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Hirani SAA, Ratushniak A. Analgesic Role of Breastfeeding: Analysis of Effectiveness, Implementation Barriers, and Strategies to Promote Evidence-Based Practice. CLINICAL LACTATION 2023. [DOI: 10.1891/cl.2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Objective:Exposure to painful stimuli serves as toxic stress for infants, increasing their subsequent pain sensitivity and resulting in neurodevelopmental impairments. Besides offering nutritional, psychological, immunological, and economic benefits, breastfeeding is reported as the most effective analgesia for the management of minor procedural pain in infants. Although breastfeeding holds several advantages, implementation of this nonpharmacological intervention is still uncommon in many clinical settings.Methods:This scoping review presents an analysis of 29 clinical trials that compare the effectiveness of breastfeeding with other nonpharmacological methods.Findings:Breastfeeding is an efficacious analgesia compared with sucrose, sweet solutions, and other nonpharmacological methods. When used alone or in combination with other nonpharmacological interventions, breastfeeding reduces infants’ biobehavioral responses to pain and promotes faster physiologic recovery after painful procedures. Breastfeeding is recommended as the first choice whenever feasible. Barriers to the uptake of this effective pain management method in clinical practice include misinformation/inconsistent use of evidence, an infant’s impaired sucking reflex, maternal–child separation, the workload of healthcare professionals, a lack of parental involvement, assumptions of healthcare providers, and a lack of adequate information/guidance for parents. Strategies to promote the uptake of breastfeeding for the management of procedural pain in infants include an effective partnership between healthcare providers and breastfeeding mothers, knowledge mobilization resources in multiple languages, informational support and media campaigns, and experiential learning opportunities for breastfeeding mothers.Conclusions:Successful implementation of baby-friendly hospital initiatives, a patient-centered approach, family-centered care, and the collaborative efforts of healthcare providers in all healthcare settings is recommended to promote the uptake of breastfeeding as analgesia.
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Ali SA, Baloch M, Maab H. Synergistic effect of pacifiers with sucrose solution: a novel non-pharmacologic approach for minor pain procedures. Minerva Pediatr (Torino) 2023; 75:125-127. [PMID: 32731731 DOI: 10.23736/s2724-5276.20.05905-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Affiliation(s)
- Shajeea A Ali
- Dow Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan -
| | - Mariam Baloch
- Dow Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Hira Maab
- Dow Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
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Lyngstad LT, Steinnes S, Le Marechal F. Improving pain management in a neonatal intensive care unit with single-family room-A quality improvement project. PAEDIATRIC & NEONATAL PAIN 2022; 4:69-77. [PMID: 35719218 PMCID: PMC9189914 DOI: 10.1002/pne2.12075] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 01/31/2022] [Accepted: 02/15/2022] [Indexed: 12/20/2022]
Abstract
Preterm birth is a risk factor for early experience of pain. Despite advances in neonatal care, evidence-based knowledge of the importance of adequate pain management and strong international guidelines for assessment and treatment of neonatal pain, only 10% of sick term and preterm infants were assessed for pain and stress on a daily basis. The aim of this quality improvement (QI) project is evaluation of implemented guidelines for pain assessment and management, and increased parental involvement in a Norwegian single-family room NICU. Method: The different steps of the project entailed translation of the English version of COMFORTneo, development and implementation of guidelines with flowcharts for pain management, and pain assessment certification of the interprofessional staff. Part two of the project is supervision of the interprofessional staff in parental involvement in stress- and painful procedures. Our study showed that one year after implementation, 88.8% of the COMFORTneo assessments were performed according to the pain management guidelines. The staff used the flowcharts to assess, treat and reassess pain and stress. There was a high interrater reliability with linearly weighted Cohen's kappa values ranging from 0.81 to 0.95, with a median of 0.90. In addition, our study showed increased parental involvement in procedures, from 50.3% before to 82.3% after the quality improvement project. The success of this quality improvement project is explained by systematic use of flowcharts and implemented guidelines for pain management, interprofessional collaboration, and cultural change agents. Theoretical lectures and practical bedside supervision to interprofessional staff increased parental involvement in stress- and painful procedures.
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Affiliation(s)
- Lene Tandle Lyngstad
- Department of Paediatric and Adolescent MedicineNeonatal Intensive Care UnitDrammen HospitalVestre Viken Hospital TrustDrammenNorway
| | - Solfrid Steinnes
- Department of Paediatric and Adolescent MedicineNeonatal Intensive Care UnitDrammen HospitalVestre Viken Hospital TrustDrammenNorway
| | - Flore Le Marechal
- Department of Paediatric and Adolescent MedicineNeonatal Intensive Care UnitDrammen HospitalVestre Viken Hospital TrustDrammenNorway
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Bošković S, Ličen S. Identification of Neonatal Infant Pain Assessment Tools as a Possibility of Their Application in Clinical Practice in Croatia: An Integrative Literature Review. Pain Manag Nurs 2021; 22:674-680. [PMID: 33582010 DOI: 10.1016/j.pmn.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/09/2020] [Accepted: 01/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This article presents an integrative review of the literature with the aim of identifying instruments already in existence for measuring neonatal infant pain with a view to exploring possibilities of applying them in clinical practice in Croatia. DESIGN An integrative review. DATA SOURCES The databases searched included MEDLINE, Cinahl Cochrane Library, and Science Direct. The search was limited to available full-text articles in English published between 1990 and 2020. The studies were selected according to the PRISMA strategy and evaluated based on the methodologic framework proposed by Whittemore and Knafl. REVIEW/ANALYSIS METHODS The research identified 13 scales for assessing pain in neonatal infants, including 5 one-dimensional and 8 multidimensional scales that assess acute and prolonged pain in preterm and full-term infants. RESULTS Overall, the articles in this review confirm that pain is a multidimensional phenomenon and that professionals should consider other specific characteristics of the neonatal infant population while measuring pain. CONCLUSIONS Our review showed that various tools exist assessing pain in neonatal infants that could be used in clinical practice in Croatia. However, it is difficult to determine the most appropriate instrument at this stage, as the choice depends on various factors that still need to be considered. The decision on which pain scale to use or which is more appropriate should be based on further psychometric tests, its accuracy, and ease of use.
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Affiliation(s)
- Sandra Bošković
- Department of Health Care, University of Rijeka, Rijeka, Croatia
| | - Sabina Ličen
- Department of Nursing, University of Primorska, Izola, Slovenia.
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Harrison D, Birnie K. Special issue on knowledge mobilization: Neonatal pain. PAEDIATRIC AND NEONATAL PAIN 2020; 2:61-62. [PMID: 35547021 PMCID: PMC8975216 DOI: 10.1002/pne2.12039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/18/2020] [Indexed: 11/07/2022]
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Sezici E, Yigit D. The Effect of Skin-to-Skin Contact on Maternal Anxiety, Heart Rate, and Oxygen Saturation during the Vaccination of One-Month-Old Infants. Compr Child Adolesc Nurs 2020; 43:410-420. [PMID: 32073934 DOI: 10.1080/24694193.2020.1721614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study aimed to reduce maternal anxiety scores and heart rates, increase oxygen saturation linked to vaccination processes with Skin-to skin contact (SSC). The study is a prospective, multicenter, paired, randomized, controlled trial. This experimental study was conducted with a pretest-posttest control group. The study was carried out with 128 mothers of infants. A Sociodemographic Questionnaire, the State Anxiety Inventory and a pulse oximeter were used in the data collection. In the study, SSC began to be given to the infants in the intervention group five minutes before vaccination and the infant was left in SSC for an uninterrupted 15 minutes following the vaccination. The maternal anxiety scores were noted before and after the vaccination process. The mothers' heart rates and oxygen saturation were monitored a total of three times. The anxiety scores of the intervention group decreased while oxygen saturation increased after the vaccination as compared to the control group. The heart rate decreased in the intervention group but increased in the control group. The study revealed that SSC reduced scores of maternal anxiety and heart rates and increased oxygen saturation during the vaccination process.
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Affiliation(s)
- Emel Sezici
- Department of Pediatric Nursing, Faculty of Health Sciences, Kutahya Health Sciences University , Kutahya, Turkey
| | - Deniz Yigit
- Department of Pediatric Nursing, School of Health Sciences, Eskisehir Osmangazi University , Eskisehir, Turkey
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Kyololo OM, Stevens BJ, Songok J. Mothers' Perceptions about Pain in Hospitalized Newborn Infants in Kenya. J Pediatr Nurs 2019; 47:51-57. [PMID: 31039509 DOI: 10.1016/j.pedn.2019.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Explore views of mothers about pain and pain treatment practices in hospitalized newborn infants. DESIGN AND METHODS A Qualitative descriptive study using photo-elicitation technique was conducted in a level I and a level II neonatal units in Kenya. Fifteen semi-structured interviews were conducted with mothers of hospitalized infants. The interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis approach. RESULTS Mothers described the experience of witnessing their infants undergo painful procedures as emotionally and psychologically traumatic. Participants felt helpless for not being able to protect their infants from pain a situation which was made worse by health care providers who appeared less concerned about pain relief during procedures. Mothers' views demonstrated a good understanding of pain-relief strategies; they identified strategies that health care providers should routinely use to relief pain in hospitalized infants. Furthermore, participants desired to be involved in comforting their infants during clinical procedures. CONCLUSION Repeated and untreated painful procedures continue to define the hospitalisation experience of newborn infants despite the presence of mothers who desire to be involved in comforting their infants during procedures. PRACTICE IMPLICATION Minimizing the burden of pain and using pain-relieving interventions could reduce parental stress and optimize parental role attainment following hospitalisation.
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Affiliation(s)
| | - Bonnie J Stevens
- University of Toronto, Toronto, Canada; The Hospital for Sick Children, Toronto, Canada
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Yiğit Ş, Ecevit A, Köroğlu ÖA. Turkish Neonatal Society guideline on the neonatal pain and its management. TURK PEDIATRI ARSIVI 2018; 53:S161-S171. [PMID: 31236029 PMCID: PMC6568292 DOI: 10.5152/turkpediatriars.2018.01802] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Pain control is an important ethical issue to be considered and constitutes the basis of treatment in premature and term newborns. The inadequacy of pain control in these infants in neonatal intensive care units leads to neurodevelopmental and behavioral problems in the long term. For this reason, it is extremely important to raise awareness of the presence of pain in newborn infants, to reduce invasive procedures applied to infants as much as possible, and to minimize pain with non-pharmacologic or pharmacologic treatments when it is inevitable.
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Affiliation(s)
- Şule Yiğit
- Division of Neonatology, Department of Pediatrics, Hacettepe University, Faculty of Medicine, Ankara, Turkey
| | - Ayşe Ecevit
- Division of Neonatology, Department of Pediatrics, Başkent University, Faculty of Medicine, Ankara, Turkey
| | - Özge Altun Köroğlu
- Division of Neonatology, Department of Pediatrics, Ege University, Faculty of Medicine, İzmir, Turkey
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Biobehavioral Responses of Preterm Infants to Conventional and Swaddled Tub Baths: A Randomized Crossover Trial. J Perinat Neonatal Nurs 2018; 32:358-365. [PMID: 29782435 DOI: 10.1097/jpn.0000000000000336] [Citation(s) in RCA: 8] [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
Bathing is a routine care procedure that exposes preterm infants to prolonged handling, which could cause stress and potentially disrupt infants' biobehavioral responses. The aim of this double-blind randomized crossover trial was to compare the preterm infant's body temperature, heart rate (HR), peripheral capillary oxygen saturation (SpO2), salivary cortisol levels, and sleep-wake states during and after swaddled and conventional tub baths. Forty-three infants born at 32 to 36 weeks postmenstrual age, weighing 2225 g or less, were enrolled in the study. Infants were videotaped before and after each type of baths. The time interval between baths ranged from 24 to 72 hours to allow a washout period. Physiological, hormonal, and behavioral responses were collected at baseline and during recovery from baths. No significant differences in the mean body temperature, HR, SpO2, salivary cortisol levels, and sleep-wake states between the bath types were observed in the baseline or recovery responses during the first 20 minutes after bath. Regardless of bath type, salivary cortisol levels showed a nonstatistical significant increase.
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Lago P, Garetti E, Bellieni CV, Merazzi D, Savant Levet P, Ancora G, Pirelli A. Systematic review of nonpharmacological analgesic interventions for common needle-related procedure in newborn infants and development of evidence-based clinical guidelines. Acta Paediatr 2017; 106:864-870. [PMID: 28295585 DOI: 10.1111/apa.13827] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Revised: 12/24/2016] [Accepted: 03/07/2017] [Indexed: 11/28/2022]
Abstract
The aim of this literature review was to develop clinical guidelines for the prevention and control of needle-related pain in newborn infants. The guidelines were developed by the Italian Society of Neonatology, using the Grading of Recommendations, Assessment, Development and Evaluation approach, based on the assessment of 232 papers published between 1986 and 2015. The quality of the evidence was high or moderate for some behavioural and nonpharmacological interventions. CONCLUSION There was sufficient evidence to strongly support the use of nonpharmacological interventions for common needle-related procedures in newborn infants. Combined interventions seemed to be more effective in relieving procedural pain.
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Affiliation(s)
- Paola Lago
- Neonatal Intensive Care Unit; Women's and Children's Health Department; Azienda Ospedaliera-University of Padova; Padova Italy
| | - Elisabetta Garetti
- NICU; Women's and Children's Health Department; Azienda Ospedaliera-University of Modena; Modena Italy
| | | | - Daniele Merazzi
- NICU; Mother's and Infant's Department; Valduce Hospital; Como Italy
| | | | - Gina Ancora
- Women's and Children's Health Department; Infermi Hospital; Azienda Ospedaliera of Rimini; Rimini Italy
| | - Anna Pirelli
- NICU; MBBM Foundation; San Gerardo Hospital; Monza Italy
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Randomized Clinical Trial of 24% Oral Sucrose to Decrease Pain Associated With Peripheral Intravenous Catheter Insertion in Preterm and Term Newborns. Adv Neonatal Care 2017; 17:E3-E11. [PMID: 27533333 DOI: 10.1097/anc.0000000000000326] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To determine whether 24% sucrose solution given orally before insertion of a peripheral intravenous (PIV) catheter decreases neonatal pain. BACKGROUND Prior studies of pain caused by heel and arterial needlesticks found oral administration of 24% sucrose to significantly blunt pain during these painful procedures. No studies have evaluated this treatment with needlestick pain associated with PIV catheter insertion. METHODS Oral 24% sucrose or placebo solution was administered 2 minutes prior to PIV catheter insertion. Outcome measures were obtained prior to, during, and for 5 minutes after PIV catheter insertion. Investigators and caregivers were blinded to group assignment. Data were analyzed with longitudinal analysis of repeated measures, with P < .05 for significance. RESULTS A total of 40 neonates (24% sucrose: N = 20; placebo: N = 20) were studied. Pain scores significantly increased from 3.2 ± 1.6 to a maximum of 7.6 ± 3.8 at the time of catheter insertion, returning to baseline levels 8 minutes after PIV catheter insertion (P < .001). No significant differences were found in pain, heart rate, or noninvasive oxygen saturation (SpO2) between the sucrose and placebo groups (P > 0.05). IMPLICATIONS FOR PRACTICE Results from this study did not find that 24% sucrose administered prior to PIV catheter insertion altered the infant's pain response. IMPLICATIONS FOR RESEARCH Since this is the first study to evaluate the pain-blunting effects of 24% sucrose administration before PIV catheter insertion, replication of this study is needed before widespread application of findings.
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Butkevich IP, Mikhailenko VA, Vershinina EA, Aloisi AM, Barr GA. Long-Term Effects of Chronic Buspirone during Adolescence Reduce the Adverse Influences of Neonatal Inflammatory Pain and Stress on Adaptive Behavior in Adult Male Rats. Front Behav Neurosci 2017; 11:11. [PMID: 28184190 PMCID: PMC5266710 DOI: 10.3389/fnbeh.2017.00011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 01/12/2017] [Indexed: 01/07/2023] Open
Abstract
Neonatal pain and stress induce long-term changes in pain sensitivity and behavior. Previously we found alterations in pain sensitivity in adolescent rats exposed to early-life adverse events. We tested whether these alterations have long-lasting effects and if those effects can be improved by the 5-hydroxytryptamine 1A (5-HT1A) receptor agonist buspirone injected chronically during the adolescent period. This study investigates: (1) effects of inflammatory pain (the injection of formalin into the pad of a hind paw) or stress (short maternal deprivation-isolation, MI), or their combination in 1-2-day-old rats on the adult basal pain, formalin-induced pain, anxiety and depression; (2) effects of adolescent buspirone in adult rats that experienced similar early-life insults. Changes in nociceptive thresholds were evaluated using the hot plate (HP) and formalin tests; levels of anxiety and depression were assessed with the elevated plus maze and forced swim tests respectively. Both neonatal painful and stressful treatments induced long-term alterations in the forced swim test. Other changes in adult behavioral responses were dependent on the type of neonatal treatment. There was a notable lack of long-term effects of the combination of early inflammatory pain and stress of MI on the pain responses, anxiety levels or on the effects of adolescent buspirone. This study provides the first evidence that chronic injection of buspirone in adolescent rats alters antinociceptive and anxiolytic effects limited to adult rats that showed behavioral alterations induced by early-life adverse treatments. These data highlight the role of 5-HT1A receptors in long-term effects of neonatal inflammatory pain and stress of short MI on adaptive behavior and possibility of correction of the pain and psychoemotional behavior that were altered by adverse pain/stress intervention using buspirone during critical adolescent period.
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Affiliation(s)
- Irina P. Butkevich
- Laboratory of Ontogenesis of the Nervous System, I.P. Pavlov Institute of Physiology, Russian Academy of SciencesSt. Petersburg, Russia
| | - Viktor A. Mikhailenko
- Laboratory of Ontogenesis of the Nervous System, I.P. Pavlov Institute of Physiology, Russian Academy of SciencesSt. Petersburg, Russia
| | - Elena A. Vershinina
- Department of Information Technologies and Mathematical Modeling, I.P. Pavlov Institute of Physiology, Russian Academy of SciencesSt. Petersburg, Russia
| | - Anna M. Aloisi
- Department of Medicine, Surgery and Neuroscience, University of SienaSiena, Italy
| | - Gordon A. Barr
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia and the Perelman School of Medicine at the University of PennsylvaniaPhiladelphia, PA, USA
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Altimier L, Phillips R. The Neonatal Integrative Developmental Care Model: Advanced Clinical Applications of the Seven Core Measures for Neuroprotective Family-centered Developmental Care. ACTA ACUST UNITED AC 2016. [DOI: 10.1053/j.nainr.2016.09.030] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Akcan E, Polat S. Comparative Effect of the Smells of Amniotic Fluid, Breast Milk, and Lavender on Newborns' Pain During Heel Lance. Breastfeed Med 2016; 11:309-314. [PMID: 27315487 DOI: 10.1089/bfm.2015.0174] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The aim of this randomized controlled experimental study was to evaluate the effect of the smells of amniotic fluid, breast milk, and lavender on the pain of newborns during heel lance. METHODS The sample of the study consisted of 102 newborn infants who complied with the sampling criteria between August and November, 2011. The newborns smelled the samples (lavender, breast milk, amniotic fluid, and distilled water) for 5 minutes before the heel lance until 5 minutes afterward. The Neonatal Infant Pain Scale (NIPS), heart rate, and oxygen saturation were evaluated 1 minute before, during, and 1 minute after the heel lance. Data were evaluated by descriptive statistics, chi-square, intraclass correlation analysis, Spearman's rho correlation, Bonferroni's advanced analysis, Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney U, Friedman, and Dunnett's tests. RESULTS The newborns in the control group had severe pain and the newborns in the breast milk, amniotic fluid, and lavender groups had moderate pain during the heel lance (p < 0.05). While the NIPS score of the newborns in the lavender group was lower than the breast milk and amniotic fluid groups during the heel lance, it was lower in the breast milk and amniotic fluid groups than the lavender group afterward. The lowest falls in oxygen saturation and increased in heart rate were in the breast milk and lavender groups during heel the lance. CONCLUSION The smells of lavender and breast milk prevent the increased heart rates, NIPS, falling oxygen saturation, and reduced pain during the invasive procedures in newborns more than amniotic fluid or control group.
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Affiliation(s)
- Esma Akcan
- 1 Department of Pediatric Nursing, Faculty of Kumluca Health Sciences, Akdeniz University , Antalya, Turkey
| | - Sevinç Polat
- 2 Department of Pediatric Nursing, School of Health, Bozok University , Yozgat, Turkey
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Lynch M. The Opioid Pendulum and the Need for Better Pain Care. PAIN MEDICINE 2016; 17:1215-1219. [PMID: 27142390 DOI: 10.1093/pm/pnw085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mary Lynch
- Department of Anesthesia, Pain Medicine, Perioperative Care and Psychiatry and Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada
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Leng HY, Zheng XL, Zhang XH, He HY, Tu GF, Fu Q, Shi SN, Yan L. Combined non-pharmacological interventions for newborn pain relief in two degrees of pain procedures: A randomized clinical trial. Eur J Pain 2015; 20:989-97. [PMID: 26685099 DOI: 10.1002/ejp.824] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Non-pharmacological interventions are effective neonatal pain reduction strategies. We aimed to study the effects of non-nutritive sucking (NNS) and swaddling on infants' behavioural and physiological parameters during shallow or deep heel stick procedures. METHOD In this prospective, multi-centred, randomized controlled clinical trial, we enrolled 671 newborns. The infants undergoing shallow or deep heel stick procedures were randomized into four groups: oral sucrose (routine care, group S), oral sucrose combined with NNS (group NS), oral sucrose combined with swaddling (group SS) and oral sucrose combined with NNS and swaddling (group NSS). The behavioural responses were evaluated by the Revised Neonatal Facial Coding System and the physiological signals were monitored by electrocardiogram monitors. RESULTS A significant synergistic analgesic effect was observed between the NS and SS groups in both the shallow (F = 5.952, p = 0.015) and deep heel stick (F = 7.452, p = 0.007) procedure. NSS group exhibited the lowest pain score. For the deep heel stick procedure, the NS group had a significantly lower increase in heart rate (HR)% and decrease in SPO2 % than the S group (F = 17.540, p = 0.000, F = 10.472, p = 0.001), while this difference was not observed in the shallow heel stick procedure. No difference was found between the S and SS groups, in terms of different physiological parameters. CONCLUSION Non-nutritive sucking and swaddling had synergistic effects on pain relief when used with oral sucrose. For the deep heel stick procedure, oral sucrose combined with NNS and swaddling provided the best pain relief effect. For the shallow heel stick procedure, addition of NNS and swaddling did not improve the effects.
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Affiliation(s)
- H-Y Leng
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - X-L Zheng
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - X-H Zhang
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - H-Y He
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - G-F Tu
- Department of Nursing, Chengdu Women's & Children's Central Hospital, Chengdu City, China
| | - Q Fu
- Department of Nursing, Shenzhen Children's Hosptial, Shenzhen City, China
| | - S-N Shi
- Department of Nursing, Hunan Children's Hosptial, Changsha City, China
| | - L Yan
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
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Taddio A, Shah V, McMurtry CM, MacDonald NE, Ipp M, Riddell RP, Noel M, Chambers CT. Procedural and Physical Interventions for Vaccine Injections: Systematic Review of Randomized Controlled Trials and Quasi-Randomized Controlled Trials. Clin J Pain 2015; 31:S20-37. [PMID: 26352919 PMCID: PMC4900423 DOI: 10.1097/ajp.0000000000000264] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 06/03/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND This systematic review evaluated the effectiveness of physical and procedural interventions for reducing pain and related outcomes during vaccination. DESIGN/METHODS Databases were searched using a broad search strategy to identify relevant randomized and quasi-randomized controlled trials. Data were extracted according to procedure phase (preprocedure, acute, recovery, and combinations of these) and pooled using established methods. RESULTS A total of 31 studies were included. Acute infant distress was diminished during intramuscular injection without aspiration (n=313): standardized mean difference (SMD) -0.82 (95% confidence interval [CI]: -1.18, -0.46). Injecting the most painful vaccine last during vaccinations reduced acute infant distress (n=196): SMD -0.69 (95% CI: -0.98, -0.4). Simultaneous injections reduced acute infant distress compared with sequential injections (n=172): SMD -0.56 (95% CI: -0.87, -0.25). There was no benefit of simultaneous injections in children. Less infant distress during the acute and recovery phases combined occurred with vastus lateralis (vs. deltoid) injections (n=185): SMD -0.70 (95% CI: -1.00, -0.41). Skin-to-skin contact in neonates (n=736) reduced acute distress: SMD -0.65 (95% CI: -1.05, -0.25). Holding infants reduced acute distress after removal of the data from 1 methodologically diverse study (n=107): SMD -1.25 (95% CI: -2.05, -0.46). Holding after vaccination (n=417) reduced infant distress during the acute and recovery phases combined: SMD -0.65 (95% CI: -1.08, -0.22). Self-reported fear was reduced for children positioned upright (n=107): SMD -0.39 (95% CI: -0.77, -0.01). Non-nutritive sucking (n=186) reduced acute distress in infants: SMD -1.88 (95% CI: -2.57, -1.18). Manual tactile stimulation did not reduce pain across the lifespan. An external vibrating device and cold reduced pain in children (n=145): SMD -1.23 (95% CI: -1.58, -0.87). There was no benefit of warming the vaccine in adults. Muscle tension was beneficial in selected indices of fainting in adolescents and adults. CONCLUSIONS Interventions with evidence of benefit in select populations include: no aspiration, injecting most painful vaccine last, simultaneous injections, vastus lateralis injection, positioning interventions, non-nutritive sucking, external vibrating device with cold, and muscle tension.
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Affiliation(s)
- Anna Taddio
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario
| | - Vibhuti Shah
- Faculty of Medicine, University of Toronto
- Department of Pediatrics, Mount Sinai Hospital
| | - C. Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Ontario
- Children’s Health Research Institute
- Department of Paediatrics, Western University, London, ON
| | - Noni E. MacDonald
- Department of Paediatrics, IWK Health Centre, Dalhousie University and Canadian Center for Vaccinology
| | - Moshe Ipp
- Faculty of Medicine, University of Toronto
- Department of Paediatrics, The Hospital for Sick Children
| | - Rebecca Pillai Riddell
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, Ontario
- Department of Psychology, York University, Toronto
| | - Melanie Noel
- Department of Psychology, University of Calgary, AB, Canada
| | - Christine T. Chambers
- Department of Pediatrics and Psychology, Faculty of Science, Dalhousie University, IWK Health Centre, Halifax, NS, Canada
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Cruz M, Fernandes A, Oliveira C. Epidemiology of painful procedures performed in neonates: A systematic review of observational studies. Eur J Pain 2015. [DOI: 10.1002/ejp.757] [Citation(s) in RCA: 221] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M.D. Cruz
- Nursing School of the University of Évora; Portugal
- Health Sciences Research Unit; Nursing hosted by the Nursing School of Coimbra; Portugal
| | - A.M. Fernandes
- Nursing School of Coimbra; Portugal
- Health Sciences Research Unit; Nursing hosted by the Nursing School of Coimbra; Portugal
| | - C.R. Oliveira
- Faculty of Medicine of the University of Coimbra; Portugal
- CNC-Center for Neuroscience and Cell Biology; University of Coimbra; Portugal
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Gibbins S, Stevens B, Dionne K, Yamada J, Pillai Riddell R, McGrath P, Asztalos E, O'Brien K, Beyene J, McNamara P, Johnston C. Perceptions of health professionals on pain in extremely low gestational age infants. QUALITATIVE HEALTH RESEARCH 2015; 25:763-74. [PMID: 25854616 DOI: 10.1177/1049732315580105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Extremely low gestational age infants (<28 weeks at birth) experience significant pain from repeated therapeutic procedures while hospitalized in the neonatal intensive care unit. As part of a program of research examining pain in preterm infants, we conducted a qualitatively driven mixed-methods design, supplemented with a qualitative and quantitative component, to understand how health care professionals (HCPs) assess and manage procedural pain for tiny and underdeveloped preterm infants. Fifty-nine HCPs from different disciplines across four tertiary-level neonatal units in Canada participated in individual or focus group interviews and completed a brief questionnaire. Four themes from the content analysis were (a) subtlety and unpredictability of pain indicators, (b) infant and caregiver attributes and contextual factors that influence pain response and practices, (c) the complex nature of pain assessment, and (d) uncertainty in the management of pain. The information gleaned from this study can assist in identifying gaps in knowledge and informing unit-based and organizational knowledge translation strategies for this vulnerable population.
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Affiliation(s)
| | | | - Kim Dionne
- Hospital for Sick Children, Toronto, Ontario, Canada
| | - Janet Yamada
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | - Karel O'Brien
- Hospital for Sick Children, Toronto, Ontario, Canada
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Sunitha Suresh BS, De Oliveira GS, Suresh S. The effect of audio therapy to treat postoperative pain in children undergoing major surgery: a randomized controlled trial. Pediatr Surg Int 2015; 31:197-201. [PMID: 25555856 DOI: 10.1007/s00383-014-3649-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2014] [Indexed: 02/01/2023]
Abstract
PURPOSE To evaluate the analgesic effect of music and audiobooks in children undergoing major surgical procedures when compared to a control (silence) group. METHODS The study was a prospective and randomized trial. Children undergoing major surgeries were randomized to one of the three groups: music, audiobook or control (silence). The primary outcome was the pain burden reduction by two treatments within 48 h postoperatively. Pain burden was measured using the area under the pain scale versus the 30 min interval for each treatment. RESULTS 60 patients were recruited and 56 completed the study. Pain burden was reduced in the music and audiobook groups compared to control, median (IQR) of -60 (-90 to 0), -45 (-90 to 0) and 0 (-30 to 90) (min × pain score), respectively, P = 0.04. A linear regression analysis demonstrated an independent group effect on pain reduction even after adjusting for the mean pain scores recorded at the beginning of the treatment, slope of regression line -56.8 ± 24 goodness of fit r (2) = 0.25 and slope significantly different from 0 (P = 0.02). CONCLUSIONS Audio therapy is an efficacious adjunct method to decrease post-surgical pain in children undergoing major surgeries. Audio therapy should be considered as an important strategy to minimize pain in children undergoing major surgery.
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Affiliation(s)
- B S Sunitha Suresh
- Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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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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22
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Carbajal R, Gréteau S, Arnaud C, Guedj R. [Pain in neonatology. Non-pharmacological treatment]. Arch Pediatr 2014; 22:217-21. [PMID: 25066701 DOI: 10.1016/j.arcped.2014.07.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 06/30/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
Abstract
Diagnostic and therapeutic skin-breaking procedures have become ubiquitous in current medical practice and neonatology does not constitute an exception. One of the main sources of neonatal pain is procedure-induced pain. It has recently become clear that pain prevention must be a health care priority. Non-pharmacological approaches constitute a first option for the analgesia of common procedures performed in neonatology. This article reviews the non-pharmacological treatments most frequently used in this context: swaddling, tucking, containment, sweet solutions, non-nutritive sucking (NNS), breastfeeding analgesia, breast milk and music. In practice, the dose of 1 to 2mL of 24% or 30% sucrose solution or 30% glucose solution immediately followed by NNS can be given for minor painful procedures in term neonates or those weighing more than 2500g. In the preterm, 0.3mL of a sweet solution (sucrose or glucose) can be given for infants weighing less than 1500g and 0.5mL for those weighing between 1500 and 2500g. The synergistic effect of sweet solutions and NNS has been clearly shown and thus their association is largely justified in practice. For breast-fed term neonates, breastfeeding can be given to sooth procedure-induced pain. All these non-pharmacological options can be effective to relieve pain from minor or moderate procedures. However, when more painful procedures are performed, stronger analgesics must be used.
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Affiliation(s)
- R Carbajal
- Service des urgences pédiatriques, hôpital Armand-Trousseau, AP-HP, 26, avenue du Dr-Netter, 75012 Paris, France.
| | - S Gréteau
- Service de pédiatrie, réanimation pédiatrique, néonatologie et urgences pédiatriques, centre hospitalier de Pau, 4, boulevard Hauterive, 64046 Pau cedex, France
| | - C Arnaud
- Service des urgences pédiatriques, hôpital Armand-Trousseau, AP-HP, 26, avenue du Dr-Netter, 75012 Paris, France
| | - R Guedj
- Service des urgences pédiatriques, hôpital Armand-Trousseau, AP-HP, 26, avenue du Dr-Netter, 75012 Paris, France
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Asadi-Noghabi F, Tavassoli-Farahi M, Yousefi H, Sadeghi T. Neonate pain management: what do nurses really know? Glob J Health Sci 2014; 6:284-93. [PMID: 25168978 PMCID: PMC4825505 DOI: 10.5539/gjhs.v6n5p284] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 06/05/2014] [Accepted: 07/14/2014] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to determine knowledge, attitude, and performance vis-à-vis pain management in neonates by nurses working in neonatal units in Bandar Abbas University hospitals. METHOD This descriptive and analytical study was executed from March-August 2011 in the neonatal units and NICU in Bandar Abbas educational hospitals. A total of 50 nurses and nurse assistants working in the neonatal units participated in the study. The data collection tool was a structured questionnaire investigating knowledge (28 items), attitude (20 items) and practices (5 items). Data was analyzed using descriptive statistical tests (Frequency, Mean and Standard deviation tables) and inferential statistic (T-test, Variance analysis). RESULTS The knowledge scores of participants had a mean value of 13.51 (48.2%) out of 28. The mean score of attitude was 54.22 out of 60 and the mean score for the nurses' level of practices was found to be 4.22 out of 10. There was a significant relationship between nurses' knowledge scores and the level of education, i.e. nurses with more education had more knowledge. CONCLUSION Results showed that the nurses had poor performance regarding the assessment, measurement, and relief of pain. However, they showed positive attitudes towards pain control in neonates.
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