151
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Assessment of pain during application of nasal-continuous positive airway pressure and heated, humidified high-flow nasal cannulae in preterm infants. J Perinatol 2015; 35:263-7. [PMID: 25429383 DOI: 10.1038/jp.2014.206] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2014] [Revised: 09/17/2014] [Accepted: 10/09/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To assess pain and compare its severity in preterm infants during application of nasal-continuous positive airway pressure (nCPAP) and heated, humidified high-flow nasal cannulae (HHHFNC). STUDY DESIGN An observational cross-sectional study. Sixty preterm infants, categorized into nCPAP (n=37) and HHHFNC groups (n=23). Pain response was assessed using Premature Infant Pain Profile (PIPP), duration of first cry and salivary-cortisol concentrations. RESULT The PIPP scores were significantly higher in the nCPAP compared with HHHFNC group (10 (7-12) vs 4 (2-6), P<0.01). None of the infants in the HHHFNC group had severe pain defined as a PIPP score >12, compared with 5 (13.5%) infants in the nCPAP group. Salivary-cortisol concentrations were significantly higher in nCPAP group compared with the HHHFNC group (5.0 (3.6-5.9) vs 1.6 (1.0-2.3) nmol l(-1), P<0.01). A lower incidence of cry was observed for infants in the HHHFNC group compared with the nCPAP group (11 (47.8%) vs 30 (81.1%), P<0.001), however, the duration of first cry was not significantly different between groups. The respiratory rate was significantly lower after application of HHHFNC compared with nCPAP (P<0.001). There were no significant differences between groups with regard to fraction of inspired oxygen (FiO2), oxygen saturation by pulse oximeter (SpO2) and heart rate. CONCLUSION The application of HHHFNC in preterm infants is associated with less pain compared with nCPAP, as it is associated with less PIPP scores and lower salivary-cortisol concentrations.
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152
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Cerritelli F, Cicchitti L, Martelli M, Barlafante G, Renzetti C, Pizzolorusso G, Lupacchini M, D'Orazio M, Marinelli B, Cozzolino V, Fusilli P, D'Incecco C. Osteopathic manipulative treatment and pain in preterms: study protocol for a randomised controlled trial. Trials 2015; 16:84. [PMID: 25872943 PMCID: PMC4362649 DOI: 10.1186/s13063-015-0615-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2014] [Accepted: 02/19/2015] [Indexed: 11/15/2022] Open
Abstract
Background Recent evidence proved the necessity to improve health care and pain management in newborns. Osteopathic manipulative treatment (OMT) has been largely used to treat painful syndromes as well as term and preterm newborns. Recent studies have demonstrated positive results of osteopathy in reducing length of stay and costs. However, no trials were carried out on pain in newborns. The aim of the present clinical trial is to explore the effectiveness of osteopathic treatment in reducing pain in a sample of preterms. Methods/design A three-armed single blinded placebo-control randomised controlled trial protocol has been designed to primarily evaluate the extent to which OMT is effective in reducing pain in preterms. One hundred and twenty newborns will be enrolled from one tertiary neonatal intensive care unit in central Italy and randomised in three groups: study, sham and control. The study group will be further prospectively randomised in two subgroups: experienced osteopaths and students. All preterms will receive standard medical care. Osteopathic treatment will be applied to the study group only whilst ‘soft touch’ will be administer to the sham group only. Newborns will undergo manual sessions once a week for the entire period of hospitalisation. Blinding will be assured for neonatal staff and outcome assessor. Primary outcome will be the mean difference in baseline score changes of PIPP questionnaire between discharge and entry among the three groups. Secondary outcomes will be: mean difference in length of stay and costs between groups. Statistical analyses will use per-protocol analysis method. Missing data will be handled using last observation carried forward imputation technique. Discussion The present single blinded randomised controlled trial has been designed to explore potential advantages of OMT in the management of newborns’ pain. Currently, based on a patient-centred need-based approach, this research will be looking at the benefit of osteopathic care rather than the efficacy of a specific technique or a pre-determined protocol. Trial registration The protocol has been registered on ClinicalTrials.gov (NCT02146677) on 20 May 2014.
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Affiliation(s)
- Francesco Cerritelli
- Clinical-based Human Research Department, C.O.ME. Collaboration, Via Amerigo Vespucci 188, 65126, Pescara, Italy. .,Accademia Italiana Osteopatia Tradizionale, Via Prati 29, 65124, Pescara, Italy.
| | - Luca Cicchitti
- Clinical-based Human Research Department, C.O.ME. Collaboration, Via Amerigo Vespucci 188, 65126, Pescara, Italy. .,Accademia Italiana Osteopatia Tradizionale, Via Prati 29, 65124, Pescara, Italy.
| | - Marta Martelli
- Clinical-based Human Research Department, C.O.ME. Collaboration, Via Amerigo Vespucci 188, 65126, Pescara, Italy. .,Accademia Italiana Osteopatia Tradizionale, Via Prati 29, 65124, Pescara, Italy.
| | - Gina Barlafante
- Accademia Italiana Osteopatia Tradizionale, Via Prati 29, 65124, Pescara, Italy.
| | - Cinzia Renzetti
- Accademia Italiana Osteopatia Tradizionale, Via Prati 29, 65124, Pescara, Italy.
| | | | | | - Marianna D'Orazio
- Accademia Italiana Osteopatia Tradizionale, Via Prati 29, 65124, Pescara, Italy.
| | - Benedetta Marinelli
- Accademia Italiana Osteopatia Tradizionale, Via Prati 29, 65124, Pescara, Italy.
| | - Vincenzo Cozzolino
- Accademia Italiana Osteopatia Tradizionale, Via Prati 29, 65124, Pescara, Italy.
| | - Paola Fusilli
- Neonatal Intensive Care Unit, Pescara's public hospital, Via Fonte Romana 8, 65124, Pescara, Italy.
| | - Carmine D'Incecco
- Neonatal Intensive Care Unit, Pescara's public hospital, Via Fonte Romana 8, 65124, Pescara, Italy.
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153
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Tseng CL, Huang CY, Park JH, Lin HR, Liang SY, Cheng SF. Experiences of Indonesian mother managing preschool children's acute abdominal pain in Taiwan. J Pediatr Nurs 2015; 30:301-9. [PMID: 25173181 DOI: 10.1016/j.pedn.2014.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 07/25/2014] [Accepted: 08/03/2014] [Indexed: 10/24/2022]
Abstract
The aim of this study was to understand the Indonesian mothers' experiences of managing preschool children's acute abdominal pain. The descriptive qualitative research design comprises semi-structured interviews with 11 Indonesian mothers. The qualitative content analysis revealed three themes, including (1) insight of abdominal pain, (2) "inheritance of the strategies for assessment of management for abdominal pain from the family of origin", (3) "obstacles and insights related to cultural differences". The results presented that pain management was affected by family, environment, cultural background and religious beliefs. Healthcare providers should provide culturally competent pain management care for the patients of difference nationalities.
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Affiliation(s)
- Chiu-Lien Tseng
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan, R.O.C
| | - Chu-Yu Huang
- Department of Nursing, Cedarville University, Cedarville, OH
| | - Jeong-Hwan Park
- Department of Nursing, Chosun University, Dong-Gu, Gwangju, South Korea
| | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan, R.O.C
| | - Shu-Yuan Liang
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan, R.O.C
| | - Su-Fen Cheng
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan, R.O.C..
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154
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Butruille L, De jonckheere J, Marcilly R, Boog C, Bras da Costa S, Rakza T, Storme L, Logier R. Development of a pain monitoring device focused on newborn infant applications: The NeoDoloris project. Ing Rech Biomed 2015. [DOI: 10.1016/j.irbm.2015.01.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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155
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Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: A randomized controlled trial. Midwifery 2015; 31:365-72. [DOI: 10.1016/j.midw.2014.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 10/25/2014] [Accepted: 11/01/2014] [Indexed: 11/17/2022]
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156
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Cabral TI, Pereira da Silva LG, Tudella E, Simões Martinez CM. Motor development and sensory processing: A comparative study between preterm and term infants. RESEARCH IN DEVELOPMENTAL DISABILITIES 2015; 36C:102-107. [PMID: 25462470 DOI: 10.1016/j.ridd.2014.09.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 09/21/2014] [Accepted: 09/23/2014] [Indexed: 06/04/2023]
Abstract
UNLABELLED Infants born preterm and/or with low birth weight may present a clinical condition of organic instability and usually face a long period of hospitalization in the Neonatal Intensive Care Units, being exposed to biopsychosocial risk factors to their development due to decreased spontaneous movement and excessive sensory stimuli. This study assumes that there are relationships between the integration of sensory information of preterm infants, motor development and their subsequent effects. OBJECTIVE To evaluate the sensory processing and motor development in preterm infants aged 4-6 months and compare performance data with their peers born at term. METHOD This was a cross-sectional and comparative study consisting of a group of preterm infants (n=15) and a group of term infants (n=15), assessed using the Test of Sensory Functions in Infants (TSFI) and the Alberta Infant Motor Scale (AIMS). RESULTS The results showed no significant association between motor performance on the AIMS scale (total score) and sensory processing in the TSFI (total score). However, all infants who scored abnormal in the total TSFI score, subdomain 1, and subdomain 5 presented motor performance at or below the 5th percentile on the AIMS scale. CONCLUSION Since all infants who presented definite alteration in tolerating tactile deep pressure and poor postural control are at risk of delayed gross motor development, there may be peculiarities not detected by the tests used that seem to establish some relationship between sensory processing and motor development.
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Affiliation(s)
- Thais Invenção Cabral
- Department of Physiotherapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP CEP 13565-905, Brazil.
| | - Louise Gracelli Pereira da Silva
- Department of Physiotherapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP CEP 13565-905, Brazil
| | - Eloisa Tudella
- Department of Physiotherapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP CEP 13565-905, Brazil
| | - Cláudia Maria Simões Martinez
- Department of Occupational Therapy, Federal University of São Carlos, Rodovia Washington Luís, km 235, São Carlos, SP CEP 13565-905, Brazil
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157
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Brummelte S, Chau CMY, Cepeda IL, Degenhardt A, Weinberg J, Synnes AR, Grunau RE. Cortisol levels in former preterm children at school age are predicted by neonatal procedural pain-related stress. Psychoneuroendocrinology 2015; 51:151-63. [PMID: 25313535 PMCID: PMC4268136 DOI: 10.1016/j.psyneuen.2014.09.018] [Citation(s) in RCA: 115] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 09/07/2014] [Accepted: 09/18/2014] [Indexed: 01/04/2023]
Abstract
Early life stress can alter hypothalamic pituitary adrenal (HPA) axis function. Differences in cortisol levels have been found in preterm infants exposed to substantial procedural stress during neonatal intensive care, compared to infants born full-term, but only a few studies investigated whether altered programming of the HPA axis persists past toddler age. Further, there is a dearth of knowledge of what may contribute to these changes in cortisol. This prospective cohort study examined the cortisol profiles in response to the stress of cognitive assessment, as well as the diurnal rhythm of cortisol, in children (n=129) born at varying levels of prematurity (24-32 weeks gestation) and at full-term (38-41 weeks gestation), at age 7 years. Further, we investigated the relationships among cortisol levels and neonatal procedural pain-related stress (controlling for multiple medical confounders), concurrent maternal factors (parenting stress, depressive and anxiety symptoms) and children's behavioral problems. For each aim we investigate acute cortisol response profiles to a cognitive challenge as well as diurnal cortisol patterns at home. We hypothesized that children born very preterm will differ in their pattern of cortisol secretion from children born full-term, possibly depended on concurrent child and maternal factors, and that exposure to neonatal pain-related stress would be associated with altered cortisol secretion in children born very preterm, possibly in a sex-dependent way. Saliva samples were collected from 7-year old children three times during a laboratory visit for assessment of cognitive and executive functions (pretest, mid-test, end-study day acute stress profile) and at four times over two consecutive non-school days at home (i.e. morning, mid-morning, afternoon and bedtime-diurnal rhythm profile). We found that cortisol profiles were similar in preterm and full-term children, albeit preterms had slightly higher cortisol at bedtime compared to full-term children. Importantly, in the preterm group, greater neonatal procedural pain-related stress (adjusted for morphine) was associated with lower cortisol levels on the study day (p=.044) and lower diurnal cortisol at home (p=.023), with effects found primarily in boys. In addition, child attention problems were negatively, and thought problems were positively, associated with the cortisol response during cognitive assessment on the study day in preterm children. Our findings suggest that neonatal pain/stress contributes to altered HPA axis function up to school-age in children born very preterm, and that sex may be an important factor.
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Affiliation(s)
- Susanne Brummelte
- Developmental Neurosciences & Child Health, Child & Family Research
Institute, Vancouver, BC, V6H 3V4, Canada,Department of Pediatrics, University of British Columbia, Vancouver, BC, V6H
3V4, Canada
| | - Cecil MY Chau
- Developmental Neurosciences & Child Health, Child & Family Research
Institute, Vancouver, BC, V6H 3V4, Canada
| | - Ivan L. Cepeda
- Developmental Neurosciences & Child Health, Child & Family Research
Institute, Vancouver, BC, V6H 3V4, Canada
| | - Amanda Degenhardt
- Department of Pediatrics, University of British Columbia, Vancouver, BC, V6H
3V4, Canada
| | - Joanne Weinberg
- Developmental Neurosciences & Child Health, Child & Family Research
Institute, Vancouver, BC, V6H 3V4, Canada,Department of Cellular and Physiological Sciences, University of British
Columbia, Vancouver, BC, V6T 1Z3, Canada
| | - Anne R. Synnes
- Developmental Neurosciences & Child Health, Child & Family Research
Institute, Vancouver, BC, V6H 3V4, Canada,Department of Pediatrics, University of British Columbia, Vancouver, BC, V6H
3V4, Canada
| | - Ruth E. Grunau
- Developmental Neurosciences & Child Health, Child & Family Research
Institute, Vancouver, BC, V6H 3V4, Canada,Department of Pediatrics, University of British Columbia, Vancouver, BC, V6H
3V4, Canada,Corresponding author: Ruth E. Grunau, Developmental
Neurosciences & Child Health, Child & Family Research Institute, F605B-4480 Oak
Street, Vancouver, BC, V6H 3V4, Canada, phone: 604-875-2447 fax: 604-875-2384,
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158
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Giordano V, Deindl P, Kuttner S, Waldhör T, Berger A, Olischar M. The Neonatal Pain, Agitation and Sedation Scale reliably detected oversedation but failed to differentiate between other sedation levels. Acta Paediatr 2014; 103:e515-21. [PMID: 25110233 DOI: 10.1111/apa.12770] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/14/2014] [Accepted: 08/04/2014] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to analyse the sedation subscale of the Neonatal Pain, Agitation and Sedation Scale (N-PASS), because the N-PASS has only been validated for the assessment of acute and prolonged pain. METHODS The nurses' expert opinion regarding the level of sedation of the study patients was used as reference scale. Paired assessments of both the N-PASS sedation subscale and the nurses' expert opinion were performed in 50 sedated neonates from 23 to 44 weeks of postmenstrual age. RESULTS A total set of 503 paired observations was included into analysis. The median N-PASS sedation subscale scores were significantly different for the three nurses' expert opinion categories, with minus eight for oversedation, minus two for adequate sedation and zero for undersedation (p < 0.0001). Interobserver agreement for the N-PASS sedation subscale was excellent - linearly weighted Cohen's Kappa was 0.93 - as was the internal consistency of 0.88, estimated by a Cronbach's alpha. The internal consistency increased to 0.90 if the vital sign item of the subscale was deleted. CONCLUSION The N-PASS sedation subscale reliably detected oversedation, but failed to differentiate between adequate and undersedation. We therefore recommend using additional methods to ensure adequate assessment of sedation in neonates.
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Affiliation(s)
- V. Giordano
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - P. Deindl
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
- Department of Neonatology and Paediatric Intensive Care Medicine; University Medical Centre Hamburg-Eppendorf; Hamburg Germany
| | - S. Kuttner
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - T. Waldhör
- Department of Epidemiology; Center for Public Health; Medical University of Vienna; Vienna Austria
| | - A. Berger
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
| | - M. Olischar
- Division of Neonatology, Paediatric Intensive Care and Neuropaediatrics; Department of Paediatrics and Adolescent Medicine; Medical University of Vienna; Vienna Austria
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159
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Britto CD, Rao Pn S, Nesargi S, Nair S, Rao S, Thilagavathy T, Ramesh A, Bhat S. PAIN--perception and assessment of painful procedures in the NICU. J Trop Pediatr 2014; 60:422-7. [PMID: 25053125 DOI: 10.1093/tropej/fmu039] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This prospective cross-sectional study was undertaken to determine the frequency of procedural pain among 101 neonates in the first 14 days of admission to a neonatal intensive care unit (NICU) in South India and to study the perception of health-care professionals (HCP) about newborn procedural pain. The total number of painful procedures was 8.09 ± 5.53 per baby per day and 68.32 ± 64.78 per baby during hospital stay. The most common procedure was heel prick (30%). The HCP were administered a questionnaire to assess their perception of pain for various procedures. Procedures were perceived as more painful by nurses than by doctors. Chest tube placements and lumbar puncture were considered most painful. This study shows that the neonates in the NICU in developing countries experience many painful procedures. The awareness about this intensity of pain should provide a valuable tool in formulating pain-reduction protocols for management in low resource settings.
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Affiliation(s)
- Carl Denis Britto
- Department of Neonatology, St. John's Medical College, Bangalore, Karnataka 560034, India
| | - Suman Rao Pn
- Department of Neonatology, St. John's Medical College, Bangalore, Karnataka 560034, India
| | - Saudamini Nesargi
- Department of Neonatology, St. John's Medical College, Bangalore, Karnataka 560034, India
| | - Sitara Nair
- Department of Pediatrics, St. John's College of Nursing, Bangalore, Karnataka 560034, India
| | - Shashidhar Rao
- Department of Neonatology, St. John's Medical College, Bangalore, Karnataka 560034, India
| | - Theradian Thilagavathy
- Department of Neonatology, St. John's Medical College, Bangalore, Karnataka 560034, India
| | - Armugam Ramesh
- Department of Otolaryngology, Head and neck surgery, St. John's Medical College Hospital, Bangalore, Karnataka 560034, India
| | - Swarnarekha Bhat
- Department of Neonatology, St. John's Medical College, Bangalore, Karnataka 560034, India
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160
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Khoza SLT, Tjale AA. Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management. Curationis 2014; 37:E1-9. [PMID: 26864181 DOI: 10.4102/curationis.v37i2.1246] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Revised: 07/25/2014] [Accepted: 09/30/2014] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Neonatal pain management has received increasing attention over the past four decades. Research into the effects of neonatal pain emphasises the professional, ethical and moral obligations of staff to manage pain for positive patient outcomes. However, evaluation studies continuously report evidence of inadequate neonate pain management and a gap between theory and practice. OBJECTIVE This study reviewed current practice in neonatal pain management to describe the knowledge, attitudes and practices of nurses and doctors regarding pain management for neonates in two academic hospitals. METHOD A non-experimental, prospective quantitative survey, the modified Infant Pain Questionnaire, was used to collect data from 150 nurses and doctors working in the neonatal wards of two academic hospitals in central Gauteng. RESULTS The response rate was 35.33% (n=53), most respondents being professional nurses (88.68%; n=47) working in neonatal intensive care units (80.77%; n=42); 24 (45.28%) had less than 5 years' and 29 respondents 6 or more years' working experience in neonatal care. A review of pain management in the study setting indicated a preference for pharmacological interventions to relieve moderate to severe pain. An association (p<0.05) was found between pain ratings on 5 procedures and frequency of administration of pharmacological pain management. Two-thirds of respondents (64%) reported that there were no pain management guidelines in the neonatal wards in which they worked. CONCLUSION The interventions to manage moderate neonatal pain are in line with international guidelines. However, neonatal pain management may not occur systematically based on prior assessment of neonatal pain, choice of most appropriate intervention and evaluation. This study recommends implementation of a guideline to standardise practice and ensure consistent and adequate pain management in neonates.
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Affiliation(s)
- Sizakele L T Khoza
- Department of Nursing Education, Faculty of Health Sciences, University of the Witwatersrand.
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161
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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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162
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163
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Oral sucrose administration to reduce pain response during immunization in 16-19-month infants: a randomized, placebo-controlled trial. Eur J Pediatr 2014; 173:1527-32. [PMID: 24942239 DOI: 10.1007/s00431-014-2358-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/20/2014] [Accepted: 05/21/2014] [Indexed: 10/25/2022]
Abstract
UNLABELLED Although the analgesic effect of sucrose on newborns is well established, little is known about whether these solutions are effective in reducing procedural pain in infants beyond the newborn period. The purpose of this study was to determine the effect of sucrose solution given orally on infant crying times and measure the distress in a 16-19-month age group. A total of 537 healthy, 16-19-month-old infants attending for their immunizations with intramuscular diphtheria, tetanus, and acellular pertussis (DTaP)/Haemophilus influenza type b/IPV (along with oral polio vaccination (OPV)), intramuscular pneumococcus and intramuscular hepatitis A were randomized to receive 2 mL of a 75 % sucrose solution, a 25 % sucrose solution or sterile water 2 min before injections. Infants receiving a 75 % sucrose solution had significantly reduced total crying times and Children's Hospital of Eastern Ontario Pain Scale scores (CHEOPS) compared with infants in the control and 25 % sucrose solution groups (p < 0.001). CONCLUSION Sucrose solution reduces infant distress and is safe and clinically useful even for 16-19-month-old infants.
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164
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Abstract
OBJECTIVES To determine the nature and frequency of painful procedures and procedural pain management practices in neonatal units in Kenya. DESIGN Cross-sectional survey. SETTING Level I and level II neonatal units in Kenya. PATIENTS Ninety-five term and preterm neonates from seven neonatal units. METHODS Medical records of neonates admitted for at least 24 h were reviewed to determine the nature and frequency of painful procedures performed in the 24 h period preceding data collection (6:00 to 6:00) as well as the pain management interventions (eg, morphine, breastfeeding, skin-to-skin contact, containment, non-nutritive sucking) that accompanied each procedure. RESULTS Neonates experienced a total of 404 painful procedures over a 24 h period (mean=4.3, SD 2.0; range 1-12); 270 tissue-damaging (mean=2.85, SD 1.1; range 1-6) and 134 non-tissue-damaging procedures (mean=1.41, SD 1.2; range 0-6). Peripheral cannula insertion (27%) and intramuscular injections (22%) were the most common painful procedures. Ventilated neonates and neonates admitted in level II neonatal units had a higher number of painful procedures than those admitted in level I units (mean 4.76 vs 2.96). Only one procedure had a pain intensity score documented; and none had been performed with any form of analgesia. CONCLUSIONS Neonates in Kenya were exposed to numerous tissue-damaging and non-tissue-damaging procedures without any form of analgesia. Our findings suggest that education is needed on how to assess and manage procedural pain in neonatal units in Kenya.
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Affiliation(s)
- O'Brien Munyao Kyololo
- School of Nursing, Moi University, Eldoret, Kenya Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Bonnie Stevens
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Denise Gastaldo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Peter Gisore
- Department of Paediatrics and Child Health, Moi University, Eldoret, Kenya
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165
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Abstract
The assessment and treatment of pain in the neonate, especially preterm neonates, has been a challenge in the NICU for many years. Nurses caring for these vulnerable patients are in a key position to not only recognize when the neonate is experiencing pain but to also work collaboratively with other health care providers in determining the best method to treat and help prevent pain associated with procedures and routine caregiving activities. The American Academy of Pediatrics along with parent groups has recognized the importance of pain-prevention programs in treating pain in the neonate. Nurses, by anticipating and reducing both painful procedures and bedside interruptions, along with innovative nonpharmacologic interventions, can dramatically decrease the neonate's exposure to pain and the potential for long-term effects. An overview of nonpharmacologic interventions in the treatment of neonatal pain is provided for NICU nurses to help them effectively reduce their patient's pain and discomfort.
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166
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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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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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168
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Temperament and behavior problems in toddlers born preterm and very low birth weight. SPANISH JOURNAL OF PSYCHOLOGY 2014; 16:E18. [PMID: 23866211 DOI: 10.1017/sjp.2013.30] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of the present study was to examine the temperament and behavior problems of 32 toddlers born preterm and very low birth weight and 25 toddlers born full-term without medical problems. Mothers completed the Early Childhood Behavior Questionnaire and the Child Behavior Checklist-1.5-5 for assessing toddler`s temperament and behavior problems, respectively. The results showed that, regarding temperament, toddlers born preterm exhibited higher scores on the temperament dimensions Motor Activation, Perceptual Sensitivity, and High Intensity Pleasure, and lower scores on the temperament dimension Cuddliness than toddlers born full-term. In regard to behavior problems, toddlers born preterm showed higher attention problems scores than the comparison group. These findings indicated that children born preterm presented developmental vulnerabilities in temperament dimensions related to behavior problems at toddlerhood. Early intervention programs for preventing psychological problems in at-risk children, especially those born preterm, could focus on children's temperament dispositions.
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Mitchell AJ, Yates CC, Williams DK, Chang JY, Hall RW. Does daily kangaroo care provide sustained pain and stress relief in preterm infants? J Neonatal Perinatal Med 2014; 6:45-52. [PMID: 24246458 DOI: 10.3233/npm-1364212] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES 1. Determine whether stress in preterm infants, measured with salivary cortisol, decreases after five days of Kangaroo Care (KC) compared to five days of Standard Care (SC). 2. To determine whether kangaroo care provides sustainable pain relief beyond the period of skin-to-skin holding. STUDY DESIGN Preterm infants (n = 38) born at 27-30 weeks gestational age were randomized to either the KC or the SC group and received the allocated intervention starting on day of life (DOL) five and continuing for five days. Salivary cortisol was collected on DOL five and again on DOL ten. Differences were analyzed using repeated measures ANOVA and t tests. Pain during nasal suctioning over five days was assessed using the Premature Infant Pain Profile (PIPP). RESULT 1. Adequate saliva samples for salivary cortisol were collected for 13 KC infants and 11 SC infants. There was no main effect of group (p = 0.49), but there was a significant main effect of age (DOL five versus DOL ten), with salivary cortisol levels decreasing in both groups (p = 0.02). 2. Pain scores for both groups (n = 38) indicted mild to moderate pain during suctioning, with no significant difference in pain scores between groups. CONCLUSION 1. KC did not affect salivary cortisol levels in preterm neonates, but levels in both the KC and SC groups decreased over time from DOL five to ten. Salivary cortisol may vary with age of infant. 2. Infants experience pain during routine suctioning and may require pain management.
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Affiliation(s)
- A J Mitchell
- College of Nursing, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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A comparative study of two remifentanil doses for procedural pain in ventilated preterm infants: a randomized, controlled study*. Pediatr Crit Care Med 2014; 15:451-5. [PMID: 24717908 DOI: 10.1097/pcc.0000000000000123] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Remifentanil is an ultrashort-acting synthetic opioid, and the metabolism of which is not influenced by hepatic or renal function. This study aims to compare the efficacy of two remifentanil doses during procedures in ventilated preterm infants. DESIGN Prospective, randomized, double-blind, noninferiority trial. SETTING Neonatal ICU. PATIENTS Preterm infants who were supported by a mechanical ventilator with tracheal tube and requiring central venous access. INTERVENTIONS Two remifentanil dosages were administered in mechanically ventilated preterm infants during peripherally inserted central catheter insertion. Fourteen preterm infants were randomly assigned to low-dose (0.1 μg/kg/min) or high-dose (0.25 μg/kg/min) remifentanil infusion. The Premature Infant Pain Profile was used to score pain during the procedure, and changes in the Premature Infant Pain Profile score between needle puncture and baseline were analyzed to investigate the noninferiority of low-dose to high-dose remifentanil. Occurrence of cardiorespiratory complications was also recorded. MEASUREMENTS AND MAIN RESULTS The median gestational age (minimum, maximum) was 26 weeks (24, 31), and the median birth weight was 825 g (610, 1,280). Changes in Premature Infant Pain Profile in the high-dose and low-dose groups were 1.43 ± 3.10 and -0.60 ± 5.32, respectively. The difference in changes in the Premature Infant Pain Profile score between the high-dose and low-dose groups was -2.03 ± 4.13. The corresponding lower limit of one-tailed 97.5% CI was -7.24, below the noninferiority margin. Apneic events and bradycardia did not occur in the low-dose group; however, there were three episodes of apnea (42.9%) and one of bradycardia (14.3%) in the high-dose group (p = 0.683 and 0.366, respectively). CONCLUSION For mechanically ventilated preterm infants, the use of remifentanil at 0.25 μg/kg/min as an analgesic for short procedures represents a therapeutic option. Our pilot study suggests the need for larger randomized trials.
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Weslinck N, De Jonckheere J, Storme L, Logier R, Appel M, Thomas D, Rakza T. [Impact of the instrumental vaginal delivery on pain perception at two months]. Arch Pediatr 2014; 21:614-9. [PMID: 24768067 DOI: 10.1016/j.arcped.2014.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 01/01/2014] [Accepted: 03/10/2014] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Although instrumental vaginal delivery reduces the risk of neonatal mortality, it increases the risk of specific morbidity including prolonged neonatal discomfort. Previous studies suggest that neonatal exposure to acute pain could have long-term effects on the pain response later in life. The aim of the study was to investigate whether instrumental vaginal delivery may alter the response to a noxious stimulus at the age of two months. METHOD Newborn infants were enrolled in this prospective observational study after parental consent. A group of children born by instrumental vaginal delivery (group 2) were compared to matched controls born by vaginal delivery (group 1). Pain was assessed in each newborn infant between two and four hours after birth using the scale of pain and discomfort of the newborn baby (EDIN). These children were reassessed for pain response to immunizations (Infanrix(®) and Prevenar(®)) at two months of age using the DAN scale. RESULTS Thirteen children were enrolled in this study, six in group 1 and seven in group 2. Gestational age, birth weight, Apgar score, and umbilical arterial blood were similar in both groups. The EDIN measured between H2 and H4 was significantly higher in group 2 (median, 4 [IQ, 3] versus 0 [3.25], P<0.05). While the DAN score before and during immunization was similar in the two groups, it was statistically higher in group 2 than in group 1 (4 [3] versus 2 [2.25], P<0.01) within the15 min following the injections. CONCLUSION These results indicate that birth by instrumental vaginal delivery causes discomfort after birth and increases the pain response to immunization at the age of two months. This study supports the hypothesis that instrumental vaginal delivery may alter pain perception later in life.
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Affiliation(s)
- N Weslinck
- Pôle femme, mère et nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, avenue Eugène-Avinée, 59038 Lille cedex, France
| | - J De Jonckheere
- Inserm CIC-IT 807, institut Hippocrate, CHRU de Lille, 59038 Lille, France; UPRES-EA4489, environnement périnatal et croissance, faculté de médecine, université Lille I et Lille II, 1, place de Verdun, 59000 Lille, France
| | - L Storme
- Pôle femme, mère et nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, avenue Eugène-Avinée, 59038 Lille cedex, France; UPRES-EA4489, environnement périnatal et croissance, faculté de médecine, université Lille I et Lille II, 1, place de Verdun, 59000 Lille, France
| | - R Logier
- Inserm CIC-IT 807, institut Hippocrate, CHRU de Lille, 59038 Lille, France
| | - M Appel
- Pôle femme, mère et nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, avenue Eugène-Avinée, 59038 Lille cedex, France
| | - D Thomas
- Pôle femme, mère et nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, avenue Eugène-Avinée, 59038 Lille cedex, France
| | - T Rakza
- Pôle femme, mère et nouveau-né, hôpital Jeanne-de-Flandre, CHRU de Lille, 1, avenue Eugène-Avinée, 59038 Lille cedex, France; UPRES-EA4489, environnement périnatal et croissance, faculté de médecine, université Lille I et Lille II, 1, place de Verdun, 59000 Lille, France.
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The neurodevelopmental impact of neonatal morphine administration. Brain Sci 2014; 4:321-34. [PMID: 24961764 PMCID: PMC4101480 DOI: 10.3390/brainsci4020321] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Revised: 04/01/2014] [Accepted: 04/15/2014] [Indexed: 12/15/2022] Open
Abstract
Medical management of newborn infants often necessitates recurrent painful procedures, which may alter nociceptive pathways during a critical developmental period and adversely effect neuropsychological outcomes. To mitigate the effects of repeated painful stimuli, opioid administration for peri-procedural analgesia and ICU (intensive care unit) sedation is common in the NICU (neonatal intensive care unit). A growing body of basic and animal evidence suggests potential long-term harm associated with neonatal opioid therapy. Morphine increases apoptosis in human microglial cells, and animal studies demonstrate long-term changes in behavior, brain function, and spatial recognition memory following morphine exposure. This comprehensive review examines existing preclinical and clinical evidence on the long-term impacts of neonatal pain and opioid therapy.
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Gibbins S, Stevens BJ, Yamada J, Dionne K, Campbell-Yeo M, Lee G, Caddell K, Johnston C, Taddio A. Validation of the Premature Infant Pain Profile-Revised (PIPP-R). Early Hum Dev 2014; 90:189-93. [PMID: 24491511 DOI: 10.1016/j.earlhumdev.2014.01.005] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 11/20/2013] [Accepted: 01/08/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To examine the construct validity, inter-rater reliability, and feasibility of the Premature Infant Pain Profile-Revised in infants of varying gestational ages, diagnoses, and procedures. METHODS A prospective cross-over study with infants in three gestational age groups (26-31, 32-36, and ≥37 weeks) at three university-affiliated Neonatal Intensive Care Units in Canada. One hundred and ninety five bedside nurses and expert raters rated 202 hospitalized infants' pain during scheduled procedures using the measure. An expert rater and a nurse independently assessed infants' pain scores, using the Premature Infant Pain Profile-Revised, during 246 scheduled pairs of painful and non-painful procedures in the 202 infants. Nurses also completed a feasibility survey on using the measure in a clinical setting. To establish construct validity, pain scores were computed during painful and non-painful procedures. Inter-rater reliability between pain experts and nurses was calculated. A 5-point Likert scale was used to measure feasibility in terms of clarity, ease of use, and time to complete. RESULTS Irrespective of gestational age, Premature Infant Pain Profile-Revised scores were significantly higher during painful procedures (mean 6.7 [SD 3.0]) compared to non-painful procedures (mean 4.8 [SD 2.9]). There was a high degree of correlation between nurses' and experts' ratings for painful (all R(2)=0.92, p<0.001) and non-painful (all R(2)=0.87, p<0.001) procedures. Mean scores on all feasibility indicators were equal to or higher than 3.8. DISCUSSION The Premature Infant Pain Profile Revised has beginning construct validation, inter-rater reliability, and is considered feasible by clinicians. Concurrent validation studies should be considered.
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Affiliation(s)
- Sharyn Gibbins
- Trillium Health Partners, Mississauga, Ontario, Canada; The University of Toronto, Toronto, Ontario, Canada.
| | - Bonnie J Stevens
- The University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Janet Yamada
- The Hospital for Sick Children, Toronto, Ontario, Canada
| | | | - Marsha Campbell-Yeo
- IWK Health Centre, Halifax, Nova Scotia, Canada; Dalhousie University, Halifax, Nova Scotia, Canada
| | - Grace Lee
- The University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kim Caddell
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Céleste Johnston
- IWK Health Centre, Halifax, Nova Scotia, Canada; McGill University, Montréal, Québec, Canada
| | - Anna Taddio
- The University of Toronto, Toronto, Ontario, Canada; The Hospital for Sick Children, Toronto, Ontario, Canada
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Abstract
Preclinical and clinical studies have demonstrated the adverse consequences of untreated pain and stress on brain development in the preterm infant. Sucrose has widely been implemented as standard therapy for minor procedural pain. Anesthetics are commonly utilized in preterm infants during major surgery. Pharmacologic agents (benzodiazepines and opioids) have been examined in clinical trials of preterm infants requiring invasive mechanical ventilation. Controversy exists regarding the safety and long-term impact of these interventions. Ongoing multidisciplinary research will help define the impact of these agents and identify potential alternative therapies.
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175
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Woo HC, Tolosa L, El-Metwally D, Viscardi RM. Glucose monitoring in neonates: need for accurate and non-invasive methods. Arch Dis Child Fetal Neonatal Ed 2014; 99:F153-7. [PMID: 24065727 DOI: 10.1136/archdischild-2013-304682] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Neonatal hypoglycaemia can lead to devastating consequences. Thus, constant, accurate and safe glucose monitoring is imperative in neonatal care. However, point-of-care (POC) devices for glucose testing currently used for neonates were originally designed for adults and do not address issues specific to neonates. This review will address currently available monitoring options and describe new methodologies for non-invasive glucose monitoring in newborns.
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Affiliation(s)
- Hyung Chul Woo
- Division of Neonatology, Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, , Baltimore, Maryland, USA
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Garcia Guerra G, Robertson CMT, Alton GY, Joffe AR, Cave DA, Yasmin F, Dinu IA, Creighton DE, Ross DB, Rebeyka IM. Neurotoxicity of sedative and analgesia drugs in young infants with congenital heart disease: 4-year follow-up. Paediatr Anaesth 2014; 24:257-65. [PMID: 24103018 DOI: 10.1111/pan.12257] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES/AIM To determine whether sedation/analgesia drugs used before, during, and after infant cardiac surgery are associated with neurocognitive and functional outcomes. BACKGROUND Some animal models suggest neurotoxic effects of anesthetic drugs on the developing brain; however, potential human effects are unknown. Whether these results can be extrapolated to humans is unknown. METHODS/MATERIALS Prospective follow-up project of all infants ≤6 weeks old having surgery for congenital heart disease between 04/03 and 12/06. Demographic, perioperative, and sedation/analgesia variables were collected. Outcomes at kindergarten age were Wechsler Preschool and Primary Scale of Intelligence-III, Beery-Buktenica Developmental Test of Visual Motor Integration (VMI-V), and General Adaptive Composite (GAC) of the Adaptive Behavior Assessment System-II. Multivariable linear regression was used to identify predictor variables. RESULTS From 135 infants who underwent heart surgery, 19 died, 17 were excluded, 8 were lost to follow-up, leaving 91 children for analysis. Multiple linear regression found days on chloral hydrate [3.5 (3.7) days] was associated with lower performance intelligence quotient (PIQ) (Effect size -1.03; 95% CI -1.96, -0.10; P = 0.03), and cumulative dose [54.2 (60.3) mg·kg(-1) ] of benzodiazepines was associated with lower VMI scores (Effect size -0.07; 95% CI -0.12, -0.01; P = 0.026). No other associations were found between sedation/analgesia variables and full-scale IQ, PIQ, Verbal IQ, VMI, or GAC. CONCLUSION Assessment of this cohort at kindergarten age found a small statistically significant association between days on chloral hydrate and PIQ, and benzodiazepine cumulative dose and lower VMI. No other association between sedation/analgesia drugs and outcomes was found.
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Cabral DM, Antonini SRR, Custódio RJ, Martinelli CE, da Silva CAB. Measurement of salivary cortisol as a marker of stress in newborns in a neonatal intensive care unit. Horm Res Paediatr 2014; 79:373-8. [PMID: 23796826 DOI: 10.1159/000351942] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 05/07/2013] [Indexed: 12/21/2022] Open
Abstract
AIMS The study was designed to evaluate the newborn (NB) stress response during the inpatient time in the neonatal intensive care unit. METHODS A quantitative, prospective, observational study was conducted with two NB groups. The first group consisted of 12 NB patients in the neonatal intensive care unit as the experimental group (EG), and the second included 43 NBs who were sent to their own homes and were considered the control group (CG). The EG's salivary cortisol concentration was measured on the 2nd day (D2) and 9th day (D9) of life. The CG's salivary cortisol concentration was measured on the 14th day of life at the child's own home. RESULTS The salivary cortisol concentration levels for the EG on D2 and D9 and for the CG were 4.3151 ± 2.6492, 1.826 ± 1.2252, and 1.0166 ± 0.8300 ng/dl, respectively. These findings indicated the presence of an adrenal response to stress during the first inpatient days. CONCLUSIONS The salivary cortisol concentration is an accurate method to indicate neonatal stress. The glucocorticoids frequently used in the prenatal period suppress the adrenal glands and interfere with the stress response.
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Tannous Elias LSD, Dos Santos AMN, Guinsburg R. Perception of pain and distress in intubated and mechanically ventilated newborn infants by parents and health professionals. BMC Pediatr 2014; 14:44. [PMID: 24528475 PMCID: PMC3928585 DOI: 10.1186/1471-2431-14-44] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/13/2014] [Indexed: 12/02/2022] Open
Abstract
Background An understanding of perceptions of parents and health caregivers who assist critically ill neonates is necessary to comprehend their actions and demands. Therefore this study aim to analyze the agreement among parents, nurse technicians and pediatricians regarding the presence and intensity of pain and distress in mechanically ventilated and intubated newborn infants. Methods Cross-sectional study comprising 52 infants and 52 trios of adults composed of one parent, one nurse technician, and one pediatrician who all observed the same infant. All infants were intubated and under mechanical ventilation and were not handled during the observations. Each newborn was simultaneously observed by the trio of adults for 1 minute to evaluate the presence of pain and distress. The intensity of pain and distress that the adults believed was felt by the infants was marked in a visual analogical scale. Adults’ agreement about the simultaneous presence of pain and distress in each infant was analyzed by marginal homogeneity and Cochran tests. The agreement about the intensity of pain and distress in each infant was studied by Bland-Altman plot and intraclass correlation coefficient (ICC). Results The assessments of pain and distress were heterogeneous in all three investigated groups of adults as determined by the results of a Bland-Altman plot. The presence of distress was more frequently reported compared with pain (marginal heterogeneity, p < 0.01). The pain and distress scores in each adult group were not correlated as shown by ICC [parents, 0.36 (95% CI: 0.01-0.63); nurses 0.47 (0.23-0.66); pediatricians, 0.46 (0.22-0.65)]. Conclusions Adults systematically underscore pain in comparison to distress in mechanically ventilated newborns, without recognizing the association between them.
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Affiliation(s)
| | | | - Ruth Guinsburg
- Division of Neonatal Medicine at Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Vicente Felix 77 apt 09, São Paulo, SP 01410-020, Brazil.
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de Lalouvière LLH, Ioannou Y, Fitzgerald M. Neural mechanisms underlying the pain of juvenile idiopathic arthritis. Nat Rev Rheumatol 2014; 10:205-11. [DOI: 10.1038/nrrheum.2014.4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Abstract
PURPOSE The aim of this study was to determine whether massage therapy can be used as an adjunct intervention to induce sleep in infants born preterm. METHODS Thirty infants born at a minimum of 28 weeks gestational age, who were at the time of the study between 32 and 48 weeks adjusted gestational age, were randomly assigned to receive massage therapy on 1 day and not receive massage on an alternate day. The Motionlogger Micro Sleep Watch Actigraph recorded lower extremity activity on the morning of each day. RESULTS No significant difference was found between groups for sleep efficiency (P = .13) during the time period evaluated. Groups differed significantly during the time period after the massage ended with more infants sleeping on the nonmassage day (χ = 4.9802, P = .026). CONCLUSIONS Massage is well tolerated in infants born preterm and infants do not fall asleep faster after massage than without massage.
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Repetitive noxious neonatal stimuli increases dentate gyrus cell proliferation and hippocampal brain-derived neurotrophic factor levels. Hippocampus 2013; 24:415-23. [DOI: 10.1002/hipo.22235] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 11/22/2013] [Accepted: 12/02/2013] [Indexed: 01/15/2023]
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Marín Gabriel MÁ, del Rey Hurtado de Mendoza B, Jiménez Figueroa L, Medina V, Iglesias Fernández B, Vázquez Rodríguez M, Escudero Huedo V, Medina Malagón L. Analgesia with breastfeeding in addition to skin-to-skin contact during heel prick. Arch Dis Child Fetal Neonatal Ed 2013; 98:F499-503. [PMID: 23839984 DOI: 10.1136/archdischild-2012-302921] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate the analgesic effect (measured with Neonatal Infant Pain Scale (NIPS)) of breastfeeding (BF) in addition to skin-to-skin contact (SSC) versus other methods of non-pharmacological analgesia during blood sampling through heel lance in healthy term neonates. DESIGN Randomised controlled trial. SETTING Tertiary level maternity ward. PATIENTS One hundred thirty-six healthy term newborns. INCLUSION CRITERIA healthy term neonates, wish to breastfeed and absence of feeding during the previous 60 min. INTERVENTION Neonates were randomly assigned to four groups: Group breastfed with SSC (BF+SSC Group) (n=35); Group sucrose with SSC (Sucrose+SSC Group) (n=35); SSC Group (n=33); or Sucrose Group (n=33). Babies were recorded with a video camera. OUTCOME MEASURES Three observers watched the videos and measured NIPS score at three time points (t0: 2 min before heel prick; t1: During heel prick; and t2: 2 min after the heel prick). The influences of non-pharmacological methods on crying time, percentage of crying while sampling, heart rate, number of attempts and duration of sampling were also studied. RESULTS BF+SSC Group achieved a significant lower median NIPS score (value=1) compared with other groups (value=2, 4 and 4, respectively). The percentage of neonates with moderate-to-severe pain was also lower in the BF+SSC Group. Both groups BF+SSC and Sucrose+SSC achieved a significant lower percentage of crying compared with SSC Group. CONCLUSIONS This study suggests that BF in addition to SSC provides superior analgesia to other kinds of non-pharmacological analgesia in healthy term neonates during heel prick.
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Simons SHP, van der Lee R, Reiss IKM, van Weissenbruch MM. Clinical evaluation of propofol as sedative for endotracheal intubation in neonates. Acta Paediatr 2013; 102:e487-92. [PMID: 23889264 DOI: 10.1111/apa.12367] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 07/16/2013] [Accepted: 07/22/2013] [Indexed: 11/30/2022]
Abstract
AIM To determine the effects of propofol for endotracheal intubation in neonates in daily clinical practice. METHODS We prospectively studied the pharmacodynamic effects of intravenous propofol administration in neonates who needed endotracheal intubation at the neonatal intensive care unit. RESULTS Propofol was used for 62 intubations in neonates with postmenstrual ages ranging from 24 + 3 weeks to 44 + 5 weeks and bodyweights ranging from 520 to 4380 g. A 2 mg/kg bodyweight propofol starting dose was sufficient in 37% of patients; additional propofol was needed less often on the first postnatal day. The mean amount of propofol used was 3.3 (±1.2) mg/kg. The success rate of intubation depended on the experience of the physician and was related to the total administered amount of propofol. Hypotension occurred in 39% of patients and occurred more often at the first postnatal day. In 15% of procedures, propofol mono therapy was insufficient. CONCLUSION This study shows that high doses of propofol are needed to reach effective sedation in neonates for intubation, with hypotension as a side effect in a considerable percentage of patients. Further research in newborn patients needs to identify optimal propofol doses and risk factors for hypotension.
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Affiliation(s)
- SHP Simons
- Division of Neonatology; Department of Pediatrics; Erasmus MC Sophia Children's Hospital; Rotterdam; The Netherlands
| | - R van der Lee
- Department of Neonatology; AMC Emma Children's Hospital; Amsterdam; The Netherlands
| | - Irwin KM Reiss
- Division of Neonatology; Department of Pediatrics; Erasmus MC Sophia Children's Hospital; Rotterdam; The Netherlands
| | - MM van Weissenbruch
- Department of Neonatology; VU Medical Center Amsterdam; Amsterdam; The Netherlands
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Reports of Chronic Pain in Childhood and Adolescence Among Patients at a Tertiary Care Pain Clinic. THE JOURNAL OF PAIN 2013; 14:1390-7. [DOI: 10.1016/j.jpain.2013.06.010] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 06/18/2013] [Accepted: 06/24/2013] [Indexed: 12/16/2022]
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Ranger M, Chau CMY, Garg A, Woodward TS, Beg MF, Bjornson B, Poskitt K, Fitzpatrick K, Synnes AR, Miller SP, Grunau RE. Neonatal pain-related stress predicts cortical thickness at age 7 years in children born very preterm. PLoS One 2013; 8:e76702. [PMID: 24204657 PMCID: PMC3800011 DOI: 10.1371/journal.pone.0076702] [Citation(s) in RCA: 178] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 08/25/2013] [Indexed: 01/13/2023] Open
Abstract
Background Altered brain development is evident in children born very preterm (24–32 weeks gestational age), including reduction in gray and white matter volumes, and thinner cortex, from infancy to adolescence compared to term-born peers. However, many questions remain regarding the etiology. Infants born very preterm are exposed to repeated procedural pain-related stress during a period of very rapid brain development. In this vulnerable population, we have previously found that neonatal pain-related stress is associated with atypical brain development from birth to term-equivalent age. Our present aim was to evaluate whether neonatal pain-related stress (adjusted for clinical confounders of prematurity) is associated with altered cortical thickness in very preterm children at school age. Methods 42 right-handed children born very preterm (24–32 weeks gestational age) followed longitudinally from birth underwent 3-D T1 MRI neuroimaging at mean age 7.9 yrs. Children with severe brain injury and major motor/sensory/cognitive impairment were excluded. Regional cortical thickness was calculated using custom developed software utilizing FreeSurfer segmentation data. The association between neonatal pain-related stress (defined as the number of skin-breaking procedures) accounting for clinical confounders (gestational age, illness severity, infection, mechanical ventilation, surgeries, and morphine exposure), was examined in relation to cortical thickness using constrained principal component analysis followed by generalized linear modeling. Results After correcting for multiple comparisons and adjusting for neonatal clinical factors, greater neonatal pain-related stress was associated with significantly thinner cortex in 21/66 cerebral regions (p-values ranged from 0.00001 to 0.014), predominately in the frontal and parietal lobes. Conclusions In very preterm children without major sensory, motor or cognitive impairments, neonatal pain-related stress appears to be associated with thinner cortex in multiple regions at school age, independent of other neonatal risk factors.
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Affiliation(s)
- Manon Ranger
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Cecil M. Y. Chau
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
- BC Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada
| | - Amanmeet Garg
- Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Todd S. Woodward
- BC Mental Health and Addictions Research Institute, Vancouver, British Columbia, Canada
- Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mirza Faisal Beg
- Engineering Science, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Bruce Bjornson
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Kenneth Poskitt
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Fitzpatrick
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
| | - Anne R. Synnes
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
- BC Children’s and Women’s Hospitals, Vancouver, British Columbia, Canada
| | - Steven P. Miller
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
- Pediatrics, Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - Ruth E. Grunau
- Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, British Columbia, Canada
- BC Children’s and Women’s Hospitals, Vancouver, British Columbia, Canada
- * E-mail:
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Doesburg SM, Chau CM, Cheung TP, Moiseev A, Ribary U, Herdman AT, Miller SP, Cepeda IL, Synnes A, Grunau RE. Neonatal pain-related stress, functional cortical activity and visual-perceptual abilities in school-age children born at extremely low gestational age. Pain 2013; 154:1946-1952. [PMID: 23711638 PMCID: PMC3778166 DOI: 10.1016/j.pain.2013.04.009] [Citation(s) in RCA: 118] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 03/06/2013] [Accepted: 04/02/2013] [Indexed: 01/05/2023]
Abstract
Children born very prematurely (< or =32 weeks) often exhibit visual-perceptual difficulties at school-age, even in the absence of major neurological impairment. The alterations in functional brain activity that give rise to such problems, as well as the relationship between adverse neonatal experience and neurodevelopment, remain poorly understood. Repeated procedural pain-related stress during neonatal intensive care has been proposed to contribute to altered neurocognitive development in these children. Due to critical periods in the development of thalamocortical systems, the immature brain of infants born at extremely low gestational age (ELGA; < or =28 weeks) may have heightened vulnerability to neonatal pain. In a cohort of school-age children followed since birth we assessed relations between functional brain activity measured using magnetoencephalogragy (MEG), visual-perceptual abilities and cumulative neonatal pain. We demonstrated alterations in the spectral structure of spontaneous cortical oscillatory activity in ELGA children at school-age. Cumulative neonatal pain-related stress was associated with changes in background cortical rhythmicity in these children, and these alterations in spontaneous brain oscillations were negatively correlated with visual-perceptual abilities at school-age, and were not driven by potentially confounding neonatal variables. These findings provide the first evidence linking neonatal pain-related stress, the development of functional brain activity, and school-age cognitive outcome in these vulnerable children.
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Affiliation(s)
- Sam M. Doesburg
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
- Program in Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Cecil M. Chau
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, BC, Canada
| | - Teresa P.L. Cheung
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, BC, Canada
- Department of Physics, Simon Fraser University, Burnaby, BC, Canada
- Down Syndrome Research Foundation, Burnaby, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | | | - Urs Ribary
- Down Syndrome Research Foundation, Burnaby, BC, Canada
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Anthony T. Herdman
- Down Syndrome Research Foundation, Burnaby, BC, Canada
- Department of Audiology and Speech Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Steven P. Miller
- Program in Neurosciences and Mental Health, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Department of Neurology, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Ivan L. Cepeda
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, BC, Canada
| | - Anne Synnes
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Ruth E. Grunau
- Developmental Neurosciences and Child Health, Child and Family Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
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187
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Abstract
Nociceptive pathways are functional following birth. In addition to physiological and behavioral responses, neurophysiological measures and neuroimaging evaluate nociceptive pathway function and quantify responses to noxious stimuli in preterm and term neonates. Intensive care and surgery can expose neonates to painful stimuli when the developing nervous system is sensitive to changing input, resulting in persistent impacts into later childhood. Early pain experience has been correlated with increased sensitivity to subsequent painful stimuli, impaired neurodevelopmental outcomes, and structural changes in brain development. Parallel preclinical studies have elucidated underlying mechanisms and evaluate preventive strategies to inform future clinical trials.
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Affiliation(s)
- Suellen M Walker
- Portex Unit: Pain Research, UCL Institute of Child Health, Great Ormond St Hospital for Children NHS Foundation Trust, 30 Guilford Street, London, UK.
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188
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Gerull R, Cignacco E, Stoffel L, Sellam G, Nelle M. Physiological parameters after nonpharmacological analgesia in preterm infants: a randomized trial. Acta Paediatr 2013; 102:e368-73. [PMID: 23651076 DOI: 10.1111/apa.12288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/28/2013] [Accepted: 05/02/2013] [Indexed: 11/30/2022]
Abstract
AIM To compare the influence of three different nonpharmacological interventions on cortical activation, heart rate and peripheral oxygen saturation (SaO2 ) after heelstick in preterm infants. METHODS Twenty five preterm infants between 24 0/7 and 32 0/7 weeks of gestational age were randomized to either oral sucrose (S), facilitated tucking (FT) or a combination of the two interventions (SFT) prior to five heelsticks each within the first 14 days of life. SaO2 , heart rate and oxygenation of the somatosensory cortex, measured by near infrared spectroscopy (NIRS), were analysed. RESULTS Hundred and twenty five heelsticks were performed. The heart rate increased significantly after heelstick in all three intervention groups (p < 0.004 in all groups). The increase was higher in the FT group compared with the other groups (S: p = 0.007; SFT: p = 0.004). There was no difference among the two groups receiving sucrose (S and SFT; p = 0.87). SaO2 did not change significantly after heelstick in all intervention groups. Near infrared spectroscopy measurements did not show a significant change in the curve but patients in the FT group showed a trend towards higher average oxygenation of the contralateral somatosensory cortex. CONCLUSION Oral sucrose seems to be more effective in reducing reaction to pain than FT. Application of both interventions did not show an additive effect.
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Affiliation(s)
- Roland Gerull
- Department of Pediatrics; Division of Neonatology; Inselspital and University of Berne; Berne Switzerland
| | - Eva Cignacco
- Medical Faculty; Institute of Nursing Science; University of Basel; Basel Switzerland
| | - Liliane Stoffel
- Department of Pediatrics; Division of Neonatology; Inselspital and University of Berne; Berne Switzerland
| | - Gila Sellam
- Medical Faculty; Institute of Nursing Science; University of Basel; Basel Switzerland
| | - Mathias Nelle
- Department of Pediatrics; Division of Neonatology; Inselspital and University of Berne; Berne Switzerland
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189
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Kostandy R, Anderson GC, Good M. Skin-to-skin contact diminishes pain from hepatitis B vaccine injection in healthy full-term neonates. Neonatal Netw 2013; 32:274-280. [PMID: 23835546 DOI: 10.1891/0730-0832.32.4.274] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE This study was conducted to test the hypothesis that skin-to-skin contact (SSC) would reduce hepatitis B vaccine injection pain in full-term neonates. DESIGN Randomized controlled trial (RCT). SAMPLE Thirty-six mother-;neonate dyads were randomly assigned to SSC or control groups. MAIN OUTCOMES Cry time (CT ), behavioral state (BSt), and heart rate (HR ) were measured throughout the 16-minute protocol. HR and BSt were measured every 30 seconds; CT was recorded continuously. RESULTS SSC neonates cried less compared with controls (23 vs 32 seconds during injection; 16 vs 72 seconds during recovery), reached calmer BSts sooner (M = 2.8 vs M = 6.5 time points), and trended toward more rapid HR decrease. SSC as described was safe and effective and merits further testing.
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191
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Thevaraja AK, Batra YK, Rakesh SV, Panda NB, Rao KLN, Chhabra M, Aggarwal M. Comparison of low-dose ketamine to midazolam for sedation during pediatric urodynamic study. Paediatr Anaesth 2013; 23:415-21. [PMID: 23061785 DOI: 10.1111/pan.12046] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2012] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Aim of sedation during pediatric urodynamic studies (UDS) is a calm and cooperative child while not affecting measurements. We compared the effectiveness of midazolam to low-dose ketamine infusion for sedation and their impact on urodynamics. MATERIALS AND METHODS ASA-I children undergoing UDS were randomly assigned to group K (ketamine) loading dose (0.25 mg·kg(-1)) followed by infusion of 10-20 μg·kg(-1) ·min(-1) or group M (midazolam) loading dose of (0.02 mg·kg(-1)) followed by 1-2 μg·kg(-1) ·min(-1). The sedation scores and reactivity to catheterization were monitored by Children Hospital of Wisconsin Sedation Scale and Frankl Behavior Rating Scale, respectively. The UDS included two-channel filling cystometry in supine position followed by a free uroflowmetry in sitting position. The UDS was performed and interpreted in accordance with good urodynamic practice guidelines of International Continence Society (2002). RESULTS A total of 34 children were enrolled. Group K children (n = 17) attained sedation earlier 6.80 (±3.36) min vs. 9.40 (±2.82) min; (P = 0.03) than group M (n = 17) and also recovered earlier 11.60 (±3.13) min vs. 19.67 (±5.49) min (P = 0.01). Reactivity scores during urinary and rectal catheterization were lower in group K (P = 0.03 and 0.01), respectively. Historical UDS data of 21 participants were available for comparison with effect of medication. None of the study drugs affected UDS parameters significantly. CONCLUSIONS Midazolam or low-dose ketamine provide satisfactory sedation during pediatric UDS without impacting urodynamic values.
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Affiliation(s)
- Arun K Thevaraja
- Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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192
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Ozawa M, Yokoo K. Pain management of neonatal intensive care units in Japan. Acta Paediatr 2013; 102:366-72. [PMID: 23311590 DOI: 10.1111/apa.12160] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 12/19/2012] [Accepted: 01/09/2013] [Indexed: 11/27/2022]
Abstract
AIM To describe current neonatal pain management and individual and organizational factors that can improve neonatal pain practice from the viewpoints of both head nurses and head neonatologists in Japan. METHODS An anonymous questionnaire was sent to general perinatal maternal and child medical centres that had level 3 units across Japan. RESULTS A total of 61 of 89 head nurses and 54 of 89 head neonatologists replied. The responses of head nurses and head neonatologists were almost the same. More than 60% of units (head nurses, 65%; head neonatologists, 61%) did not use pain scales, and about 63% units (both head nurses and head neonatologists) had no rules for health care professionals on the best methods for implementing pain relief for painful diagnostic and therapeutic procedures. Only 17% of head nurses and 24% of head neonatologists considered that nurses and physicians in their units collaborated in pain management, and <20% of units (both head nurses and head neonatologists) had written guidelines for their unit on neonatal pain management. CONCLUSION This study suggested that Japanese neonatal intensive care units need national guidelines for pain management, and these might improve collaboration between nurses and physicians in minimizing neonatal pain.
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Affiliation(s)
- Mio Ozawa
- Midwifery and Maternal-Newborn Nursing; Graduate School of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
| | - Kyoko Yokoo
- Midwifery and Maternal-Newborn Nursing; Graduate School of Biomedical & Health Sciences; Hiroshima University; Hiroshima Japan
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Voigt B, Brandl A, Pietz J, Pauen S, Kliegel M, Reuner G. Negative reactivity in toddlers born prematurely: indirect and moderated pathways considering self-regulation, neonatal distress and parenting stress. Infant Behav Dev 2012; 36:124-38. [PMID: 23274535 DOI: 10.1016/j.infbeh.2012.11.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 09/11/2012] [Accepted: 11/08/2012] [Indexed: 11/24/2022]
Abstract
High negative reactivity in early childhood interferes with later academic and behavioral adjustment. Thus, investigating the origins of high negative affectivity in early childhood is of high relevance for understanding emotional morbidity after preterm birth. The present work explored (1) direct prematurity-related consequences for negative reactivity, (2) self-regulatory deficits as a mechanism indirectly relating prematurity to negative affectivity and (3) the implications of the interplay between procedural distress in the neonatal period and parenting stress for preterm children's negative reactivity. The sample was comprised of 146 preterm children (very vs. moderately to late preterm) and 86 healthy full-term children, both free of major neurological impairment. Assessment involved negative affect and parenting stress (parent-report; 12, 24 months corrected age, CA), effortful control (behavioral battery, parent report; 24 months CA) and the number of potentially distressing neonatal intensive care procedures as well as severity of illness during the neonatal period (retrospective chart review). There was no direct link from prematurity to a disposition for high negative reactivity in early childhood nor was prematurity indirectly associated with higher negative reactivity through lower levels of effortful control. The relation between neonatal pain and distress and negative affectivity depended on the level of parenting stress with low parenting stress at the end of the first year of children's life buffering the negative influence of neonatal distress. The present findings underscore the importance of complex interactions among environmental factors in processes of emotional plasticity after preterm birth thereby providing critical suggestions for follow-up care.
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Affiliation(s)
- Babett Voigt
- Children's Hospital, University Hospital of Heidelberg, Germany.
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194
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Abstract
The morbidity and mortality of preterm infants are impacted by their ability to maintain physiologic homeostasis using metabolic, endocrine, and immunologic mechanisms independent of the mother's placenta. Exploring McEwen's allostatic load model in preterm infants provides a new way to understand the altered physiologic processes associated with frequently occurring complications of prematurity such as bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity. The purpose of this article is to present a new model to enhance understanding of the altered physiologic processes associated with complications of prematurity. The model of allostatic load and complications of prematurity was derived to explore the relationship between general stress of prematurity and complications of prematurity. The proposed model uses the concepts of general stress of prematurity, allostasis, physiologic response patterns (adaptive-maladaptive), allostatic load, and complications of prematurity. These concepts are defined and theoretical relationships in the proposed model are interpreted using the four maladaptive response patterns of repeated hits, lack of adaptation, prolonged response, and inadequate response. Empirical evidence for cortisol, inflammation, and oxidative stress responses are used to support the theoretical relationships. The proposed model provides a new way of thinking about physiologic dysregulation in preterm infants. The ability to describe and understand complex physiologic mechanisms involved in complications of prematurity is essential for research. Advancing the knowledge of complications of prematurity will advance clinical practice and research and lead to testing of interventions to reduce negative outcomes in preterm infants.
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196
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Arias MCC, Guinsburg R. Differences between uni-and multidimensional scales for assessing pain in term newborn infants at the bedside. Clinics (Sao Paulo) 2012; 67:1165-70. [PMID: 23070343 PMCID: PMC3460019 DOI: 10.6061/clinics/2012(10)08] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 06/15/2012] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES This study sought to determine the level of agreement between behavioral and multidimensional pain assessment scales in term newborn infants submitted to an acute nociceptive stimulus. METHODS This cross-sectional study was performed on 400 healthy term newborns who received an intramuscular injection of vitamin K during the first 6 hours of life. Two behavioral pain scales (the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain) and one multidimensional tool (the Premature Infant Pain Profile) were applied by a single observer before the procedure, during cleansing, during injection and two minutes after injection. The Cochran Q, McNemar and kappa tests were used to compare the presence and degree of agreement between the three scales. The Hotelling T2 test was used to compare the groups of newborns for which the scales showed agreement or disagreement. A generalized linear regression was used to compare the results of the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain across the four study time points. RESULTS The neonates studied had a gestational age of 39±1 weeks, a birth weight of 3169±316 g and and postnatal age of 67±45 minutes. During the stimulus procedure, 80% of the newborns exhibited pain behaviors according to the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain, and 70% experienced pain according to the Premature Infant Pain Profile (p<0.001). The frequencies of the detection of pain using the Behavioral Indicators of Infant Pain and the Neonatal Facial Coding System were similar. The characteristics of the neonates were not associated with the level of agreement between the scales. CONCLUSION The Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain behavioral scales are more sensitive for the identification of pain in healthy term newborn infants than the multidimensional Premature Infant Pain Profile scale.
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Affiliation(s)
- Maria Carmenza Cuenca Arias
- Escola Paulista de Medicina, Division of Neonatal Medicine, Federal University of São Paulo (UNIFESP), São Paulo/SP, Brazil
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197
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Vederhus BJ, Eide GE, Natvig GK, Markestad T, Graue M, Halvorsen T. Pain Tolerance and Pain Perception in Adolescents Born Extremely Preterm. THE JOURNAL OF PAIN 2012; 13:978-87. [DOI: 10.1016/j.jpain.2012.07.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 06/20/2012] [Accepted: 07/11/2012] [Indexed: 10/27/2022]
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198
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Pain management, morphine administration, and outcomes in preterm infants: a review of the literature. Neonatal Netw 2012; 31:21-30. [PMID: 22232038 DOI: 10.1891/0730-0832.31.1.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infants in the Neonatal Intensive Care Unit may experience a myriad of painful procedures and stressful experiences. Pain management for infants requiring mechanical ventilation is complex and challenging especially in the preterm population. Many infants may not receive analgesia, primarily due to the unknown long-term neurodevelopmental effects of morphine exposure on the developing brain. Currently, there is no consensus on how to treat pain related to mechanical ventilation due to conflicting scientific evidence lacks clarity and certainty about the role of morphine in pain in preterm infants. The Advance Practice Neonatal Nurse must make the best use of available information about morphine analgesia for the preterm infant, and use it to guide policy and practice for infants. The Advance Practice Neonatal Nurse must use his/her clinical expertise to judicially balance the risks and benefits of morphine analgesia, when used, and tailor the treatment plan to each infant's specific needs.
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199
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Campbell-Yeo ML, Johnston CC, Joseph KS, Feeley N, Chambers CT, Barrington KJ. Cobedding and recovery time after heel lance in preterm twins: results of a randomized trial. Pediatrics 2012; 130:500-6. [PMID: 22926182 DOI: 10.1542/peds.2012-0010] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Cobedding of preterm twin infants provides tactile, olfactory, and auditory stimulation and may affect pain reactivity. We carried out a randomized trial to assess the effect of cobedding on pain reactivity and recovery in preterm twin neonates. METHODS Stable preterm twins (n = 67 sets) between 28 and 36 weeks of gestational age were randomly assigned to a cobedding group (cared for in the same incubator or crib) or a standard care group (cared for in separate incubators or cribs). Pain response (determined by the Premature Infant Pain Profile [PIPP]) and time to return to physiologic baseline parameters were compared between groups with adjustment for the nonindependence of twin infants. RESULTS Maternal and infant characteristics were not significantly different between twin infants in the cobedding and standard care groups except for 5-minute Apgar <7 and postnatal age and corrected gestational age on the day of the heel lance. Mean PIPP scores were not different between groups at 30, 60, or 120 seconds. At 90 seconds, mean PIPP scores were higher in the cobedding group (6.0 vs 5.0, P = .04). Recovery time was shorter in the cobedding group compared with the standard care group, (mean = 75.6 seconds versus 142.1 seconds, P = .001). No significant adverse events were associated with cobedding. Adjustment for nonindependence between twins and differences in baseline characteristics did not change the results. CONCLUSIONS Cobedding enhanced the physiologic recovery of preterm twins undergoing heel lance, but did not lead to lower pain scores.
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Affiliation(s)
- Marsha L Campbell-Yeo
- Women’s and Newborn Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada.
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200
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Beggs S, Alvares D, Moss A, Currie G, Middleton J, Salter MW, Fitzgerald M. A role for NT-3 in the hyperinnervation of neonatally wounded skin. Pain 2012; 153:2133-2139. [PMID: 22871470 PMCID: PMC3657181 DOI: 10.1016/j.pain.2012.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 05/10/2012] [Accepted: 07/06/2012] [Indexed: 12/31/2022]
Abstract
Neurotrophin-3 (NT-3) is a target-derived neurotrophic factor that regulates sensory neuronal survival and growth. Here we report that NT-3 plays a critical permissive role in cutaneous sensory nerve sprouting that contributes to pain and sensitivity following skin wounding in young animals. Sensory terminal sprouting in neonatally wounded dermis and epidermis is accompanied by increased NT-3 transcription, NT-3 protein levels, and NT-3 protein release 3-7 days post skin injury in newborn rats and mice. Functional blockade of NT-3 activity with specific antibodies greatly reduces sensory neurite outgrowth induced by wounded skin, but not by naïve skin, in dorsal root ganglion/skin co-cultures. The requirement for NT-3 for sensory terminal sprouting in vivo is confirmed by the absence of wound-induced hyperinnervation in heterozygous transgenic mice (NT-3(+/-)lacZ). We conclude that upregulation of NT-3 in neonatally wounded skin is a critical factor mediating the sensory nerve sprouting that underlies hypersensitivity and pain following skin injury.
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Affiliation(s)
- Simon Beggs
- Programme in Neurosciences & Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
- Corresponding author at: Programme in Neurosciences & Mental Health, The Hospital for Sick Children, 555 University Avenue, Toronto, ON, Canada M5G 1X8. Tel.: +1 4168135021.
| | - Debie Alvares
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, UK
| | - Andrew Moss
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, UK
| | - Gillian Currie
- Faculty of Dentistry, University of Toronto, Toronto, ON, Canada
| | - Jacqueta Middleton
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, UK
| | - Michael W. Salter
- Programme in Neurosciences & Mental Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology & Pharmacology, University College London, London, UK
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