Improving Consistency in the Use of Sucrose With Comfort Measures During Minor Painful Procedures

Abstract

There are approximately 500,000 neonatal patients in the United States requiring neonatal intensive care annually. 1 Cruz et al 2 determined that the hospitalized neonate experiences between 7 and 17 painful procedures per day, with premature infants experiencing the highest number daily. The landmark article by Anand and Hickey 3 described evidence, suggesting physiologic responses to painful stimuli in neonates of various gestational ages are reflected in hormonal, metabolic, and cardiorespiratory changes. The American Academy of Pediatrics (AAP) 4 acknowledged that repeated exposure to painful stimuli early in life has physiologic, neurodevelopmental, behavioral, and cognitive consequences. Recommendations from the AAP 4 call for institutions caring for the neonatal population to implement evidence-based guidelines that include use of comfort measure therapies during procedures to minimize neonatal pain. Comfort measure therapies include oral sucrose, nonnutritive sucking, swaddling, facilitated tucking, kangaroo care, and breastfeeding.A community hospital in a low-resource urban setting with a 26-bed, level III neonatal intensive care unit (NICU) lacked an algorithm that guided pain management practices. In 2019, approximately 3000 newborns were delivered and 15.8% of newborns required neonatal intensive care at the project site. Data from the site revealed inconsistent pain management practices during peripheral intravenous catheter (PIV) insertions. Oral sucrose use with comfort measures was electronically documented in