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Lisanti AJ, Vittner D, Medoff-Cooper B, Fogel J, Wernovsky G, Butler S. Individualized Family-Centered Developmental Care: An Essential Model to Address the Unique Needs of Infants With Congenital Heart Disease. J Cardiovasc Nurs 2020; 34:85-93. [PMID: 30303895 PMCID: PMC6283700 DOI: 10.1097/jcn.0000000000000546] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infants born with critical congenital heart disease (cCHD) who require surgical intervention in the newborn period are often hospitalized in a cardiac intensive care unit (CICU). Cardiac surgery and the CICU environment are traumatic to infants and their families. Infants are exposed to overwhelming stress, which can result in increased pain, physiologic instability, behavioral disorganization, disrupted attachment, and altered brain development. Individualized Family-centered Developmental Care (IFDC) is a model that can address the unique needs and developmental challenges of infants with cCHD. PURPOSE The purpose of this article is to (1) clearly describe the uniqueness of the infant with cCHD, including the medical, neurological, and parental challenges, and (2) propose methods to apply IFDC to support recovery of infants with cCHD in the CICU. CONCLUSIONS The experiences in the CICU shape the developing brain and alter recovery and healing, thus adversely impacting development. Individualized Family-centered Developmental Care is a promising model of care that nurses can integrate into the CICU to promote neuroprotection and development. Nurses can effectively integrate IFDC into the CICU by understanding the unique characteristics of infants with cCHD and applying IFDC interventions that include both maturity and recovery perspectives. CLINICAL IMPLICATIONS The incorporation of IFDC interventions is essential for the infant with cCHD and should be a standard of care. Applying IFDC with a recovery perspective in all aspects of caregiving will provide opportunities for individualization of care and parent engagement, allowing infants in the CICU to recover from surgery while supporting both short- and long-term neurodevelopment.
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Affiliation(s)
- Amy Jo Lisanti
- Amy Lisanti, PhD, RN, CCNS, CCRN-K NRSA Postdoctoral Fellow, University of Pennsylvania School of Nursing; and Clinical Nurse Specialist/Nurse Scientist, Cardiac Nursing at Children's Hospital of Philadelphia, Pennsylvania. Dorothy Vittner, PhD, RN Nurse Scientist, Connecticut Children's Medical Center, Hartford; and Faculty, School of Nursing and an Assistant Professor, University of Connecticut School of Nursing, Storrs. Barbara Medoff-Cooper, PhD, RN Professor, Univeristy of Pennsylvania School of Nursing, Philadelphia. Jennifer Fogel, M.S.CCC-SLP/L Pediatric Speech Language Pathologist, Advocate Children's Hospital, Oak Lawn, Illinois. Gil Wernovsky, MD Senior Consultant in Cardiac Critical Care and Pediatric Cardiology, Children's National Health System, Washington, District of Columbia. Samantha Butler, PhD Developmental and Clinical Psychologist Director, Boston Children's; and Assistant Professor in Psychiatry, Harvard Medical School, Boston, Massachusetts
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Mehler K, Hucklenbruch‐Rother E, Trautmann‐Villalba P, Becker I, Roth B, Kribs A. Delivery room skin-to-skin contact for preterm infants-A randomized clinical trial. Acta Paediatr 2020; 109:518-526. [PMID: 31423649 DOI: 10.1111/apa.14975] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 06/25/2019] [Accepted: 08/16/2019] [Indexed: 01/21/2023]
Abstract
AIM To investigate the effects of 60 minutes delivery room skin-to-skin contact (DR-SSC) compared with 5 minutes visual contact (VC) on mother-child interaction (MCI), salivary cortisol, maternal depression, stress and bonding at 6 months corrected age. METHODS A single-centre randomized controlled trial conducted in a German level III NICU. Eighty-eight preterm infants (25-32 weeks of gestational age) were randomized after initial stabilization to either 60 minutes DR-SSC or 5 minutes VC. Forty-five infants were allocated to DR-SSC, 43 to VC. RESULTS Delivery room skin-to-skin contact dyads showed a higher quantity of maternal motoric (18 vs 15, P = .030), infant's vocal (7 vs 5, P = .044) and motoric (20 vs 15, P = .032) responses. Moreover, the combined score of maternal and infant responsive behaviour was higher (86 vs 71, P = .041) in DR-SSC dyads. DR-SSC mothers had lower risk of both, early postpartum depression (15% vs 45%, P = .003) and impaired bonding (Score 3 vs 5, P = .031). CONCLUSION In addition to regular intermittent kangaroo mother care, DR-SSC promotes MCI and decreases risk of maternal depression and bonding problems. Thus, DR-SSC may have positive effects on preterm development.
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Affiliation(s)
- Katrin Mehler
- Division of Neonatology Children's Hospital University of Cologne Cologne Germany
| | - Eva Hucklenbruch‐Rother
- Research group of Metabolism and Perinatal Programming Children's Hospital University of Cologne Cologne Germany
| | | | - Ingrid Becker
- Institute of Medical Statistics, Informatics, and Epidemiology University of Cologne Cologne Germany
| | - Bernhard Roth
- Division of Neonatology Children's Hospital University of Cologne Cologne Germany
| | - Angela Kribs
- Division of Neonatology Children's Hospital University of Cologne Cologne Germany
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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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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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Wallois F, Routier L, Bourel-Ponchel E. Impact of prematurity on neurodevelopment. HANDBOOK OF CLINICAL NEUROLOGY 2020; 173:341-375. [PMID: 32958184 DOI: 10.1016/b978-0-444-64150-2.00026-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The consequences of prematurity on brain functional development are numerous and diverse, and impact all brain functions at different levels. Prematurity occurs between 22 and 36 weeks of gestation. This period is marked by extreme dynamics in the physiologic maturation, structural, and functional processes. These different processes appear sequentially or simultaneously. They are dependent on genetic and/or environmental factors. Disturbance of these processes or of the fine-tuning between them, when caring for premature children, is likely to induce disturbances in the structural and functional development of the immature neural networks. These will appear as impairments in learning skills progress and are likely to have a lasting impact on the development of children born prematurely. The level of severity depends on the initial alteration, whether structural or functional. In this chapter, after having briefly reviewed the neurodevelopmental, structural, and functional processes, we describe, in a nonexhaustive manner, the impact of prematurity on the different brain, motor, sensory, and cognitive functions.
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Affiliation(s)
- Fabrice Wallois
- Research Group on Multimodal Analysis of Brain Function, Jules Verne Picardie University, Amiens, France; Department of Pediatric Functional Exploration of the Nervous System, University Hospital, Picardie, Amiens, France.
| | - Laura Routier
- Research Group on Multimodal Analysis of Brain Function, Jules Verne Picardie University, Amiens, France; Department of Pediatric Functional Exploration of the Nervous System, University Hospital, Picardie, Amiens, France
| | - Emilie Bourel-Ponchel
- Research Group on Multimodal Analysis of Brain Function, Jules Verne Picardie University, Amiens, France; Department of Pediatric Functional Exploration of the Nervous System, University Hospital, Picardie, Amiens, France
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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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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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Music exposure attenuates anxiety- and depression-like behaviors and increases hippocampal spine density in male rats. Behav Brain Res 2019; 372:112023. [DOI: 10.1016/j.bbr.2019.112023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 05/18/2019] [Accepted: 06/07/2019] [Indexed: 01/14/2023]
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Lee Mongerson CR, Jennings RW, Zurakowski D, Bajic D. Quantitative MRI study of infant regional brain size following surgery for long-gap esophageal atresia requiring prolonged critical care. Int J Dev Neurosci 2019; 79:11-20. [PMID: 31563705 DOI: 10.1016/j.ijdevneu.2019.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 09/05/2019] [Accepted: 09/23/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Little is known regarding the impact of concurrent critical illness and thoracic noncardiac perioperative critical care on postnatal brain development. Previously, we reported smaller total brain volumes in both critically ill full-term and premature patients following complex perioperative critical care for long-gap esophageal atresia (LGEA). Our current report assessed trends in regional brain sizes during infancy, and probed for any group differences. METHODS Full-term (n = 13) and preterm (n = 13) patients without any previously known neurological concerns, and control infants (n = 16), underwent non-sedated 3 T MRI in infancy (<1 year old). T2-weighted images underwent semi-automated brain segmentation using Morphologically Adaptive Neonatal Tissue Segmentation (MANTiS). Regional tissue volumes of the forebrain, deep gray matter (DGM), cerebellum, and brainstem are presented as absolute (cm3) and normalized (% total brain volume (%TBV)) values. Group differences were assessed using a general linear model univariate analysis with corrected age at scan as a covariate. RESULTS Absolute volumes of regions analyzed increased with advancing age, paralleling total brain size, but were significantly smaller in both full-term and premature patients compared to controls. Normalized volumes (%TBV) of forebrain, DGM, and cerebellum were not different between subject groups analyzed. Normalized brainstem volumes showed group differences that warrant future studies to confirm the same finding. DISCUSSION Both full-term and premature critically ill infants undergoing life-saving surgery for LGEA are at risk of smaller total and regional brain sizes. Normalized volumes support globally delayed or diminished brain growth in patients. Future research should look into neurodevelopmental outcomes of infants born with LGEA.
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Affiliation(s)
- Chandler Rebecca Lee Mongerson
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Bader 3, 300 Longwood Ave., Boston, MA, United States
| | - Russell William Jennings
- Esophageal and Airway Treatment Center, Department of Surgery, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
- Harvard Medical School, 25 Shattuck St., Boston, MA, United States
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Bader 3, 300 Longwood Ave., Boston, MA, United States
- Esophageal and Airway Treatment Center, Department of Surgery, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
- Harvard Medical School, 25 Shattuck St., Boston, MA, United States
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Bader 3, 300 Longwood Ave., Boston, MA, United States
- Esophageal and Airway Treatment Center, Department of Surgery, Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
- Harvard Medical School, 25 Shattuck St., Boston, MA, United States
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Farinetti A, Aspesi D, Marraudino M, Marzola E, Amianto F, Abbate-Daga G, Gotti S. Sexually dimorphic behavioral effects of maternal separation in anorexic rats. Dev Psychobiol 2019; 62:297-309. [PMID: 31502241 DOI: 10.1002/dev.21909] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 01/11/2023]
Abstract
Exposure to negative events during the neonatal period is one of the leading factors contributing to the development of psychiatric disorders, including anorexia nervosa. In this study, we investigated the effects of maternal separation (MS) on the development of anorexia in rodents using the mild-stress form of the activity-based anorexia (ABA) model (2 hr of free access to a running wheel and a 1-hr feeding test) in both male and female rats. We assessed anxiety-like and locomotor behavior and hyperactivity with the open field and elevated plus maze tests. Our results showed that ABA rats of both sexes displayed hyperactive behavior associated with reduced anxiety-like behavior when compared to controls. However, a sexually dimorphic effect of MS emerged in anorexic rats: while the females exposed to MS + ABA were hyperactive with diminished anxiety-related behaviors compared to females of the ABA group, MS in males attenuated or did not alter the effects of the ABA protocol. In conclusion, our data reveal that the synergistic effects of MS and ABA on physical activity and anxiety-like behavior act in opposite directions in the two sexes.
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Affiliation(s)
- Alice Farinetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,NICO- Neuroscience Institute Cavalieri Ottolenghi, Turin, Italy
| | - Dario Aspesi
- Department of Psychiatry, The Psychiatric Institute, University of Illinois, Chicago, IL, USA
| | - Marilena Marraudino
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,NICO- Neuroscience Institute Cavalieri Ottolenghi, Turin, Italy
| | - Enrica Marzola
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Eating disorders Unit of AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Federico Amianto
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Eating disorders Unit of AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Giovanni Abbate-Daga
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Eating disorders Unit of AOU Città della Salute e della Scienza, University of Turin, Turin, Italy
| | - Stefano Gotti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,NICO- Neuroscience Institute Cavalieri Ottolenghi, Turin, Italy
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Maillard A, Garnier E, Saliba E, Favrais G. Prematurity alters skin conductance and behavioural scoring after acute stress in term-equivalent age infants. Acta Paediatr 2019; 108:1609-1615. [PMID: 30851198 DOI: 10.1111/apa.14777] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 11/28/2022]
Abstract
AIM The primary objective was to assess the effect of prematurity at term-equivalent age on skin conductance and behavioural responses to acute stress. The secondary objective was to explore the reliability of skin conductance in detecting neonatal discomfort in preterm and full-term populations. METHODS Very preterm infants at term-equivalent age and healthy full-term neonates, 34 infants in each group, underwent the hip dysplasia screening test. The acute pain in newborn infants (APN) scale was scored before and 15, 45 and 90 seconds after stimulus. Skin conductance was measured in the 30-second time-lap before and after stimulus. RESULTS The APN score was lower in preterm infants after intervention (term: 5.4 ± 2.8 vs. preterm: 3.9 ± 2.2; p = 0.03). Peaks-per-second, a skin conductance parameter, exhibited lower basal values in preterm infants than in term infants, with similar rise induced by stressful challenge. Peaks-per-second values were correlated to the 15-second APN score in both groups (term: r = 0.55, p < 0.001; preterm: r = 0.43, p = 0.01). CONCLUSION Preterm birth changed skin conductance signal and behavioural response to stress at term-equivalent age. The skin conductance device may be an objective tool for a continuous monitoring of acute neonatal stress.
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Affiliation(s)
| | | | - Elie Saliba
- Neonatal Intensive Care Unit CHRU de Tours Tours France
- UMR 1253 iBrain Université de Tours, INSERM Tours France
| | - Geraldine Favrais
- Neonatal Intensive Care Unit CHRU de Tours Tours France
- UMR 1253 iBrain Université de Tours, INSERM Tours France
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Kamel Escalante MC, Abdennour A, Farah A, Rivera-Richardson E, Burgos F, Forero I, Murrieta-Aguttes M, El Laboudy M, Diagne-Gueye NR, Barragan Padilla S. Prescription patterns of analgesics, antipyretics, and non steroidal anti-inflammatory drugs for the management of fever and pain in pediatric patients: a cross-sectional, multicenter study in Latin America, Africa, and the Middle East. Pragmat Obs Res 2019; 10:41-51. [PMID: 31616200 PMCID: PMC6699589 DOI: 10.2147/por.s168140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/24/2019] [Indexed: 11/23/2022] Open
Abstract
Objective To evaluate the daily practice of pediatricians, physician-perceived reasons for unsatisfactory effects of treatment, and unmet needs in the management of acute pain and/or fever. Methods This was a multinational (n=13), multicenter, non interventional, cross-sectional study conducted in Latin America, Africa, and the Middle East in children under 16 years of age with fever (defined as a central body temperature ≥38°C) and/or acute pain (defined as pain lasting ≤6 weeks). Data were collected during a single visit using a structured physician-administered questionnaire and case report forms. Results A total of 2125 patients were recruited by 178 physicians between September 2010 and September 2011. From the 2117 analyzed patients, 1856 (87.7%) had fever, 705 (33.3%) had acute pain, and 446 (21.1%) had both. Of 1843 analyzed patients with fever, 1516 (82.3%) were previously prescribed a pharmacological treatment for the management of fever concomitantly with a non pharmacological approach, while 1817/1856 patients (97.9%) were currently receiving a prescribed pharmacological treatment for fever. Paracetamol/acetaminophen was the most commonly prescribed antipyretic medication during both previous (70.8%) and current (64.1%) consultations. With regard to acute pain management, 67.2% of the patients received previous and 93.9% received current treatment for pain. The most frequently prescribed analgesic during previous consultations was paracetamol/acetaminophen (53.7%), and the current most commonly prescribed analgesics were non steroidal anti-inflammatory drugs (55.2%). Treatment patterns for patients with both fever and acute pain were similar. Overall, 53.4% of the physicians reported poor treatment compliance as a reason for the unsatisfactory effect of the pain/fever treatment, and the most common unmet need was the availability of new drugs (according to 63.5% of the physicians). Conclusions Adequate management of fever was observed; however, due to the complex etiology of pediatric pain, better evaluation and management of pain in pediatrics is necessary.
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Affiliation(s)
| | - Abbas Abdennour
- Department of Pediatrics, Santé Publique Baraki, Algiers, Algeria
| | - Antoine Farah
- Department of Pediatrics, Saint-Georges Hospital, Ajaltoun, Lebanon
| | | | - Fernando Burgos
- Maternal and Child Department, Hospital Universitario Austral, Buenos Aires, Argentina
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Zhang J, Yin J, Chen X, Mao X, Xu J, Cheng R, Wu J. Down-regulation of miR-140-3p can alleviate neonatal repetitive pain in rats via inhibiting TGF-β3. Biochem Biophys Res Commun 2019; 515:627-635. [DOI: 10.1016/j.bbrc.2019.05.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 05/21/2019] [Indexed: 12/12/2022]
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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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65
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Pirlotte S, Beeckman K, Ooms I, Van Rompaey B, Cools F. Non-pharmacological interventions for the prevention of pain during endotracheal suctioning in ventilated neonates. Hippokratia 2019. [DOI: 10.1002/14651858.cd013353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Katrien Beeckman
- Universiteit Antwerpen; Midwifery Research, Education and Policymaking; Brussel Belgium
| | - Isabel Ooms
- UZ Brussel; Physiotherapy and Neonatology; Jette Belgium
| | - Bart Van Rompaey
- University of Antwerp; Department of Nursing and Midwifery; Antwerp Belgium
| | - Filip Cools
- CEBAM, Belgian Centre for Evidence-Based Medicine; Kapucijnenvoer 33, blok J, bus 7001 Leuven Vlaams-Brabant Belgium 3000
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66
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Pirlotte S, Beeckman K, Ooms I, Van Rompaey B, Cools F. Pharmacological interventions for the prevention of pain during endotracheal suctioning in ventilated neonates. Hippokratia 2019. [DOI: 10.1002/14651858.cd013355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Katrien Beeckman
- Universiteit Antwerpen; Midwifery Research, Education and Policymaking; Brussel Belgium
| | - Isabel Ooms
- UZ Brussel; Physiotherapy and Neonatology; Jette Belgium
| | - Bart Van Rompaey
- University of Antwerp; Department of Nursing and Midwifery; Antwerp Belgium
| | - Filip Cools
- UZ Brussel; Department Neonatology; Laarbeeklaan Brussels Belgium
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67
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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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68
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A Systematic Review of Behavioral and Environmental Interventions for Procedural Pain Management in Preterm Infants. J Pediatr Nurs 2019; 44:22-30. [PMID: 30683278 DOI: 10.1016/j.pedn.2018.10.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 11/23/2022]
Abstract
PROBLEM Current research suggests behavioral and environmental interventions to prevent neonatal pain prior to an invasive procedure are rarely administered and seldom documented. The aim of this study was to systematically review findings from published randomized controlled trials that tested the effects of behavioral and environmental procedural pain management interventions on behavioral pain response in preterm infants. ELIGIBILITY CRITERIA Randomized controlled trials examining the effects of behavioral and environmental pain management interventions on behavioral pain response in preterm infants were identified. Articles accepted for inclusion met the following criteria: English language, original, peer refereed, randomized controlled clinical trials published within the past 5 years, study sample: preterm infants, setting: neonatal intensive care units, study intervention behavioral and environmental, outcome pain measurement score from valid and reliable pain scale. SAMPLE Fourteen randomized controlled trials from a literature search of PubMed and Medline databases were included in this review. RESULTS Across all age groups, facilitated tucking, oral sucrose, and kangaroo care decreased behavioral and physiologic pain response alone and in combination with other behavioral and environmental interventions. CONCLUSION Among preterm infants, facilitated tucking, oral sucrose, and kangaroo care significantly mitigates biobehavioral pain response associated with acutely painful procedures. IMPLICATIONS Evidence suggests that behavioral and environmental interventions can decrease biobehavioral pain response associated with acutely painful procedures in preterm infants. This review highlights the need for rigorous studies to help healthcare providers to build a tailored pain treatment plan for preterm infants.
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69
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Mongerson CRL, Wilcox SL, Goins SM, Pier DB, Zurakowski D, Jennings RW, Bajic D. Infant Brain Structural MRI Analysis in the Context of Thoracic Non-cardiac Surgery and Critical Care. Front Pediatr 2019; 7:315. [PMID: 31428593 PMCID: PMC6688189 DOI: 10.3389/fped.2019.00315] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 07/11/2019] [Indexed: 01/20/2023] Open
Abstract
Objective: To determine brain magnetic resonance imaging (MRI) measures of cerebrospinal fluid (CSF) and whole brain volume of full-term and premature infants following surgical treatment for thoracic non-cardiac congenital anomalies requiring critical care. Methods: Full-term (n = 13) and pre-term (n = 13) patients with long-gap esophageal atresia, and full-term naïve controls (n = 19) < 1 year corrected age, underwent non-sedated brain MRI following completion of thoracic non-cardiac surgery and critical care treatment. Qualitative MRI findings were reviewed and reported by a pediatric neuroradiologist and neurologist. Several linear brain metrics were measured using structural T1-weighted images, while T2-weighted images were required for segmentation of total CSF and whole brain tissue using the Morphologically Adaptive Neonatal Tissue Segmentation (MANTiS) tool. Group differences in absolute (mm, cm3) and normalized (%) data were analyzed using a univariate general linear model with age at scan as a covariate. Mean normalized values were assessed using one-way ANOVA. Results: Qualitative brain findings suggest brain atrophy in both full-term and pre-term patients. Both linear and volumetric MRI analyses confirmed significantly greater total CSF and extra-axial space, and decreased whole brain size in both full-term and pre-term patients compared to naïve controls. Although linear analysis suggests greater ventricular volumes in all patients, volumetric analysis showed that normalized ventricular volumes were higher only in premature patients compared to controls. Discussion: Linear brain metrics paralleled volumetric MRI analysis of total CSF and extra-axial space, but not ventricular size. Full-term infants appear to demonstrate similar brain vulnerability in the context of life-saving thoracic non-cardiac surgery requiring critical care as premature infants.
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Affiliation(s)
- Chandler R L Mongerson
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Sophie L Wilcox
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Stacy M Goins
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
| | - Danielle B Pier
- Massachusetts General Hospital Child Neurology, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Harvard Medical School, Harvard University, Boston, MA, United States
| | - Russell W Jennings
- Harvard Medical School, Harvard University, Boston, MA, United States.,Department of Surgery, Boston Children's Hospital, Boston, MA, United States
| | - Dusica Bajic
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States.,Massachusetts General Hospital Child Neurology, Boston, MA, United States
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70
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Nist MD, Harrison TM, Steward DK. The biological embedding of neonatal stress exposure: A conceptual model describing the mechanisms of stress-induced neurodevelopmental impairment in preterm infants. Res Nurs Health 2018; 42:61-71. [PMID: 30499161 DOI: 10.1002/nur.21923] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 10/27/2018] [Indexed: 12/15/2022]
Abstract
The biological embedding of early life stress exposure may result in life-long neurodevelopmental impairment in preterm infants. Infants hospitalized in the neonatal intensive care unit are exposed to significant experiential, environmental, and physiologic stressors over the course of their extended hospitalization. Stress exposure during the sensitive period of brain development may alter biological processes, including functioning of the immune system, the autonomic nervous system, and the hypothalamic-pituitary-adrenal axis as well as gene expression. These alterations may subsequently affect brain structure and function. Changes to these processes may mediate the relationship between neonatal stress exposure and neurodevelopment in preterm infants and represent potential therapeutic targets to improve long-term outcomes. The purpose of this paper is to introduce a conceptual model, based on published research, that describes the mechanisms mediating stress exposure and neurodevelopment impairment in preterm infants and to provide the theoretical foundation on which to base future descriptive research, intervention studies, and clinical care.
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71
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Mooney-Leber SM, Spielmann SS, Brummelte S. Repetitive neonatal pain and reduced maternal care alter brain neurochemistry. Dev Psychobiol 2018; 60:963-974. [DOI: 10.1002/dev.21777] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 08/03/2018] [Accepted: 08/07/2018] [Indexed: 01/22/2023]
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72
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Giordano V, Deindl P, Fuiko R, Unterasinger L, Waldhoer T, Cardona F, Berger A, Olischar M. Effect of increased opiate exposure on three years neurodevelopmental outcome in extremely preterm infants. Early Hum Dev 2018; 123:1-5. [PMID: 29935388 DOI: 10.1016/j.earlhumdev.2018.06.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND International guidelines recommend the use of item based scales for the assessment of pain and sedation. In our previous study, the implementation of the Neonatal Pain Agitation and Sedation Scale (N-PASS), and the associated systematic assessment and treatment of pain and sedation reduced pain and over-sedation in our intervention group, but lead to a significant increase of individual opiate exposure. This increased opiate exposure was not associated with impaired motor and mental development at one year of age. As one-year follow-up is not necessarily representative for future outcomes, we retested our sample at three years of age. METHODS Fifty-three patients after (intervention group) and 61 before implementation (control group) of the N-PASS and the Vienna Protocol for the Management of Neonatal Pain and Sedation (VPNPS), were compared for motor, mental and behavioural development at three-years follow-up using the Bayley Scales of Infant Development. RESULTS Cumulative opiate exposure was not associated with mental (p = .31) and motor (p = .20) problems when controlling for other important medical conditions, but was associated to lower behavioural scores (p = .007). No statistically significant differences were found with regard to mental (p = .65), psychomotor (p = .12) and behavioural (p = .61) development before and after the implementation of the N-PASS and the VPNPS. CONCLUSION Implementing a neonatal pain and sedation protocol increased opiate exposure without affecting neurodevelopmental outcome at three-years of age.
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Affiliation(s)
- V Giordano
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria.
| | - P Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg Eppendorf, Germany
| | - R Fuiko
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - L Unterasinger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - T Waldhoer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Austria
| | - F Cardona
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - A Berger
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
| | - M Olischar
- Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University of Vienna, Austria
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73
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Watson RS, Asaro LA, Hertzog JH, Sorce LR, Kachmar AG, Dervan LA, Angus DC, Wypij D, Curley MAQ. Long-Term Outcomes after Protocolized Sedation versus Usual Care in Ventilated Pediatric Patients. Am J Respir Crit Care Med 2018; 197:1457-1467. [PMID: 29313710 PMCID: PMC6005554 DOI: 10.1164/rccm.201708-1768oc] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 01/08/2018] [Indexed: 02/02/2023] Open
Abstract
RATIONALE Whether a nurse-implemented goal-directed sedation protocol resulting in more awake yet calm intubated children affects postdischarge functional status, health-related quality of life, or risk for post-traumatic stress disorder is unknown. OBJECTIVES To compare postdischarge outcomes in children with acute respiratory failure cluster-randomized to a sedation protocol or usual care. METHODS A stratified random sample of 1,360 patients from 31 centers in the RESTORE (Randomized Evaluation of Sedation Titration for Respiratory Failure) trial was assessed by mail, electronically, and/or telephone 6 months after ICU discharge. In treatment group comparisons, we controlled for age, baseline functional status, and severity of illness. MEASUREMENTS AND MAIN RESULTS We used the Pediatric Overall Performance Category and the Pediatric Cerebral Performance Category to characterize functional status, the Infant and Toddler Quality of Life Questionnaire (97-item full-length version) (<2 yr old) or Pediatric Quality of Life Inventory (≥2 yr old), and the Child Post-traumatic Stress Disorder Symptom Scale (≥8 yr old and developmentally able). Functional status worsened from baseline to follow-up in 20%. Decline in functional status did not differ by treatment arm and was more common among those with baseline impairment than those with baseline normal function (27 vs. 18%; P < 0.001). There were no significant differences in health-related quality of life total scores by treatment arm. Scores indicating risk of post-traumatic stress disorder occurred in 30%, with no difference between treatment arms. CONCLUSIONS A sedation strategy that allows patients to be more awake and exposes them to fewer sedative and analgesic medications produces no long-term harm. However, postdischarge morbidity after acute respiratory failure is common. Clinical trial registered with www.clinicaltrials.gov (NCT00814099).
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Affiliation(s)
- R. Scott Watson
- Department of Pediatrics, University of Washington, Seattle, Washington
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
| | | | - James H. Hertzog
- Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Lauren R. Sorce
- Division of Pediatric Critical Care, Ann & Robert H. Lurie Children’s Hospital, Chicago, Illinois
| | | | - Leslie A. Dervan
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Derek C. Angus
- Clinical Research, Investigation, and Systems Modeling of Acute Illness Center and
- Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - David Wypij
- Department of Cardiology and
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, Massachusetts; and
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Martha A. Q. Curley
- Critical Care and Cardiovascular Program, Boston Children’s Hospital, Boston, Massachusetts
- School of Nursing and
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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74
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Qiu J, Zhao L, Yang Y, Zhang JH, Feng Y, Cheng R. Effects of fentanyl for pain control and neuroprotection in very preterm newborns on mechanical ventilation. J Matern Fetal Neonatal Med 2018; 32:3734-3740. [PMID: 29712500 DOI: 10.1080/14767058.2018.1471593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: This study aimed to evaluate the cerebral protection effect of fentanyl infusion in very preterm infants in the first 72 h of mechanical ventilation. Methods: In this double-blind, randomized, controlled trial, mechanically ventilated newborns (<32 weeks' gestational age) were randomized to fentanyl (continuous infusion of fentanyl) or placebo (continuous infusion of glucose, controls) in the first 72 h of the mechanical ventilation period. The premature infant pain profile (PIPP), cerebral blood flow velocity, neuron-specific enolase (NSE) concentrations in plasma samples, and cerebral function monitoring (CFM) recordings were evaluated. Results: Twenty-seven infants were allocated to the fentanyl group and 26 to the control group. The fentanyl group had significantly lower PIPP scores than did the control group at 12, 24, 48, and 72 h after the start of infusion (all p < .05). No significant changes in hemodynamic parameters were observed during the observation period using transcranial Doppler flow measurements (p > .05). The fentanyl group had lower NSE levels and higher total CFM scores compared with the control group (both p < .05). Conclusion: In very preterm infants on mechanical ventilation, continuous fentanyl infusion might protect the developing brain by relieving pain during the first 72 h of mechanical ventilation.
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Affiliation(s)
- Jie Qiu
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Li Zhao
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Yang Yang
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Jing-Han Zhang
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Yun Feng
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
| | - Rui Cheng
- a Department of Newborn Infants , Children's Hospital of Nanjing Medical University , Nanjing , China
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75
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Deindl P, Waldhör T, Unterasinger L, Berger A, Keck M. Arterial catheterisation in neonates can result in severe ischaemic complications but does not impair long-term extremity function. Acta Paediatr 2018; 107:240-248. [PMID: 28960442 DOI: 10.1111/apa.14100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/19/2017] [Accepted: 09/25/2017] [Indexed: 11/27/2022]
Abstract
AIM We evaluated the incidence of arterial catheterisation and analysed the risk factors and the extent and outcome of ischaemic complications in neonates. METHODS This was a retrospective cohort study of 1506 neonates admitted to two, ten-bed neonatal intensive care units (NICUs) at the Medical University of Vienna, Austria, between 1 January 2011 and 31 December 2014. Medical charts, daily reports and photo documentation were reviewed for arterial catheterisation and ischaemic complications. Patients with severe ischaemic complications were followed up to evaluate extremity function, scaring and cosmetic results. RESULTS There were 542 arterial catheterisations in 485 patients, including 275 born below 28 weeks, which resulted in severe complications in 19 of 485 (4%) patients. Three died before follow-up. Patients with complications had a significantly lower birthweight, lower postmenstrual age and higher rates of intracranial haemorrhage, retinopathy of prematurity and necrotising enterocolitis. They had also undergone multiple arterial catheterisations more often, needed longer inotropic support and had longer NICU stays than patients without complications. Extremity function was unimpaired in ten of 16 patients with severe ischaemic complications. CONCLUSION Severe ischaemic complications in neonates following arterial catheterisation were rare events, but could cause devastating damage. Most patients didn't show impaired extremity function at follow-up.
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Affiliation(s)
- Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine; University Children's Hospital; University Medical Center Hamburg Eppendorf; Hamburg Germany
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Thomas Waldhör
- Department of Epidemiology; Center for Public Health; Medical University of Vienna; Vienna Austria
| | - Lukas Unterasinger
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Maike Keck
- Department of Plastic and Reconstructive Surgery; Medical University of Vienna; Vienna Austria
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76
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Bröring T, Königs M, Oostrom KJ, Lafeber HN, Brugman A, Oosterlaan J. Sensory processing difficulties in school-age children born very preterm: An exploratory study. Early Hum Dev 2018; 117:22-31. [PMID: 29227903 DOI: 10.1016/j.earlhumdev.2017.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Very preterm birth has a detrimental impact on the developing brain, including widespread white matter brain abnormalities that threaten efficient sensory processing. Yet, sensory processing difficulties in very preterm children are scarcely studied, especially at school age. AIMS To investigate somatosensory registration, multisensory integration and sensory modulation. PARTICIPANTS 57 very preterm school-age children (mean age=9.2years) were compared to 56 gender and age matched full-term children. METHODS Group differences on somatosensory registration tasks (Registration of Light Touch, Sensory Discrimination of Touch, Position Sense, Graphestesia), a computerized multisensory integration task, and the parent-reported Sensory Profile were investigated using t-tests and Mann-Whitney U tests. RESULTS In comparison to full-term children, very preterm children are less accurate on somatosensory registration tasks, including Registration of Light Touch (d=0.34), Position Sense (d=0.31) and Graphestesia (d=0.42) and show more sensory modulation difficulties (d=0.41), including both behavioral hyporesponsivity (d=0.52) and hyperresponsivity (d=0.56) to sensory stimuli. Tactile discrimination and multisensory integration efficiency were not affected in very preterm children. Aspects of sensory processing were only modestly related. CONCLUSION Very preterm children show sensory processing difficulties regarding somatosensory registration and sensory modulation, and preserved multisensory (audio-visual) integration. Follow-up care for very preterm children should involve screening of sensory processing difficulties at least up to school age.
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Affiliation(s)
- Tinka Bröring
- Department of Medical Psychology, VU University Medical Center, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Marsh Königs
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands.
| | - Kim J Oostrom
- Department of Medical Psychology, VU University Medical Center, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands; Psychosocial Department, Emma Children's Hospital, Academic Medical Center, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
| | - Harrie N Lafeber
- Department of Pediatrics, VU University Medical Center, Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands.
| | - Anniek Brugman
- Department of Medical Psychology, VU University Medical Center, de Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Department of Pediatrics, Emma Children's Hospital, Academic Medical Center, PO Box 22660, 1100 DD, Amsterdam, The Netherlands; Department of Pediatrics, VU University Medical Center, Amsterdam, de Boelelaan 1118, 1081 HV Amsterdam, The Netherlands; Clinical Neuropsychology Section, Vrije Universiteit Amsterdam, van der Boechorstraat 1, 1081 BT Amsterdam, The Netherlands.
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77
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Lipner HS, Huron RF. Developmental and Interprofessional Care of the Preterm Infant: Neonatal Intensive Care Unit Through High-Risk Infant Follow-up. Pediatr Clin North Am 2018; 65:135-141. [PMID: 29173714 DOI: 10.1016/j.pcl.2017.08.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Practices in the neonatal intensive care unit (NICU) that reduce infant stress and respond to behavioral cues positively influence developmental outcomes. Proactive developmental surveillance and timely introduction of early intervention services improve outcomes for premature infants. A model that emphasizes infant development and a continuum of care beginning in the NICU with transition to outpatient monitoring and provision of early intervention services is hypothesized to support the most optimal outcomes for premature infants.
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Affiliation(s)
- Hildy S Lipner
- Pediatric Speech Pathology, Institute for Child Development, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA.
| | - Randye F Huron
- Developmental and Behavioral Pediatrics, Institute for Child Development, Joseph M. Sanzari Children's Hospital, Hackensack University Medical Center, 30 Prospect Avenue, Hackensack, NJ 07601, USA
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78
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Ropars S, Tessier R, Charpak N, Uriza LF. The long-term effects of the Kangaroo Mother Care intervention on cognitive functioning: Results from a longitudinal study. Dev Neuropsychol 2018; 43:82-91. [DOI: 10.1080/87565641.2017.1422507] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Stéphanie Ropars
- School of Psychology, Université Laval, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec, Canada
| | - Réjean Tessier
- School of Psychology, Université Laval, Québec, Canada
- CHU de Québec-Université Laval Research Center, Québec, Canada
| | | | - Luis Felipe Uriza
- Department of Radiology, Pontifica Universidad Javeriana, Bogota, Colombia
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79
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Simões ALB, Silva GAR, Giorgetto C, de Cassia do Carmo-Campos E, Dias FJ, Fazan VPS. Substance P in Dorsal Root Ganglion Neurons in Young and Adult Rats, after Nociceptive Stimulation during the Neonatal Period. Anat Rec (Hoboken) 2018; 301:849-861. [PMID: 29244245 DOI: 10.1002/ar.23755] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 08/25/2017] [Accepted: 09/17/2017] [Indexed: 12/21/2022]
Abstract
The nervous system is highly plastic during the neonatal period, being sensitive to noxious stimuli, which may cause short- and long-term pain responsivity changes. Understanding plasticity in peripheral pain pathways is crucial, particularly when the nervous system is still under development and remodeling process. Substance P (SP) is widely used as a marker for peripheral neurons with unmyelinated and small myelinated fibers. We investigated the number of SP immunoreactive neurons in the dorsal root ganglion (DRG) of male and female Wistar rats, 15 and 180 days after nociceptive stimulation during the neonatal period. Right and left 5th lumbar (L5) DRG were incubated in rabbit polyclonal anti-substance P primary followed by biotinylated donkey anti-rabbit secondary antibodies. Reaction was revealed with a nickel-diaminobenzidine solution. Labeled neurons were counted and compared between ages, genders and groups. Gender differences were present in both ages, with the number of SP-positive DRG neurons being larger in 15-days-old males on both sides. After 180 days, males showed a larger number of SP-positive neurons than females only on the nociceptive stimulated side. An increased number of SP-positive neurons in the DRG on the stimulated side was present in females, immediately after nociceptive stimulation, but not after 180 days. In conclusion, neonatal noxious stimulation caused a permanent increase in SP-positive DRG neurons in males that was not observed in females, suggesting that differences in pain processing/responsivity between genders could be related to morphological alterations of the nervous system. Anat Rec, 301:849-861, 2018. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Ana Leda Bertoncini Simões
- Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Greice Anne Rodrigues Silva
- Department of Neurosciences and Behavioral Science, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Carolina Giorgetto
- Department of Neurosciences and Behavioral Science, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Elisabete de Cassia do Carmo-Campos
- Department of Neurosciences and Behavioral Science, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Fernando José Dias
- Department of Integral Dentistry, CICO - Research Centre in Dental Sciences, Dental School, Universidad de La Frontera, Temuco, Chile
| | - Valéria Paula Sassoli Fazan
- Department of Surgery and Anatomy, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049-900, Brazil.,Department of Neurosciences and Behavioral Science, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, 14049-900, Brazil
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80
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Ionizing radiation from computed tomography versus anesthesia for magnetic resonance imaging in infants and children: patient safety considerations. Pediatr Radiol 2018; 48:21-30. [PMID: 29181580 DOI: 10.1007/s00247-017-4023-6] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/19/2017] [Accepted: 10/30/2017] [Indexed: 12/20/2022]
Abstract
In the context of health care, risk assessment is the identification, evaluation and estimation of risk related to a particular clinical situation or intervention compared to accepted medical practice standards. The goal of risk assessment is to determine an acceptable level of risk for a given clinical treatment or intervention in association with the provided clinical circumstances for a patient or group of patients. In spite of the inherent challenges related to risk assessment in pediatric cross-sectional imaging, the potential risks of ionizing radiation and sedation/anesthesia in the pediatric population are thought to be quite small. Nevertheless both issues continue to be topics of discussion concerning risk and generate significant anxiety and concern for patients, parents and practicing pediatricians. Recent advances in CT technology allow for more rapid imaging with substantially lower radiation exposures, obviating the need for anesthesia for many indications and potentially mitigating concerns related to radiation exposure. In this review, we compare and contrast the potential risks of CT without anesthesia against the potential risks of MRI with anesthesia, and discuss the implications of this analysis on exam selection, providing specific examples related to neuroblastoma surveillance imaging.
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81
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Abstract
Mortality rates among children with CHD have significantly declined, although the incidence of neurological abnormalities and neurodevelopmental impairment has increased. Research has focussed on outcomes, with limited attention on prevention and intervention. Although some developmental differences and challenges seen in children with CHD are explained by the cumulative effect of medical complications associated with CHD, many sequelae are not easily explained by medical complications alone. Although cardiac intensive care is lifesaving, it creates high levels of environmental and tactile stimulation, which potentially contribute to adverse neurodevelopmental outcomes. The therapeutic method of individualised developmental care, such as the Newborn Individualized Developmental Care and Assessment Program, provides early support and preventive intervention based on each child's behavioural signals of stress, comfort, and strength. Implementing developmental care practices in a cardiac ICU requires a thoughtful and well-planned approach to ensure successful adoption of practice changes. This paper reviews how developmental care was introduced in a paediatric inpatient cardiac service through multidisciplinary collaborative staff education, clinician support, child neurodevelopment assessment, parent support, and research initiatives. Given the known risk for children with CHD, cardiac medical professionals must shift their focus to not only assuring the child's survival but also optimising development through individualised developmental care in the cardiac ICU.
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82
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Eeles AL, Walsh JM, Olsen JE, Cuzzilla R, Thompson DK, Anderson PJ, Doyle LW, Cheong JLY, Spittle AJ. Continuum of neurobehaviour and its associations with brain MRI in infants born preterm. BMJ Paediatr Open 2017; 1:e000136. [PMID: 29637152 PMCID: PMC5862173 DOI: 10.1136/bmjpo-2017-000136] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/06/2017] [Accepted: 09/12/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Infants born very preterm (VPT) and moderate-to-late preterm (MLPT) are at increased risk of long-term neurodevelopmental deficits, but how these deficits relate to early neurobehaviour in MLPT children is unclear. The aims of this study were to compare the neurobehavioural performance of infants born across three different gestational age groups: preterm <30 weeks' gestational age (PT<30); MLPT (32-36 weeks' gestational age) and term age (≥37 weeks' gestational age), and explore the relationships between MRI brain abnormalities and neurobehaviour at term-equivalent age. METHODS Neurobehaviour was assessed at term-equivalent age in 149 PT<30, 200 MLPT and 200 term-born infants using the Neonatal Intensive Care UnitNetwork Neurobehavioral Scale (NNNS), the Hammersmith Neonatal Neurological Examination (HNNE) and Prechtl's Qualitative Assessment of General Movements (GMA). A subset of 110 PT<30 and 198 MLPT infants had concurrent brain MRI. RESULTS Proportions with abnormal neurobehaviour on the NNNS and the HNNE, and abnormal GMA all increased with decreasing gestational age. Higher brain MRI abnormality scores in some regions were associated with suboptimal neurobehaviour on the NNNS and HNNE. The relationships between brain MRI abnormality scores and suboptimal neurobehaviour were similar in both PT<30 and MLPT infants. The relationship between brain MRI abnormality scores and abnormal GMA was stronger in PT<30 infants. CONCLUSIONS There was a continuum of neurobehaviour across gestational ages. The relationships between brain abnormality scores and suboptimal neurobehaviour provide evidence that neurobehavioural assessments offer insight into the integrity of the developing brain, and may be useful in earlier identification of the highest-risk infants.
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Affiliation(s)
- Abbey L Eeles
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, Monash University, Melbourne, Victoria, Australia
| | - Jennifer M Walsh
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Paediatric Infant Perinatal Emergency Retrieval (PIPER), The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Joy E Olsen
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Rocco Cuzzilla
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
| | - Deanne K Thompson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Peter J Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Victoria, Australia
| | - Lex W Doyle
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeanie L Y Cheong
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Alicia J Spittle
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Newborn Research, The Royal Women's Hospital, Melbourne, Victoria, Australia
- Department of Physiotherapy, University of Melbourne, Melbourne, Victoria, Australia
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83
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Haslbeck FB, Bucher HU, Bassler D, Hagmann C. Creative music therapy to promote brain structure, function, and neurobehavioral outcomes in preterm infants: a randomized controlled pilot trial protocol. Pilot Feasibility Stud 2017; 3:36. [PMID: 28975039 PMCID: PMC5613472 DOI: 10.1186/s40814-017-0180-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 08/31/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Preterm birth is associated with increased risk of neurological impairment and deficits in cognition, motor function, and behavioral problems. Limited studies indicate that multi-sensory experiences support brain development in preterm infants. Music appears to promote neurobiological processes and neuronal learning in the human brain. Creative music therapy (CMT) is an individualized, interactive therapeutic approach based on the theory and methods of Nordoff and Robbins. CMT may promote brain development in preterm infants via concurrent interaction and meaningful auditory stimulation. We hypothesize that preterm infants who receive creative music therapy during neonatal intensive care admission will have developmental benefits short- and long-term brain function. METHODS/DESIGN A prospective, randomized controlled single-center pilot trial involving 60 clinically stable preterm infants under 32 weeks of gestational age is conducted in preparation for a multi-center trial. Thirty infants each are randomized to either standard neonatal intensive care or standard care with CMT. Music therapy intervention is approximately 20 min in duration three times per week. A trained music therapist sings for the infants in lullaby style, individually entrained and adjusted to the infant's rhythm and affect. Primary objectives of this study are feasibility of protocol implementation and investigating the potential mechanism of efficacy for this new intervention. To examine the effect of this new intervention, non-invasive, quantitative magnetic resonance imaging (MRI) methods at corrected age and standardized neurodevelopmental assessments using the Bayley Scales of Infant and Toddler Development third edition at a corrected age of 24 months and Kaufman Assessment Battery for Children at 5 years will be performed. All assessments will be performed and analyzed by blinded experts. DISCUSSION To our knowledge, this is the first randomized controlled clinical trial to systematically examine possible effects of creative music therapy on short- and long-term brain development in preterm infants. This project lies at the interface of music therapy, neuroscience, and medical imaging. New insights into the potential role and impact of music on brain function and development may be elucidated. If such a low-cost, low-risk intervention is demonstrated in a future multi-center trial to be effective in supporting brain development in preterm neonates, findings could have broad clinical implications for this vulnerable patient population. TRIAL REGISTRATION ClinicalTrials.gov, NCT02434224.
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Affiliation(s)
| | - Hans-Ulrich Bucher
- Department of Neonatology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Cornelia Hagmann
- Department of Pediatric Intensive Care and Neonatology, University Children’s Hospital, 8032 Zurich, Switzerland
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84
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Frie J, Bartocci M, Lagercrantz H, Kuhn P. Cortical Responses to Alien Odors in Newborns: An fNIRS Study. Cereb Cortex 2017; 28:3229-3240. [DOI: 10.1093/cercor/bhx194] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jakob Frie
- Neonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Neonatal Medicine, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Bartocci
- Neonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Neonatal Medicine, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Hugo Lagercrantz
- Neonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Pierre Kuhn
- Neonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Service de Médecine et Réanimation du Nouveau-né, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, France
- Institut de Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique et Unistra, Strasbourg, France
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85
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Cignacco E, Schenk K, Stevens B, Stoffel L, Bassler D, Schulzke S, Nelle M. Individual contextual factors in the validation of the Bernese pain scale for neonates: protocol for a prospective observational study. BMC Pediatr 2017; 17:171. [PMID: 28724434 PMCID: PMC5518104 DOI: 10.1186/s12887-017-0914-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 06/29/2017] [Indexed: 01/07/2023] Open
Abstract
Background The Bernese Pain Scale for Neonates (BPSN) is a multidimensional pain assessment tool that is already widely used in clinical settings in the German speaking areas of Europe. Recent findings indicate that pain responses in preterm neonates are influenced by individual contextual factors, such as gestational age (GA), gender and the number of painful procedures experienced. Currently, the BPSN does not consider individual contextual factors. Therefore, the aim of this study is the validation of the BPSN using a large sample of neonates with different GAs. Furthermore, the influence of individual contextual factors on the variability in pain reactions across GA groups will be explored. The results will be used for a modification of the BPSN to account for individual contextual factors in future clinical pain assessment in neonates. Methods and design This prospective multisite validation study with a repeated measures design will take place in three university hospital neonatal intensive care units (NICUs) in Switzerland (Bern, Basel and Zurich). To examine the impact of GA on pain responses and their variability, the infants will be stratified into six GA groups ranging from 24 0/7 to 42 0/7. Among preterm infants, 2–5 routine capillary heel sticks within the first 14 days of life, and among full-term infants, two heel sticks during the first days of life will be documented. For each heel stick, measurements will be video recorded for each of three phases: baseline, heel stick, and recovery. The infants’ pain responses will be rated according to the BPSN by five nurses who are blinded as to the number of each heel stick and as to the measurement phases. Individual contextual factors of interest will be extracted from patient charts. Discussion Understanding and considering the influence of individual contextual factors on pain responses in a revised version of the BPSN will help the clinical staff to more appropriately assess pain in neonates, particularly preterm neonates hospitalized in NICUs. Pain assessment is a first step toward appropriate and efficient pain management, which itself is an important factor in later motor and cognitive development in this vulnerable patient population. Trial registration The study is registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461. Registration date: 12 April 2016.
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Affiliation(s)
- Eva Cignacco
- Health Department, Midwifery Discipline, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.
| | - Karin Schenk
- Health Department, Midwifery Discipline, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland
| | - Bonnie Stevens
- Lawrence S. Bloomberg Faculty of Nursing and Faculties of Medicine and Dentistry, University of Toronto, Toronto, Canada
| | - Liliane Stoffel
- Neonatalogy, Children's Hospital, University Hospital of Bern, Bern, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Sven Schulzke
- Department of Neonatology, University of Basel Children's Hospital (UKBB), Basel, Switzerland
| | - Mathias Nelle
- Department of Neonatology, Children's University Hospital, Bern, Switzerland
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86
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Burke NN, Trang T. Neonatal Injury Results in Sex-Dependent Nociceptive Hypersensitivity and Social Behavioral Deficits During Adolescence, Without Altering Morphine Response. THE JOURNAL OF PAIN 2017; 18:1384-1396. [PMID: 28709955 DOI: 10.1016/j.jpain.2017.07.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/30/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
Neonatal injury is associated with persistent changes in sensory function and altered nociceptive thresholds that give rise to aberrant pain sensitivity in later life. Although these changes are well documented in adult rodents, little is known about the consequences of neonatal injury during adolescence. Because adolescence is a critical developmental period during which persistent pain conditions can arise, we examined the effect of neonatal injury on nociception, social behavior, and response to morphine in adolescent Sprague Dawley rats. Male and female rats exposed to plantar incision injury at postnatal day 3 displayed mechanical hypersensitivity that resolved by 24 hours after incision. When these animals reached adolescence (postnatal day 28-40), neonatally-injured male rats showed ipsilaterally restricted mechanical, heat, and cold hypersensitivity, as well as social behavioral deficits. In contrast, these effects were not seen in female rats. Neonatal injury did not alter acute morphine antinociception or the development of analgesic tolerance in either sex. Morphine-induced conditioned place preference, behavioral sensitization, and physical withdrawal were also not affected by neonatal incision. Thus, early-life injury results in sex-dependent pain-related hypersensitivity and social behavior deficits during adolescence, without altering the response to opioids. PERSPECTIVE Neonatal surgery has greater effects on adolescent male than female rats, resulting in pain-related hypersensitivity and social behavioral deficits. Neonatal surgery does not alter the antinociceptive effects of morphine or abuse liability.
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Affiliation(s)
- Nikita N Burke
- Department of Comparative Biology and Experimental Medicine, Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Tuan Trang
- Department of Comparative Biology and Experimental Medicine, Department of Physiology and Pharmacology, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada.
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87
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Benoit B, Martin-Misener R, Newman A, Latimer M, Campbell-Yeo M. Neurophysiological assessment of acute pain in infants: a scoping review of research methods. Acta Paediatr 2017; 106:1053-1066. [PMID: 28326623 DOI: 10.1111/apa.13839] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/14/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022]
Abstract
A systematic scoping search to describe the neurophysiological methods used in infant acute pain assessment research was conducted. Of the 2411 abstracts screened, 19 articles were retained. Nine studies utilised near-infrared spectroscopy (NIRS), two utilised functional magnetic resonance imaging (fMRI), and eight utilised electroencephalography (EEG). There was methodological variability in studies utilising NIRS, whereas EEG and fMRI studies reported consistent methods. Of the eight EEG studies, six identified a nociceptive-specific event-related potential. CONCLUSION While more methodologically rigorous studies are needed, ERPs appear to hold some promise as indicators of infant nociception during clinical procedures to supplement existing measures.
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Affiliation(s)
- B Benoit
- School of Nursing; Dalhousie University; Halifax Nova Scotia Canada
- Centre for Pediatric Pain Research; IWK Health Centre; Halifax NS Canada
- Maternal Newborn Program; IWK Health Centre; Halifax NS Canada
| | - R Martin-Misener
- School of Nursing; Dalhousie University; Halifax Nova Scotia Canada
| | - A Newman
- Department of Psychology and Neuroscience; Dalhousie University; Halifax NS Canada
- Department of Pediatrics; IWK Health Centre; Halifax NS Canada
| | - M Latimer
- School of Nursing; Dalhousie University; Halifax Nova Scotia Canada
- Centre for Pediatric Pain Research; IWK Health Centre; Halifax NS Canada
- Department of Pain, Anesthesia and Perioperative Medicine; Faculty of Medicine; Dalhousie University; Halifax NS Canada
| | - M Campbell-Yeo
- School of Nursing; Dalhousie University; Halifax Nova Scotia Canada
- Centre for Pediatric Pain Research; IWK Health Centre; Halifax NS Canada
- Maternal Newborn Program; IWK Health Centre; Halifax NS Canada
- Department of Psychology and Neuroscience; Dalhousie University; Halifax NS Canada
- Department of Pediatrics; IWK Health Centre; Halifax NS Canada
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88
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Acupuncture in the neonatal intensive care unit-using ancient medicine to help today's babies: a review. J Perinatol 2017; 37:749-756. [PMID: 27977013 DOI: 10.1038/jp.2016.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/21/2016] [Accepted: 11/01/2016] [Indexed: 11/08/2022]
Abstract
Acupuncture has been used for thousands of years in Eastern medicine for a variety of conditions and illnesses, including pain. Neonatal intensive care, on the other hand, is a relatively new branch of medicine that has emerged as the pivotal influence in increasing survival of critically ill newborn infants only within the last 50 years. Unfortunately, pain is an inevitable part of treatment in a neonatal intensive care unit (NICU). The control and prevention of pain remains a major issue for clinicians despite recognition and understanding of the myriad of short- and long-term problems that are associated with both pain and its treatment within the NICU environment. In this review, we examine the potential role of acupuncture to decrease and treat pain in babies requiring neonatal intensive care and discuss future therapeutic and research implications for the use of this ancient therapy within the modern environment of the NICU.
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89
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Ferrari LF, Araldi D, Green P, Levine JD. Age-Dependent Sexual Dimorphism in Susceptibility to Develop Chronic Pain in the Rat. Neuroscience 2017; 387:170-177. [PMID: 28676241 DOI: 10.1016/j.neuroscience.2017.06.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/18/2017] [Accepted: 06/22/2017] [Indexed: 01/08/2023]
Abstract
Neonatal pain has been suggested to contribute to the development and/or persistence of adult pain. Observations from animal models have shown that neonatal inflammation produces long-term changes in sensory neuron function, which can affect the susceptibility of adults to develop persistent pain. We used a preclinical model of transition to chronic pain, hyperalgesic priming, in which a previous inflammatory stimulus triggers a long-lasting increase in responsiveness to pro-algesic mediators, prototypically prostaglandin E2 (PGE2), to investigate if post-natal age influences susceptibility of adult rats to develop chronic pain. Priming was induced by tumor necrosis factor alpha (TNFα), in male and female rats, 1, 2, 3, 4, 5 or 7weeks after birth. When adults (8weeks after birth), to evaluate for the presence of priming, PGE2 was injected at the same site as TNFα. In males that had received TNFα at post-natal weeks 1, 2 or 3, priming was attenuated compared to the 4-, 5- and 7-week-old treated groups, in which robust priming developed. In contrast, in females treated with TNFα at post-natal week 1, 2, 3, or 4, but not at 5 or 7, priming was present. This age and sex difference in the susceptibility to priming was estrogen-dependent, since injection of TNFα in 3-week-old males and 5-week-old females, in the presence of the estrogen receptor antagonist ICI 182,780, did produce priming. These results suggest that estrogen levels, which vary differently in males and females over the post-natal period, until they stabilize after puberty, impact pain as an adult.
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Affiliation(s)
- Luiz F Ferrari
- Departments of Medicine and Oral Surgery, and Division of Neuroscience, University of California at San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Dioneia Araldi
- Departments of Medicine and Oral Surgery, and Division of Neuroscience, University of California at San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Paul Green
- Departments of Oral & Maxillofacial Surgery, Preventive & Restorative Dental Sciences, and Division of Neuroscience, University of California at San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143, USA.
| | - Jon D Levine
- Departments of Medicine and Oral Surgery, and Division of Neuroscience, University of California at San Francisco, 521 Parnassus Avenue, San Francisco, CA 94143, USA.
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Bahi A. Hippocampal BDNF overexpression or microR124a silencing reduces anxiety- and autism-like behaviors in rats. Behav Brain Res 2017; 326:281-290. [PMID: 28284951 DOI: 10.1016/j.bbr.2017.03.010] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 02/27/2017] [Accepted: 03/04/2017] [Indexed: 12/16/2022]
Abstract
MicroRNA124a (miR124a) has emerged recently as a key player for multiple neuropsychiatric disorders including depression, anxiety, alcoholism, and cocaine addiction. Although we have previously reported that miR124a and its target the brain-derived neutrophic factor (BDNF) play an important role in autism-like behaviors, the molecular and behavioral dysfunctions remain unknown. The aim of this study was to understand the effects of sustained decreases in miR124a and increases of BDNF in the dentate gyrus (DG) on neonatal isolation-induced anxiety-and autism like behaviors in rats. Here we report that lentiviral-mediated silencing of miR124a in the adult DG attenuated neonatal isolation-induced anxiety-like behavior in the elevated plus maze (EPM) and open-field (OF) tests. Also, miR124a silencing decreased autism-like phenotype in the marble burying test (MBT), self-grooming (SG), and social interaction tests. Pearson's correlations demonstrated that high levels of BDNF, a direct target of miR124a, were negatively correlated with miR124a expression. Interestingly, viral-mediated BDNF overexpression in the DG also reversed the neonatal isolation-induced anxiety-and autism like phenotypes. Collectively, these findings suggest that miR124a, through its target BDNF, may influence neonatal isolation-induced anxiety-and autism like behaviors. In conclusion, these results do support the hypothesis that miR124a in discrete hippocampal areas contributes to anxiety- and autism-like behaviors and may be involved in the neuroadaptations underlying the development of autism spectrum disorders as a persistent and lasting condition, and therefore provide a clearer mechanistic framework for understanding the physiopathology of such psychiatric illnesses.
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Affiliation(s)
- Amine Bahi
- Department of Anatomy, Tawam Medical Campus, United Arab Emirates University, Al Ain, United Arab Emirates.
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91
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Walther-Larsen S, Pedersen MT, Friis SM, Aagaard GB, Rømsing J, Jeppesen EM, Friedrichsdorf SJ. Pain prevalence in hospitalized children: a prospective cross-sectional survey in four Danish university hospitals. Acta Anaesthesiol Scand 2017; 61:328-337. [PMID: 28032329 DOI: 10.1111/aas.12846] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/11/2016] [Accepted: 11/19/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pain management in hospitalized children is often inadequate. The prevalence and main sources of pain in Danish university hospitals is unknown. METHODS This prospective mixed-method cross-sectional survey took place at four university hospitals in Denmark. We enrolled 570 pediatric patients who we asked to report their pain experience and its management during the previous 24 hours. For patients identified as having moderate to severe pain, patient characteristics and analgesia regimes were reviewed. RESULTS Two hundred and thirteen children (37%) responded that they had experienced pain in the previous 24 hours. One hundred and thirty four (24%) indicated moderate to severe pain and 43% would have preferred an intervention to alleviate the pain. In children hospitalized for more than 24 hours, the prevalence of moderate/severe pain was significantly higher compared to children admitted the same day. The single most common painful procedure named by the children was needle procedures, such as blood draw and intravenous cannulation. CONCLUSION This study reveals high pain prevalence in children across all age groups admitted to four Danish university hospitals. The majority of children in moderate to severe pain did not have a documented pain assessment, and evidence-based pharmacological and/or integrative ('non-pharmacological') measures were not systematically administered to prevent or treat pain. Thus, practice changes are needed.
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Affiliation(s)
- S. Walther-Larsen
- Pediatric Pain Service; Department of Anesthesiology; The Juliane Marie Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - M. T. Pedersen
- Pediatric Pain Service; Department of Anesthesiology; The Juliane Marie Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - S. M. Friis
- Pediatric Pain Service; Department of Anesthesiology; The Juliane Marie Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - G. B. Aagaard
- Pediatric Pain Service; Department of Anesthesiology; The Juliane Marie Centre; Copenhagen University Hospital Rigshospitalet; Copenhagen Denmark
| | - J. Rømsing
- Department of Drug Design and Pharmacology; Faculty of Health and Medical Sciences; University of Copenhagen; Copenhagen Denmark
| | - E. M. Jeppesen
- Department of Pediatrics; Copenhagen University Hospital Herlev; Copenhagen Denmark
| | - S. J. Friedrichsdorf
- Department of Pain Medicine, Palliative Care & Integrative Medicine; Children's Hospitals and Clinics of Minnesota; Minneapolis MN USA
- Department of Pediatrics; University of Minnesota Medical School; Minneapolis MN USA
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92
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Bröring T, Oostrom KJ, Lafeber HN, Jansma EP, Oosterlaan J. Sensory modulation in preterm children: Theoretical perspective and systematic review. PLoS One 2017; 12:e0170828. [PMID: 28182680 PMCID: PMC5300179 DOI: 10.1371/journal.pone.0170828] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 01/11/2017] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Neurodevelopmental sequelae in preterm born children are generally considered to result from cerebral white matter damage and noxious effects of environmental factors in the neonatal intensive care unit (NICU). Cerebral white matter damage is associated with sensory processing problems in terms of registration, integration and modulation. However, research into sensory processing problems and, in particular, sensory modulation problems, is scarce in preterm children. AIM This review aims to integrate available evidence on sensory modulation problems in preterm infants and children (<37 weeks of gestation) and their association with neurocognitive and behavioral problems. METHOD Relevant studies were extracted from PubMed, EMBASE.com and PsycINFO following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Selection criteria included assessment of sensory modulation in preterm born children (<37 weeks of gestation) or with prematurity as a risk factor. RESULTS Eighteen studies were included. Results of this review support the presence of sensory modulation problems in preterm children. Although prematurity may distort various aspects of sensory modulation, the nature and severity of sensory modulation problems differ widely between studies. CONCLUSIONS Sensory modulation problems may play a key role in understanding neurocognitive and behavioral sequelae in preterm children. Some support is found for a dose-response relationship between both white matter brain injury and length of NICU stay and sensory modulation problems.
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Affiliation(s)
- Tinka Bröring
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Kim J. Oostrom
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Harrie N. Lafeber
- Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Elise P. Jansma
- Department of Epidemiology and Biostatistics, EMGO+ Institute for Health and Care Research and Medical Library, VU University Medical Center, Amsterdam, Netherlands
| | - Jaap Oosterlaan
- Department of Clinical Neuropsychology, VU University Amsterdam, Amsterdam, The Netherlands
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93
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Abstract
BACKGROUND Hospitalised newborn neonates frequently undergo painful invasive procedures that involve penetration of the skin and other tissues by a needle. One intervention that can be used prior to a needle insertion procedure is application of a topical local anaesthetic. OBJECTIVES To evaluate the efficacy and safety of topical anaesthetics such as amethocaine and EMLA in newborn term or preterm infants requiring an invasive procedure involving puncture of skin and other tissues with a needle. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase and CINAHL up to 15 May 2016; previous reviews including cross-references, abstracts, and conference proceedings. We contacted expert informants. We contacted authors directly to obtain additional data. We imposed no language restrictions. SELECTION CRITERIA Randomised, quasi-randomised controlled trials, and cluster and cross-over randomised trials that compared the topical anaesthetics amethocaine and eutectic mixture of local anaesthetics (EMLA) in terms of anaesthetic efficacy and safety in newborn term or preterm infants requiring an invasive procedure involving puncture of skin and other tissues with a needle DATA COLLECTION AND ANALYSIS: From the reports of the clinical trials we extracted data regarding clinical outcomes including pain, number of infants with methaemoglobin level 5% and above, number of needle prick attempts prior to successful needle-related procedure, crying, time taken to complete the procedure, episodes of apnoea, episodes of bradycardia, episodes of oxygen desaturation, neurodevelopmental disability and other adverse events. MAIN RESULTS Eight small randomised controlled trials met the inclusion criteria (n = 506). These studies compared either EMLA and placebo or amethocaine and placebo. No studies compared EMLA and amethocaine. We were unable to meta-analyse the outcome of pain due to differing outcome measures and methods of reporting. For EMLA, two individual studies reported a statistically significant reduction in pain compared to placebo during lumbar puncture and venepuncture. Three studies found no statistical difference between the groups during heel lancing. For amethocaine, three studies reported a statistically significant reduction in pain compared to placebo during venepuncture and one study reported a statistically significant reduction in pain compared to placebo during cannulation. One study reported no statistical difference between the two groups during intramuscular injection.One study reported no statistical difference between EMLA and the placebo group for successful venepuncture at first attempt. One study similarly reported no statistically significant difference between Amethocaine and the placebo group for successful cannulation at first attempt.Risk for local redness, swelling or blanching was significantly higher with EMLA (typical risk ratio (RR) 1.65, 95% confidence interval (CI) 1.24 to 2.19; typical risk difference (RD) 0.17, 95% CI 0.09 to 0.26; n = 272; number needed to treat for an additional harmful outcome (NNTH) 6, 95% CI 4 to 11; I2 = 92% indicating considerable heterogeneity) although not for amethocaine (typical RR 2.11, 95% CI 0.72 to 6.16; typical RD 0.05, 95% CI -0.02 to 0.11, n = 221). These local skin reactions for EMLA and amethocaine were reported as short-lasting. Two studies reported no methaemoglobinaemia with single application of EMLA. The quality of the evidence on outcomes assessed according to GRADE was low to moderate. AUTHORS' CONCLUSIONS Overall, all the trials were small, and the effects of uncertain clinical significance. The evidence regarding the effectiveness or safety of the interventions studied is inadequate to support clinical recommendations. There has been no evaluation regarding any long-term effects of topical anaesthetics in newborn infants.High quality studies evaluating the efficacy and safety of topical anaesthetics such as amethocaine and EMLA for needle-related pain in newborn term or preterm infants are required. These studies should aim to determine efficacy of these topical anaesthetics and on homogenous groups of infants for gestational age. While there was no methaemoglobinaemia in the studies that reported methaemoglobin, the efficacy and safety of EMLA, especially in very preterm infants, and for repeated application, need to be further evaluated in future studies.
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Affiliation(s)
| | - Christine Taylor
- University of Western SydneyParramatta Campus, Bldg EI G15Locked Bag 1797PenrithAustralia2751
| | - Kaye Spence
- The Children's Hospital at WestmeadGrace Centre for Newborn CareLocked Bag 4001WestmeadAustralia2145
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94
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O'Leary HM, Marschik PB, Khwaja OS, Ho E, Barnes KV, Clarkson TW, Bruck NM, Kaufmann WE. Detecting autonomic response to pain in Rett syndrome. Dev Neurorehabil 2017; 20:108-114. [PMID: 26457613 DOI: 10.3109/17518423.2015.1087437] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To quantify pain response in girls affected by Rett syndrome (RTT) using electrodermal activity (EDA), a measure of skin conductance, reflecting sympathetic activity known to be modulated by physical and environmental stress. METHODS EDA increase, heart rate (HR) increase and Face Legs Activity Cry Consolability (FLACC) values calculated during venipuncture (invasive) and vital signs collection (non-invasive) events were compared with values calculated during a prior baseline and a RTT clinical severity score (CSS). RESULTS EDA and HR increase were significantly higher than baseline during venipuncture only and not significantly correlated with FLACC or CSS. EDA increase was the most sensitive measure of pain response. CONCLUSIONS These preliminary findings revealed that motor impairment might bias non-verbal pain scales, underscore the importance of using autonomic measures when assessing pain and warrant further investigation into the utility of using EDA to objectively quantify RTT pain response to inform future RTT pain management.
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Affiliation(s)
- Heather M O'Leary
- a Department of Neurology , Boston Children's Hospital and Harvard Medical School , Boston , MA , USA
| | - Peter B Marschik
- b Institute of Physiology, Graz Medical University , Graz , Austria.,c Department of Women's and Children's Health , Center for Neurodevelopmental Disorders (KIND), Karolinska Institute , Stockholm , Sweden
| | - Omar S Khwaja
- d Roche Pharma Research and Early Development, Roche Innovation Center, F. Hoffmann-La Roche , Basel , Switzerland
| | - Eugenia Ho
- e Department of Neurology , Children's Hospital Los Angeles , Los Angeles , CA , USA , and
| | - Katherine V Barnes
- a Department of Neurology , Boston Children's Hospital and Harvard Medical School , Boston , MA , USA
| | - Tessa W Clarkson
- f Division of Developmental Medicine , Boston Children's Hospital and Harvard Medical School , Boston , MA , USA
| | - Natalie M Bruck
- a Department of Neurology , Boston Children's Hospital and Harvard Medical School , Boston , MA , USA
| | - Walter E Kaufmann
- a Department of Neurology , Boston Children's Hospital and Harvard Medical School , Boston , MA , USA
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95
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Chik YM, Ip WY, Choi KC. The Effect of Upper Limb Massage on Infants’ Venipuncture Pain. Pain Manag Nurs 2017; 18:50-57. [DOI: 10.1016/j.pmn.2016.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 07/07/2016] [Accepted: 10/04/2016] [Indexed: 11/25/2022]
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96
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Tsang SW, Auyeung KKW, Bian ZX, Ko JKS. Pathogenesis, Experimental Models and Contemporary Pharmacotherapy of Irritable Bowel Syndrome: Story About the Brain-Gut Axis. Curr Neuropharmacol 2017; 14:842-856. [PMID: 27009115 PMCID: PMC5333584 DOI: 10.2174/1570159x14666160324144154] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 02/07/2016] [Accepted: 03/22/2016] [Indexed: 11/22/2022] Open
Abstract
Background Although the precise pathophysiology of irritable bowel syndrome (IBS) remains unknown, it is generally considered to be a disorder of the brain-gut axis, representing the disruption of communication between the brain and the digestive system. The present review describes advances in understanding the pathophysiology and experimental approaches in studying IBS, as well as providing an update of the therapies targeting brain-gut axis in the treatment of the disease. Methods Causal factors of IBS are reviewed. Following this, the preclinical experimental models of IBS will be introduced. Besides, both current and future therapeutic approaches of IBS will be discussed. Results When signal of the brain-gut axis becomes misinterpreted, it may lead to dysregulation of both central and enteric nervous systems, altered intestinal motility, increased visceral sensitivity and consequently contributing to the development of IBS. Interference of the brain-gut axis can be modulated by various psychological and environmental factors. Although there is no existing animal experiment that can represent this complex multifactorial disease, these in vivo models are clinically relevant readouts of gastrointestinal functions being essential to the identification of effective treatments of IBS symptoms as well as their molecular targets. Understanding the brain-gut axis is essential in developing the effective therapy for IBS. Therapies include improvement of GI motor functions, relief of visceral hypersensitivity and pain, attenuation of autonomic dysfunctions and suppression of mucosal immune activation. Conclusion Target-oriented therapies that provide symptomatic, psychological and physiological benefits could surely help to improve the quality of life of IBS patients.
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Affiliation(s)
| | | | | | - J K S Ko
- Center for Cancer and Inflammation Research, School of Chinese Medicine, Hong Kong Baptist University, 7 Baptist University Road, Kowloon Tong, Hong Kong SAR, China
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97
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Oxidative Stress as a Physiological Pain Response in Full-Term Newborns. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2017; 2017:3759287. [PMID: 28133505 PMCID: PMC5241471 DOI: 10.1155/2017/3759287] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 11/29/2016] [Accepted: 12/07/2016] [Indexed: 11/23/2022]
Abstract
This research paper aims to investigate if oxidative stress biomarkers increase after a painful procedure in term newborns and if nonpharmacological approaches, or sex, influence pain degree, and the subsequent OS. 83 healthy term newborns were enrolled to receive 10% oral glucose or sensorial saturation (SS) for analgesia during heel prick (HP). The ABC scale was used to score the pain. Advanced oxidation protein products (AOPP) and total hydroperoxides (TH) as biomarkers of OS were measured at the beginning (early-sample) and at the end (late-sample) of HP. The early-sample/late-sample ratio for AOPP and TH was used to evaluate the increase in OS biomarkers after HP. Higher levels of both AOPP and TH ratio were observed in high degree pain (4–6) compared with low degree pain score (0–3) (AOPP: p = 0.049; TH: p = 0.001). Newborns receiving SS showed a significantly lower pain score (p = 0.000) and AOPP ratio levels (p = 0.021) than those without. Males showed higher TH levels at the end of HP (p = 0.005) compared to females. The current study demonstrates that a relationship between pain degree and OS exists in healthy full-term newborns. The amount of OS is gender related, being higher in males. SS reduces pain score together with pain-related OS in the newborns.
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98
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Zhao F, Li M, Jiang Z, Tsien JZ, Lu Z. Camera-Based, Non-Contact, Vital-Signs Monitoring Technology May Provide a Way for the Early Prevention of SIDS in Infants. Front Neurol 2016; 7:236. [PMID: 28066320 PMCID: PMC5179534 DOI: 10.3389/fneur.2016.00236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 12/09/2016] [Indexed: 12/12/2022] Open
Abstract
Sudden infant death syndrome (SIDS) is the unexplained death, usually during sleep, of a baby younger than 1-year-old. Even though researchers have discovered some factors that may put babies at extra risk, SIDS remains unpredictable up until now. One hypothesis is that impaired cardiovascular control may play a role in the underlying mechanism of SIDS. A reduction of heart rate variability (HRV) and progressive decrease in heart rate (HR) have been observed in infants who have later succumbed to SIDS. Many clues indicated the heart could be the final weakness in SIDS. Therefore, continuous monitoring of the dynamic changes within the heart may provide a possible preventive strategy of SIDS. Camera-based photoplethysmography was recently demonstrated as a contactless method to determine HR and HRV. This perspective presents a hypothesis that a camera-based, non-contact, vital-sign monitoring technology, which can indicate abnormal changes or a sudden loss of vital signs in a timely manner, may enable a crucial and low-cost means for the early prevention of SIDS in newborn infants.
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Affiliation(s)
- Fang Zhao
- Brain and Behavior Discovery Institute and Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA; Banna Biomedical Research Institute, Xi-Shuang-Ban-Na, Yunnan, China
| | - Meng Li
- Brain and Behavior Discovery Institute and Department of Neurology, Medical College of Georgia, Augusta University , Augusta, GA , USA
| | - Zhongyi Jiang
- Department of Thoracic and Cardiac Surgery, Shanghai Children's Medical Center, Affiliated with Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Joe Z Tsien
- Brain and Behavior Discovery Institute and Department of Neurology, Medical College of Georgia, Augusta University, Augusta, GA, USA; Banna Biomedical Research Institute, Xi-Shuang-Ban-Na, Yunnan, China
| | - Zhaohui Lu
- Department of Thoracic and Cardiac Surgery, Shanghai Children's Medical Center, Affiliated with Shanghai Jiaotong University School of Medicine , Shanghai , China
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Montirosso R, Tronick E, Borgatti R. Promoting Neuroprotective Care in Neonatal Intensive Care Units and Preterm Infant Development: Insights From the Neonatal Adequate Care for Quality of Life Study. CHILD DEVELOPMENT PERSPECTIVES 2016. [DOI: 10.1111/cdep.12208] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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100
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Elhaik E. A "Wear and Tear" Hypothesis to Explain Sudden Infant Death Syndrome. Front Neurol 2016; 7:180. [PMID: 27840622 PMCID: PMC5083856 DOI: 10.3389/fneur.2016.00180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/04/2016] [Indexed: 01/22/2023] Open
Abstract
Sudden infant death syndrome (SIDS) is the leading cause of death among USA infants under 1 year of age accounting for ~2,700 deaths per year. Although formally SIDS dates back at least 2,000 years and was even mentioned in the Hebrew Bible (Kings 3:19), its etiology remains unexplained prompting the CDC to initiate a sudden unexpected infant death case registry in 2010. Due to their total dependence, the ability of the infant to allostatically regulate stressors and stress responses shaped by genetic and environmental factors is severely constrained. We propose that SIDS is the result of cumulative painful, stressful, or traumatic exposures that begin in utero and tax neonatal regulatory systems incompatible with allostasis. We also identify several putative biochemical mechanisms involved in SIDS. We argue that the important characteristics of SIDS, namely male predominance (60:40), the significantly different SIDS rate among USA Hispanics (80% lower) compared to whites, 50% of cases occurring between 7.6 and 17.6 weeks after birth with only 10% after 24.7 weeks, and seasonal variation with most cases occurring during winter, are all associated with common environmental stressors, such as neonatal circumcision and seasonal illnesses. We predict that neonatal circumcision is associated with hypersensitivity to pain and decreased heart rate variability, which increase the risk for SIDS. We also predict that neonatal male circumcision will account for the SIDS gender bias and that groups that practice high male circumcision rates, such as USA whites, will have higher SIDS rates compared to groups with lower circumcision rates. SIDS rates will also be higher in USA states where Medicaid covers circumcision and lower among people that do not practice neonatal circumcision and/or cannot afford to pay for circumcision. We last predict that winter-born premature infants who are circumcised will be at higher risk of SIDS compared to infants who experienced fewer nociceptive exposures. All these predictions are testable experimentally using animal models or cohort studies in humans. Our hypothesis provides new insights into novel risk factors for SIDS that can reduce its risk by modifying current infant care practices to reduce nociceptive exposures.
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Affiliation(s)
- Eran Elhaik
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield, UK
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