Use Of Sucrose I n Paediatric Immunisations

1. Use Of Sucrose In Paediatric Immunisations Dr Nadeem Akhtar

2. Non-Malificence • Key ethical principle in medicine • Aim to do no harm • Every effort should be made to minimise pain • WHO refers to pain management as a fundamental human right

3. Painful Procedures • Venepuncture • Cannulation • Injections • PAEDIATRIC IMMUNISATIONS

5. What can be done? • Non pharmalogical • Freindley environment • Parental factors • Swaddling • Pacifiers • Pharmacological • Sucrose

6. Evidence • Cochrane review “ • “Babies undergoing painful procedures need help to have their pain reduced” • “The review of trials found that giving sucrose to babies decreases their crying time and other pain indicators such as facial action”

7. Evidence • Archieves of Paediatrics, Evidence based review • “All of the included studies reported that sucrose provided effective short-term pain management in children less than 24 months of age” • “for routine immunizations, a 24% oral sucrose solution was an effective analgesic”

8. Evidence • Great Ormand Street Sucrose protocol • “Reduces distress associated with painful procedures” • “Is safe, and easily administered” • Recommend 24% Sucrose • Indications IM/SC injections

9. Audit Cycle 1 • Audit current practice during routine paediatric immunisations against evidence • Aim observe 3 immunisations clinics (18 pts)

10. Proforma • Age • No. Of injections • Site • Vaccine used • Pharmacological method used ( Sucrose) • Non pharmacological methods used • Pain score • No response • Grimace • Cry • Nurse Score 0-10 (10 excellent)

11. Results Cycle 1 • 20 babies • Average age 18 weeks (range 12-52weeks) • Each baby received 2/3 IM injections • None received sucrose • 18 cried • 2 grimaced • Nurse average rating was 5.5

12. Recommendations After Cycle 1 • Aim to apply current evidence • Write up protocol • Training • Ensure materials available • Sucrose • Syringes • REAUDIT

13. Audit Cycle 2 • Audit current practice during routine paediatric immunisations against evidence • Aim observe 3 immunisations clinics (18 pts)

14. Proforma • Age • No. Of injections • Site • Vaccine used • Pharmacological method used ( Sucrose) • Non pharmacological methods used • Pain score • No response • Grimace • Cry • Nurse Score 0-10 (10 excellent)

15. Results Cycle 2 • 20 babies • Average age 16 weeks (range 9-24weeks) • Each baby received 2/3 IM injections • All babies recieved sucrose • 16 cried • 3 grimaced • 1 no response • Nurse average rating was 7.5 • Crying time less

16. Recommendations After Cycle 2 • Evidence suggests sucrose works • Aim to continue to apply current evidence • Posters and leaflets to inform parents • Doctors to be trained and introduce idea of sucrose during baby checks • To share information with other practices and encourage the use of sucrose in all practices • REAUDIT

17. Pro’s & Con’s Pro’s • Effective analgesia • Nurses and parents feel better • Evidence based practice Con’s • Cost • Time • Consent • Other factors

18. Thank You For Listening • 1. Dilli D, Küçük IZ, Dallar Y. Interventions to Reduce Pain during Vaccination in Infancy. JPediatr2008 Oct 10. [Epub ahead of print]. PubMed: PM18849052 • 2. Hatfield LA, Gusic ME, Dyer AM, Polomano RC. Analgesic properties of oral sucrose during routine immunizations at 2 and 4 months of age. Pediatrics 2008;121(2):e327-e334. • 3. Hatfield LA. Sucrose decreases infant biobehavioral pain response to immunizations: a randomized controlled trial. J NursScholarsh 2008;40(3):219-25. • 4. Schechter NL, Zempsky WT, Cohen LL, McGrath PJ, McMurtry CM, Bright NS. Pain reduction during pediatric immunizations: evidence-based review and recommendations. Pediatrics2007;119(5):e1184-e1198 • 5. Stevens B et al Sucrose for Analgesia in newborn infants undergoing painful procedures 2004 Cochrane Database Systematic review; Any Questions? References