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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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103
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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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104
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Xu W, Walsh S, Cong XS. Development of Accumulated Pain/Stressor Scale (APSS) in NICUs: A National Survey. Pain Manag Nurs 2016; 17:354-362. [PMID: 27756592 DOI: 10.1016/j.pmn.2016.08.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/02/2016] [Accepted: 08/19/2016] [Indexed: 11/18/2022]
Abstract
High-risk neonates experience numerous painful/stressful procedures daily in neonatal intensive care units (NICUs). Accumulated pain and stress have a detrimental impact on infants' neurodevelopment. Few valid tools are available to measure accumulated pain/stressors among NICU infants. The aim of this study was to obtain nurses' perceptions about severity and acuity levels regarding each painful/stressful procedure that infants may experience in the NICU. The data will support developing a new instrument, the Accumulated Pain/Stressor Scale (APSS) in NICUs. A nationwide online survey was conducted through the U.S. National Association of Neonatal Nurses membership. Respondents were asked to rate the perceived severity of pain/stress associated with 68 procedures using a 5-point Likert scale and to categorize pain/stress as acute or chronic. Modal values were used to determine summary rankings among the procedures. Eighty-four neonatal nurses completed the survey. Among 68 procedures, nearly all were rated as painful/stressful to some degree. Five procedures (7%) had a modal value of five (extremely painful/stressful), nine (14%) had a value of four, 20 (29%) had a value of three, 30 (44%) a value of two, and four (6%) had a value of one (not painful/stressful). Forty-four procedures (65%) were perceived as acute, six (9%) as chronic, and 18 (26%) as both acute and chronic. Nurses' perceptions of pain severity and acuity regarding procedures in NICUs varied somewhat. Further studies are needed in developing and validating the scale. The development of the APSS can quantitatively measure the accumulated neonatal pain/stress.
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Affiliation(s)
- Wanli Xu
- University of Connecticut School of Nursing, Storrs, Connecticut
| | - Stephen Walsh
- University of Connecticut School of Nursing, Storrs, Connecticut
| | - Xiaomei S Cong
- University of Connecticut School of Nursing, Storrs, Connecticut.
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105
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Viola TW, Wearick-Silva LE, De Azeredo LA, Centeno-Silva A, Murphy C, Marshall P, Li X, Singewald N, Garcia F, Bredy TW, Grassi-Oliveira R. Increased cocaine-induced conditioned place preference during periadolescence in maternally separated male BALB/c mice: the role of cortical BDNF, microRNA-212, and MeCP2. Psychopharmacology (Berl) 2016; 233:3279-88. [PMID: 27392631 DOI: 10.1007/s00213-016-4373-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Accepted: 06/18/2016] [Indexed: 12/15/2022]
Abstract
RATIONALE Early life stress is a major risk factor for cocaine addiction; however, the underlying molecular mechanisms remain relatively unexplored. MicroRNA-212 (miR-212) and methyl CpG binding protein 2 (MeCP2) have recently emerged as key regulators of brain-derived neurotrophic factor (BDNF) signaling during the acquisition and maintenance of cocaine-seeking behaviors. OBJECTIVES We therefore investigated the effect of maternal separation (MS) on cocaine-induced conditioned place preference (CPP) during periadolescence and how this influences miR-212, Mecp2, and Bdnf expressions in the prefrontal cortex. METHODS Male BALB/c mice subjected to MS (3 h/day) from postnatal day 2 to 15 or normal animal facility rearing (AFR) were tested for CPP at postnatal day 45, or not exposed to experimental manipulations (drug-naïve animals). Cultured primary cortical neurons were used to determine miR-212 expression changes following depolarization by KCL treatment. RESULTS MS increased cocaine-induced CPP and decreased Bdnf exon IV expression, which correlated with higher CPP scores in such animals. An experience-dependent decrease in miR-212 expression was observed following CPP test. This effect was mimicked in primary cortical neurons in vitro, under activity-dependent conditions. In contrast, increased Mecp2 expression was found after CPP test, suggesting an opposing relationship between miR-212 and Mecp2 expression following cocaine place preference acquisition. However, these effects were not present in mice exposed to MS. CONCLUSIONS Together, our results suggest that early life stress can enhance the motivational salience for cocaine-paired cues during periadolescence, and that altered expression of miR-212, Mecp2, and Bdnf in the prefrontal cortex is involved in this process.
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Affiliation(s)
- Thiago Wendt Viola
- Postgraduate Program in Pediatrics and Child Health, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Developmental Cognitive Neuroscience Lab (DCNL), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga, 6681, prédio 11, sala 928, Porto Alegre, 90619-900, RS, Brazil
| | - Luis Eduardo Wearick-Silva
- Postgraduate Program in Pediatrics and Child Health, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil.,Developmental Cognitive Neuroscience Lab (DCNL), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga, 6681, prédio 11, sala 928, Porto Alegre, 90619-900, RS, Brazil
| | - Lucas Araújo De Azeredo
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga, 6681, prédio 11, sala 928, Porto Alegre, 90619-900, RS, Brazil.,Postgraduate Program in Medicine and Health Sciences, PUCRS, Porto Alegre, RS, Brazil
| | - Anderson Centeno-Silva
- Developmental Cognitive Neuroscience Lab (DCNL), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga, 6681, prédio 11, sala 928, Porto Alegre, 90619-900, RS, Brazil
| | - Conor Murphy
- Department of Pharmacology and Toxicology, Institute of Pharmacy, Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Paul Marshall
- Department of Neurobiology and Behavior, Center for the Neurobiology of Learning and Memory, University of California-Irvine, Irvine, 92697, CA, USA
| | - Xiang Li
- Department of Neurobiology and Behavior, Center for the Neurobiology of Learning and Memory, University of California-Irvine, Irvine, 92697, CA, USA
| | - Nicolas Singewald
- Department of Pharmacology and Toxicology, Institute of Pharmacy, Center for Molecular Biosciences Innsbruck, University of Innsbruck, Innsbruck, Austria
| | - Frederico Garcia
- Department of Psychiatry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Timothy W Bredy
- Department of Neurobiology and Behavior, Center for the Neurobiology of Learning and Memory, University of California-Irvine, Irvine, 92697, CA, USA.,Queensland Brain Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Rodrigo Grassi-Oliveira
- Postgraduate Program in Pediatrics and Child Health, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil. .,Developmental Cognitive Neuroscience Lab (DCNL), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Avenida Ipiranga, 6681, prédio 11, sala 928, Porto Alegre, 90619-900, RS, Brazil.
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PREMM: preterm early massage by the mother: protocol of a randomised controlled trial of massage therapy in very preterm infants. BMC Pediatr 2016; 16:146. [PMID: 27568006 PMCID: PMC5002318 DOI: 10.1186/s12887-016-0678-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background Preterm infants follow an altered neurodevelopmental trajectory compared to their term born peers as a result of the influence of early birth, and the altered environment. Infant massage in the preterm infant has shown positive effects on weight gain and reduced length of hospital stay. There is however, limited current evidence of improved neurodevelopment or improved attachment, maternal mood or anxiety. The aim of this study is to investigate the effects of infant massage performed by the mother in very preterm (VPT) infants. Effects on the infant will be assessed at the electrophysiological, neuroradiological and clinical levels. Effects on maternal mood, anxiety and mother-infant attachment will also be measured. Methods/Design A randomised controlled trial to investigate the effect of massage therapy in VPT infants. Sixty VPT infants, born at 28 to 32 weeks and 6 days gestational age, who are stable, off supplemental oxygen therapy and have normal cranial ultrasounds will be recruited and randomised to an intervention (infant massage) group or a control (standard care) group. Ten healthy term born infants will be recruited as a reference comparison group. The intervention group will receive standardised massage therapy administered by the mother from recruitment, until term equivalent age (TEA). The control group will receive care as usual (CAU). Infants and their mothers will be assessed at baseline, TEA, 12 months and 24 months corrected age (CA), with a battery of clinical, neuroimaging and electrophysiological measures, as well as structured questionnaires, psychoanalytic observations and neurodevelopmental assessments. Discussion Optimising preterm infant neurodevelopment is a key aim of neonatal research, which could substantially improve long-term outcomes and reduce the socio-economic impact of VPT birth. This study has the potential to give insights into the mother-baby relationship and any positive effects of infant massage on neurodevelopment. An early intervention such as massage that is relatively easy to administer and could alter the trajectory of preterm infant brain development, holds potential to improve neurodevelopmental outcomes in this vulnerable population. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12612000335897. Date registered: 22/3/2012.
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107
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108
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Bluth MH, Thomas R, Cohen C, Bluth AC, Goldberg E. Martial arts intervention decreases pain scores in children with malignancy. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2016; 7:79-87. [PMID: 29388580 PMCID: PMC5683288 DOI: 10.2147/phmt.s104021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Martial arts intervention in disease has been mostly limited to adult inflammatory, musculoskeletal, or motor diseases, where a mechanical intervention effects positive change. However, the application and benefit to pain management in childhood malignancy are not well described. Here, we assess the effects of defined martial arts intervention in children with cancer with respect to their pain perception and management. Methods Sixty-four children with childhood malignancies were enrolled in a martial arts program, which encompassed both meditation and movement modalities. Pain scores (0–10) were recorded pre- and post- 1-hour session intervention. Pain scores were crossed by total visits and tabulated by whether participant pain reduced at least 1 unit, stayed the same, or increased in intensity immediately after (post) participation session. Differences in pain scores were further compared by age and sex. Results Prepain and postpain scale data were measured for 64 participants, 43 males (67.2%) and 21 females (32.8%), ranging from 3 years to 19 years. Preintervention and postintervention data were obtained for 223 individual session visits. Mean number of patient participation visits was 1.8±1.6 (range one to nine visits). Of 116 individual measured sessions where the participants began with a pain score of at least 1, pain intensity reduced ≥1 unit in 85.3% (99/116) of visits, remained the same in 7.8% (9/116), and increased in 6.9% (8/116). For the majority (96.3%; 77/80) of sessions, participants began with a prepain intensity score of at least 5–10 with reduction in pain intensity following the session. The overall mean pain score presession visit was reduced bŷ40% (pre: 5.95±2.64 and post: 3.03±2.45 [95% CI: 2.34–3.50]; P≤0.001). Median pain intensity scores had greater reductions with increased age of participants (3–6 years [–1], 7–10 years [–2], 11–14 years [–3], and 15–19 years [–4]). Conclusion Martial arts intervention can provide a useful modality to decrease pain in childhood cancer, with greater effect achieved with higher baseline pain scores and patient age. Martial arts intervention may improve patient compliance with respect to medical and surgical management, thus reducing disease morbidity and health care costs.
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Affiliation(s)
- Martin H Bluth
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI.,Kids Kicking Cancer, Southfield, MI
| | - Ronald Thomas
- Children's Research Center of Michigan at Children's Hospital of Michigan, Detroit MI.,Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI
| | | | | | - Elimelech Goldberg
- Kids Kicking Cancer, Southfield, MI.,Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI
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109
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Affiliation(s)
- Kanwaljeet J. S. Anand
- Departments of Pediatrics; Anesthesiology, Perioperative & Pain Medicine; Stanford University School of Medicine; Stanford CA, USA
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110
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Deindl P, Giordano V, Fuiko R, Waldhoer T, Unterasinger L, Berger A, Olischar M. The implementation of systematic pain and sedation management has no impact on outcome in extremely preterm infants. Acta Paediatr 2016; 105:798-805. [PMID: 26792117 DOI: 10.1111/apa.13334] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Revised: 10/30/2015] [Accepted: 01/14/2016] [Indexed: 11/28/2022]
Abstract
AIM This study compared the short-term and neurodevelopmental outcomes of extremely preterm infants before and after the implementation of a protocol to manage neonatal pain and sedation. METHODS Our study cohort comprised 140 extremely preterm infants from two neonatal intensive care units. We retrospectively analysed opiate exposure, time on mechanical ventilation, inotropic support, nutritional aspects and growth 12 months before (controls) vs 12 months after (intervention) the implementation of the Vienna Protocol for Neonatal Pain and Sedation. Infants were evaluated at the corrected age of 12 months using the Bayley Scales of Infant Development - Second Edition. RESULTS After the protocol was implemented, the cumulative opiate dose increased from a baseline of 15 mg/kg ± 41 to 89 mg/kg ± 228 morphine equivalents. Time on mechanical ventilation, inotropic support, length of parenteral nutrition, growth, length of stay and in-hospital morbidity were similar before and after the implementation, with no differences between the groups in mental, motor and behavioural development at the one-year follow-up. However, opiate exposure was a possible risk factor for lower behaviour rating scores (estimate = -0.04; p = 0.006). [Correction added on 23 February 2016, after online publication: In the preceding sentences, the cumulative opiate dose as well as the estimate value for the behavioral rating scale were previously incorrect and have been amended in this current version.] CONCLUSION Implementing a neonatal pain and sedation protocol increased opiate exposure, but had no effect on the in-hospital and neurodevelopmental outcomes of extremely preterm infants.
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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 Eppendorf Germany
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Vito Giordano
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Renate Fuiko
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
| | - Thomas Waldhoer
- 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
| | - Monika Olischar
- Department of Pediatrics and Adolescent Medicine; Division of Neonatology; Pediatric Intensive Care and Neuropediatrics; Medical University of Vienna; Vienna Austria
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111
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Kommers D, Oei G, Chen W, Feijs L, Bambang Oetomo S. Suboptimal bonding impairs hormonal, epigenetic and neuronal development in preterm infants, but these impairments can be reversed. Acta Paediatr 2016; 105:738-51. [PMID: 26519107 DOI: 10.1111/apa.13254] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/24/2015] [Accepted: 10/26/2015] [Indexed: 01/21/2023]
Abstract
UNLABELLED This review aimed to raise awareness of the consequences of suboptimal bonding caused by prematurity. In addition to hypoxia-ischaemia, infection and malnutrition, suboptimal bonding is one of the many unnatural stimuli that preterm infants are exposed to, compromising their physiological development. However, the physiological consequences of suboptimal bonding are less frequently addressed in the literature than those of other threatening unnatural stimuli. CONCLUSION This review found that suboptimal bonding significantly impaired hormonal, epigenetic and neuronal development, but these impairments could be reversed by bonding interventions. This suggests that neonatal intensive care units should focus more on interventions that optimise bonding.
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Affiliation(s)
- D Kommers
- Department of Neonatology; Máxima Medical Centre Veldhoven; Veldhoven The Netherlands
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - G Oei
- Department of Electrical Engineering; Eindhoven University of Technology; Eindhoven The Netherlands
- Department of Gynaecology; Máxima Medical Centre Veldhoven; Veldhoven The Netherlands
| | - W Chen
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - L Feijs
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
| | - S Bambang Oetomo
- Department of Neonatology; Máxima Medical Centre Veldhoven; Veldhoven The Netherlands
- Department of Industrial Design; Eindhoven University of Technology; Eindhoven The Netherlands
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Abstract
A growing body of evidence demonstrates that untreated pain is associated with adverse consequences that can compromise clinical and developmental outcomes in children but that these adverse consequences can be prevented or attenuated by appropriate analgesic therapy. Thus, effective treatment of acute pain must be a clinical priority for children of all ages. Over the past 20 years, extensive pediatric research exploring pain assessment, developmental pharmacology of analgesics, and the clinical use of analgesics has dispelled many myths and misconceptions about pain management in pediatric patients; proven that analgesics can be used safely in neonates, infants, and children; and provided a framework for the development of pediatric pain management guidelines. This article reviews guidelines recommended for managing acute pain in pediatric patients and the treatment options for children experiencing acute pain. Contemporary issues regarding acetaminophen, nonsteroidal anti-inflammatory agents, and opioids are discussed.
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Affiliation(s)
- Paul C. Walker
- Departement of Pharmacy Services, University of Michigan Health System, College of Pharmacy at the University of Michigan,
| | - Deborah S. Wagner
- College of Pharmacy and Medical School, University of Michigan and Clinical Pharmacist, Department of Pharmacy Services, University of Michigan Health System
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113
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Donia AES, Tolba OA. Effect of early procedural pain experience on subsequent pain responses among premature infants. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2016. [DOI: 10.1016/j.epag.2016.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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114
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Sood E, Berends WM, Butcher JL, Lisanti AJ, Medoff-Cooper B, Singer J, Willen E, Butler S. Developmental Care in North American Pediatric Cardiac Intensive Care Units: Survey of Current Practices. Adv Neonatal Care 2016; 16:211-9. [PMID: 27140031 PMCID: PMC5659348 DOI: 10.1097/anc.0000000000000264] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Developmental care practices across pediatric cardiac intensive care units (CICUs) have not previously been described. PURPOSE To characterize current developmental care practices in North American CICUs. METHODS A 47-item online survey of developmental care practices was developed and sent to 35 dedicated pediatric CICUs. Staff members who were knowledgeable about developmental care practices in the CICU completed the survey. FINDINGS/RESULTS Completed surveys were received from 28 CICUs (80% response rate). Eighty-nine percent reported targeted efforts to promote developmental care, but only 50% and 43% reported having a developmental care committee and holding developmental rounds, respectively. Many CICUs provide darkness for sleep (86%) and indirect lighting for alertness (71%), but fewer provide low levels of sound (43%), television restrictions (43%), or designated quiet times (21%). Attempts to cluster care (82%) and support self-soothing during difficult procedures (86%) were commonly reported, but parental involvement in these activities is not consistently encouraged. All CICUs engage in infant holding, but practices vary on the basis of medical status and only 46% have formal holding policies. IMPLICATIONS FOR PRACTICE Implementation of developmental care in the CICU requires a well-planned process to ensure successful adoption of practice changes, beginning with a strong commitment from leadership and a focus on staff education, family support, value of parents as the primary caregivers, and policies to increase consistency of practice. IMPLICATIONS FOR RESEARCH Future studies should examine the short- and long-term effects of developmental care practices on infants born with congenital heart disease and cared for in a pediatric CICU.
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Affiliation(s)
- Erica Sood
- Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, and Nemours Cardiac Center, Alfred I. duPont Hospital for Children, Wilmington, Delaware (Dr Sood); Johns Hopkins Medicine International, Baltimore, Maryland (Ms Berends); Pediatrics, University of Michigan Medical School, Ann Arbor, and C.S. Mott Children's Hospital, Ann Arbor, Michigan (Dr Butcher); Cardiac Nursing, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania (Dr Lisanti); Pediatric Nursing, University of Pennsylvania School of Nursing, Philadelphia (Dr Medoff-Cooper); Pediatrics and Psychiatry, Harvard Medical School, and Division of Developmental Medicine, Boston Children's Hospital, Boston, Massachusetts (Dr Singer); Pediatrics, School of Medicine, University of Missouri-Kansas City, and Division of Developmental and Behavioral Sciences, Children's Mercy, Kansas City, Missouri (Dr Willen); and Psychiatry, Harvard Medical School, and Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts (Dr Butler)
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Lee JH, Espinera AR, Chen D, Choi KE, Caslin AY, Won S, Pecoraro V, Xu GY, Wei L, Yu SP. Neonatal inflammatory pain and systemic inflammatory responses as possible environmental factors in the development of autism spectrum disorder of juvenile rats. J Neuroinflammation 2016; 13:109. [PMID: 27184741 PMCID: PMC4867541 DOI: 10.1186/s12974-016-0575-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 05/06/2016] [Indexed: 02/28/2023] Open
Abstract
Background Autism spectrum disorder (ASD) affects many children and juveniles. The pathogenesis of ASD is not well understood. Environmental factors may play important roles in the development of ASD. We examined a possible relationship of inflammatory pain in neonates and the development of ASD in juveniles. Methods Acute inflammation pain was induced by 5 % formalin (5 μl/day) subcutaneous injection into two hindpaws of postnatal day 3 to 5 (P3–P5) rat pups. Western blot, immunohistochemical, and behavioral examinations were performed at different time points after the insult. Results Formalin injection caused acute and chronic inflammatory responses including transient local edema, increased levels of inflammatory cytokines, TNF-α, and IL-1β in the blood as well as in the brain, and increased microglia in the brain. One day after the pain insult, there was significant cell death in the cortex and hippocampus. Two weeks later, although the hindpaw local reaction subsided, impaired axonal growth and demyelization were seen in the brain of P21 juvenile rats. The number of bromodeoxyuridine (BrdU) and doublecortin (DCX) double-positive cells in the hippocampal dentate gyrus of P21 rats was significantly lower than that in controls, indicating reduced neurogenesis. In the P21 rat’s brain of the formalin group, the expression of autism-related gene neurexin 1 (NRXN1), fragile X mental retardation 1 (FMR1), and oxytocin was significantly downregulated, consistent with the gene alteration in ASD. Juvenile rats in the formalin group showed hyperalgesia, repetitive behaviors, abnormal locomotion, sleep disorder, and distinct deficits in social memory and social activities. These alterations in neuroinflammatory reactions, gene expression, and behaviors were more evident in male than in female rats. Importantly, an anti-inflammation treatment using indomethacin (10 mg/kg, i.p.) at the time of formalin injections suppressed inflammatory responses and neuronal cell death and prevented alterations in ASD-related genes and the development of abnormal behaviors. Conclusions These novel observations indicate that severe inflammatory pain in neonates and persistent inflammatory reactions may predispose premature infants to development delays and psychiatric disorders including ASD. The prevention of pain stimuli and prompt treatments of inflammation during development appear vitally important in disrupting possible evolution of ASD syndromes. Electronic supplementary material The online version of this article (doi:10.1186/s12974-016-0575-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jin Hwan Lee
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Alyssa R Espinera
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Dongdong Chen
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30322, USA.,The Laboratory of Translational Pain Medicine, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Ko-Eun Choi
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Asha Yoshiko Caslin
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Soonmi Won
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Valentina Pecoraro
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Guang-Yin Xu
- The Laboratory of Translational Pain Medicine, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, 215123, China
| | - Ling Wei
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30322, USA.,Department of Neurology, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Shan Ping Yu
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, GA, 30322, USA. .,Center for Visual and Neurocognitive Rehabilitation, Atlanta VA Medical Center, Atlanta, GA, 30033, USA. .,Emory University School of Medicine, 101 Woodruff Circle, WMB Suite 620, Atlanta, GA, 30322, USA.
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116
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Mooney-Leber SM, Brummelte S. Neonatal pain and reduced maternal care: Early-life stressors interacting to impact brain and behavioral development. Neuroscience 2016; 342:21-36. [PMID: 27167085 DOI: 10.1016/j.neuroscience.2016.05.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/22/2016] [Accepted: 05/02/2016] [Indexed: 12/21/2022]
Abstract
Advances in neonatal intensive care units (NICUs) have drastically increased the survival chances of preterm infants. However, preterm infants are still exposed to a wide range of stressors during their stay in the NICU, which include painful procedures and reduced maternal contact. The activation of the hypothalamic-pituitary-adrenal (HPA) axis, in response to these stressors during this critical period of brain development, has been associated with many acute and long-term adverse biobehavioral outcomes. Recent research has shown that Kangaroo care, a non-pharmacological analgesic based on increased skin-to-skin contact between the neonate and the mother, negates the adverse outcomes associated with neonatal pain and reduced maternal care, however the biological mechanism remains widely unknown. This review summarizes findings from both human and rodent literature investigating neonatal pain and reduced maternal care independently, primarily focusing on the role of the HPA axis and biobehavioral outcomes. The physiological and positive outcomes of Kangaroo care will also be discussed in terms of how dampening of the HPA axis response to neonatal pain and increased maternal care may account for positive outcomes associated with Kangaroo care.
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Affiliation(s)
- Sean M Mooney-Leber
- Department of Psychology, Wayne State University, Detroit, MI, United States
| | - Susanne Brummelte
- Department of Psychology, Wayne State University, Detroit, MI, United States.
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117
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Jansen M. Routine circumcision of infant boys: It's time to make progress through the common ground. J Paediatr Child Health 2016; 52:477-9. [PMID: 27329900 DOI: 10.1111/jpc.13224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Melanie Jansen
- Centre for Children's Health Ethics and Law, Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, 4101, Queensland, Australia
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118
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Banga S, Datta V, Rehan HS, Bhakhri BK. Effect of Sucrose Analgesia, for Repeated Painful Procedures, on Short-term Neurobehavioral Outcome of Preterm Neonates: A Randomized Controlled Trial. J Trop Pediatr 2016; 62:101-6. [PMID: 26615181 PMCID: PMC4886114 DOI: 10.1093/tropej/fmv079] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Safety of oral sucrose, commonly used procedural analgesic in neonates, is questioned. AIM To evaluate the effect of sucrose analgesia, for repeated painful procedures, on short-term neurobehavioral outcome of preterm neonates. METHODS Stable preterm neonates were randomized to receive either sucrose or distilled water orally, for every potentially painful procedure during the first 7 days after enrollment. Neurodevelopmental status at 40 weeks postconceptional age (PCA) measured using the domains of Neurobehavioral Assessment of Preterm Infants scale. RESULTS A total of 93 newborns were analyzed. The baseline characteristics of the groups were comparable. No statistically significant difference was observed in the assessment at 40 weeks PCA, among the groups. Use of sucrose analgesia, for repeated painful procedures on newborns, does not lead to any significant difference in the short-term neurobehavioral outcome.
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Affiliation(s)
- Shreshtha Banga
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India 110001
| | - Vikram Datta
- Department of Neonatology, Lady Hardinge Medical College, New Delhi, India 110001
| | - Harmeet Singh Rehan
- Department of Pharmacology, Lady Hardinge Medical College, New Delhi, India 110001
| | - Bhanu Kiran Bhakhri
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India 110001
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Abstract
This study examined the incidence of adverse prenatal, perinatal, and neonatal experiences amongst children with anxiety disorders, and the relationship to clinical symptomology and functional impairment in treatment-seeking children (N = 107) with a primary anxiety disorder. Anxious children had higher rates of reported maternal prescription medication use during pregnancy, maternal smoking and illness during pregnancy and neonatal complications (including neonatal intensive care and feeding issues) compared with population base rates and non-affected children. Almost one-third had early problems with sleep. Developmental problems were common with more than half having at least one area of delay. More than three quarters of anxious children had a first-degree family member with a psychiatric history. There were several associations between neonatal complications and subsequent clinical symptomology, including attention deficit hyperactivity disorder and depressive comorbidity, anxiety severity and functional impairment. Findings suggest higher rates of perinatal complications in anxious children.
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120
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Montirosso R, Casini E, Del Prete A, Zanini R, Bellù R, Borgatti R. Neonatal developmental care in infant pain management and internalizing behaviours at 18 months in prematurely born children. Eur J Pain 2016; 20:1010-21. [DOI: 10.1002/ejp.826] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2015] [Indexed: 12/12/2022]
Affiliation(s)
- R. Montirosso
- 0-3 Centre for the Study of Social Emotional Development of the At-Risk Infant; Scientific Institute; IRCCS Eugenio Medea; Lecco Italy
| | - E. Casini
- 0-3 Centre for the Study of Social Emotional Development of the At-Risk Infant; Scientific Institute; IRCCS Eugenio Medea; Lecco Italy
| | - A. Del Prete
- Department of Neonatal Care and Neonatal Intensive Care Unit; Manzoni Hospital; Lecco Italy
| | - R. Zanini
- Department of Neonatal Care and Neonatal Intensive Care Unit; Manzoni Hospital; Lecco Italy
| | - R. Bellù
- Department of Neonatal Care and Neonatal Intensive Care Unit; Manzoni Hospital; Lecco Italy
| | - R. Borgatti
- Neuropsychiatry and Neurorehabilitation Unit; Scientific Institute; IRCCS Eugenio Medea; Lecco Italy
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121
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Neubauer V, Wegleiter K, Posod A, Urbanek M, Wechselberger K, Kiechl-Kohlendorfer U, Keller M, Griesmaier E. Delayed application of the haematopoietic growth factors G-CSF/SCF and FL reduces neonatal excitotoxic brain injury. Brain Res 2016; 1634:94-103. [PMID: 26772988 DOI: 10.1016/j.brainres.2015.12.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 12/03/2015] [Accepted: 12/29/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Developmental brain injury results in cognitive and motor deficits in the preterm infant. Enhanced glutamate release and subsequent receptor activation are major pathogenetic factors. The effect of haematopoietic growth factors, such as granulocyte colony-stimulating factor (G-CSF), stem cell factor (SCF) and flt-3 ligand (FL) on neonatal brain injury is controversially discussed. Timing of treatment is known to be a crucial factor. Based on the hypothesis that an exacerbation of injury is caused by administration of substances in the acute phase, the objective of this study was to evaluate the effect of delayed administration of G-CSF/SCF and FL to protect against excitotoxic brain injury in vivo. METHODS In an established neonatal mouse model of excitotoxic brain injury, we evaluated the effect of daily intraperitoneal doses of G-CSF/SCF or FL, starting 60 h after the excitotoxic insult. RESULTS Intraperitoneal injections of G-CSF/SCF and FL, given 60 h after the excitotoxic insult, significantly reduced lesion size at postnatal days 10, 18 and 90. G-CSF/SCF treatment resulted in a decrease in apoptotic cell death indicated by reduced caspase-3 activation. G-CSF/SCF and FL treatment did not affect apoptosis-inducing factor-dependent apoptosis or cell proliferation. CONCLUSION We show that delayed systemic treatment with the haematopoietic growth factors G-CSF/SCF and FL protects against N-methyl-D-aspartate receptor-mediated developmental excitotoxic brain damage. Our results suggest that neuroprotective effects in this neonatal animal model of excitotoxic brain injury depend on the timing of drug administration after the insult.
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Affiliation(s)
- Vera Neubauer
- Department of Paediatrics II (Neonatology), Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Karina Wegleiter
- Department of Paediatrics II (Neonatology), Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Anna Posod
- Department of Paediatrics II (Neonatology), Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Martina Urbanek
- Department of Paediatrics II (Neonatology), Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Karina Wechselberger
- Department of Paediatrics II (Neonatology), Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Ursula Kiechl-Kohlendorfer
- Department of Paediatrics II (Neonatology), Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria
| | - Matthias Keller
- Kinderklinik Dritter Orden, Munich Technical University, Bischof Altmann-Strasse 9, 94032 Passau, Germany
| | - Elke Griesmaier
- Department of Paediatrics II (Neonatology), Medical University of Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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122
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Matas E, Bock J, Braun K. The Impact of Parent-Infant Interaction on Epigenetic Plasticity Mediating Synaptic Adaptations in the Infant Brain. Psychopathology 2016; 49:201-210. [PMID: 27668788 DOI: 10.1159/000448055] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 06/26/2016] [Indexed: 11/19/2022]
Abstract
The development of the brain depends on an individual's nature (genes) and nurture (environments). This interaction between genetic predispositions and environmental events during brain development drives the maturation of functional brain circuits such as sensory, motor, emotional, and complex cognitive pathways. Adverse environmental conditions such as early life stress can interfere with the functional development of emotional and cognitive brain systems and thereby increase the risk of developing psychiatric disorders later in life. In order to develop more efficient and individualized protective and therapeutic interventions, it is essential to understand how environmental stressors during infancy affect cellular and molecular mechanisms involved in brain maturation. Animal models of early life stress have been able to reveal brain structural and metabolic changes in prefrontolimbic circuits, which are time, brain region, neuron, and sex specific. By focusing on animal models of separation stress during infancy, this review highlights epigenetic and cytoarchitectural modifications which are assumed to mediate lasting changes of brain function and behavior.
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Affiliation(s)
- Emmanuel Matas
- Department of Zoology/Developmental Neurobiology, Otto von Guericke University Magdeburg, Magdeburg, Germany
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123
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Hogan ME, Shah VS, Smith RW, Yiu A, Taddio A. Glucose for the management of procedural pain in neonates. Hippokratia 2015. [DOI: 10.1002/14651858.cd009721.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Mary-Ellen Hogan
- University of Toronto; Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy; 144 College Street Toronto ON Canada M5S 3M2
| | - Vibhuti S Shah
- University of Toronto; Department of Paediatrics and Institute of Health Policy, Management and Evaluation; 600 University Avenue Toronto ON Canada M5G 1X5
| | - Ryan W Smith
- University of Toronto; Graduate Department of Pharmaceutical Sciences, Leslie Dan Faculty of Pharmacy; 144 College Street Toronto ON Canada M5S 3M2
| | - Ashley Yiu
- University of Toronto; Leslie Dan Faculty of Pharmacy; 144 College Street Toronto ON Canada M5S 3M2
| | - Anna Taddio
- Hospital for Sick Children Research Institute; Graduate Department of Pharmaceutical Sciences; 555 University Avenue Toronto ON Canada M5G 1X8
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124
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Hall AJ, Humphriss R, Baguley DM, Parker M, Steer CD. Prevalence and risk factors for reduced sound tolerance (hyperacusis) in children. Int J Audiol 2015; 55:135-41. [PMID: 26642866 DOI: 10.3109/14992027.2015.1092055] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To estimate the prevalence of reduced sound tolerance (hyperacusis) in a UK population of 11-year-old children and examine the association of early life and auditory risk factors with report of hyperacusis. DESIGN A prospective UK population-based study. STUDY SAMPLE A total of 7097 eleven-year-old children within the Avon longitudinal study of parents and children (ALSPAC) were asked about sound tolerance; hearing and middle-ear function was measured using audiometry, otoacoustic emissions, and tympanometry. Information on neonatal risk factors and socioeconomic factors were obtained through parental questionnaires. RESULTS 3.7% (95% CI 3.25, 4.14) children reported hyperacusis. Hyperacusis report was less likely in females (adj OR 0.64, 95% CI 0.49, 0.85), and was more likely with higher maternal education level (adj OR 1.72, 95% CI 1.08, 2.72) and with readmission to hospital in first four weeks (adj OR 1.98, 95% CI 1.20, 3.25). Report of hyperacusis was associated with larger amplitude otoacoustic emissions but with no other auditory factors. CONCLUSIONS The prevalence of hyperacusis in the population of 11-year-old UK children is estimated to be 3.7%. It is more common in boys.
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Affiliation(s)
- Amanda J Hall
- a Children's Hearing Centre , University Hospitals Bristol NHS Foundation Trust , Bristol , UK .,b Centre for Child and Adolescent Health , School of Social and Community Medicine, University of Bristol , UK
| | - Rachel Humphriss
- a Children's Hearing Centre , University Hospitals Bristol NHS Foundation Trust , Bristol , UK .,c School of Social and Community Medicine, University of Bristol , UK
| | - David M Baguley
- d Audiology Department , Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK .,e Department of Vision and Hearing Sciences , Anglia Ruskin University , Cambridge , UK , and
| | - Melanie Parker
- f Community Children's Health Partnership, North Bristol NHS Trust , Bristol , UK
| | - Colin D Steer
- b Centre for Child and Adolescent Health , School of Social and Community Medicine, University of Bristol , UK
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125
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Auriculotherapy: Alleviating Pain and Distress in Neonates in the Intensive Care Unit. Med Acupunct 2015. [DOI: 10.1089/acu.2015.1119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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126
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Butkevich IP, Mikhailenko VA, Vershinina EA, Ulanova NA. Differences in adaptive behaviors of adolescent male and female rats exposed at birth to inflammatory pain or stress. J EVOL BIOCHEM PHYS+ 2015. [DOI: 10.1134/s0022093015040067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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127
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Abbasoglu A, Cabioglu MT, Tugcu AU, Yapakci E, Tekindal MA, Tarcan A. Laser acupuncture before heel lancing for pain management in healthy term newborns: a randomised controlled trial. Acupunct Med 2015; 33:445-50. [PMID: 26438556 DOI: 10.1136/acupmed-2015-010765] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Healthy term newborns commonly undergo painful procedures during routine follow-up visits. Non-pharmacological strategies have currently become more important than pharmacological analgesic agents in neonatal pain management. Acupuncture is a new non-pharmacological method for preventing pain in newborns. OBJECTIVE We aimed to investigate the effect of laser acupuncture (LA) at the Yintang point before heel lancing as a non-pharmacological intervention for procedural pain management in infants. METHODS Forty-two term newborns, who were undergoing heel lancing between postnatal days 3 to 8 as part of routine neonatal screening, were randomly assigned to the LA group or the oral sucrose group. In the LA group, 2 min before the heel lancing, 0.3 J of energy was applied to the Yintang point using a Laser PREMIO-30 unit for 30 s. In the sucrose group, each infant received 0.5 mL of 24% sucrose orally via syringe 2 min before the heel lancing. Each baby's behaviour was scored using the Neonatal Infant Pain Scale (NIPS), assessed blinded to group. RESULTS There were no significant differences between the LA and oral sucrose groups with respect to means for gestational week of age at birth, birth weight, actual weight, or Apgar score. Mean procedure time was significantly shorter in the LA group; however, mean crying time was longer and NIPS score was lower compared to the oral sucrose group. CONCLUSIONS Our results indicate that 0.3 J of LA at the Yintang point before heel lancing is less effective than oral sucrose for reducing the discomfort of this procedure. TRIAL REGISTRATION NUMBER KA14/09.
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Affiliation(s)
- Aslihan Abbasoglu
- Division of Neonatology, Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey
| | | | - Ali Ulas Tugcu
- Division of Neonatology, Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Ece Yapakci
- Division of Neonatology, Department of Pediatrics, Güven Hospital, Ankara, Turkey
| | | | - Aylin Tarcan
- Division of Neonatology, Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey
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128
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Craig MM, Bajic D. Long-term behavioral effects in a rat model of prolonged postnatal morphine exposure. Behav Neurosci 2015; 129:643-55. [PMID: 26214209 PMCID: PMC4586394 DOI: 10.1037/bne0000081] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Prolonged morphine treatment in neonatal pediatric populations is associated with a high incidence of opioid tolerance and dependence. Despite the clinical relevance of this problem, our knowledge of long-term consequences is sparse. The main objective of this study was to investigate whether prolonged morphine administration in a neonatal rat is associated with long-term behavioral changes in adulthood. Newborn animals received either morphine (10 mg/kg) or equal volume of saline subcutaneously twice daily for the first 2 weeks of life. Morphine-treated animals underwent 10 days of morphine weaning to reduce the potential for observable physical signs of withdrawal. Animals were subjected to nonstressful testing (locomotor activity recording and a novel-object recognition test) at a young age (Postnatal Days [PDs] 27-31) or later in adulthood (PDs 55-56), as well as stressful testing (calibrated forceps test, hot plate test, and forced swim test) only in adulthood. Analysis revealed that prolonged neonatal morphine exposure resulted in decreased thermal but not mechanical threshold. Importantly, no differences were found for total locomotor activity (proxy of drug reward/reinforcement behavior), individual forced swim test behaviors (proxy of affective processing), or novel-object recognition test. Performance on the novel-object recognition test was compromised in the morphine-treated group at the young age, but the effect disappeared in adulthood. These novel results provide insight into the long-term consequences of opioid treatment during an early developmental period and suggest long-term neuroplastic differences in sensory processing related to thermal stimuli.
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Affiliation(s)
- Michael M. Craig
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA, USA
| | - Dusica Bajic
- Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children’s Hospital, 300 Longwood Ave., Boston, MA, USA
- Department of Anaesthesia, Harvard Medical School, 25 Shattuck St., Boston, MA, USA
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129
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Agell N, van Ganzewinkel CJ, Sánchez M, Roselló L, Prats F, Andriessen P. A consensus model for Delphi processes with linguistic terms and its application to chronic pain in neonates definition. Appl Soft Comput 2015. [DOI: 10.1016/j.asoc.2015.03.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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130
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Early Life Experience and Gut Microbiome: The Brain-Gut-Microbiota Signaling System. Adv Neonatal Care 2015; 15:314-23; quiz E1-2. [PMID: 26240939 DOI: 10.1097/anc.0000000000000191] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Over the past decades, advances in neonatal care have led to substantial increases in survival among preterm infants. With these gains, recent concerns have focused on increases in neurodevelopment morbidity related to the interplay between stressful early life experiences and the immature neuroimmune systems. This interplay between these complex mechanisms is often described as the brain-gut signaling system. The role of the gut microbiome and the brain-gut signaling system have been found to be remarkably related to both short- and long-term stress and health. Recent evidence supports that microbial species, ligands, and/or products within the developing intestine play a key role in early programming of the central nervous system and regulation of the intestinal innate immunity. PURPOSE The purpose of this state-of-the-science review is to explore the supporting evidence demonstrating the importance of the brain-gut-microbiota axis in regulation of early life experience. We also discuss the role of gut microbiome in modulating stress and pain responses in high-risk infants. A conceptual framework has been developed to illustrate the regulation mechanisms involved in early life experience. CONCLUSIONS The science in this area is just beginning to be uncovered; having a fundamental understanding of these relationships will be important as new discoveries continue to change our thinking, leading potentially to changes in practice and targeted interventions.
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131
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Krahe TE, Medina AE, Lantz CL, Filgueiras CC. Hyperactivity and depression-like traits in Bax KO mice. Brain Res 2015; 1625:246-54. [PMID: 26363094 DOI: 10.1016/j.brainres.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/31/2015] [Accepted: 09/01/2015] [Indexed: 01/11/2023]
Abstract
The Bax gene is a member of the Bcl-2 gene family and its pro-apoptotic Bcl-associated X (Bax) protein is believed to be crucial in regulating apoptosis during neuronal development as well as following injury. With the advent of mouse genomics, mice lacking the pro-apoptotic Bax gene (Bax KO) have been extensively used to study how cell death helps to determine synaptic circuitry formation during neurodevelopment and disease. Surprisingly, in spite of its wide use and the association of programmed neuronal death with motor dysfunctions and depression, the effects of Bax deletion on mice spontaneous locomotor activity and depression-like traits are unknown. Here we examine the behavioral characteristics of Bax KO male mice using classical paradigms to evaluate spontaneous locomotor activity and depressive-like responses. In the open field, Bax KO animals exhibited greater locomotor activity than their control littermates. In the forced swimming test, Bax KO mice displayed greater immobility times, a behavior despair state, when compared to controls. Collectively, our findings corroborate the notion that a fine balance between cell survival and death early during development is critical for normal brain function later in life. Furthermore, it points out the importance of considering depressive-like and hyperactivity behavioral phenotypes when conducting neurodevelopmental and other studies using the Bax KO strain.
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Affiliation(s)
- Thomas E Krahe
- Departamento de Ciências Fisiológicas, IBRAG, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil; Department of Anatomy and Neurobiology, Virginia Commonwealth University Medical Center, Richmond, USA
| | | | - Crystal L Lantz
- Department of Biology, University of Maryland, College Park, USA
| | - Cláudio C Filgueiras
- Departamento de Ciências Fisiológicas, IBRAG, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
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132
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Environmental enrichment does not reverse the effects of maternal deprivation on NMDAR and Balb/c mice behaviors. Brain Res 2015; 1624:479-488. [PMID: 26300221 DOI: 10.1016/j.brainres.2015.08.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 08/06/2015] [Accepted: 08/13/2015] [Indexed: 11/24/2022]
Abstract
Early adverse life experiences have been associated with anxiety-like behavior and memory impairment. N-methyl-d-aspartate receptors (NMDARs) play an important role in brain development. Enriched environments are known to positively influence emotional and cognitive functions in the brain. We examined the effects of maternal deprivation (MD) on NMDAR subunits in the hippocampus, locomotor activity, anxiety behaviors, and learning-memory performance of Balb/c mice. We also examined whether these effects could be reversed by raising the offspring in an enriched environment. The mice were separated from their mothers for a single 24h episode on postnatal day (PND) 9. The mice were weaned on day 21 and were housed under either standard (SE) or enriched (EE) environmental conditions. Emotional behaviors and cognitive processes of mice were evaluated using an open field (OF) test, an elevated plus maze (EPM) test, and a Morris water-maze (MWM). NMDAR subunits (GluN1, GluN2A, and GluN2B) mRNA expression levels in the hippocampus were examined by real-time PCR. In OF, MD had no effect on horizontal locomotor activity. MD increased anxiety-like behaviors in the EPM and decreased spatial learning performance in MWM; however, these effects were not reversed by EE. MD (in SE and EE conditions) increased GluN1, GluN2A, and GluN2B mRNA expressions in the hippocampus. In conclusion, MD led to the deterioration of the emotional and cognitive processes during adulthood. Moreover, environmental enrichment did not reverse the deleterious effects of the MD on emotional and cognitive functions and increased the NMDAR levels.
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133
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Zimmerman KO, Hornik CP, Ku L, Watt K, Laughon MM, Bidegain M, Clark RH, Smith PB. Sedatives and Analgesics Given to Infants in Neonatal Intensive Care Units at the End of Life. J Pediatr 2015; 167:299-304.e3. [PMID: 26012893 PMCID: PMC4516679 DOI: 10.1016/j.jpeds.2015.04.059] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/24/2015] [Accepted: 04/16/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To describe the administration of sedatives and analgesics at the end of life in a large cohort of infants in North American neonatal intensive care units. STUDY DESIGN Data on mortality and sedative and analgesic administration were from infants who died from 1997-2012 in 348 neonatal intensive care units managed by the Pediatrix Medical Group. Sedatives and analgesics of interest included opioids (fentanyl, methadone, morphine), benzodiazepines (clonazepam, diazepam, lorazepam, midazolam), central alpha-2 agonists (clonidine, dexmedetomidine), ketamine, and pentobarbital. We used multivariable logistic regression to evaluate the association between administration of these drugs on the day of death and infant demographics and illness severity. RESULTS We identified 19 726 infants who died. Of these, 6188 (31%) received a sedative or analgesic on the day of death; opioids were most frequently administered, 5366/19 726 (27%). Administration of opioids and benzodiazepines increased during the study period, from 16/283 (6%) for both in 1997 to 523/1465 (36%) and 295/1465 (20%) in 2012, respectively. Increasing gestational age, increasing postnatal age, invasive procedure within 2 days of death, more recent year of death, mechanical ventilation, inotropic support, and antibiotics on the day of death were associated with exposure to sedatives or analgesics. CONCLUSIONS Administration of sedatives and analgesics increased over time. Infants of older gestational age and those more critically ill were more likely to receive these drugs on the day of death. These findings suggest that drug administration may be driven by severity of illness.
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Affiliation(s)
- Kanecia O Zimmerman
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Christoph P Hornik
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Lawrence Ku
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Kevin Watt
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
| | - Matthew M Laughon
- Department of Pediatrics, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Margarita Bidegain
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - P Brian Smith
- Department of Pediatrics, Duke University School of Medicine, Durham, NC; Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC.
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134
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Mikhailenko VA, Butkevich IP, Vershinina EA, Ulanova NA. Long-term changes in adaptive behavior of rats after inflammatory pain stimulation during neonatal development. J EVOL BIOCHEM PHYS+ 2015. [DOI: 10.1134/s0022093015020052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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135
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Aita M, Goulet C, Oberlander TF, Snider L, Johnston C. A randomized controlled trial of eye shields and earmuffs to reduce pain response of preterm infants. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jnn.2014.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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136
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Kiechl-Kohlendorfer U, Merkle U, Deufert D, Neubauer V, Peglow UP, Griesmaier E. Effect of developmental care for very premature infants on neurodevelopmental outcome at 2 years of age. Infant Behav Dev 2015; 39:166-72. [DOI: 10.1016/j.infbeh.2015.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Revised: 02/12/2015] [Accepted: 02/15/2015] [Indexed: 10/23/2022]
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137
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Nuseir KQ, Alzoubi KH, Alabwaini J, Khabour OF, Kassab MI. Sucrose-induced analgesia during early life modulates adulthood learning and memory formation. Physiol Behav 2015; 145:84-90. [PMID: 25846434 DOI: 10.1016/j.physbeh.2015.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/02/2015] [Accepted: 04/02/2015] [Indexed: 12/25/2022]
Abstract
This study is aimed at examining the long-term effects of chronic pain during early life (postnatal day 0 to 8weeks), and intervention using sucrose, on cognitive functions during adulthood in rats. Pain was induced in rat pups via needle pricks of the paws. Sucrose solution or paracetamol was administered for analgesia before the paw prick. Control groups include tactile stimulation to account for handling and touching the paws, and sucrose alone was used. All treatments were started on day one of birth and continued for 8weeks. At the end of the treatments, behavioral studies were conducted to test the spatial learning and memory using radial arm water maze (RAWM), as well as pain threshold via foot-withdrawal response to a hot plate apparatus. Additionally, the hippocampus was dissected, and blood was collected. Levels of neurotrophins (BDNF, IGF-1 and NT-3) and endorphins were assessed using ELISA. The results show that chronic noxious stimulation resulted in comparable foot-withdrawal latency between noxious and tactile groups. On the other hand, pretreatment with sucrose or paracetamol increased pain threshold significantly both in naive rats and noxiously stimulated rats (P<0.05). Chronic pain during early life impaired short-term memory, and sucrose treatment prevented such impairment (P<0.05). Sucrose significantly increased serum levels of endorphin and enkephalin. Chronic pain decreased levels of BDNF in the hippocampus and this decrease was prevented by sucrose and paracetamol treatments. Hippocampal levels of NT-3 and IGF-1 were not affected by any treatment. In conclusion, chronic pain induction during early life induced short memory impairment, and pretreatment with sucrose prevented this impairment via mechanisms that seem to involve BDNF. As evident in the results, sucrose, whether alone or in the presence of pre-noxious stimulation, increases pain threshold in such circumstances; most likely via a mechanism that involves an increase in endogenous opioids.
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Affiliation(s)
- Khawla Q Nuseir
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
| | - Karem H Alzoubi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Jehad Alabwaini
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Omar F Khabour
- Department of Biology, Faculty of Science, Tibah University, Al Madinah, Saudi Arabia; Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Manal I Kassab
- Department of Maternal and Child Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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138
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Abstract
Neonatal abstinence syndrome (NAS) is reaching epidemic proportions related to perinatal use of opioids. There are many approaches to assess and manage NAS, including one we have outlined. A standardized approach is likely to reduce length of stay and variability in practice. Circumcision is a frequent, painful procedure performed in the neonatal period. The rationale for providing analgesia is presented as well as a review of methods. Pharmacogenomics and pharmacogenetics have expanded our understanding of diseases and their drug therapy. Some applications of pharmacogenomics to the neonatal period are presented, along with pediatric challenges of developmental expression of drug-metabolizing enzymes.
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139
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Thomas D, Kircher J, Plint AC, Fitzpatrick E, Newton AS, Rosychuk RJ, Grewal S, Ali S. Pediatric Pain Management in the Emergency Department: The Triage Nurses' Perspective. J Emerg Nurs 2015; 41:407-13. [PMID: 25837698 DOI: 10.1016/j.jen.2015.02.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 02/21/2015] [Accepted: 02/23/2015] [Indexed: 11/17/2022]
Abstract
UNLABELLED Understanding triage nurses' perspectives of pain management is essential for timely pain care for children in the emergency department. Objectives of this study were to describe the triage pain treatment protocols used, knowledge of pain management modalities, and barriers and attitudes towards implementation of pain treatment protocols. METHODS A paper-based survey was administered to all triage nurses at three Canadian pediatric emergency departments, between December 2011 and January 2012. RESULTS The response rate was 86% (n=126/147). The mean respondent age was 40 years (standard deviation [SD] 9.3) with 8.6 years (SD 7.7) of triage experience. General triage emergency department (GTED) nurses rated adequacy of triage pain treatment lower than pediatric-only triage emergency department (PTED) nurses (P < .001). GTED nurses reported a longer acceptable delay between triage time and administration of analgesia than PTED nurses (P < .002). Most nurses rated more comfort with a protocol involving administration of acetaminophen (97 mm, interquartile range [IQR] 92, 99) or ibuprofen (97 mm, IQR 93, 100) than for oral morphine (67 mm, IQR 35, 94) or oxycodone (57 mm, IQR 15, 81). The top three reported barriers to triage-initiated pain protocols were monitoring capability, time, and access to medications. Willingness to implement a triage-initiated pain protocol was rated as 81 mm (IQR 71, 96). DISCUSSION Triage nurses are willing to implement pain protocols for children in the emergency department, but differences in comfort and experience exist between PTED and GTED nurses. Provision of triage initiated pain protocols and associated education may empower nurses to improve care for children in pain in the emergency department.
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Affiliation(s)
- Daina Thomas
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Janeva Kircher
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Amy C Plint
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Eleanor Fitzpatrick
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Amanda S Newton
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Rhonda J Rosychuk
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Simran Grewal
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada
| | - Samina Ali
- Edmonton, Alberta, Ottawa, Ontario, Halifax, Nova Scotia, and Vancouver, British Columbia, Canada.
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140
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Mehler K, Ulbrich L, Börner S, Joachim A, Becker I, Roth B, Hünseler C. Multidimensional response to vaccination pain in very preterm, moderate- to-late preterm and full-term infants at age three months. Early Hum Dev 2015; 91:199-204. [PMID: 25682563 DOI: 10.1016/j.earlhumdev.2015.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 01/22/2015] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Very early life pain exposure and stress induces alterations in the developing brain and leads to altered pain sensitivity. In premature infants with a history of numerous early postnatal adverse events, behavioral responsiveness and hypothalamic-pituitary-adrenal (HPA) axis reactivity may show alterations as well. AIMS We compared a multidimensional response to a painful situation (vaccination) in three month old infants. The study involved very preterm, moderate to late preterm infants and full-term infants with varying exposure to pain and stress within the first weeks of life. STUDY DESIGN At the age of three months, we evaluated the infants' reactivity to intramuscular injections for immunization. SUBJECTS The study included 61 very preterm infants, 30 moderate to late preterm infants and 30 full-term infants. OUTCOME MEASURES We assessed heart rate recovery, Bernese pain Score and increase of salivary cortisol following vaccination. We also evaluated the flexor withdrawal reflex threshold as well as Prechtl's General Movements. Secondly, we assessed factors potentially influencing pain reactivity such as exposure to pain/stress, gender, use of steroids or opioids and mechanical ventilation. RESULTS Very preterm, moderate to late preterm and full-term infants showed different reactivity to pain in all analyzed aspects. Very preterm infants showed a lower level of behavioral and physiologic reactivity and exposure to pain/stress predicted lower cortisol increase. CONCLUSION At three months of age, very preterm infants show an altered level of HPA axis reactivity. Efforts aiming at minimizing pain and stress in premature infants should be taken.
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Affiliation(s)
- Katrin Mehler
- University Hospital of Cologne, Department of Neonatology, Germany.
| | - Lisa Ulbrich
- University Hospital of Cologne, Department of Neonatology, Germany
| | - Sarah Börner
- University Hospital of Cologne, Department of Neonatology, Germany
| | | | - Ingrid Becker
- Institute of Medical Statistics, Informatics and Epidemiology, University of Cologne, Germany
| | - Bernhard Roth
- University Hospital of Cologne, Department of Neonatology, Germany
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141
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Benetti F, da Silveira CKB, Rosa J, Izquierdo I. Histamine acting on the basolateral amygdala reverts the impairment of aversive memory of rats submitted to neonatal maternal deprivation. Behav Brain Res 2015; 278:83-9. [DOI: 10.1016/j.bbr.2014.09.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2014] [Revised: 09/09/2014] [Accepted: 09/13/2014] [Indexed: 12/22/2022]
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142
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Friedrichsdorf SJ, Postier A, Eull D, Weidner C, Foster L, Gilbert M, Campbell F. Pain Outcomes in a US Children's Hospital: A Prospective Cross-Sectional Survey. Hosp Pediatr 2015; 5:18-26. [PMID: 25554755 DOI: 10.1542/hpeds.2014-0084] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Pain in hospitalized children may be underrecognized and undertreated. The objective of this survey was to benchmark pain prevalence, intensity, assessment, and pharmacologic as well as integrative treatment of pain in inpatients in a US children's hospital. METHODS This was a single-day, cross-sectional survey and electronic medical record review of inpatients who received medical care at a pediatric hospital. Inpatients and emergency department patients were asked to report their experience with pain and its management during the previous 24 hours. RESULTS Of 279 inpatients listed on the morning census, 178 children and parents were located and completed the survey. Seventy-six percent had experienced pain during the previous 24 hours, usually acute or procedural pain, 12% of whom possibly suffered from chronic pain. Twenty percent of all children surveyed experienced moderate and 30% severe pain in that time period. The worst pain reported by patients was caused by needle pokes (40%), followed by trauma/injury (34%). Children and their parents rated 5 integrative, nonpharmacologic modalities as more effective than medications. Pain assessments and management were documented in the medical record for 58% of patients covering the 24-hour period before the morning census. The most commonly prescribed analgesics were acetaminophen, morphine, and ibuprofen. CONCLUSIONS Despite existing hospital policies and a pain consult team, significant room for improvement in pain management was identified. A hospital-wide, 3-year Lean quality improvement initiative on reducing pain was commenced as a result of this survey.
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Affiliation(s)
- Stefan J Friedrichsdorf
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota; University of Minnesota Medical School, Minneapolis, Minnesota;
| | - Andrea Postier
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Donna Eull
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Christian Weidner
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Laurie Foster
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Michele Gilbert
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Fiona Campbell
- The Hospital for Sick Children, Toronto, Canada; and University of Toronto, Toronto, Canada
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143
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Ranger M, Grunau RE. Early repetitive pain in preterm infants in relation to the developing brain. Pain Manag 2014; 4:57-67. [PMID: 24641344 DOI: 10.2217/pmt.13.61] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infants born preterm (<37 weeks of gestation) are particularly vulnerable to procedural stress and pain exposure during neonatal intensive care, at a time of rapid and complex brain development. Concerns regarding effects of neonatal pain on brain development have long been expressed. However, empirical evidence of adverse associations is relatively recent. Thus, many questions remain to be answered. This review discusses the short- and long-term effects of pain-related stress and associated treatments on brain maturation and neurodevelopmental outcomes in children born preterm. The current state of the evidence is presented and future research directions are proposed.
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Affiliation(s)
- Manon Ranger
- Pediatrics, University of British Columbia, BC, Canada
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144
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Hatfield LA. Neonatal pain: What's age got to do with it? Surg Neurol Int 2014; 5:S479-89. [PMID: 25506507 PMCID: PMC4253046 DOI: 10.4103/2152-7806.144630] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 07/10/2014] [Indexed: 11/16/2022] Open
Abstract
Background: The neurobiology of neonatal pain processing, especially in preterm infants, differs significantly from older infants, children, adolescence, and adults. Research suggests that strong painful procedures or repeated mild procedures may permanently modify individual pain processing. Acute injuries at critical developmental periods are risk factors for persistent altered neurodevelopment. The purpose of this narrative review is to present the seminal and current literature describing the unique physiological aspects of neonatal pain processing. Methods: Articles describing the structures and physiological processes that influence neonatal pain were identified from electronic databases Medline, PubMed, and CINAHL. Results: The representation of neonatal pain physiology is described in three processes: Local peripheral nervous system processes, referred to as transduction; spinal cord processing, referred to as transmission and modulation; and supraspinal processing and integration or perception of pain. The consequences of undermanaged pain in preterm infants and neonates are discussed. Conclusion: Although the process and pain responses in neonates bear some similarity to processes and pain responses in older infants, children, adolescence, and adults; there are some pain processes and responses that are unique to neonates rendering them at risk for inadequate pain treatment. Moreover, exposure to repeated painful stimuli contributes to adverse long-term physiologic and behavioral sequelae. With the emergence of studies showing that painful experiences are capable of rewiring the adult brain, it is imperative that we treat neonatal pain effectively.
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Affiliation(s)
- Linda A Hatfield
- Assistant Professor of Evidence-based Practice, Department of Family and Community Health University of Pennsylvania School of Nursing, Director of Research and Evidence-based practice, Pennsylvania Hospital, USA
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145
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MARHOFER P, LÖNNQVIST PA. The use of ultrasound-guided regional anaesthetic techniques in neonates and young infants. Acta Anaesthesiol Scand 2014; 58:1049-60. [PMID: 25059918 DOI: 10.1111/aas.12372] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2014] [Indexed: 12/14/2022]
Abstract
Optimal pain therapy during the perioperative period or at the neonatal intensive care unit and subsequent reduced use of opioids and various sedative drugs is an important factor for patients care. The use of various regional anaesthetic techniques in experienced hands provides excellent pain relief and has the potency to reduce the requirement for perioperative mechanical ventilation. Most of regional anaesthesia techniques are applicable also in neonates and young infants and can be used in an effective and safe manner. Ultrasound guidance should be used for all regional anaesthetic techniques to increase efficacy and safety. The spectrum of indications for ultrasound-guided regional anaesthesia in babies and infants are surgery, selective pain therapy and sympathicolysis. This review reflects an expert-based description of the most recent developments in ultrasound-guided regional anaesthetic techniques in babies and infants.
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Affiliation(s)
- P. MARHOFER
- Department of Anaesthesia and Intensive Care Medicine; Medical University Vienna; Vienna Austria
| | - P.-A. LÖNNQVIST
- Section of Anaesthesiology and Intensive Care; Department of Physiology and Pharmacology; The Karolinska Institute; Stockholm Sweden
- Paediatric Anaesthesia, Intensive Care and ECMO Services; Karolinska University Hospital-Solna; Stockholm Sweden
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146
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Iversen J, Hoftun G, Romundstad P, Rygg M. Adolescent chronic pain and association to perinatal factors: Linkage of Birth Registry data with the Young-HUNT Study. Eur J Pain 2014; 19:567-75. [DOI: 10.1002/ejp.581] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/08/2022]
Affiliation(s)
- J.M. Iversen
- Department of Laboratory Medicine; Children's and Women's Health; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - G.B. Hoftun
- Department of Pediatrics; St. Olavs Hospital; Trondheim Norway
| | - P.R. Romundstad
- Department of Public Health; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
| | - M. Rygg
- Department of Laboratory Medicine; Children's and Women's Health; Faculty of Medicine; Norwegian University of Science and Technology; Trondheim Norway
- Department of Pediatrics; St. Olavs Hospital; Trondheim Norway
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147
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The effects of kangaroo mother care in a sample of preterm, preschool aged children. HEALTH PSYCHOLOGY REPORT 2014. [DOI: 10.5114/hpr.2014.44423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
<b>Background</b><br />
The research has shown that kangaroo mother care has a protective impact both on health and future cognitive skills of prematurely born babies. The aim of this study was to investigate the relation between the early skin-to-skin contact and the cognitive and emotional-social functioning of preschool aged preterm babies.<br />
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<b>Participants and procedure</b><br />
The study group included 99 preterm babies. The children participated in a psychological examination conducted using the Columbia Mental Maturity Scale and the Terman-Merrill Test. The data concerning the skin-to-skin contact during the child’s hospitalisation were acquired during interviews with mothers. The emotional development was assessed on the basis of interviews with mothers, conducted using the Rescorla DSM-IV Orientation Scale (2005).<br />
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<b>Results</b><br />
The study showed no relation between kangaroo mother care and cognitive development. Nevertheless the early skin-to-skin contact turned out to be connected with the emotional functioning of the subjects. Preterm babies who used to experience kangaroo mother care experienced fewer anxiety and depressive disorders than those who did not. In addition it was revealed that the children who suffered from early damage to the brain in the forms of intraventricular and periventricular haemorrhages and experienced kangaroo mother care demonstrated less intense depressive symptoms than those who did not.<br />
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<b>Conclusions</b><br />
The obtained results, combined with the review of the foreign literature of the subject, indicate the usefulness of introducing kangaroo mother care to neonatal wards and encouraging parents to care about their prematurely born babies in such a way.
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148
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Alvarez-Garcia A, Fornieles-Deu A, Costas-Moragas C, Botet-Mussons F. Maturational changes associated with neonatal stress in preterm infants hospitalised in the NICU. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2014.937411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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149
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Cosentino-Rocha L, Klein VC, Linhares MBM. Effects of preterm birth and gender on temperament and behavior in children. Infant Behav Dev 2014; 37:446-56. [DOI: 10.1016/j.infbeh.2014.04.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 01/09/2014] [Accepted: 04/08/2014] [Indexed: 11/29/2022]
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150
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Abstract
Pain control in newborns is poorly understood and often neglected in neonatal practice in many settings in our environment. Managing pain among newborns can be quite challenging and the effectiveness of various interventions used to ameliorate pain in this category of patients are either unknown or poorly understood by many a people engaged in the care of newborns in one way or the other. A search for published works on neonatal analgesia was performed using Google and PubMed. The Cochrane Database of Systematic Reviews was also searched. The areas of focus were definition, pathophysiology and management of pain in neonates. Relevant information was extracted and processed. Contrary to what is widely believed in many quarters, howbeit erroneously, there is compelling evidence that newborns do indeed feel pain. Supportive care, comprising of use of sucrose, glucose, breastfeeding, kangaroo mother care are worthwhile measures in ameliorating pain in the newborn. Novel therapies (such as sensorial saturation and swaddling) have been evaluated and proven useful. The use of sedation did not show any beneficial results.
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Affiliation(s)
- Herbert A Obu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu 01129, Nigeria
| | - Josephat M Chinawa
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu 01129, Nigeria
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