This is for Lucy Brey's inquiry about using D5 for "comfort" measures in a 
breastfeeding baby, in particular for circumcisions.  At our facility we use a 
product called SweetEase which is 24% sucrose.  It comes in 10 ml individual 
container and our policy is that it is to be used for any procedures that may 
cause pain or considered to cause pain in the newborn.  These events may 
include:  circs, voiding cystograms, needle sticks and iv starts and other procedures 
in the NICU.  
The concept of dipping a pacifier in this solution and giving to baby counts 
as one millimeter (ml.) per dip.  It should be charted as a med.  We need to 
notify Mom that it is used as part of the pain management strategy for her 
baby.
I also let Moms of circumcised infants where penile blocks are used it will 
be used in conjunction.  I advise Mom that the premise is sucking reduces 
stress.  I will also encourage a breastfeeding Mom that she can express colostrum 
and we can "finger dip" and get a similar response.  I also let Moms know that 
for circed babes that the ycan anticipate that the baby may not breastfeed as 
well post procedure especially where no penile block is used.  I will tell Mom 
that when the baby is returned to her that she should attempt to breastfeed 
the baby because its the best thing she can do  is to provide him with pain 
relief by nursing. And to plan on during it as often as he crys after diaper 
changes or anytime during the first few days.  We may have Tylenol but it can be 
only given so often but Mom can breastfeed on demand and provide solace 
whenever.
I may have mentioned it before here we also encourage lab techs to have 
breastfeeding Moms nurse during heelsticks like for the Multiple Screening Tests or 
Bilirubin sticks if the baby is in the room.  Most techs are now getting the 
idea that we want them to do the procedure in the room so the Moms can provide 
pain management.  I give baby to Mom prior to Hep B vaccine for nursing 
during the stick.  Baby seldom if ever crys and Mom then learns she can do it when 
she visits the doctor's office for either lab or immunizations.  
We have printed up an announcement and hung it near the elevators promoting 
one technician who embraced this and now does it routinely. ( I have caught 
pedis and family members reading it and nodding approvingly.)  We wrote a letter 
of commendation to his file and supervisor and CEO and sent him a gift 
certificate to the Latte Da cart in the lobby. We are going to use this is one of our 
focuses during Breastfeeding week in the hospital so we can promote the 
concept of you learned it here, NOW take it home and out into the community. 
We still have a ways to go in the NICU because their babies are far more ill, 
they do use SweetEase more often.  They also use it when they insert the 
urinary caths for voiding cystograms for us....am trying to get nurses to get more 
on top of having EBM available, but since Radiology calls on short notice and 
we have to go to NICU and then down to Radiology many forget to tell Mom they 
are going to use pacifiers, sucrose and often a bottle.  Hopefully we get 
better at it.
Happy Paddy's Day!
Leanne Jewell, RNC, IBCLC, LCCE, FACCE 
 

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