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Carollo A, Montefalcone P, Bornstein MH, Esposito G. A Scientometric Review of Infant Cry and Caregiver Responsiveness: Literature Trends and Research Gaps over 60 Years of Developmental Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1042. [PMID: 37371273 DOI: 10.3390/children10061042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 05/28/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
Infant cry is an adaptive signal of distress that elicits timely and mostly appropriate caring behaviors. Caregivers are typically able to decode the meaning of the cry and respond appropriately, but maladaptive caregiver responses are common and, in the worst cases, can lead to harmful events. To tackle the importance of studying cry patterns and caregivers' responses, this review aims to identify key documents and thematic trends in the literature as well as existing research gaps. To do so, we conducted a scientometric review of 723 documents downloaded from Scopus and performed a document co-citation analysis. The most impactful publication was authored by Barr in 1990, which describes typical developmental patterns of infant cry. Six major research thematic clusters emerged from the analysis of the literature. Clusters were renamed "Neonatal Pain Analyzer" (average year of publication = 2002), "Abusive Head Trauma" (average year of publication = 2007), "Oxytocin" (average year of publication = 2009), "Antecedents of Maternal Sensitivity" (average year of publication = 2010), "Neurobiology of Parental Responses" (average year of publication = 2011), and "Hormonal Changes & Cry Responsiveness" (average year of publication = 2016). Research clusters are discussed on the basis of a qualitative inspection of the manuscripts. Current trends in research focus on the neurobiology of caregiver responses and the identification of factors promoting maternal sensitivity. Recent studies have also developed evidence-based strategies for calming crying babies and preventing caregivers' maladaptive responses. From the clusters, two topics conspicuously call for future research: fathers' responsiveness to infant cry and the impact of caregiver relationship quality on cry responsiveness.
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Affiliation(s)
- Alessandro Carollo
- Department of Psychology and Cognitive Science, University of Trento, Corso Angelo Bettini 31, 38068 Rovereto, Italy
| | - Pietro Montefalcone
- Department of Psychology and Cognitive Science, University of Trento, Corso Angelo Bettini 31, 38068 Rovereto, Italy
| | - Marc H Bornstein
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD 20892, USA
- United Nations Children's Fund, New York, NY 10017, USA
- Institute for Fiscal Studies, London WC1E 7AE, UK
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, Corso Angelo Bettini 31, 38068 Rovereto, Italy
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Campbell-Yeo M, Eriksson M, Benoit B. Assessment and Management of Pain in Preterm Infants: A Practice Update. CHILDREN (BASEL, SWITZERLAND) 2022; 9:244. [PMID: 35204964 PMCID: PMC8869922 DOI: 10.3390/children9020244] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/20/2022] [Accepted: 02/02/2022] [Indexed: 12/11/2022]
Abstract
Infants born preterm are at a high risk for repeated pain exposure in early life. Despite valid tools to assess pain in non-verbal infants and effective interventions to reduce pain associated with medical procedures required as part of their care, many infants receive little to no pain-relieving interventions. Moreover, parents remain significantly underutilized in provision of pain-relieving interventions, despite the known benefit of their involvement. This narrative review provides an overview of the consequences of early exposure to untreated pain in preterm infants, recommendations for a standardized approach to pain assessment in preterm infants, effectiveness of non-pharmacologic and pharmacologic pain-relieving interventions, and suggestions for greater active engagement of parents in the pain care for their preterm infant.
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Affiliation(s)
- Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Pediatrics, Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
- IWK Health, Halifax, NS B3K 6R8, Canada
| | - Mats Eriksson
- School of Health Sciences, Faculty of Medicine and Health, Örebro University, SE-701 82 Örebro, Sweden;
| | - Britney Benoit
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS B2G 2N5, Canada;
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Salekin MS, Mouton PR, Zamzmi G, Patel R, Goldgof D, Kneusel M, Elkins SL, Murray E, Coughlin ME, Maguire D, Ho T, Sun Y. Future roles of artificial intelligence in early pain management of newborns. PAEDIATRIC AND NEONATAL PAIN 2021; 3:134-145. [PMID: 35547946 PMCID: PMC8975206 DOI: 10.1002/pne2.12060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Md Sirajus Salekin
- Computer Science and Engineering Department University of South Florida Tampa FL USA
| | | | - Ghada Zamzmi
- Computer Science and Engineering Department University of South Florida Tampa FL USA
| | - Raj Patel
- Muma College of Business University of South Florida Tampa FL USA
| | - Dmitry Goldgof
- Computer Science and Engineering Department University of South Florida Tampa FL USA
| | - Marcia Kneusel
- College of Medicine Pediatrics USF Health University of South Florida Tampa FL USA
| | | | | | | | - Denise Maguire
- College of Nursing USF Health University of South Florida Tampa FL USA
| | - Thao Ho
- College of Medicine Pediatrics USF Health University of South Florida Tampa FL USA
| | - Yu Sun
- Computer Science and Engineering Department University of South Florida Tampa FL USA
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Icht M, Wiznitser Ressis-Tal H, Lotan M. Can the Vocal Expression of Intellectually Disabled Individuals Be Used as a Pain Indicator? Initial Findings Supporting a Possible Novice Assessment Method. Front Psychol 2021; 12:655202. [PMID: 34366973 PMCID: PMC8339267 DOI: 10.3389/fpsyg.2021.655202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 06/22/2021] [Indexed: 11/23/2022] Open
Abstract
Pain is difficult to assess in non-verbal populations such as individuals with intellectual and developmental disability (IDD). Due to scarce research in this area, pain assessment for individuals with IDD is still lacking, leading to maltreatment. To improve medical care for individuals with IDD, immediate, reliable, easy to use pain detection methods should be developed. The goal of this preliminary study was to examine the sensitivity of acoustic features of vocal expressions in identifying pain for adults with IDD, assessing their feasibility as a pain detection indicator for those individuals. Such unique pain related vocal characteristics may be used to develop objective pain detection means. Adults with severe-profound IDD level (N = 9) were recorded in daily activities associated with pain (during diaper changes), or without pain (at rest). Spontaneous vocal expressions were acoustically analyzed to assess several voice characteristics. Analyzing the data revealed that pain related vocal expressions were characterized by significantly higher number of pulses and higher shimmer values relative to no-pain vocal expressions. Pain related productions were also characterized by longer duration, higher jitter and Cepstral Peak Prominence values, lower Harmonic-Noise Ratio, lower difference between the amplitude of the 1st and 2nd harmonic (corrected for vocal tract influence; H1H2c), and higher mean and standard deviation of voice fundamental frequency relative to no-pain related vocal productions, yet these findings were not statistically significant, possibly due to the small and heterogeneous sample. These initial results may prompt further research to explore the possibility to use pain related vocal output as an objective and easily identifiable indicator of pain in this population.
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Affiliation(s)
- Michal Icht
- Department of Communication Disorders, Ariel University, Ariel, Israel
| | | | - Meir Lotan
- Department of Physiotherapy, Ariel University, Ariel, Israel
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Evaluation of Voice Acoustics as Predictors of Clinical Depression Scores. J Voice 2017; 31:256.e1-256.e6. [DOI: 10.1016/j.jvoice.2016.06.006] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/14/2016] [Accepted: 06/16/2016] [Indexed: 11/20/2022]
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Tejman-Yarden S, Levi O, Beizerov A, Parmet Y, Nguyen T, Saunders M, Rudich Z, Perry JC, Baker DG, Moeller-Bertram T. Heart rate analysis by sparse representation for acute pain detection. Med Biol Eng Comput 2015; 54:595-606. [DOI: 10.1007/s11517-015-1350-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 07/07/2015] [Indexed: 02/05/2023]
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Effect of premedication regimen on infant pain and stress response to endotracheal intubation. J Perinatol 2015; 35:415-8. [PMID: 25569679 DOI: 10.1038/jp.2014.227] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 11/04/2014] [Accepted: 11/18/2014] [Indexed: 01/31/2023]
Abstract
OBJECTIVE (1) Evaluate the effect of different medications on pain and stress in neonates during nonemergent endotracheal intubation; (2) determine whether gestational age affects medication use; (3) determine whether better sedation results in a decrease in the number of attempts and/or total time for the procedure. STUDY DESIGN Prospective observational study. Infant responses were measured using a clinical pain scale and blood glucose, a biochemical marker of acute stress. RESULT A total of 166 infants were included, with adjusted gestational ages 24 to 44 weeks at the time of procedure. Premedication regimens included no medication ('none,' 27%), morphine (19%), morphine+midazolam (11%), fentanyl (14%), fentanyl+midazolam (19%) and midazolam alone (10%). Fentanyl+midazolam resulted in lower pain scores and less increase in blood glucose (both P<0.0001). No other regimen was different from 'none'. The most immature infants were less likely to receive premedication (P=0.023), although their pain scores and blood glucose responses were similar to more mature infants. None of the medication regimens reduced the total procedure time (P=0.55) or the number of attempts (P=0.145). CONCLUSION Only fentanyl+midazolam significantly attenuated both the clinical pain score and the increase in blood glucose. Less mature infants had responses similar to those of more mature infants, but were less likely to receive premedication. None of the regimens decreased the time or number of attempts required for successful intubation.
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Abstract
Pain assessment and measurement are the cornerstones of pain management. Pain assessment connotes a comprehensive multidimensional description. Conversely, pain measurement provides a numeric quantitative description of each factor illustrating pain qualities. Pain scales provide a composite score used to guide practice and research. The type of infant pain instrument chosen is a significant factor in guiding pain management practice. The purpose of this review was to summarize current infant pain measures by introducing a conceptual framework for pain measurement. Although more than 40 infant pain instruments exist, many were devised solely for research purposes; several of the newly developed instruments largely overlap with existing instruments. Integration of pain management into daily practice remains problematic. Understanding how each instrument measures infant pain allows clinicians to make better decisions about what instrument to use with which infant and in what circumstances. In addition, novel new measurement techniques need further testing.
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Bellieni CV. Pain assessment in human fetus and infants. AAPS JOURNAL 2012; 14:456-61. [PMID: 22528505 DOI: 10.1208/s12248-012-9354-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2011] [Accepted: 03/26/2012] [Indexed: 11/30/2022]
Abstract
In humans, painful stimuli can arrive to the brain at 20-22 weeks of gestation. Therefore several researchers have devoted their efforts to study fetal analgesia during prenatal surgery, and during painful procedures in premature babies. Aim of this paper is to gather from scientific literature the available data on the signals that the human fetus and newborns produce, and that can be interpreted as signals of pain. Several signs can be interpreted as signals of pain. We will describe them in the text. In infants, these signs can be combined to create specific and sensible pain assessment tools, called pain scales, used to rate the level of pain.
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Liaw JJ, Yang L, Chou HL, Yin T, Chao SC, Lee TY. Psychometric analysis of a Taiwan-version pain assessment scale for preterm infants. J Clin Nurs 2011; 21:89-100. [DOI: 10.1111/j.1365-2702.2011.03770.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Liaw JJ, Yang L, Ti Y, Blackburn ST, Chang YC, Sun LW. Non-nutritive sucking relieves pain for preterm infants during heel stick procedures in Taiwan. J Clin Nurs 2010; 19:2741-51. [DOI: 10.1111/j.1365-2702.2010.03300.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Buscemi N, Vandermeer B, Curtis S. The Cochrane Library and Procedural Pain in Children: An Overview of Reviews. ACTA ACUST UNITED AC 2008. [DOI: 10.1002/ebch.225] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Bellieni C, Maffei M, Ancora G, Cordelli D, Mastrocola M, Faldella G, Ferretti E, Buonocore G. Is the ABC pain scale reliable for premature babies? Acta Paediatr 2007; 96:1008-10. [PMID: 17577340 DOI: 10.1111/j.1651-2227.2007.00355.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIM We recently developed the ABC scale to assess pain in term newborns. The aim of the present study was to assess the reliability of the scale in preterm babies. MATERIAL AND METHODS The scale consists of three cry parameters: (a) pitch of the first cry, (b) rhythmicity of the bout of crying and (c) cry constancy. Changes in these parameters were previously found to distinguish medium and high levels of pain as evaluated by spectral analysis of crying. We enrolled 72 babies to perform the steps usually requested to validate a scale, namely the study of the concurrent validity, specificity and sensibility. Moreover, we assessed the interjudge reliability and the clinical utility and ease of the scale. RESULTS A good correlation (r = 0.68; r(2)= 0.45; p < 0.0001) was found between scores obtained with the ABC scale and the premature infant pain profile (PIPP) scale, demonstrating a good concurrent validity. The scale also showed good sensitivity and specificity (we found statistically significant differences between mean values of scores obtained in babies who underwent pain and babies who underwent non-painful stimulus.) Interobserver reliability was good: Cohen's kappa = 0.7. CONCLUSION The good correlation between the two scales shows that the ABC scale is also reliable for premature babies.
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Affiliation(s)
- Cv Bellieni
- Department of Pediatrics, Obstetrics and Reproduction Medicine, University of Siena, Siena, Italy.
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