dip pacifier in sucrose solution and allow infant to suck or administer via an oral syringe directly onto tongue; administer 1 to 2 minutes prior to procedure; for direct administration onto tongue, begin with 1 drop and assess tolerance; use minimum volume needed for pain relief up to the following maximum dose:
GA 27 to 31 weeks: 0.5 mL/procedure
GA 32 to 36 weeks: 1 mL/procedure
GA ≥37 weeks: 2 mL/procedure
Note: Repeat doses may be administered if needed.
Weight-directed dosing (Krishnan 2013): Note: Administer dose 2 minutes prior to procedure; do not use more than 3 doses per procedure. Oral:
<1 kg: 0.1 mL/dose
1 to 2 kg: 0.1 to 0.2 mL/dose
>2 kg: 0.1 to 0.5 mL/dose
Analgesia (mild)/Comfort: Oral:
Manufacturer's labeling: Infants: 0.2 to 0.5 mL of 24% sucrose solution placed on the tongue or buccal surface or dip pacifier in sucrose solution and allow infant to suck
Immunization: Limited data available; optimal dose not established: Infants: Usual dose: 2 mL of 24% solution administered 1 to 2 minutes prior to vaccine administration; effective range: 1 to 2 mL of 12% to 75% solution (Kassab 2012)
Minor ED painful procedures (eg, heel sticks, venipuncture, IV line insertion, arterial puncture, insertion of a Foley catheter, and lumbar puncture): Limited data available: Infants ≤6 months: 2 mL of 25% sucrose no more than 2 minutes before the start of the painful procedure; may be administered as 1 mL in each cheek or allow infant to suck solution from pacifier (AAP [Fein 2012])
There are no dosage adjustments in the manufacturer's labeling.
There are no dosage adjustments in the manufacturer's labeling.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, oral:
Sweet-Ease® Preserved: 24% (15 mL)
TootSweet™: 24% (0.5 mL, 1 mL, 2 mL, 12 mL)
Solution, oral [preservative free]:
Sweet-Ease Natural®: 24% (15 mL)
No
For oral use only. May be administered directly onto baby's tongue or buccal surface or via a pacifier dipped into solution. Dispose of product after use.
Volume of drops differs between dropper (cup) and vial:
Sweet-ease vial: 5 to 8 drops equivalent to 0.2 to 0.5 mL
Sweet-ease cup: Dropper: 1 to 2 drops equivalent to 0.2 to 0.5 mL. Pacifier dip: 1 dip equivalent to 0.1 mL.
Store at 4°C to 32°C (40°F to 90°F). Unused portion should be discarded.
To calm or soothe in times of distress (OTC product: Approved in infants); has also been used for short-term analgesia in neonates during minor procedures (eg, heel stick, immunization, venipuncture, OG or NG tube insertion, IM or SubQ injection, bladder catheterization) and adjunctive analgesia for more complex procedures (eg, circumcision, eye exam for retinopathy of prematurity); provide short-term analgesia in infants during immunization administration and select minor procedures in the ED
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined.
Cardiovascular: Bradycardia (self-limiting)
Hematologic & oncologic: Oxygen desaturation (premature neonates; spontaneous resolution)
Respiratory: Apnea (brief apnea in premature neonates; spontaneous resolution)
Disease-related concerns:
• Gastrointestinal disorders: Patients should have a functioning gastrointestinal tract; avoid use in patients with gastrointestinal tract abnormalities (eg, esophageal atresia or tracheal esophageal fistula); while necrotizing enterocolitis (NEC) has not been reported with sucrose administration, risk:benefit assessment should be considered in patients at high risk for NEC.
Special populations:
• Neonates: Efficacy in unstable or extremely low birth weight, premature neonates has not been established (LeFrak 2006).
Other warnings/precautions:
• Appropriate use: Avoid use in patients at risk for aspiration; sucrose should not be used for patients requiring ongoing analgesia.
Use with caution in patients who are intubated to avoid gagging and choking; avoid use in paralyzed patients (LeFrak 2006).
Concerns have been raised regarding repeated use of sucrose in patients <31 weeks postconceptual age and neurodevelopmental and physical outcomes. In a randomized, double-blind, placebo-controlled trial, 103 neonates were randomized to sucrose (n=53) or sterile water at the beginning of minor procedures, repeat doses were given every 2 minutes for 3 doses or if longer than 15 minutes, 3 more doses were allowed. Patients receiving a higher number of sucrose doses had lower scores on motor development and vigor, and alertness and orientation components of the Neurobehavioral Assessment of the Preterm Infant (NAPI) at 36 weeks postconceptual age, lower motor development and vigor at 40 weeks postconceptual age, and higher Neuro-Biological Risk Score (NBRS) at 2 weeks postnatal age (Johnston 2002). The authors conducted a secondary analysis of the raw data and suggested neonates receiving >10 doses of sucrose over a 24-hour period are at a higher risk of poorer neurodevelopmental outcomes (Johnston 2007).
Pain relief (including heart rate and respiratory rate)
Exact mechanism is not known; it has been proposed that sucrose induces endogenous opioid release.
Onset: Maximum effect: 2 minutes (Blass 1991)
Duration: 3 to 5 minutes (Blass 1991)
