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Filippa M, Della Casa E, D’amico R, Picciolini O, Lunardi C, Sansavini A, Ferrari F. Effects of Early Vocal Contact in the Neonatal Intensive Care Unit: Study Protocol for a Multi-Centre, Randomised Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083915. [PMID: 33917889 PMCID: PMC8068283 DOI: 10.3390/ijerph18083915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022]
Abstract
Preterm infants are at risk for developing altered trajectories of cognitive, social, and linguistic competences compared to a term population. This is mainly due to medical and environmental factors, as they are exposed to an atypical auditory environment and simultaneously, long periods of early separation from their parents. The short-term effects of early vocal contact (EVC) on an infant’s early stability have been investigated. However, there is limited evidence of its impact on the infant’s autonomic nervous system maturation, as indexed by heart rate variability, and its long-term impact on infant neurodevelopment. Our multi-centric study aims to investigate the effects of EVC on a preterm infant’s physiology, neurobehaviour, and development. Eighty stable preterm infants, born at 25–32 weeks and 6 days gestational age, without specific abnormalities, will be enrolled and randomised to either an intervention or control group. The intervention group will receive EVC, where mothers will talk and sing to their infants for 10 min three times per week for 2 weeks. Mothers in the control group will be encouraged to spend the same amount of time next to the incubator and observe the infant’s behaviour through a standard cluster of indicators. Infants will be assessed at baseline; the end of the intervention; term equivalent age; and 3, 6, 12, and 24 months corrected age, with a battery of physiological, neurobehavioral, and developmental measures. Early interventions in the neonatal intensive care unit have demonstrated effects on the neurodevelopment of preterm infants, thereby lowering the negative long-term effects of an atypical auditory and interactional environment. Our proposed study will provide new insight into mother–infant early contact as a protective intervention against the sequelae of prematurity during this sensitive period of development. Early intervention, such as EVC, is intuitive and easy to implement in the daily care of preterm infants. However, its long-term effects on infant neurodevelopment and maternal sensitivity and stress are still unclear. Trial Registration: NCT04759573, retrospectively registered, 17 February 2021.
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Affiliation(s)
- Manuela Filippa
- Department of Psychology and Educational Sciences, University of Geneva, 24, rue General Dufour, 1211 Geneva, Switzerland
- Department of Social Sciences, University of Valle d’Aosta, Str. Cappuccini, 2, 11100 Aosta, Italy
- Correspondence:
| | - Elisa Della Casa
- Neonatal Intensive Care Unit, Department of Medical and Surgical Science of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy; (E.D.C.); (F.F.)
| | - Roberto D’amico
- Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy;
| | - Odoardo Picciolini
- Pediatric Physical Medicine & Rehabilitation Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy;
| | - Clara Lunardi
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy;
| | - Alessandra Sansavini
- Department of Psychology “Renzo Canestrari”, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy;
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Science of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy; (E.D.C.); (F.F.)
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Gouin S, Alix-Séguin L, Desjardins MP, Gravel J, Lebel D, Gaucher N. Effect on Pain of an Oral Sucrose Solution vs. Placebo in Children 1 to 3 Months Old Needing Nasopharyngeal Aspiration: A Randomized Controlled Trial. J Emerg Med 2021; 61:151-156. [PMID: 33795167 DOI: 10.1016/j.jemermed.2021.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/25/2021] [Accepted: 02/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Oral sweet solutions have been proposed as effective pain-reducing agents for procedures. OBJECTIVES To compare the efficacy of an oral sucrose solution vs. placebo in alleviating pain in children (1-3 months) during nasopharyngeal aspiration (NPA). METHODS A randomized, double-blind, controlled clinical trial was conducted in a pediatric hospital emergency department. Participants (aged 1-3 months) requiring NPA were randomly allocated to receive 2 mL of 88% sucrose (SUC) or 2 mL of a placebo (PLA) 2 min prior to the procedure. The primary outcome was the mean difference in pain scores at 1 min post NPA as assessed by the Face, Legs, Activity, Cry and Consolability (FLACC) Pain Scale. RESULTS Seventy-two participants completed the study, 37 receiving SUC and 35 PLA. The mean difference in FLACC scores compared with baseline was 3.3 (2.5-4.1) for SUC vs. 3.2 (2.3-4.1) for PLA (p = .094) at 1 min and -1.2 (-1.7-0.7) for SUC vs. -0.8 (-1.5 to -0.1) for PLA (p = 0.66) at 3 min after NPA. For the Neonatal Infant Pain Scale scores, it was 2.3 (1.6-3.0) (SUC) vs. 2.5 (1.8-3.2) (PLA) (p = .086) at 1 min and -1.2 (-1.6 to -0.8) (SUC) vs. -0.8 (-1.3 to 0.2) (PLA) (p = 0.59) 3 min after NPA. There was no difference in the mean crying time, 114 (98-130) s, SUC vs. 109 (92-126) s, PLA (p = 0.81). No significant difference was found in participants' heart rate at 1 min 174 (154-194) beats/min in SUC vs. 179 (160-198) beats/min in PLA (p = 0.32). CONCLUSIONS In infants (1-3 months) undergoing NPA, administration of an oral sweet solution did not statistically decrease pain scores.
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Affiliation(s)
- Serge Gouin
- Departments of Pediatric Emergency Medicine & Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Alix-Séguin
- Departments of Pediatric Emergency Medicine & Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie Pier Desjardins
- Departments of Pediatric Emergency Medicine & Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Departments of Pediatric Emergency Medicine & Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Lebel
- Department of Pharmacy, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Nathalie Gaucher
- Departments of Pediatric Emergency Medicine & Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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53
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Chen Y, Li Y, Sun J, Han D, Feng S, Zhang X. The Effect of Maternal Voice on Venipuncture Induced Pain in Neonates: A Randomized Study. Pain Manag Nurs 2021; 22:668-673. [PMID: 33674242 DOI: 10.1016/j.pmn.2021.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 12/03/2020] [Accepted: 01/09/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Venipuncture is a common procedure in the neonatal intensive care unit (NICU) and causes significant pain for neonates. AIM To evaluate the effect of maternal voice on pain caused by venipuncture (including peripheral venipuncture and femoral venipuncture) in neonates hospitalized in the NICU. DESIGN Experimental, randomized controlled study. SETTING The study was conducted in the NICU of two hospitals in China from November 2017 to January 2019. METHODS One hundred and sixteen neonates were randomly assigned to the maternal voice or routine care groups. The maternal voice group received recorded maternal voice intervention before, during, and after venipuncture. Three phases of procedures were videotaped. Neonatal Infant Acute Pain Assessment Scale (NIAPAS) was assessed by the same evaluator at different phases. RESULTS The study showed that NIAPAS scores, behavioral indicator scores, and physiological indicator scores in the maternal voice group were significantly lower compared with those in the routine care group. CONCLUSION Recorded maternal voice can improve pain caused by venipuncture in neonates. These are simple, rapid, and cost-effective methods that nurses can implement during venipuncture in neonates.
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Affiliation(s)
- Yanjun Chen
- Peking Union Medical College Hospital, Beijing, China
| | - Yang Li
- School of Nursing, Peking Union Medical College, Beijing, China.
| | - Jing Sun
- Department of Pediatrics, Peking Union Medical College Hospital, Beijing, China
| | - Dongren Han
- Department of Neonate, Beijing Obstetrics and Gynecology Hospital, Beijing, China
| | - Shuju Feng
- Department of Neonate, Peking Union Medical College Hospital, Beijing, China
| | - Xin Zhang
- School of Nursing, Peking Union Medical College, Beijing, China
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Sethna NF, Fish B, Yahalom B, Schmidt B, Zurakowski D. Antinociceptive effect of vapocoolant medium stream spray on hotplate latency in rat pups. Paediatr Anaesth 2021; 31:330-337. [PMID: 33274557 DOI: 10.1111/pan.14096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 11/08/2020] [Accepted: 11/23/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Heel sticks account for most blood tests performed in neonates without analgesia because topical local anesthetics are ineffective on heel glabrous skin. We investigated the antinociceptive effect of an alternative topical analgesic, a vapocoolant spray, on hind paw glabrous skin of rat pups. The spray was applied by two methods: method 1 for 4 s at a distance of 8 cm and method 2 for 10 s at a distance of 18 cm. METHODS The rat pups were randomized to either method 1 (n = 32) or method 2 (n = 31). Vapocoolant spray was applied to one hind paw randomly, and saline spray was applied to the contralateral paw. The paws were exposed to a hotplate test to measure withdrawal latency time before and 30 s after the spray applications. Additionally, rat pups were tested for tissue toxicity in method 1 (n = 20) and method 2 (n = 20) after application of the vapocoolant spray before heel sticks three times a day for two consecutive days. Analyses of spray and method effects on hotplate withdrawal latency time were determined by nonparametric Wilcoxon tests to assess paired difference between vapocoolant spray and saline spray and to compare difference in medians between the two methods. RESULTS Method 1 and method 2 vapocoolant spray applications significantly prolonged the withdrawal latency time compared with saline, a median difference of 0.6 s (IQR 0.1-1.2) for method 1 and 9.5 s (IQR 5.5-10.7) for method 2 (a 15-fold longer latency time with method 2). Method-2 produced significantly longer withdrawal latency time than method 1 with a difference in median time of 8.9 s (CI: 95% 7.3-10.4 s, P < .0001). No histopathological changes were detected. CONCLUSIONS Compared with method- 1, the vapocoolant spray in method 2 produced significantly longer withdrawal latency time that is clinically applicable to collecting blood samples after a heel stick.
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Affiliation(s)
- Navil F Sethna
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - Brenden Fish
- Contract Research Organization Operations, Biomere-BioMedical Research Models, Worcester, MA, USA
| | - Barak Yahalom
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.,Contract Research Organization Operations, Biomere-BioMedical Research Models, Worcester, MA, USA
| | - Birgitta Schmidt
- Department of Pathology, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston Children's Hospital, Boston, MA, USA.,Director of Biostatistics, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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55
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Anne RP, Deshabhotla S, Ahmed SW, Ahmed SJ, Reddy N, Farooqui D, Oleti TP. A quality improvement initiative to improve management of procedural pain in preterm neonates. Paediatr Anaesth 2021; 31:221-229. [PMID: 33188650 DOI: 10.1111/pan.14075] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/23/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Neonates managed in neonatal intensive care units undergo several invasive procedures. However, neonatal procedural pain is not well recognized and managed in most neonatal units. AIMS To decrease the severity of procedural pain in preterm neonates (<37 weeks gestational age at birth), as measured by Premature Infant Pain Profile , by 50% by April 2020. METHODS A quality improvement initiative was conducted in a level 3 neonatal intensive care unit in South India. The pain was assessed independently by 2 interns not involved in clinical care using Premature Infant Pain Profile. After a baseline data recording and questionnaire assessing knowledge of healthcare personnel regarding neonatal pain, the interventions were planned. These were conducted as plan-do-study-act cycles-(i) Educational sessions, (ii) Introduction of bedside visual aids, (iii) Simulation sessions demonstrating the use of nonpharmacological measures and introduction of procedure surveillance chart in daily rounds, and (iv) Video feedback-based sessions. In the maintenance phase, the observations were continued. RESULTS The healthcare personnel under recognized pain related to heel pricks and endotracheal intubation. They also had poor awareness of signs and symptoms of neonatal pain. A total of 202 procedures were observed during the study period. The mean pain score decreased significantly from 12.8 ± 4.5 in baseline period to 6.2 ± 1.8 in the maintenance phase. The use of analgesic measures increased from 13% in the baseline period to 73% in the maintenance phase. The use of automated lancet for heel prick increased from 0% to 94% in maintenance phase. More and more procedures were done with appropriate environment and baby state. The mean number of procedures per day decreased from 6.5 ± 1.8 in baseline period to 2.7 ± 0.9 in the maintenance phase. CONCLUSIONS Targeted interventions can improve neonatal procedural pain management by improving use of analgesic measures, decreasing the number of procedures, and educating and training healthcare personnel.
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Mühlrad H, Haraldson P, Harlow BL, Anell Olofsson M, Bohm-Starke N. Early Life Health in Women with Provoked Vestibulodynia and/or Vaginismus. J Womens Health (Larchmt) 2021; 30:799-806. [PMID: 33395559 DOI: 10.1089/jwh.2020.8551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The lifetime prevalence of prolonged vulvar pain ranges from 3% to 28% among premenopausal women. Provoked vestibulodynia (PVD), often accompanied with various degrees of vaginismus, is the predominant cause. We explored the association between birth-related events and the risk of developing PVD/vaginismus during adulthood. Materials and Methods: We identified all women born in Sweden between 1973 and 2001 and categorized those with and without a diagnosis of PVD/vaginismus between 2001 and 2016 (during ages 15-43 years). Nationwide registry data were used to estimate the association between health during infancy (preterm birth, low birth weight, small for gestational age [SGA], Appearance, Pulse, Grimace, Activity and Respiration [APGAR] scores <7, and pain exposure during infancy) and the onset of PVD/vaginismus later in life using an event probability model. Results: Of the 1,359,315 women born in Sweden during 1973-2001, 9,247 were diagnosed with PVD (n = 6,648), vaginismus (n = 3,567), or both (n = 969). Preterm delivery <37 weeks (adjusted odds ratios [aOR]: 1.15, 95% confidence interval [CI]: 1.05-1.26), low birth weight <2,500 g (aOR: 1.24, 95% CI: 1.12-1.36), extremely low birth weight <1,500 g (aOR 1.41, 95% CI: 1.10-1.82), and SGA (aOR 1.20, 95% CI: 1.08-1.34) were factors associated with developing PVD/vaginismus. APGAR scores <7 or pain exposure during birth or infancy was not associated with PVD/vaginismus. Advanced maternal age, higher educational attainment, and being born in Sweden were associated with having a female offspring diagnosed with PVD/vaginismus. Conclusions: In a population of Swedish women 15-43 years of age, adverse health at birth was associated with developing PVD/vaginismus later on in life.
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Affiliation(s)
- Hanna Mühlrad
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Philip Haraldson
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Marie Anell Olofsson
- Division for Pediatric Anesthesia and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Nina Bohm-Starke
- Division of Obstetrics and Gynecology, Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
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Páramo-Cano T, Ortiz MI, Gómez-Busto FJ, Espinoza-Ramírez AL. Management of Procedural Pain in Children. Curr Pediatr Rev 2021; 17:288-328. [PMID: 33820520 DOI: 10.2174/1573396317666210405150526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/02/2020] [Accepted: 01/25/2021] [Indexed: 11/22/2022]
Abstract
In recent years, there has been increased interest in the study of pain in children and its treatment. It is known that when facing diagnostic and therapeutic procedures similar to those performed on adults, children either do not receive specific pain treatment or receive it on a significantly lower scale. However, recent research suggests a change in attitude and an improvement in the current treatment of children's pain. Although current knowledge demonstrates the falsity of many preconceived ideas about pain and its management, our results suggest that attitudinal change towards childhood pain remains slow and that real improvement in the training and practical application of the pediatrician who has to treat childhood pain is urgently needed. In this context, this manuscript has prepared standards and guidelines to improve pain management practices in a large number of national and international professional settings.
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Affiliation(s)
- Tatjana Páramo-Cano
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Mario I Ortiz
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Federico J Gómez-Busto
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
| | - Ana L Espinoza-Ramírez
- Academic Area of Medicine, Institute of Health Sciences, Universidad Autónoma del Estado de Hidalgo, Pachuca, Hidalgo, Mexico., Dr. Eliseo Ramírez Ulloa 400, Col. Doctores, 42090, Pachuca, Hidalgo,Mexico
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Todorović J, Petrović-Lazić M. Sensory processing disorders in premature infants. PRAXIS MEDICA 2021. [DOI: 10.5937/pramed2102019t] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Introduction. Children born prematurely have an increased risk of immediate medical complications, as well as socioemotional, cognitive, linguistic and sensory processing disorders later in life. Studies have examined the effects of prematurity on developmental outcomes, such as cognition, however, there is a need for a more detailed examination of sensory processing disorders in preterm infants. Not only is prenatal neurosensory development interrupted in utero, but these children may also experience intense stimulation in the neonatal unit, which can further alter the development and function of the sensory system. Objective. The paper presents an overview of research on sensory processing disorders in premature infants, with special emphasis on the impact of the environment of the neonatal unit. Method. Insight into the relevant literature was performed by specialized search engines on the Internet and insight into the electronic database. Results. Sensory processing disorders affect 39% to 52% of newborns born prematurely, with some evidence to suggest that children born before 32 weeks are most at risk. The literature to date has consistently reported difficulties in sensory modulation of preterm infants, within the tactile, vestibular, auditory, oral, and visual domains. Conclusion. Sensory processing disorders in preterm infants appear to occur as a result of their immature neurological and biological system and being in the environment of a neonatal intensive care unit, which is unable to meet the sensory needs of preterm infants. Altered sensory experiences, during periods of neurodevelopmental vulnerability and fragility, can result in sensory processing disorders, which may include enhanced responses or less response to stimuli (hyper or hyposensitivity).
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McLean MA, Niknafs N, Scoten OC, Chau CMY, MacKay M, Weinberg J, Synnes A, Miller SP, Grunau RE. Sensory processing and cortisol at age 4 years: Procedural pain-related stress in children born very preterm. Dev Psychobiol 2020; 63:915-930. [PMID: 33377181 DOI: 10.1002/dev.22079] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/08/2020] [Accepted: 12/07/2020] [Indexed: 12/28/2022]
Abstract
Children born preterm display altered sensory processing, which may manifest as hyper- and/or hypo-sensitivity to sensory information. In this vulnerable population, exposure to neonatal pain-related stress is associated with altered stress regulation, as indexed by alterations in cortisol levels. It is unknown whether sensory processing behaviors are also affected by early life adversity, and whether dysregulated cortisol is related to sensory processing problems in preterm children. We examined relationships between neonatal pain-related stress, sensory processing profiles and cortisol levels at age 4 years, and whether pathways were sex-specific. In a longitudinal prospective cohort study, N = 146 infants born 24-32 weeks gestational age were recruited from BC Women's Hospital, Vancouver, BC, Canada; neonatal factors were collected from daily chart review. At age 4 years, saliva to assay cortisol was collected three times across cognitive assessment (pre-test, during, end) and parents completed the Short Sensory Profile questionnaire. Using generalized linear modeling, independent of other neonatal factors, higher number of invasive procedures (pain/stress) was associated with more sensory processing problems (total, hypo- and hyper-sensitivity) for girls only. After accounting for neonatal factors, greater cortisol output across the assessment was associated with more total sensory processing problems in girls only, and hypersensitivity to sensory input in both boys and girls. Findings suggest that in children born very preterm, how a child responds to sensory input and cortisol reactivity to stress are related but may have different precursors. Girls may be somewhat more susceptible to neonatal pain-related stress exposure in relation to sensory processing at preschool age.
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Affiliation(s)
- Mia A McLean
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Nikoo Niknafs
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Women's Hospital, Vancouver, BC, Canada
| | - Olivia C Scoten
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Cecil M Y Chau
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | | | - Joanne Weinberg
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Anne Synnes
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Women's Hospital, Vancouver, BC, Canada
| | - Steven P Miller
- Department of Neurology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Ruth E Grunau
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.,BC Women's Hospital, Vancouver, BC, Canada
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Castillo Barrio B, Rasines Rodríguez A, Aneiros Suanzes C, Royuela Vicente A, Ortiz Movilla R, Marín Gabriel MA. A survey of procedural pain assessment and non-pharmacologic analgesic interventions in neonates in Spanish public maternity units. J Perinatol 2020; 40:1764-1769. [PMID: 32873906 DOI: 10.1038/s41372-020-00800-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/27/2020] [Accepted: 08/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To qualify and quantify clinical practices related to pain assessment and non-pharmacologic analgesia (NPA) in newborns in Spanish public maternity hospitals STUDY DESIGN: We surveyed providers online regarding their use of pain assessment scales, NPA interventions in neonates undergoing procedures, as well parents' presence or absence during interventions. RESULTS The number of painful procedures and the subjective grading of pain from the responding physicians were similar in all hospitals. Only 12.5% of hospitals used pain scales. No NPA was employed in 37.7% of procedures, with less NPA used in the lower complexity hospitals for venous extraction (p < 0.001) and gastric lavage (p = 0.001). Respondents reported parents' absence during 56.1% of procedures. CONCLUSIONS Available pain assessment scales and NPA interventions to mitigate pain are being underused. The presence of the parents during painful interventions is low despite the evidence that this may help to reduce newborns' perception of pain.
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Affiliation(s)
| | | | | | - Ana Royuela Vicente
- Clinical Biostatistics Unit, Puerta de Hierro Majadahonda University Hospital, Instituto de Investigación Puerta de Hierro (IDIPHIM), Madrid, Spain
| | - Roberto Ortiz Movilla
- Department of Pediatrics, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Miguel A Marín Gabriel
- Department of Pediatrics, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain. .,Department of Pediatrics, Autónoma University, Madrid, Spain.
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Salekin MS, Zamzmi G, Goldgof D, Kasturi R, Ho T, Sun Y. Multimodal spatio-temporal deep learning approach for neonatal postoperative pain assessment. Comput Biol Med 2020; 129:104150. [PMID: 33348218 DOI: 10.1016/j.compbiomed.2020.104150] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
The current practice for assessing neonatal postoperative pain relies on bedside caregivers. This practice is subjective, inconsistent, slow, and discontinuous. To develop a reliable medical interpretation, several automated approaches have been proposed to enhance the current practice. These approaches are unimodal and focus mainly on assessing neonatal procedural (acute) pain. As pain is a multimodal emotion that is often expressed through multiple modalities, the multimodal assessment of pain is necessary especially in case of postoperative (acute prolonged) pain. Additionally, spatio-temporal analysis is more stable over time and has been proven to be highly effective at minimizing misclassification errors. In this paper, we present a novel multimodal spatio-temporal approach that integrates visual and vocal signals and uses them for assessing neonatal postoperative pain. We conduct comprehensive experiments to investigate the effectiveness of the proposed approach. We compare the performance of the multimodal and unimodal postoperative pain assessment, and measure the impact of temporal information integration. The experimental results, on a real-world dataset, show that the proposed multimodal spatio-temporal approach achieves the highest AUC (0.87) and accuracy (79%), which are on average 6.67% and 6.33% higher than unimodal approaches. The results also show that the integration of temporal information markedly improves the performance as compared to the non-temporal approach as it captures changes in the pain dynamic. These results demonstrate that the proposed approach can be used as a viable alternative to manual assessment, which would tread a path toward fully automated pain monitoring in clinical settings, point-of-care testing, and homes.
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Affiliation(s)
- Md Sirajus Salekin
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA.
| | - Ghada Zamzmi
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
| | - Dmitry Goldgof
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
| | - Rangachar Kasturi
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
| | - Thao Ho
- College of Medicine Pediatrics, USF Health, University of South Florida, Tampa, FL, USA
| | - Yu Sun
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
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Balakrishnan A, Sanghera RS, Boyle EM. New techniques, new challenges—The dilemma of pain management for less invasive surfactant administration? PAEDIATRIC AND NEONATAL PAIN 2020; 3:2-8. [PMID: 35548851 PMCID: PMC8975189 DOI: 10.1002/pne2.12033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/01/2020] [Accepted: 06/09/2020] [Indexed: 12/18/2022]
Abstract
Recent years have seen the increasing use of noninvasive respiratory support in preterm infants with the aim of minimizing the risk of mechanical ventilation and subsequent bronchopulmonary dysplasia. Respiratory distress syndrome is the most common respiratory diagnosis in preterm infants, and is best treated by administration of surfactant. Until recently, this has been performed via an endotracheal tube using premedication, which has often included opiate analgesia; subsequently, the infant has been ventilated. Avoidance of mechanical ventilation, however, does not negate the need for surfactant therapy. Less invasive surfactant administration (LISA) in spontaneously breathing infants is increasing in popularity, and appears to have beneficial effects. However, laryngoscopy is necessary, which carries adverse effects and is painful for the infant. Conventional methods of premedication for intubation tend to reduce respiratory drive, which increases the likelihood of ventilation being required. This has led to intense debate about the best strategy for providing appropriate treatment, taking into account both the respiratory needs of the infant and the need to alleviate procedural pain. Currently, clinical practice varies considerably and there is no consensus with respect to optimal management. This review seeks to summarize the benefits, risks, and challenges associated with this new approach.
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Affiliation(s)
| | | | - Elaine M. Boyle
- Department of Health Sciences University of Leicester Leicester UK
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Foubert R, Devroe S, Foubert L, Van de Velde M, Rex S. Anesthetic neurotoxicity in the pediatric population: a systematic review of the clinical evidence. ACTA ANAESTHESIOLOGICA BELGICA 2020. [DOI: 10.56126/71.2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Background: Exposure to general anesthesia (GA) in early life is known to be neurotoxic to animals.
Objectives: To evaluate the risk of GA inducing long-term neurodevelopmental deficits in human children.
Design: Systematic review.
Methods: We included observational and randomized studies that compared the long-term neurodevelopment of postnatal children exposed to GA to the long-term neurodevelopment of children not exposed to GA. We searched MEDLINE, Embase and Web of Science for relevant studies published in the year 2000 or later. We screened all the identified studies on predetermined inclusion and exclusion criteria. A risk of bias assessment was made for each included study. We identified 9 neurodevelopmental domains for which a sub-analysis was made: intelligence; memory; learning; language/speech; motor function; visuospatial skills; development/emotions/behavior; ADHD/attention; autistic disorder.
Results: We included 26 studies involving 605.391 participants. Based on AHRQ-standards 11 studies were of poor quality, 7 studies were of fair quality and 8 studies were of good quality. The major causes of potential bias were selection and comparability bias. On 2 neurodevelopmental domains (visuospatial skills and autistic disorder), the available evidence showed no association with exposure to GA. On 7 other neurodevelopmental domains, the available evidence showed mixed results. The 4 studies that used a randomized or sibling-controlled design showed no association between GA and neurodevelopmental deficits in their primary endpoints.
Limitations: The absence of a meta-analysis and funnel plot.
Conclusions: Based on observational studies, we found an association between GA in childhood and neuro-developmental deficits in later life. Randomized and sibling-matched observational studies failed to show the same association and therefore no evidence of a causal relationship exists at present. Since GA seems to be a marker, but not a cause of worse neurodevelopment, we argue against delaying or avoiding interventional or diagnostic procedures requiring GA in childhood based on the argument of GA-induced neurotoxicity.
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Menin D, Dondi M. Methodological Issues in the Study of the Development of Pain Responsivity in Preterm Neonates: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103507. [PMID: 32429581 PMCID: PMC7277564 DOI: 10.3390/ijerph17103507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Abstract
The study of the development of neonatal pain responses is of key importance, both for research and for clinical reasons, with particular regard to the population of preterm neonates, given the amount of painful procedures they are exposed to on a daily basis. The aim of this work was to systematize our knowledge about the development of pain responses in prematurely born neonates by focusing on some key methodological issues. Studies on the impact of age variables, namely gestational age (GA), postmenstrual age (PMA) and chronological age (CH), on pain responsivity in premature neonates were identified using Medline and Scopus. Studies (N = 42) were categorized based on terminological and methodological approaches towards age variables, and according to output variables considered (facial, nonfacial behavioral, physiological). Distinct multidimensional developmental patterns were found for each age-sampling strategy. Overall, each of the three age variables seems to affect pain responsivity, possibly differently across age windows. Targeted as well as integrated approaches, together with a renewed attention for methodological consistency, are needed to further our knowledge on this topic.
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Affiliation(s)
| | - Marco Dondi
- Correspondence: ; Tel.: +39-0532-293538; Fax: +39-0532-455234
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Nelson S, Burns M, McEwen B, Borsook D. Stressful experiences in youth: "Set-up" for diminished resilience to chronic pain. Brain Behav Immun Health 2020; 5:100095. [PMID: 34589863 PMCID: PMC8474662 DOI: 10.1016/j.bbih.2020.100095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 06/07/2020] [Indexed: 01/01/2023] Open
Abstract
Chronic pain in youth is common, with prevalence rates in some reports exceeding 50%. Given the plasticity of brain systems in youth and their general level of activity, the underlying processes relating to the evolution of chronic pain may be different from that observed in adults. One aspect that affects brain development is childhood stress. Preliminary research indicates that maladaptive responses to stressful events that induce biological and psychological inability to adapt may be related to pain chronicity in youth. This relationship is particularly notable given the high rates of exposure to stressful events in pediatric pain populations. A review of the literature was performed in the areas of biological, cognitive, psychological and social processes associated with chronic pain and psychological stress and trauma in youth and adult populations. The current review presents a theoretical framework, adapted from McEwen's model (1998) on stress and allostatic load, which aims to outline the potential connection between exposure to stressful events and pediatric chronic pain. Avenues for future investigation are also identified.
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Affiliation(s)
- Sarah Nelson
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
- Department of Psychiatry, Harvard Medical School, USA
| | - Maureen Burns
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
| | | | - David Borsook
- Center for Pain and the Brain, Departments of Anesthesiology, Critical Care, and Pain Medicine and Radiology, Boston Children’s Hospital, USA
- Department of Anesthesia, Harvard Medical School, USA
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Raffaeli G, Tripodi A, Manzoni F, Scalambrino E, Pesenti N, Amodeo I, Cavallaro G, Villamor E, Peyvandi F, Mosca F, Ghirardello S. Is placental blood a reliable source for the evaluation of neonatal hemostasis at birth? Transfusion 2020; 60:1069-1077. [PMID: 32315090 DOI: 10.1111/trf.15785] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 01/28/2020] [Accepted: 03/03/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Phlebotomy is among the main determinants of anemia of prematurity. Blood sparing policies endorsed umbilical cord blood (here called placental) as an alternative source for laboratory testing. Little is known on the suitability of placental blood to evaluate neonatal hemostasis of newborn infants. We aimed to compare the hemostatic profile of paired placental and infant venous blood, by means of prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen, antithrombin, protein C, thromboelastography (TEG) and thrombin generation assay (TGA). STUDY DESIGN This was an observational single-center study. METHODS We collected at birth venous citrated blood from both placental and infant venous source and performed PT, APTT, fibrinogen, antithrombin, protein C, TEG (reaction time-R; kinetics-K alpha angle-α, maximum amplitude-MA and lysis at 30 minutes-LY30), and TGA (endogenous thrombin potential-ETP). RESULTS We enrolled 60 neonates with a median gestational age (range) of 37 weeks (28+1 -41) and birth-weight 2417 g (950-4170). Based on TEG and TGA, placental blood showed a procoagulant imbalance as indicated by lower median R (4.0 vs. 6.1 min; p < 0.001) and K (1.3 vs. 2.2 min; p < 0.001); higher α-angle (69.7 vs. 57.4°; p < 0.001) and ETP (1260 vs. 1078; p = 0.002) than those observed for infant venous blood. PT and APTT did not differ significantly between the two groups. CONCLUSIONS While placental and neonatal blood samples are equally suitable to measure the standard coagulation tests PT and APTT, placental blood leads to a procoagulant imbalance when testing is performed with TEG or TGA. These effects should be considered when interpreting results stemming from investigation of neonatal hemostasis.
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Affiliation(s)
- Genny Raffaeli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Armando Tripodi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Francesca Manzoni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Erica Scalambrino
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy
| | - Nicola Pesenti
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Ilaria Amodeo
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Giacomo Cavallaro
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Eduardo Villamor
- Department of Pediatrics, Maastricht University Medical Center (MUMC+), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands
| | - Flora Peyvandi
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center and Fondazione Luigi Villa, Milan, Italy.,Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Stefano Ghirardello
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
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Schenk K, Stoffel L, Bürgin R, Stevens B, Bassler D, Schulzke S, Nelle M, Cignacco E. Acute pain measured with the modified Bernese Pain Scale for Neonates is influenced by individual contextual factors. Eur J Pain 2020; 24:1107-1118. [PMID: 32170786 DOI: 10.1002/ejp.1555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 02/28/2020] [Accepted: 03/11/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Individual contextual factors like gestational age (GA) or previous painful experiences have an influence on neonates' pain responses and may lead to inaccurate pain assessment when not appropriately considered. OBJECTIVES We set out to determine the influence of individual contextual factors on variability in pain response in neonates, measured with the modified Bernese Pain Scale for Neonates (BPSN), and, if necessary, to incorporate relevant individual factors into a revised version of the BPSN. METHODS We videotaped 154 full-term and preterm neonates of different GAs during 1-5 capillary heel sticks in their first 14 days of life. For each heel stick, we produced three video sequences: baseline, heel stick, and recovery. The randomized sequences were rated on the BPSN by five blinded nurses. Individual contextual factors were retrospectively extracted from patient charts and from the video recordings. We analysed the data in single and multiple linear mixed models. RESULTS Premature birth (b = -0.721), caffeine (b = -0.302), and the behavioural states quiet and awake (b = -0.283), active and asleep (b = -0.158), and quiet and asleep (b = -0.498) were associated with changes in behavioural pain scores. Premature birth (b = -0.232), mechanical ventilation (b = -0.196), and duration of the heel stick procedure (b = 0.0004) were associated with changes in physiological pain scores. Premature birth (b = -0.907), Caffeine (b = -0.402), the behavioural states quiet and awake (b = -0.274), and quiet and asleep (b = -0.459), and duration of the heel stick procedure (b = 0.001) were associated with changes in the modified BPSN total scores. CONCLUSIONS Postmenstrual age, behavioural state, caffeine, and ventilation status have an influence on neonates' pain response and should be incorporated in the revised BPSN to enhance clinical pain assessment in neonates with different GAs. SIGNIFICANCE We identified individual contextual factors associated with dampened pain response in neonates and will incorporate them into a revised version of the Bernese Pain Scale for Neonates to provide clinicians with a tool they can use to more accurately assess and manage pain in this vulnerable population.
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Affiliation(s)
- Karin Schenk
- Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Lilian Stoffel
- Neonatalogy, Children's Hospital, University Hospital of Bern, Bern, Switzerland
| | - Reto Bürgin
- Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
| | - Bonnie Stevens
- Lawrence S. Bloomberg Faculty of Nursing and Faculties of Medicine and Dentistry, University of Toronto, Toronto, Canada
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Sven Schulzke
- Department of Neonatology, University Children's Hospital Basel UKBB, Basel, Switzerland
| | - Mathias Nelle
- Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Eva Cignacco
- Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Bern, Switzerland
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Neuromotor and sensory development in preterm infants: prospective study. Turk Arch Pediatr 2020; 55:46-53. [PMID: 32231449 PMCID: PMC7096571 DOI: 10.14744/turkpediatriars.2019.88709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 10/31/2019] [Indexed: 11/20/2022]
Abstract
Aim To investigate the relationship between motor and sensory development in the first 4 months of life in preterm infants born at 32 gestational weeks and below. Material and Methods The study consisted of 56 high-risk infants with a corrected age of 1 month who were born at 32 gestational weeks and stayed in the neonatal intensive care unit for at least 15 days. Neuro Sensory Motor Developmental Assessment and Infant Sensory Profile-2 were used for evaluation. These assessments were applied to preterm infants at the 1st and 4th months. The results of assessments were analyzed using the Wilcoxon test. The relationship between the results of motor and sensory assessments was analyzed using Spearman's correlation test. Results The mean gestational age of the infants was 29.58±2.09 weeks, their birth weights were 1233.87±251.22 grams, and their duration of stay in the neonatal intensive care unit was 26.48±9.58 days. There was a statistically significant difference between the Neuro Sensory Motor Developmental Assessment and Infant Sensory Profile-2 scores between the 1st and 4th months (p<0.05). It was found that there was a risk in terms of sensory development in 86-91% of the preterm infants at the 1st month and in 69-85% at the 4th month. There was moderate-strong degree of significant relationship between motor and sensory development. Conclusion Considering the findings of our study, preterm infants are at risk for motor and sensory development. There is, therefore, a need for future research to investigate the effect of early sensory-based intervention approaches on preterm infants.
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Williams MD, Lascelles BDX. Early Neonatal Pain-A Review of Clinical and Experimental Implications on Painful Conditions Later in Life. Front Pediatr 2020; 8:30. [PMID: 32117835 PMCID: PMC7020755 DOI: 10.3389/fped.2020.00030] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/20/2020] [Indexed: 12/13/2022] Open
Abstract
Modern health care has brought our society innumerable benefits but has also introduced the experience of pain very early in life. For example, it is now routine care for newborns to receive various injections or have blood drawn within 24 h of life. For infants who are sick or premature, the pain experiences inherent in the required medical care are frequent and often severe, with neonates requiring intensive care admission encountering approximately fourteen painful procedures daily in the hospital. Given that much of the world has seen a steady increase in preterm births for the last several decades, an ever-growing number of babies experience multiple painful events before even leaving the hospital. These noxious events occur during a critical period of neurodevelopment when the nervous system is very vulnerable due to immaturity and neuroplasticity. Here, we provide a narrative review of the literature pertaining to the idea that early life pain has significant long-term effects on neurosensory, cognition, behavior, pain processing, and health outcomes that persist into childhood and even adulthood. We refer to clinical and pre-clinical studies investigating how early life pain impacts acute pain later in life, focusing on animal model correlates that have been used to better understand this relationship. Current knowledge around the proposed underlying mechanisms responsible for the long-lasting consequences of neonatal pain, its neurobiological and behavioral effects, and its influence on later pain states are discussed. We conclude by highlighting that another important consequence of early life pain may be the impact it has on later chronic pain states-an area of research that has received little attention.
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Affiliation(s)
- Morika D. Williams
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Translational Research in Pain Program, North Carolina State University, Raleigh, NC, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States
| | - B. Duncan X. Lascelles
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Translational Research in Pain Program, North Carolina State University, Raleigh, NC, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Center for Translational Pain Medicine, Duke University, Durham, NC, United States
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Vu-Ngoc H, Uyen NCM, Thinh OP, Don LD, Danh NVT, Truc NTT, Vi VT, Vuong NL, Huy NT, Duong PDT. Analgesic effect of non-nutritive sucking in term neonates: A randomized controlled trial. Pediatr Neonatol 2020; 61:106-113. [PMID: 31474462 DOI: 10.1016/j.pedneo.2019.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/15/2019] [Accepted: 07/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Newborns commonly experience pain due to a variety of reasons. Non-nutritive sucking (NNS) is thought to be an effective non-pharmacological method of pain-relief. However, the significant heterogeneity in some systematic reviews limited the certainty of the findings about NNS. Hence, this study was aimed at evaluating the analgesic effect and safety of NNS in healthy term neonates during the heel prick test, using the Neonatal Pain Agitation and Sedation Scale (N-PASS). METHODS In this randomized controlled trial, 42 term infants were included: 22 infants in the intervention group (receiving NNS) and 20 infants in the control group (not receiving NNS). In the intervention group, neonates were given a silicone pacifier 120 s before, during, and 120 s after the heel puncture, while neonates in the control group received routine care. Pain-related outcomes were assessed using the N-PASS at 30s, 60s, 90s, and 120s after the heel prick. Any adverse events during the procedure were noted. The Spearman correlation coefficients between the pain scores on the N-PASS and two other scales (NFCS and NIPS) were calculated at all four moments of evaluation. RESULTS The mean N-PASS pain scores at 30s, 60s, 90s, and 120s after heel prick were significantly lower in the NNS group than in the control group: 4.73 ± 2.78 vs. 7.90 ± 1.52 (p = 0.0002); 3.64 ± 3.06 vs. 5.55 ± 2.95 (p = 0.052); 2.59 ± 3.08 vs. 5.25 ± 3.51 (p = 0.011); and 2.05 ± 2.94 vs. 4.90 ± 3.99 (p = 0.013), respectively. No adverse events were detected in either group. Our findings revealed a strong positive correlation between the pain scores on the N-PASS and two other scales (NFCS and NIPS), which was statistically significant (p < 0.01). CONCLUSIONS NNS is considered a safe and effective pain-relief method during the heel prick procedure in term neonates, demonstrated using the N-PASS. These findings were correlated with the pain evaluation by NFCS and NIPS.
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Affiliation(s)
- Hai Vu-Ngoc
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam; Faculty of Medicine, University Paris Descartes, Paris 75006, Ile-de-France, France
| | - Nguyen Cao Minh Uyen
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Ong Phuc Thinh
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Le Duc Don
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Vo Tan Danh
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Tran Thanh Truc
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Vu Tuong Vi
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Lam Vuong
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang 550000, Viet Nam.
| | - Pham Diep Thuy Duong
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
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Abstract
BACKGROUND Newborn infants have the ability to experience pain. Hospitalised infants are exposed to numerous painful procedures. Healthy newborns are exposed to pain if the birth process consists of assisted vaginal birth by vacuum extraction or by forceps and during blood sampling for newborn screening tests. OBJECTIVES To determine the efficacy and safety of paracetamol for the prevention or treatment of procedural/postoperative pain or pain associated with clinical conditions in neonates. To review the effects of various doses and routes of administration (enteral, intravenous or rectal) of paracetamol for the prevention or treatment of pain in neonates. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL 2016, Issue 4), MEDLINE via PubMed (1966 to 9 May 2016), Embase (1980 to 9 May 2016), and CINAHL (1982 to 9 May 2016). We searched clinical trials' databases, Google Scholar, conference proceedings, and the reference lists of retrieved articles. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials of paracetamol for the prevention/treatment of pain in neonates (≤ 28 days of age). DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the articles using pre-designed forms. We used this form to decide trial inclusion/exclusion, to extract data from eligible trials and to request additional published information from authors of the original reports. We entered and cross-checked data using RevMan 5 software. When noted, we resolved differences by mutual discussion and consensus. We used the GRADE approach to assess the quality of evidence. MAIN RESULTS We included nine trials with low risk of bias, which assessed paracetamol for the treatment of pain in 728 infants. Painful procedures studied included heel lance, assisted vaginal birth, eye examination for retinopathy of prematurity assessment and postoperative care. Results of individual studies could not be combined in meta-analyses as the painful conditions, the use of paracetamol and comparison interventions and the outcome measures differed. Paracetamol compared with water, cherry elixir or EMLA cream (eutectic mixture of lidocaine and prilocaine) did not significantly reduce pain following heel lance. The Premature Infant Pain Profile score (PIPP) within three minutes following lancing was higher in the paracetamol group than in the oral glucose group (mean difference (MD) 2.21, 95% confidence interval (CI) 0.72 to 3.70; one study, 38 infants). Paracetamol did not reduce "modified facies scores" after assisted vaginal birth (one study, 119 infants). In another study (n = 123), the Échelle de Douleur et d'Inconfort du Nouveau-Né score at two hours of age was significantly higher in the group that received paracetamol suppositories than in the placebo suppositories group (MD 1.00, 95% CI 0.60 to 1.40). In that study, when infants were subjected to a heel lance at two to three days of age, Bernese Pain Scale for Neonates scores were higher in the paracetamol group than in the placebo group, and infants spent a longer time crying (MD 19 seconds, 95% CI 14 to 24). For eye examinations, no significant reduction in PIPP scores in the first or last 45 seconds of eye examination was reported, nor at five minutes after the eye examination. In one study (n = 81), the PIPP score was significantly higher in the paracetamol group than in the 24% sucrose group (MD 3.90, 95% CI 2.92 to 4.88). In one study (n = 114) the PIPP score during eye examination was significantly lower in the paracetamol group than in the water group (MD -2.70, 95% CI -3.55 to 1.85). For postoperative care following major surgery, the total amount of morphine (µg/kg) administered over 48 hours was significantly less among infants assigned to the paracetamol group than to the morphine group (MD -157 µg/kg, 95% CI -27 to -288). No adverse events were noted in any study. The quality of evidence according to GRADE was low. AUTHORS' CONCLUSIONS The paucity and low quality of existing data do not provide sufficient evidence to establish the role of paracetamol in reducing the effects of painful procedures in neonates. Paracetamol given after assisted vaginal birth may increase the response to later painful exposures. Paracetamol may reduce the total need for morphine following major surgery, and for this aspect of paracetamol use, further research is needed.
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Affiliation(s)
- Arne Ohlsson
- University of TorontoDepartments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and EvaluationTorontoCanada
- Mount Sinai HospitalDepartment of PaediatricsTorontoCanada
| | - Prakeshkumar S Shah
- University of Toronto Mount Sinai HospitalDepartment of Paediatrics and Institute of Health Policy, Management and Evaluation600 University AvenueTorontoONCanadaM5G 1XB
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Mascarenhas CJ, Liu R, Barr GA. Effects of plant-derived analgesic compounds sinomenine and salvinorin A in infant rats. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2020; 18:174-180. [PMID: 31992510 DOI: 10.1016/j.joim.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/03/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Premature and ill neonates undergo painful but medically necessary procedures while hospitalized. Although opiate drugs are administered as analgesics, problems associated with their side effects, tolerance, and potential dependence necessitate research into alternative pain-relieving medications. Here we test two plant-derived compounds in infant rats: sinomenine, which targets the Mas-related G-protein-coupled receptor member X2 opioid receptor; and salvinorin A, which is a κ opioid receptor agonist. In adult animals both sinomenine and salvinorin A are analgesic, but neither has been tested in infants. METHODS We used the formalin and thermal plantar tests in rats 7 and 21 days of age (PN7 and PN21) for behavioral signs of pain. In addition, brain sections were stained using Fos immunohistochemistry to examine patterns of brain activation in the midbrain periaqueductal gray and the paraventricular nucleus of the hypothalamus. RESULTS Sinomenine was analgesic in both the formalin and thermal tests on animals 21 days of age. At PN7 only the highest dose elevated response latencies in the thermal test and there were no effects of sinomenine in the formalin test. Analysis of Fos expression in the sinomenine-treated animals showed no drug effect, in contrast to the behavioral results. Salvinorin A was analgesic in the formalin test only at the highest dose at 21 days of age but not in the thermal test at either age. CONCLUSION The increased modest effectiveness of sinomenine in older animals and the minimum salvinorin A drug effect suggest that the compounds act on sites that develop during the preweaning period (sinomenine) or after weaning (salvinorin A).
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Affiliation(s)
- Conrad J Mascarenhas
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Gordon A Barr
- Department of Anesthesiology and Critical Care, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA; Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA; Department of Psychology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Parent-Targeted Education Regarding Infant Pain Management Delivered During the Perinatal Period: A Scoping Review. J Perinat Neonatal Nurs 2020; 34:56-65. [PMID: 31996645 DOI: 10.1097/jpn.0000000000000439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
All infants experience pain in early life from procedures. Parents recognize pain as a prevalent issue, reporting a strong desire for more information on infant pain. The aim of this study was to explore and map the current evidence of parent-targeted educational interventions about infant pain, delivered throughout the perinatal period. Records were identified in PubMed, CINAHL, EMBASE, and ERIC databases and hand searching recent publications in 3 relevant journals. Records in English that described or evaluated educational interventions on infant pain management aimed at parents during the perinatal period were eligible for review and those not related to pain or aimed at healthcare providers were excluded. Evaluation was completed following the Methodology for JBI Scoping Reviews and standardized critical appraisal instruments from the Joanna Briggs Institute. Initial search yielded 6946 records, with 9 included in analysis. Six studies were quantitative, 2 qualitative, and 1 mixed methods. Included interventions contained information about parent-led pain management strategies for infants in the neonatal intensive care unit (n = 4), full term (n = 4), or both (n = 1). Despite being an area of high concern for parents of newborns, few studies addressed parent-targeted education regarding infant pain. Future research examining the impact and efficacy of these interventions addressing parental and neonatal outcomes is warranted.
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Opioid and benzodiazepine use during therapeutic hypothermia in encephalopathic neonates. J Perinatol 2020; 40:79-88. [PMID: 31616049 DOI: 10.1038/s41372-019-0533-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 09/26/2019] [Accepted: 09/30/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To evaluate the use of sedatives and analgesics during therapeutic hypothermia in encephalopathic neonates and assess associations between medication exposure and hospital outcomes. STUDY DESIGN We identified neonates ≥35 weeks gestational age treated with therapeutic hypothermia at 125 neonatal intensive care units between 2007 and 2015. We compared characteristics and hospital outcomes between unexposed neonates and neonates exposed to opioids and/or benzodiazepines. RESULTS Opioids were administered to 1 677/2 621 (64%) neonates, and exposure increased from 38% in 2008 to 68% in 2015. Sedation/analgesia varied widely between centers. Opioid-exposed neonates experienced greater durations of respiratory support and were more likely to receive inotropes and inhaled nitric oxide. Mortality during postnatal days 0-3 was lower among opioid-exposed neonates (31/625 [5%]) than unexposed neonates (64/714 [9%]). CONCLUSIONS Sedation/analgesia during therapeutic hypothermia is prevalent but not uniform across centers. Prospective studies are needed to assess if exposure independently predicts intensity and duration of physiologic support.
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Parga JJ, Lewin S, Lewis J, Montoya-Williams D, Alwan A, Shaul B, Han C, Bookheimer SY, Eyer S, Dapretto M, Zeltzer L, Dunlap L, Nookala U, Sun D, Dang BH, Anderson AE. Defining and distinguishing infant behavioral states using acoustic cry analysis: is colic painful? Pediatr Res 2020; 87:576-580. [PMID: 31585457 PMCID: PMC7033040 DOI: 10.1038/s41390-019-0592-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 07/10/2019] [Accepted: 08/17/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND To characterize acoustic features of an infant's cry and use machine learning to provide an objective measurement of behavioral state in a cry-translator. To apply the cry-translation algorithm to colic hypothesizing that these cries sound painful. METHODS Assessment of 1000 cries in a mobile app (ChatterBabyTM). Training a cry-translation algorithm by evaluating >6000 acoustic features to predict whether infant cry was due to a pain (vaccinations, ear-piercings), fussy, or hunger states. Using the algorithm to predict the behavioral state of infants with reported colic. RESULTS The cry-translation algorithm was 90.7% accurate for identifying pain cries, and achieved 71.5% accuracy in discriminating cries from fussiness, hunger, or pain. The ChatterBaby cry-translation algorithm overwhelmingly predicted that colic cries were most likely from pain, compared to fussy and hungry states. Colic cries had average pain ratings of 73%, significantly greater than the pain measurements found in fussiness and hunger (p < 0.001, 2-sample t test). Colic cries outranked pain cries by measures of acoustic intensity, including energy, length of voiced periods, and fundamental frequency/pitch, while fussy and hungry cries showed reduced intensity measures compared to pain and colic. CONCLUSIONS Acoustic features of cries are consistent across a diverse infant population and can be utilized as objective markers of pain, hunger, and fussiness. The ChatterBaby algorithm detected significant acoustic similarities between colic and painful cries, suggesting that they may share a neuronal pathway.
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Affiliation(s)
- Joanna J. Parga
- 0000 0001 0680 8770grid.239552.aChildren’s Hospital of Pennsylvania, Philadelphia, PA USA
| | - Sharon Lewin
- 0000 0000 9632 6718grid.19006.3eDavid Geffen School of Medicine, University of California, Los Angeles, CA USA
| | - Juanita Lewis
- 0000 0000 9632 6718grid.19006.3eDavid Geffen School of Medicine, University of California, Los Angeles, CA USA
| | - Diana Montoya-Williams
- 0000 0001 0680 8770grid.239552.aChildren’s Hospital of Pennsylvania, Philadelphia, PA USA
| | - Abeer Alwan
- 0000 0000 9632 6718grid.19006.3eUniversity of California, Los Angeles, CA USA
| | | | - Carol Han
- 0000 0000 9632 6718grid.19006.3eUniversity of California, Los Angeles, CA USA
| | - Susan Y. Bookheimer
- 0000 0000 9632 6718grid.19006.3eUniversity of California, Los Angeles, CA USA
| | - Sherry Eyer
- 0000 0001 0746 317Xgrid.256175.2Gallaudet University, Washington, DC USA
| | - Mirella Dapretto
- 0000 0000 9632 6718grid.19006.3eUniversity of California, Los Angeles, CA USA
| | - Lonnie Zeltzer
- 0000 0000 9632 6718grid.19006.3eDavid Geffen School of Medicine, University of California, Los Angeles, CA USA
| | - Lauren Dunlap
- 0000 0000 9632 6718grid.19006.3eUniversity of California, Los Angeles, CA USA
| | - Usha Nookala
- 0000 0000 9632 6718grid.19006.3eUniversity of California, Los Angeles, CA USA
| | - Daniel Sun
- 0000 0000 9632 6718grid.19006.3eUniversity of California, Los Angeles, CA USA
| | - Bianca H. Dang
- 0000 0000 9632 6718grid.19006.3eUniversity of California, Los Angeles, CA USA
| | - Ariana E. Anderson
- 0000 0000 9632 6718grid.19006.3eUniversity of California, Los Angeles, CA USA
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Rudisill SS, Wang JT, Jaimes C, Mongerson CRL, Hansen AR, Jennings RW, Bajic D. Neurologic Injury and Brain Growth in the Setting of Long-Gap Esophageal Atresia Perioperative Critical Care: A Pilot Study. Brain Sci 2019; 9:E383. [PMID: 31861169 PMCID: PMC6955668 DOI: 10.3390/brainsci9120383] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 12/11/2019] [Accepted: 12/14/2019] [Indexed: 12/14/2022] Open
Abstract
We previously showed that infants born with long-gap esophageal atresia (LGEA) demonstrate clinically significant brain MRI findings following repair with the Foker process. The current pilot study sought to identify any pre-existing (PRE-Foker process) signs of brain injury and to characterize brain and corpus callosum (CC) growth. Preterm and full-term infants (n = 3/group) underwent non-sedated brain MRI twice: before (PRE-Foker scan) and after (POST-Foker scan) completion of perioperative care. A neuroradiologist reported on qualitative brain findings. The research team quantified intracranial space, brain, cerebrospinal fluid (CSF), and CC volumes. We report novel qualitative brain findings in preterm and full-term infants born with LGEA before undergoing Foker process. Patients had a unique hospital course, as assessed by secondary clinical end-point measures. Despite increased total body weight and absolute intracranial and brain volumes (cm3) between scans, normalized brain volume was decreased in 5/6 patients, implying delayed brain growth. This was accompanied by both an absolute and relative CSF volume increase. In addition to qualitative findings of CC abnormalities in 3/6 infants, normative CC size (% brain volume) was consistently smaller in all infants, suggesting delayed or abnormal CC maturation. A future larger study group is warranted to determine the impact on the neurodevelopmental outcomes of infants born with LGEA.
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Affiliation(s)
- Samuel S. Rudisill
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.S.R.); (J.T.W.); (C.R.L.M.)
| | - Jue T. Wang
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.S.R.); (J.T.W.); (C.R.L.M.)
- Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA
| | - Camilo Jaimes
- Department of Radiology, Division of Neuroradiology, Boston Children’s Hospital, and Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
| | - Chandler R. L. Mongerson
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.S.R.); (J.T.W.); (C.R.L.M.)
| | - Anne R. Hansen
- Department of Pediatrics, Division of Neonatal Medicine, Boston Children’s Hospital, and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA;
| | - Russell W. Jennings
- Department of Surgery, Boston Children’s Hospital, and Department of Surgery, Harvard Medical School, Boston, MA 02115, USA;
- Esophageal and Airway Treatment Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (S.S.R.); (J.T.W.); (C.R.L.M.)
- Department of Anaesthesia, Harvard Medical School, Boston, MA 02115, USA
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Abstract
Preterm and term neonate pain assessment in neonatal intensive care units is vitally important because of the prevalence of procedural and postoperative pain. Of the 40 plus tools available, a few should be chosen for different populations and contexts (2 have been validated in premature infants). Preterm neonates do not display pain behaviors and physiologic indicators as reliably and specifically as full-term infants, and are vulnerable to long-term sequelae of painful experiences. Brain-oriented approaches may become available in the future; meanwhile, neonatal pain assessment tools must be taught, implemented, and their use optimized for consistent, reproducible, safe, and effective treatment.
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Affiliation(s)
- Lynne G Maxwell
- Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Wood 6021, Philadelphia, PA 19104, USA.
| | - María V Fraga
- Perelman School of Medicine, University of Pennsylvania, The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Carrie P Malavolta
- The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Fang A, Allen KY, Marino BS, Brady KM. Neurologic outcomes after heart surgery. Paediatr Anaesth 2019; 29:1086-1093. [PMID: 31532867 DOI: 10.1111/pan.13744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 09/05/2019] [Accepted: 09/14/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Amy Fang
- Anesthesia, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Kiona Y Allen
- Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
| | - Bradley S Marino
- Cardiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
| | - Ken M Brady
- Anesthesia, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
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79
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Völler S, Flint RB, Andriessen P, Allegaert K, Zimmermann LJI, Liem KD, Koch BCP, Simons SHP, Knibbe CAJ. Rapidly maturing fentanyl clearance in preterm neonates. Arch Dis Child Fetal Neonatal Ed 2019; 104:F598-F603. [PMID: 31498775 DOI: 10.1136/archdischild-2018-315920] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/10/2018] [Accepted: 12/31/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Fentanyl is frequently used off-label in preterm newborns. Due to very limited pharmacokinetic and pharmacodynamic data, fentanyl dosing is mostly based on bodyweight. This study describes the maturation of the pharmacokinetics in preterm neonates born before 32 weeks of gestation. METHODS 442 plasma samples from 98 preterm neonates (median gestational age: 26.9 (range 23.9-31.9) weeks, postnatal age: 3 (range 0-68) days, bodyweight 1.00 (range 0.39-2.37) kg) were collected in an opportunistic trial and fentanyl plasma levels were determined. NONMEM V.7.3 was used to develop a population pharmacokinetic model and to perform simulations. RESULTS Fentanyl pharmacokinetics was best described by a two-compartment model. A pronounced non-linear influence of postnatal and gestational age on clearance was identified. Clearance (L/hour/kg) increased threefold, 1.3-fold and 1.01-fold in the first, second and third weeks of life, respectively. In addition, clearance (L/hour/kg) was 1.4-fold and 1.7-fold higher in case of a gestational age of 28 and 31 weeks, respectively, compared with 25 weeks. Volume of distribution changed linearly with bodyweight and was 8.7 L/kg. To achieve similar exposure across the entire population, a continuous infusion (µg/kg/hour) dose should be reduced by 50% and 25% in preterm neonates with a postnatal age of 0-4 days and 5-9 days in comparison to 10 days and older. CONCLUSION Because of low clearance, bodyweight-based dosages may result in fentanyl accumulation in neonates with the lowest postnatal and gestational ages which may require dose reduction. Together with additional information on the pharmacodynamics, the results of this study can be used to guide dosing.
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Affiliation(s)
- Swantje Völler
- Division of Pharmacology, Division Systems Pharmacology and Biomedicine, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands
| | - Robert B Flint
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter Andriessen
- Division of Neonatology, Department of Pediatrics, Máxima Medical Center, Veldhoven, The Netherlands
| | - Karel Allegaert
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Luc J I Zimmermann
- Department of Pediatrics, School of Oncology and Developmental Biology, School of Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Kian D Liem
- Division of Neonatology, Department of Pediatrics, Radboudumc, Nijmegen, The Netherlands
| | - Birgit C P Koch
- Department of Pharmacy, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sinno H P Simons
- Division of Neonatology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Catherijne A J Knibbe
- Division of Pharmacology, Division Systems Pharmacology and Biomedicine, Leiden Academic Centre for Drug Research, Leiden University, Leiden, The Netherlands.,Department of Clinical Pharmacy, St Antonius Hospital, Nieuwegein, The Netherlands
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The Effects of Acute Neonatal Pain on Expression of Corticotropin-Releasing Hormone and Juvenile Anxiety in a Rodent Model. eNeuro 2019; 6:ENEURO.0162-19.2019. [PMID: 31601633 PMCID: PMC6860982 DOI: 10.1523/eneuro.0162-19.2019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 01/01/2023] Open
Abstract
Premature infants in the neonatal intensive care unit (NICU) may be subjected to numerous painful procedures without analgesics. One necessary, though acutely painful, procedure is the use of heel lances to monitor blood composition. The current study examined the acute effects of neonatal pain on maternal behavior as well as amygdalar and hypothalamic activation, and the long-term effects of neonatal pain on later-life anxiety-like behavior, using a rodent model. Neonatal manipulations consisted of either painful needle pricks or non-painful tactile stimulation in subjects’ left plantar paw surface which occurred four times daily during the first week of life [postnatal day (PND)1–PND7]. Additionally, maternal behaviors in manipulated litters were compared against undisturbed litters via scoring of videotaped interactions to examine the long-term effects of pain on dam-pup interactions. Select subjects underwent neonatal brain collection (PND6) and fluorescent in situ hybridization (FISH) for corticotropin-releasing hormone (CRH) and the immediate early gene c-fos. Other subjects were raised to juvenile age (PND24 and PND25) and underwent innate anxiety testing utilizing an elevated plus maze (EPM) protocol. FISH indicated that neonatal pain influenced amygdalar CRH and c-fos expression, predominately in males. No significant increase in c-fos or CRH expression was observed in the hypothalamus. Additionally, neonatal pain altered anxiety behaviors independent of sex, with neonatal pain subjects showing the highest frequency of exploratory behavior. Neonatal manipulations did not alter maternal behaviors. Overall, neonatal pain drives CRH expression and produces behavioral changes in anxiety that persist until the juvenile stage.
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81
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Pettersson M, Olsson E, Ohlin A, Eriksson M. Neurophysiological and behavioral measures of pain during neonatal hip examination. ACTA ACUST UNITED AC 2019; 1:15-20. [PMID: 35546870 PMCID: PMC8974883 DOI: 10.1002/pne2.12006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 11/08/2022]
Abstract
Introduction The aim of this study was to test the hypothesis that neonatal hip examination causes pain in newborns. Pain assessment using instruments such as the Premature Infant Pain Profile‐Revised (PIPP‐R) scale is recommended, but recently physiological and neurophysiological measures, for example, near‐infrared spectroscopy (NIRS) and galvanic skin response (GSR), have been used as well. Methods Heart auscultation and hip examination were performed, and the response of the newborn was registered by NIRS optodes, GSR electrodes, and a pulse oximeter probe attached to the infant. The face of the newborn was filmed. Heart auscultation was used as a nonpainful reference. Results The pain scores for hip examination were higher than for the heart auscultation. Near‐infrared spectroscopy showed a significant higher increase from baseline in oxygenated hemoglobin (HbO2) on both sides of the cortex at hip examination compared with at heart auscultation (P = .011 and P = .017). Mean PIPP‐R scores for the hip examination compared with heart auscultation increased from 3.0 to 8.1 (P = .000). The GSR analyses of hip examination compared with heart auscultation showed a significant increase in area under small peaks during the hip examination (P = .016), however, not when measured in peaks per second (P = .104). Interrater reliability was calculated for the NIRS interpretations, with an intraclass correlation coefficient (ICC) range of 0.93‐1.0 (P = .000). Discussion Pain in newborns can have negative consequences, and pain prevention and treatment are therefore important. We conclude that neonatal hip examinations are painful and that the pain should be treated, for example, with oral sweet solution. This is a change from present routines during neonatal hip examination and is hoped to lead to a change in national guidelines.
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Affiliation(s)
- Miriam Pettersson
- Department of Paediatrics Faculty of Medicine and Health Örebro University Örebro Sweden
- Faculty of Medicine and Health School of Medical Sciences Örebro University Örebro Sweden
| | - Emma Olsson
- Department of Paediatrics Faculty of Medicine and Health Örebro University Örebro Sweden
- Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
| | - Andreas Ohlin
- Department of Paediatrics Faculty of Medicine and Health Örebro University Örebro Sweden
- Faculty of Medicine and Health School of Medical Sciences Örebro University Örebro Sweden
| | - Mats Eriksson
- Department of Paediatrics Faculty of Medicine and Health Örebro University Örebro Sweden
- Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
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Richardson B, Benoit B, Rutledge K, Dol J, Misener RM, Latimer M, Smit M, McGrath P, Campbell-Yeo M. The impact of parent-targeted eHealth educational interventions on infant procedural pain management: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2019; 17:1589-1599. [PMID: 31404050 DOI: 10.11124/jbisrir-d-19-00007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The objective of this review is to determine if electronic health (eHealth) educational interventions for infant procedural pain and pain management impact parental outcomes (mental health outcomes, knowledge utilization outcomes, and parental involvement in care outcomes) and infant outcomes (morbidity outcomes, pain outcomes, health system outcomes). INTRODUCTION Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, yet infants often receive little to no pain management. While research has shown that parents can reduce their infant's pain during procedures by breastfeeding or skin-to-skin contact, parents may not be aware of their role in pain management. Despite the recent rapid increase in eHealth resources to educate parents about infant pain management, their impact has yet to be evaluated. INCLUSION CRITERIA This review will consider studies that include eHealth educational interventions targeted at parents during pregnancy and up to one year postpartum. All experimental study designs will be included. Primary outcomes will include: parental stress and anxiety, self-efficacy, knowledge, attitudes, eHealth intervention usage, acceptance of eHealth intervention, involvement in pain management, and infant pain response. METHODS PubMed, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO will be searched for studies published in English. Critical appraisal and data extraction will be conducted by two independent reviewers using standardized tools. Quantitative data, where possible, will be pooled in statistical meta-analysis, or if statistical pooling is not possible, the findings will be reported narratively.
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Affiliation(s)
- Brianna Richardson
- School of Nursing, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence
- Centre for Transformative Nursing and Health Research, Halifax, Canada
| | - Britney Benoit
- School of Nursing, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence
- Centre for Transformative Nursing and Health Research, Halifax, Canada
| | - Kallen Rutledge
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | - Justine Dol
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence
- Faculty of Health, Dalhousie University, Halifax, Canada
| | - Ruth Martin Misener
- School of Nursing, Dalhousie University, Halifax, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence
- Centre for Transformative Nursing and Health Research, Halifax, Canada
| | - Margot Latimer
- School of Nursing, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence
- Centre for Transformative Nursing and Health Research, Halifax, Canada
| | - Michael Smit
- School of Information Management, Dalhousie University, Halifax, Canada
| | - Patrick McGrath
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Department of Psychiatry, Dalhousie University, Halifax, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Dalhousie University, Halifax, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): a Joanna Briggs Institute Centre of Excellence
- Centre for Transformative Nursing and Health Research, Halifax, Canada
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, Canada
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Davis SM, Rice M, Burman MA. Inflammatory neonatal pain disrupts maternal behavior and subsequent fear conditioning in a rodent model. Dev Psychobiol 2019; 62:88-98. [PMID: 31270817 DOI: 10.1002/dev.21889] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 05/22/2019] [Accepted: 06/08/2019] [Indexed: 01/05/2023]
Abstract
Infants spending extended time in the neonatal intensive care unit are at greater risk of developing a variety of mental health problems later in life, possibly due to exposure to painful/stressful events. We used a rodent model of inflammatory neonatal pain to explore effects on fear conditioning, somatosensory function and maternal behavior. Hindpaw injections of 2% λ-carrageenan on postnatal days 1 and 4 produced an attenuation in conditioned freezing during the postweaning period, similar to our previous work with acute pain, but did not cause lasting impacts on contextual freezing nor somatosensory function. Additionally, we assessed maternal behavior to observe dam-pup interactions during the neonatal period. Results showed dams of litters which experienced pain spent similar amounts of time with pups as undisturbed controls. However, the specific behaviors differed per condition. Dams of pain litters exhibited less time licking/grooming, but more time nursing than controls. These results suggest changes in maternal care following pain could be a contributing factor underlying the long-term effects of neonatal trauma. Furthermore, our laboratory has previously shown acute, but not inflammatory pain, disrupted conditioned freezing; the current experiment observed the long-term effects of neonatal inflammatory pain on conditioned fear using a weak conditioning protocol.
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Affiliation(s)
- Seth M Davis
- Department of Psychology, University of New England, Biddeford, Maine.,Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine
| | - Makaela Rice
- Department of Psychology, University of New England, Biddeford, Maine.,Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine
| | - Michael A Burman
- Department of Psychology, University of New England, Biddeford, Maine.,Center for Excellence in the Neurosciences, University of New England, Biddeford, Maine
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84
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Harrison TM. Improving neurodevelopment in infants with complex congenital heart disease. Birth Defects Res 2019; 111:1128-1140. [PMID: 31099484 DOI: 10.1002/bdr2.1517] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 05/02/2019] [Indexed: 12/15/2022]
Abstract
Worldwide, more than 400,000 infants are born each year with complex congenital heart disease (CCHD) requiring surgical intervention within the first months of life. Although improvements in perioperative care have resulted in increased rates of survival, more than half of infants with CCHD have neurodevelopmental impairments affecting subsequent educational achievements, job opportunities, and mental health. Brain maturity and impaired outcomes in infants with CCHD are similar to those of prematurely born infants. Developmentally supportive care, including foundational application of kangaroo care (KC), improves neurodevelopment in premature infants. Provision of developmentally supportive care with KC during the early hospitalization of infants with CCHD has the potential to similarly improve neurodevelopment. The purposes of the article are to describe common congenital heart defects, describe developmentally supportive care with an emphasis on KC, and to offer specific recommendations for KC and research in infants with CCHD.
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85
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Filippa M, Poisbeau P, Mairesse J, Monaci MG, Baud O, Hüppi P, Grandjean D, Kuhn P. Pain, Parental Involvement, and Oxytocin in the Neonatal Intensive Care Unit. Front Psychol 2019; 10:715. [PMID: 31001173 PMCID: PMC6454868 DOI: 10.3389/fpsyg.2019.00715] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 03/14/2019] [Indexed: 12/16/2022] Open
Abstract
Preterm infants (PTI) typically experience many painful and stressful procedures or events during their first weeks of life in a neonatal intensive care unit, and these can profoundly impact subsequent brain development and function. Several protective interventions during this sensitive period stimulate the oxytocin system, reduce pain and stress, and improve brain development. This review provides an overview of the environmental risk factors experienced by PTI during hospitalization, with a focus on the effects of pain, and early maternal separation. We also describe the long-term adverse effects of the simultaneous experiences of pain and maternal separation, and the potential beneficial effects of maternal vocalizations, parental contact, and several related processes, which appear to be mediated by the oxytocin system.
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Affiliation(s)
- Manuela Filippa
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology and Educational Sciences, Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland.,Department of Social Sciences, University of Valle d'Aosta, Aosta, Italy
| | - Pierrick Poisbeau
- Centre National de la Recherche Scientifique, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, Strasbourg, France
| | - Jérôme Mairesse
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,Division of Neonatology and Paediatric Intensive Care, Department of Paediatrics, Gynaecology and Obstetrics, Universtiy of Geneva, Geneva, Switzerland
| | | | - Olivier Baud
- INSERM U1141 Protect, Paris-Diderot University, Paris, France.,Division of Neonatology and Paediatric Intensive Care, Department of Paediatrics, Gynaecology and Obstetrics, Universtiy of Geneva, Geneva, Switzerland.,Service de Médecine et Réanimation Néonatale, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Petra Hüppi
- Division of Development and Growth, Department of Paediatrics, Gynaecology and Obstetrics, University of Geneva, Geneva, Switzerland.,Division of Neonatology and Paediatric Intensive Care, Department of Paediatrics, Gynaecology and Obstetrics, Universtiy of Geneva, Geneva, Switzerland
| | - Didier Grandjean
- Neuroscience of Emotion and Affective Dynamics Laboratory, Department of Psychology and Educational Sciences, Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Pierre Kuhn
- Centre National de la Recherche Scientifique, Institute for Cellular and Integrative Neurosciences, University of Strasbourg, Strasbourg, France.,Service de Médecine et Réanimation Néonatale, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
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86
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Dani C, Becciani S, Pratesi S. Changes in total serum bilirubin during phototherapy in late preterm and term infants with non-haemolytic hyperbilirubinemia. Early Hum Dev 2019; 131:41-44. [PMID: 30831388 DOI: 10.1016/j.earlhumdev.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/06/2019] [Accepted: 02/25/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is no standardized method for total serum bilirubin (TSB) monitoring during phototherapy for neonatal hyperbilirubinemia and national guidelines give heterogeneous indications. AIM To assess the hypothesis that TSB values do not exceed exsanguino-transfusion (EXT) threshold during phototherapy and that it is possible to decrease its monitoring frequency in jaundiced infants. STUDY DESIGN We carried out a prospective observational study in which changes in TSB during phototherapy for non-haemolytic hyperbilirubinemia were recorded in a cohort of late preterm and term infants. TSB values after 6, 12, 18, and 24 h of phototherapy were compared to the EXT threshold matched to infants' gestational and postnatal age according to the specific nomogram of the Italian Society of Neonatology guidelines. RESULTS We studied 105 infants who started phototherapy at a mean age of 89 ± 37 h when mean TSB was 17.1 ± 2.5 mg/dL. We found that TSB decreased during phototherapy and the difference between mean TSB and EXT threshold progressively increased during phototherapy; TSB exceeded EXT threshold in none of our patients (0%). CONCLUSIONS Our study demonstrates that differences between mean TSB and EXT threshold increased during phototherapy in late preterm and term infants with non-haemolytic hyperbilirubinemia; in none of our patients TSB exceeded EXT threshold. Our findings support the possibility of safely decreasing TSB monitoring during phototherapy, thus limiting noxious painful stimuli in neonates.
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Affiliation(s)
- Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy; Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy.
| | - Sabrina Becciani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Simone Pratesi
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
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87
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Olsson E, Pettersson M, Eriksson M, Ohlin A. Oral sweet solution to prevent pain during neonatal hip examination: a randomised controlled trial. Acta Paediatr 2019; 108:626-629. [PMID: 30246505 PMCID: PMC6585692 DOI: 10.1111/apa.14588] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/25/2018] [Accepted: 09/19/2018] [Indexed: 11/28/2022]
Abstract
Aim To determine if oral glucose can have a pain‐relieving effect during routine hip examinations in newborn infants. Methods In this randomised controlled study 100 newborn infants undergoing the routine physical examination including the potentially painful hip examination were included between March 2016 and April 2017. Fifty infants were randomised to water (control) and 50 to oral glucose (intervention) before their examination. Pain was assessed using crying time, Astrid Lindgren and Lund Children's Hospital Pain and Stress Assessment Scale (ALPS‐Neo) and Visual analogue scale (VAS). Results Total crying time (p = 0.006), crying time during the hip examination (p = 0.026), ALPS‐Neo (p = 0.004) and VAS (p = 0.006) (when assessed by the physician) were all significantly decreased in the group of infants receiving glucose. VAS assessment made by the parents did not reach statistical significance (p = 0.127). Conclusion Oral glucose given before the examination has a pain‐relieving effect during the hip examination in healthy newborn infants.
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Affiliation(s)
- Emma Olsson
- Department of Pediatrics; Faculty of Medicine and Health; Örebro University; Örebro Sweden
- Faculty of Medicine and Health; School of Health Sciences; Örebro University; Örebro Sweden
| | - Miriam Pettersson
- Department of Pediatrics; Faculty of Medicine and Health; Örebro University; Örebro Sweden
- Faculty of Medicine and Health; School of Medical Sciences; Örebro University; Örebro Sweden
| | - Mats Eriksson
- Department of Pediatrics; Faculty of Medicine and Health; Örebro University; Örebro Sweden
- Faculty of Medicine and Health; School of Health Sciences; Örebro University; Örebro Sweden
| | - Andreas Ohlin
- Department of Pediatrics; Faculty of Medicine and Health; Örebro University; Örebro Sweden
- Faculty of Medicine and Health; School of Medical Sciences; Örebro University; Örebro Sweden
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88
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Pascoe MJ, Melzer TR, Horwood LJ, Woodward LJ, Darlow BA. Altered grey matter volume, perfusion and white matter integrity in very low birthweight adults. NEUROIMAGE-CLINICAL 2019; 22:101780. [PMID: 30925384 PMCID: PMC6438988 DOI: 10.1016/j.nicl.2019.101780] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Revised: 03/11/2019] [Accepted: 03/14/2019] [Indexed: 11/26/2022]
Abstract
This study examined the long-term effects of being born very-low-birth-weight (VLBW, <1500 g) on adult cerebral structural development using a multi-method neuroimaging approach. The New Zealand VLBW study cohort comprised 413 individuals born VLBW in 1986. Of the 338 who survived to discharge, 229 were assessed at age 27–29 years. Of these, 150 had a 3 T MRI scan alongside 50 healthy term-born controls. The VLBW group included 53/57 participants born <28 weeks gestation. MRI analyses included: a) structural MRI to assess grey matter (GM) volume and cortical thickness; b) arterial spin labelling (ASL) to quantify GM perfusion; and c) diffusion tensor imaging (DTI) to measure white matter (WM) integrity. Compared to controls, VLBW adults had smaller GM volumes within frontal, temporal, parietal and occipital cortices, bilateral cingulate gyri and left caudate, as well as greater GM volumes in frontal, temporal and occipital areas. Thinner cortex was observed within frontal, temporal and parietal cortices. VLBW adults also had less GM perfusion within limited temporal areas, bilateral hippocampi and thalami. Finally, lower fractional anisotropy (FA) and axial diffusivity (AD) within principal WM tracts was observed in VLBW subjects. Within the VLBW group, birthweight was positively correlated with GM volume and perfusion in cortical and subcortical regions, as well as FA and AD across numerous principal WM tracts. Between group differences within temporal cortices were evident across all imaging modalities, suggesting that the temporal lobe may be particularly susceptible to disruption in development following preterm birth. Overall, findings reveal enduring and pervasive effects of preterm birth on brain structural development, with individuals born at lower birthweights having greater long-term neuropathology. Very-low-birth-weight adults had smaller GM volumes and thinner cortex than controls. VLBW adults also showed regions of larger grey matter volumes and thicker cortex. Several small regions showed lower cerebral perfusion in VLBW adults than in controls. Diffusion tensor MRI suggested poorer WM integrity in VLBW adults than in controls. Within VLBW adults, all MRI measures showed positive associations with birthweight.
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Affiliation(s)
- Maddie J Pascoe
- New Zealand Brain Research Institute, Christchurch 8011, New Zealand.
| | - Tracy R Melzer
- New Zealand Brain Research Institute, Christchurch 8011, New Zealand; Department of Medicine, University of Otago, Christchurch 8011, New Zealand.
| | - L John Horwood
- Department of Psychological Medicine, University of Otago, Christchurch 8011, New Zealand.
| | - Lianne J Woodward
- School of Health Sciences, University of Canterbury, Christchurch 8041, New Zealand.
| | - Brian A Darlow
- Department of Paediatrics, University of Otago, Christchurch 8011, New Zealand.
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89
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Williams N, MacLean K, Guan L, Collet JP, Holsti L. Pilot Testing a Robot for Reducing Pain in Hospitalized Preterm Infants. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2019; 39:108-115. [PMID: 30770034 DOI: 10.1177/1539449218825436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Optimizing neurodevelopment is a key goal of neonatal occupational therapy. In preterm infants, repeated procedural pain is associated with adverse effects on neurodevelopment long term. Calmer is a robot designed to reduce infant pain. The objective of this study was to examine the effects of Calmer on heart rate variability (HRV) during routine blood collection in preterm infants. In a randomized controlled pilot trial, 10 infants were assigned to either standard care ( n = 5, facilitated tucking [FT]) or Calmer treatment ( n = 5). HRV was recorded continuously and quantified using the area (power) of the spectrum in high and low frequency (HF: 0.15-0.40Hz/ms2; LF: 0.04-0.15 Hz/ms2) regions. Changes in HRV during three, 2-min phases (Baseline, Heel Poke, and Recovery) were compared between groups. Calmer infants had 90% greater parasympathetic activation ([PS] reduced stress) during Baseline, 82% greater PS activation during Poke, and 24% greater PS activation during Recovery than FT infants. Calmer reduced physiological preterm infant pain reactivity during blood collection.
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Affiliation(s)
| | - Karon MacLean
- The University of British Columbia, Vancouver, Canada
| | - Ling Guan
- The University of British Columbia, Vancouver, Canada
| | | | - Liisa Holsti
- The University of British Columbia, Vancouver, Canada
- BC Children’s Hospital Research Institute, Vancouver, Canada
- BC Women’s Hospital Research Institute, Vancouver, Canada
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90
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Abstract
Historically, newborns, and especially premature newborns, were thought to "feel nothing." However, over the past decades, a growing body of evidence has shown that newborns are aware of their environment, but the extent and the onset of some sensory capacities remain largely unknown. The goal of this review is to update our current knowledge concerning newborns' perceptual world and how ready they are to cope with an entirely different sensory environment following birth. We aim to establish not only how and when each sensory ability arises during the pre-/postbirth period but also discuss how senses are studied. We conclude that although many studies converge to show that newborns are clearly sentient beings, much is still unknown. Further, we identify a series of internal and external factors that could explain discrepancies between studies, and we propose perspectives for future studies. Finally, through examples from animal studies, we illustrate the importance of this detailed knowledge to pursue the enhancement of newborns' daily living conditions. Indeed, this is a prerequisite for assessing the effects of the physical environment and routine procedures on newborns' welfare.
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91
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Kommers DR, Joshi R, van Pul C, Feijs L, Bambang Oetomo S, Andriessen P. Changes in autonomic regulation due to Kangaroo care remain unaffected by using a swaddling device. Acta Paediatr 2019; 108:258-265. [PMID: 29959869 PMCID: PMC6586026 DOI: 10.1111/apa.14484] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 06/19/2018] [Accepted: 06/27/2018] [Indexed: 12/17/2022]
Abstract
Aim To investigate the effects of a swaddling device known as the Hugsy (Hugsy, Eindhoven, the Netherlands) towards improving autonomic regulation. This device can be used both in the incubator and during Kangaroo care to absorb parental scent and warmth. After Kangaroo care, these stimuli can continue to be experienced by infants, while in the incubator. Additionally, a pre‐recorded heartbeat sound can be played. Method Autonomic regulation was compared in preterm infants before, during and after Kangaroo care with and without the use of a swaddling device in a within‐subject study carried out in a level III neonatal intensive care unit. Descriptive statistics and effect sizes were calculated corresponding to changes in heart rate, respiratory rate, oxygen saturation, temperature and heart rate variability on intervention versus control days. Results In this study of 20 infants with a median (interquartile range) gestational age of 28.4 (27–29.9) weeks, Kangaroo care was associated with a decrease in heart rate, respiratory rate and heart rate variability on both intervention and control days. There were no differences between intervention and control days. Conclusion The use of an alternative swaddling device aimed at facilitating Kangaroo care did not enhance autonomic regulation, as measured by vital signs and heart rate variability.
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Affiliation(s)
- Deedee R. Kommers
- Department of Neonatology; Máxima Medical Centre; Veldhoven The Netherlands
- Department of Applied Physics; Eindhoven University of Technology; Eindhoven The Netherlands
| | - Rohan Joshi
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
- Department of Clinical Physics; Máxima Medical Centre Veldhoven; Veldhoven The Netherlands
- Department of Fertility; Pregnancy and Parenting Solutions, Philips Research; Eindhoven The Netherlands
| | - Carola van Pul
- Department of Applied Physics; Eindhoven University of Technology; Eindhoven The Netherlands
- Department of Clinical Physics; Máxima Medical Centre Veldhoven; Veldhoven The Netherlands
| | - Loe Feijs
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - Sidarto Bambang Oetomo
- Department of Neonatology; Máxima Medical Centre; Veldhoven The Netherlands
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - Peter Andriessen
- Department of Neonatology; Máxima Medical Centre; Veldhoven The Netherlands
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92
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The interplay between prematurity, maternal stress and children's intelligence quotient at age 11: A longitudinal study. Sci Rep 2019; 9:450. [PMID: 30679588 PMCID: PMC6345959 DOI: 10.1038/s41598-018-36465-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
Very premature children (<33 weeks of gestational age (GA)) experience greater academic difficulties and have lower, though normal-range, intelligence quotients (IQs) versus their full-term peers. These differences are often attributed to GA or familial socio-economic status (SES). However, additional factors are increasingly recognized as likely contributors. Parental stress after a child's premature birth can present as post-traumatic stress disorder (PTSD) symptoms and can in turn reinforce difficulties in parent-child interaction pattern. Following a longitudinal design, we studied the interplay between a premature child's perinatal history and maternal PTSD symptoms on intelligence abilities assessed at 11 years of age. Thirty-three very preterm and 21 full-term mother-children dyads partook in the study. Children's perinatal risk was evaluated at hospital discharge, maternal PTSD symptoms were assessed when the children were 18 months old, and children's IQ was measured at 11 years old. IQ was significantly lower for preterm than full-term children, without reliable influences from perinatal risk scores. However, lower maternal PTSD symptoms predicted higher IQ in preterm children. This preliminary study highlights the importance detecting maternal PTSD symptoms after a preterm birth and suggests interventions should target reducing maternal PTSD symptoms during early childhood to enhance very preterm children's intelligence development.
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93
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Chen YS, Tan YJ, Zhou LS. [Clinical effect of maternal voice stimulation in alleviating procedural pain in hospitalized neonates]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:58-63. [PMID: 30675865 PMCID: PMC7390185 DOI: 10.7499/j.issn.1008-8830.2019.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/07/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To study the clinical effect of maternal voice stimulation in alleviating procedural pain in neonates during heel blood collection. METHODS A total of 72 neonates who were admitted to the neonate intensive care unit were randomly divided into an intervention group (n=35) and a control group (n=37). Heel blood collection was performed by the routine method in the control group. The intervention group listened to their mothers' voice from 1 minute before heel blood collection to the end of the procedure. Pain score, incidence of crying, and vital signs were recorded before and after heel blood collection. RESULTS Compared with the control group, the heart rate was significantly reduced, the blood oxygen saturation significantly increased, the incidence of crying and the pain score were significantly reduced in the intervention group during the procedure of heel blood collection (P<0.05). CONCLUSIONS Maternal voice stimulation helps to reduce procedural pain and maintain stable vital signs in neonates.
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94
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Mbozi P, Ratcliff C. Clinical Audit Project Report —Audit of the Palliative Care Practitioners’ Adherence to WHO Guidelines in Managing Patients’ Pain at Cancer Diseases Hospital, Lusaka, Zambia. Health (London) 2019. [DOI: 10.4236/health.2019.1112124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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95
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Bomersbach A, Sochocka L. Assessment of the intensity of procedural pain in newborns treated in the intensive care unit measured by the Neonatal Infant Pain Scale (NIPS). ACTA ACUST UNITED AC 2018. [DOI: 10.5604/01.3001.0012.8319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
<b>Introduction:</b> Newborns born prematurely and treated in intensive care units are at greater risk of experiencing pain than patients treated in other units. <b>Purpose:</b> To evaluate the severity of pain perceived by children during the performance of medical procedures related to the treatment and care process. <b>Materials and methods:</b> The study was conducted at one of the Intensive Care Units in Opole. The study group consisted of 100 newborns, 60% of the subjects were prematurely born newborns, and 40% - were full-term. The degree of procedural pain associated with blood collection, peripheral puncture insertion, upper respiratory tract suction, gastric tube insertion and ophthalmic examination was assessed by an observation method using the standard Neonatal Infant Pain Scale Form (NIPS). <b>Results:</b> Out of the analysed medical procedures, 100% of children experienced acute, severe pain over the course of suction and ophthalmological examination. The highest perception of pain was experienced by 88.3% of premature newborns and 71.8% of full-term newborns. Over the course of medical procedures, 84% of male and 79.6% female newborns experienced acute pain. It was shown that the degree of pain perception was determined by the type of performed medical procedure (p=0.001) and the gestational age of the newborn (p=0.037). On the other hand, there was no correlation between the sex of the newborn child and the degree of pain perception (p=0.758). <b>Conclusions:</b> Based on the foregoing study result, bearing in mind the need to minimise the effects of pain stimulation, it seems important to use standardised tools to assess the severity of pain in newborns treated in Intensive Care Units on a larger scale.
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Affiliation(s)
- A. Bomersbach
- Faculty of Medical Sciences, Public Higher Medical Professional School in Opole, Poland
| | - L. Sochocka
- Opole Centre for Gynecology, Obstetrics and Neonatology, Poland
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96
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Campbell-Yeo M, Benoit B. Use of morphine before retinopathy of prematurity examinations. Lancet 2018; 392:2521-2523. [PMID: 30509742 DOI: 10.1016/s0140-6736(18)32324-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/13/2018] [Indexed: 10/27/2022]
Affiliation(s)
| | - Britney Benoit
- Dalhousie University School of Nursing, Halifax, NS B3H 4R2, Canada
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97
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Kinoshita M, Iwata S, Okamura H, Tsuda K, Saikusa M, Harada E, Yamashita Y, Saitoh S, Iwata O. Feeding-Induced Cortisol Response in Newborn Infants. J Clin Endocrinol Metab 2018; 103:4450-4455. [PMID: 30085188 DOI: 10.1210/jc.2018-01052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 07/31/2018] [Indexed: 02/13/2023]
Abstract
CONTEXT Understanding the biological rhythms and stress response in sick newborns is important to minimize the negative effects of intensive care. Salivary cortisol has been used as a noninvasive surrogate marker of adrenal function; however, understanding of its control variables is insufficient. OBJECTIVE To investigate the presence of feeding-induced cortisol response and its control variables in newborns. DESIGN, SETTING, AND PATIENTS Fifty-three newborn infants, who were between 30 and 40 weeks' corrected age and were on 3-hourly regular oral/enteral feeding, were recruited between January 2013 and June 2014. MAIN OUTCOME MEASURE Saliva samples were collected before and 1 hour after regular feeding. Dependence of cortisol levels (adjusted for postnatal age) and their feeding-related elevation on clinical variables was assessed by using generalized estimating equations. RESULTS Higher cortisol levels were associated with corrected age ≥37 weeks and saliva samples collected after feeding (both P < 0.001). Oral feeding was associated with a greater feeding-induced cortisol response compared with exclusive enteral feeding (P = 0.034), whereas a prolonged feeding duration (≥30 minutes) was associated with a reduced cortisol response compared with brief feeding (<30 minutes) (P < 0.001). Gestational age, corrected age, antenatal/postnatal glucocorticoids, type of milk, and daily feeding volume had no effect on cortisol response. CONCLUSIONS Feeding-induced cortisol response was observed in newborns. The cortisol response was more prominent following oral feeding and was reduced with prolonged feeding. Future studies may investigate whether feeding-induced cortisol response plays a role in the acquisition of adrenal ultradian and diurnal rhythms.
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Affiliation(s)
- Masahiro Kinoshita
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Sachiko Iwata
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Hisayoshi Okamura
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Kennosuke Tsuda
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Mamoru Saikusa
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Eimei Harada
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Yushiro Yamashita
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Shinji Saitoh
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Osuke Iwata
- Centre for Developmental and Cognitive Neuroscience, Department of Paediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
- Center for Human Development and Family Science, Department of Neonatology and Pediatrics, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
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98
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Hundert AS, Campbell-Yeo M, Brook HR, Wozney LM, O'Connor K. Development and Usability Evaluation of a Desktop Software Application for Pain Assessment in Infants. Can J Pain 2018; 2:302-314. [PMID: 35005387 PMCID: PMC8730649 DOI: 10.1080/24740527.2018.1540261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Background Pain assessment is a key component of pain management and research in infants. We developed software to assist in coding of pain in infants called PAiN (Pain Assessment in Neonates). Aims The aims of this study were to evaluate the usability of PAiN in terms of effectiveness, efficiency, and satisfaction among novice and expert users and to compare the efficiency and satisfaction of PAiN to existing software for coding of infant pain among expert users. Methods A quantitative usability testing approach was conducted with two participant groups, representing novice and expert end-users. Testing included an observed session with each participant completing a pain assessment coding task, followed by administration of the Post Study System Usability Questionnaire and Desirability Toolkit. For comparison, the usability of existing coding software was also evaluated by the expert group. Results Twelve novice and six expert users participated. Novice users committed 14 noncritical navigational errors, and experts committed six. For experts, the median time for completing the coding task was 28.6 min in PAiN, compared to 46.5 min using the existing software. The mean Post Study System Usability Questionnaire score among novice (1.89) and expert users (1.40) was not significantly different (P = 0.0917). Among experts, the score for the existing software (4.83) was significantly (P = 0.0277) higher compared to PAiN (1.40). Lower scores indicate more positive responses. Conclusions Users were highly satisfied with PAiN. Experts were more efficient with PAiN compared to the existing software. The study was critical to ensuring that PAiN is error free and easy to use prior to implementation.
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Affiliation(s)
- Amos S Hundert
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada.,Novum Scientific, Antigonish, Nova Scotia, Canada
| | - Marsha Campbell-Yeo
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada.,School of Nursing, Centre for Transformative Nursing and Health Research, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Harrison R Brook
- Novum Scientific, Antigonish, Nova Scotia, Canada.,Department of Geosciences, University of Edinburgh, Edinburgh, UK
| | - Lori M Wozney
- Centre for Research in Family Health, IWK Health Centre, Halifax, Nova Scotia,Canada
| | - Kelly O'Connor
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
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99
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Nelson S, Conroy C, Logan D. The biopsychosocial model of pain in the context of pediatric burn injuries. Eur J Pain 2018; 23:421-434. [PMID: 30288844 DOI: 10.1002/ejp.1319] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/20/2018] [Accepted: 09/28/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND Burns are a common and traumatic source of childhood injury in the United States. The treatment and recovery from burn injuries can be significantly painful and may lead to chronic or persistent pain for years following the initial incident. Further, burn injuries in youth have been found to increase the potential for significant psychosocial (e.g., anxiety, depression, PTSD) and physical (e.g., decreased mobility) impairment. Relatedly, the general experience and processing of pain in youth can also be associated with greater psychosocial (e.g., anxiety, depression) impairment and functional disability over time. However, the phenomenology and associated characteristics of the pain experience following burn injury and, in particular, the potential for combined impact on physical and psychosocial outcomes in youth with severe and/or prolonged pain and a history of burn injury is poorly understood. METHODS A review of the literature was performed in the areas of burn injuries and outcomes associated with both acute and chronic pain with youth and adult populations. RESULTS The current review highlights current gaps in the literature in important areas of function in youth with a history of burn injuries using the biopsychosocial model of pain. Future research and considerations for practice are also outlined. CONCLUSIONS Gaining a greater understanding of the relationship between pain, physical impairment, and psychosocial functioning in these youth is significantly important in order to provide greater preventative and treatment-related intervention going forward. SIGNIFICANCE Using a biopsychosocial framework, this review highlights the need for a greater understanding of pain processing and the long-term potential for persistent pain and pain-related impairment (e.g., functional disability) in youth with a history of burn injuries.
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Affiliation(s)
- Sarah Nelson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Caitlin Conroy
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts.,Mayo Clinic Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, Massachusetts
| | - Deirdre Logan
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
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100
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Buyuktiryaki M, Uras N, Okur N, Oncel MY, Simsek GK, Isik SO, Oguz SS. Evaluation of prolonged pain in preterm infants with pneumothorax using heart rate variability analysis and EDIN (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) scores. KOREAN JOURNAL OF PEDIATRICS 2018; 61:322-326. [PMID: 30304911 PMCID: PMC6212710 DOI: 10.3345/kjp.2017.05939] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 07/16/2018] [Indexed: 02/01/2023]
Abstract
Purpose The EDIN scale (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) and heart rate variability has been used for the evaluation of prolonged pain. The aim of our study was to assess the value of the newborn infant parasympathetic evaluation (NIPE) index and EDIN scale for the evaluation of prolonged pain in preterm infants with chest tube placement due to pneumothorax. Methods This prospective observational study assessed prolonged pain in preterm infants with a gestational age between 33 and 35 weeks undergoing installation of chest tubes. Prolonged pain was assessed using the EDIN scale and NIPE index. Results There was a significant correlation between the EDIN scale and NIPE index (r=-0.590, P=0.003). Prolonged pain is significantly more severe in the first 6 hours following chest tube installation (NIPE index: 60 [50–86] vs. 68 [45–89], P<0.002; EDIN score: 8 [7–11] vs. 6 [4–8], P<0.001). Conclusion Prolonged pain can be accurately assessed with the EDIN scale and NIPE index. However, evaluation with the EDIN scale is time-consuming. The NIPE index can provide instantaneous assessment of prolonged and continuous pain.
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Affiliation(s)
- Mehmet Buyuktiryaki
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Nurdan Uras
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Nilufer Okur
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Mehmet Yekta Oncel
- Division of Neonatology, Department of Pediatrics, Katip Çelebi University, İzmir, Turkey
| | | | - Sehribanu Ozluer Isik
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Serife Suna Oguz
- Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
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