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Selvanathan T, Miller SP. Effects of pain, sedation and analgesia on neonatal brain injury and brain development. Semin Perinatol 2024:151928. [PMID: 38937163 DOI: 10.1016/j.semperi.2024.151928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Critically ill newborns experience numerous painful procedures as part of lifesaving care in the Neonatal Intensive Care Unit. However, painful exposures in the neonatal period have been associated with alterations in brain maturation and poorer neurodevelopmental outcomes in childhood. The most frequently used medications for pain and sedation in the NICU are opioids, benzodiazepines and sucrose; these have also been associated with abnormalities in brain maturation and neurodevelopment making it challenging to know what the best approach is to treat neonatal pain. This article provides clinicians with an overview of how neonatal exposure to pain as well as analgesic and sedative medications impact brain maturation and neurodevelopmental outcomes in critically ill infants. We also highlight areas in need of future research to develop standardized neonatal pain monitoring and management strategies.
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Affiliation(s)
- Thiviya Selvanathan
- Pediatrics, BC Children's Hospital Research Institute and University of British Columbia, Vancouver, BC, Canada; Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Steven P Miller
- Pediatrics, BC Children's Hospital Research Institute and University of British Columbia, Vancouver, BC, Canada; Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada; Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada.
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2
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Selvanathan T, Miller SP. Brain health in preterm infants: importance of early-life pain and analgesia exposure. Pediatr Res 2024:10.1038/s41390-024-03245-w. [PMID: 38806664 DOI: 10.1038/s41390-024-03245-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/23/2024] [Indexed: 05/30/2024]
Abstract
"Everyday" exposures in the neonatal period, such as pain, may impact brain health in preterm infants. Specifically, greater exposure to painful procedures in the initial weeks after birth have been related to abnormalities in brain maturation and growth and poorer neurodevelopmental outcomes in preterm infants. Despite an increasing focus on the importance of treating pain in preterm infants, there is a lack of consensus of optimal approaches to managing pain in this population. This may be due to recent findings suggesting that commonly used analgesic and sedative medications in preterm infants may also have adverse effects of brain maturation and neurodevelopmental outcomes. This review provides an overview of potential impacts of pain and analgesia exposure on preterm brain health while highlighting research areas in need of additional investigations for the development of optimal pain management strategies in this population.
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Affiliation(s)
- Thiviya Selvanathan
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Steven P Miller
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada.
- BC Children's Hospital Research Institute, Vancouver, BC, Canada.
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada.
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Felderhoff-Müser U. Impact of sociodemographic status of countries on neonatal analgosedation management. Pediatr Res 2024:10.1038/s41390-024-03262-9. [PMID: 38778227 DOI: 10.1038/s41390-024-03262-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Ursula Felderhoff-Müser
- Department of Paediatrics I, Neonatology, Paed. Intensive Care, Paed. Infectiology, Paed. Neurology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
- Center of Translational Neuro- and Behavioral Sciences, C-TNBS, Faculty of Medicine, University of Duisburg- Essen, Essen, Germany.
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Damera SR, De Asis-Cruz J, Cook KM, Kapse K, Spoehr E, Murnick J, Basu S, Andescavage N, Limperopoulos C. Regional homogeneity as a marker of sensory cortex dysmaturity in preterm infants. iScience 2024; 27:109662. [PMID: 38665205 PMCID: PMC11043889 DOI: 10.1016/j.isci.2024.109662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 01/23/2024] [Accepted: 04/01/2024] [Indexed: 04/28/2024] Open
Abstract
Atypical perinatal sensory experience in preterm infants is thought to increase their risk of neurodevelopmental disabilities by altering the development of the sensory cortices. Here, we used resting-state fMRI data from preterm and term-born infants scanned between 32 and 48 weeks post-menstrual age to assess the effect of early ex-utero exposure on sensory cortex development. Specifically, we utilized a measure of local correlated-ness called regional homogeneity (ReHo). First, we demonstrated that the brain-wide distribution of ReHo mirrors the known gradient of cortical maturation. Next, we showed that preterm birth differentially reduces ReHo across the primary sensory cortices. Finally, exploratory analyses showed that the reduction of ReHo in the primary auditory cortex of preterm infants is related to increased risk of autism at 18 months. In sum, we show that local connectivity within sensory cortices has different developmental trajectories, is differentially affected by preterm birth, and may be associated with later neurodevelopment.
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Affiliation(s)
- Srikanth R. Damera
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Josepheen De Asis-Cruz
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Kevin M. Cook
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Kushal Kapse
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Emma Spoehr
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Jon Murnick
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Sudeepta Basu
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Nickie Andescavage
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
| | - Catherine Limperopoulos
- Developing Brain Institute, Children’s National, 111 Michigan Avenue NW, Washington, DC 20010, USA
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Ling R, Wang Y, Zheng W, Min C, Chen M, Xia D, Li X. Effects of different types of neonatal pain on somatosensory and cognitive development in male juvenile rats. Brain Behav 2023; 13:e3309. [PMID: 37968885 PMCID: PMC10726798 DOI: 10.1002/brb3.3309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Premature infants are inevitably exposed to painful events, including repetitive procedures, inflammation, or mixed stimulation that may induce long-term behavioral outcomes. Here, we set up three neonatal painful models to investigate their long-term effect on somatosensation and cognition. METHODS Three types of neonatal pain models in rat were set up. Rat pups were randomly assigned to four groups. The needling pain (NP) group received repetitive needle pricks on the paws from the day of birth (PD0) to postnatal day 7 (PD7) to mimic the diagnostic and therapeutic procedures. The inflammatory pain (IP) group received the injection of carrageenan into the left hindpaw at PD3 to induce IP in peripheral tissues. The mixed pain group received a combination of the NP and IP (NIP). The control (CON) group was untreated. We performed behavioral and biochemical testing of juvenile rats (PD21-PD26). RESULTS The NIP group showed a longer hypersensitivity than the NP group, when given a secondary inflammatory stimulation. NP led to insensitivity to anxiety-causing stimuli and impairment of fear memory both aggravated by NIP. NP reduced the expression of synapse-related molecules (GluN1/PSD95/GFAP) in the medial prefrontal cortex, and NIP exacerbated this decrease. The corticosterone secretion in the NIP group increased after the behavioral task, compared with those in other three groups. CONCLUSION A combination of NP with inflammation occurring in the neonatal period might aggravate the adverse effects of each on somatosensory and cognitive development of rats, the mechanism of which might be associated with the increase of corticosterone secretion and the dysregulation of synaptic molecules.
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Affiliation(s)
- Ru Ling
- Department of Child Health CareChildren's Hospital of Nanjing Medical UniversityNanjingJiangsuP. R. China
| | - Yueshu Wang
- Department of Child Health CareChildren's Hospital of Nanjing Medical UniversityNanjingJiangsuP. R. China
| | - Wen Zheng
- Department of Child Health CareChildren's Hospital of Nanjing Medical UniversityNanjingJiangsuP. R. China
| | - Cuiting Min
- Department of Child Health CareChildren's Hospital of Nanjing Medical UniversityNanjingJiangsuP. R. China
| | - Mengying Chen
- Department of Child Health CareChildren's Hospital of Nanjing Medical UniversityNanjingJiangsuP. R. China
| | - Dongqing Xia
- Department of Child Health CareChildren's Hospital of Nanjing Medical UniversityNanjingJiangsuP. R. China
| | - Xiaonan Li
- Department of Child Health CareChildren's Hospital of Nanjing Medical UniversityNanjingJiangsuP. R. China
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Boboshko MY, Savenko IV, Garbaruk ES, Knyazeva VM, Vasilyeva MJ. Impact of Prematurity on Auditory Processing in Children. PATHOPHYSIOLOGY 2023; 30:505-521. [PMID: 37987307 PMCID: PMC10661290 DOI: 10.3390/pathophysiology30040038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/16/2023] [Accepted: 10/24/2023] [Indexed: 11/22/2023] Open
Abstract
Prematurity is one of the most crucial risk factors negatively affecting the maturation of the auditory system. Children born preterm demonstrate high rates of hearing impairments. Auditory processing difficulties in preterm children might be a result of disturbances in the central auditory system development and/or sensory deprivation due to peripheral hearing loss. To investigate auditory processing in preterm children, we utilized a set of psychoacoustic tests to assess temporal processing and speech intelligibility. A total of 241 children aged 6-11 years old (136 born preterm and 105 healthy full-term children forming the control group) were assessed. The preterm children were divided into three groups based on their peripheral hearing status: 74 normal hearing (NH group); 30 children with bilateral permanent sensorineural hearing loss (SNHL group) and 32 children with bilateral auditory neuropathy spectrum disorder (ANSD group). The results showed significantly worse performance in all tests in premature children compared with full-term children. NH and SNHL groups showed significant age-related improvement in speech recognition thresholds in noise that might signify a "bottom-up" auditory processing maturation effect. Overall, all premature children had signs of auditory processing disorders of varying degrees. Analyzing and understanding the auditory processing specificity in preterm children can positively contribute to the more effective implementation of rehabilitation programs.
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Affiliation(s)
- Maria Y. Boboshko
- Department of Higher Nervous Activity and Psychophysiology, St. Petersburg State University, 199034 St. Petersburg, Russia;
- Laboratory of Hearing and Speech, Pavlov First St. Petersburg State Medical University, 197022 St. Petersburg, Russia; (I.V.S.); (E.S.G.)
| | - Irina V. Savenko
- Laboratory of Hearing and Speech, Pavlov First St. Petersburg State Medical University, 197022 St. Petersburg, Russia; (I.V.S.); (E.S.G.)
| | - Ekaterina S. Garbaruk
- Laboratory of Hearing and Speech, Pavlov First St. Petersburg State Medical University, 197022 St. Petersburg, Russia; (I.V.S.); (E.S.G.)
- Scientific Research Center, St. Petersburg State Pediatric Medical University, 194100 St. Petersburg, Russia
| | - Veronika M. Knyazeva
- Department of Higher Nervous Activity and Psychophysiology, St. Petersburg State University, 199034 St. Petersburg, Russia;
| | - Marina J. Vasilyeva
- Department of Higher Nervous Activity and Psychophysiology, St. Petersburg State University, 199034 St. Petersburg, Russia;
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de Carvalho RC, Generoso LP, da Silva AL, Pereira GS, de Paula DC, Candido NL, Capello MGM, da Silva JRT, da Silva ML. Effects of repetitive pinprick stimulation on preterm offspring: Alterations in nociceptive responses and inflammatory hypersensitivity in adulthood. Behav Brain Res 2023; 454:114633. [PMID: 37597588 DOI: 10.1016/j.bbr.2023.114633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/14/2023] [Accepted: 08/14/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION This study investigates the effects of repetitive pinprick stimulation on preterm offspring and its impact on nociceptive responses and inflammatory hypersensitivity in adulthood. OBJECTIVES The objective is to shed light on the potential long-term consequences of neonatal pain and prematurity on sensory processing. METHODS Term and preterm rats were subjected to repetitive pinprick (PP) stimulation or control (CC) during the neonatal period. Adult rats received CFA injection to induce inflammatory hypersensitivity, and mechanical hypersensitivity was measured. Gender differences in inflammatory hypersensitivity were also examined. Maternal behavior, litter weight, and offspring growth were monitored to assess any potential influences of the stimulation on these parameters. RESULTS In preterm rats, the PP stimulation did not affect baseline thresholds to mechanical stimuli, but increased mechanical hypersensitivity after CFA injection in adult rats. Females exhibited greater inflammatory hypersensitivity compared to males. Maternal behavior, litter weight, and offspring growth were not influenced by the stimulation. PP stimulation during the neonatal period led to changes in nociceptive responses in adulthood, potentially altering sensory processing. CONCLUSION PP stimulation in preterm rats during the neonatal period resulted in changes in nociceptive responses in adulthood, leading to increased inflammatory hypersensitivity. The study emphasizes how early development can significantly impact sensory processing and further highlights the potential long-term consequences of prematurity and neonatal pain on this processing.
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Affiliation(s)
- Ravena Carolina de Carvalho
- Postgraduate Program in Biosciences Applied to Health (PPGB), UNIFAL, Alfenas, MG, Brazil; Laboratory of Neuroscience, Neuromodulation and Study of Pain (LANNED), UNIFAL-MG, Alfenas, MG, Brazil
| | - Laura Pereira Generoso
- Postgraduate Program in Biosciences Applied to Health (PPGB), UNIFAL, Alfenas, MG, Brazil; Laboratory of Neuroscience, Neuromodulation and Study of Pain (LANNED), UNIFAL-MG, Alfenas, MG, Brazil
| | - Ana Laura da Silva
- Graduation in Physiotherapy at the Motricity Sciences Institute, UNIFAL, Alfenas, MG, Brazil; Laboratory of Neuroscience, Neuromodulation and Study of Pain (LANNED), UNIFAL-MG, Alfenas, MG, Brazil
| | - Gabrielly Santos Pereira
- Graduation in Physiotherapy at the Motricity Sciences Institute, UNIFAL, Alfenas, MG, Brazil; Laboratory of Neuroscience, Neuromodulation and Study of Pain (LANNED), UNIFAL-MG, Alfenas, MG, Brazil
| | - Danielle Cavalcante de Paula
- Graduation in Physiotherapy at the Motricity Sciences Institute, UNIFAL, Alfenas, MG, Brazil; Laboratory of Neuroscience, Neuromodulation and Study of Pain (LANNED), UNIFAL-MG, Alfenas, MG, Brazil
| | - Natalie Lange Candido
- Postgraduate Program in Biosciences Applied to Health (PPGB), UNIFAL, Alfenas, MG, Brazil; Laboratory of Neuroscience, Neuromodulation and Study of Pain (LANNED), UNIFAL-MG, Alfenas, MG, Brazil
| | - Maria Gabriela Maziero Capello
- Postgraduate Program in Biosciences Applied to Health (PPGB), UNIFAL, Alfenas, MG, Brazil; Laboratory of Neuroscience, Neuromodulation and Study of Pain (LANNED), UNIFAL-MG, Alfenas, MG, Brazil
| | | | - Marcelo Lourenço da Silva
- Laboratory of Neuroscience, Neuromodulation and Study of Pain (LANNED), UNIFAL-MG, Alfenas, MG, Brazil.
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Von Adamovich GMG, Bastos Torres JAG, Vianna FS, Barradas PC, Alves de Oliveira BF, Villela NR, De Rodrigues MCC, Montes GC. Evaluation of Pain Prevalence in Children Who Experienced Perinatal Hypoxia-Ischemia Events: Characteristics and Associations With Sociodemographic Factors. Cureus 2023; 15:e46359. [PMID: 37920623 PMCID: PMC10619469 DOI: 10.7759/cureus.46359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Pain in children who suffer from hypoxia-ischemia (HI) events is still not widely studied. Hypoxia-ischemia is characterized by the momentary or permanent cessation of blood flow and, consequently, of oxygen supply, becoming the main cause of encephalopathy in children. Hyperalgesia was identified in animals undergoing prenatal hypoxia-ischemia by researchers from the Universidade do Estado do Rio de Janeiro (UERJ). Premature and asphyxiated newborns have been admitted to the neonatal intensive care unit (NICU) of Pedro Ernesto University Hospital (HUPE) in Brazil and are monitored by the Outpatient Follow-up of High-Risk Newborns Project (SARAR), but no pain assessment was performed. OBJECTIVE To assess pain in children born in high-risk situations, such as prematurity and perinatal asphyxia, with higher chances of perinatal HI, discharged from the NICU/HUPE, and followed by SARAR. METHODOLOGY The study was approved by the HUPE Research Ethics Committee. The epidemiological, descriptive, cross-sectional study started in 2021 and finished in 2023, with the application of the pain assessment tool or instrument adapted from the Lübeck Pain-Screening Questionnaire to the caregivers and with the collection of growth and development data. The population consisted of asphyxiated infants born with a gestational age greater than 35 weeks and submitted to the Therapeutic Hypothermia protocol and premature infants discharged from the NICU between two (gestational age 1 (GA1)) and 12 years old. For most of them, pain prevalence was assessed according to its frequency and intensity, as were sociodemographic variables of the child and mother, neural alterations, and the Children's Developmental Scale (DENVER II). The percentage differences between the evaluated factors and the presence of pain were performed using Fisher's exact test and medians using the non-parametric Wilcoxon rank-sum test, both appropriate for the small sample of children. Significance levels of 10% were considered for trends and 5% for statistically significant differences. RESULTS Of the 86 children included in our search, 26 (30%) were born with a gestational age greater than 35 weeks and diagnosed with perinatal asphyxia (hereinafter referred to as the asphyxiation group), and 60 (70%) were premature. Pain was reported by 22 (25%) children, of whom 54.4% reported moderate or severe pain. The head and abdomen were the most reported sites (36%). Differences were observed in the percentage distribution of pain between asphyxiates and premature infants (11% vs. 32%; p-value 0.061 on the Fisher test) and between females and males (34% vs. 17%; p-value 0.085 on the Fisher test). Black and Brown children had higher median pain scale values than White children (p-value < 0.027, Wilcoxon rank sum test). CONCLUSION There is a higher prevalence of pain in girls, in the head, in premature infants, and greater intensity among Black and Brown children. Therefore, knowing the pain profile can help improve their quality of life by offering treatments.
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Affiliation(s)
| | | | - Felipe S Vianna
- Internal Medicine, Faculty of Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, BRA
| | - Penha C Barradas
- Pharmacology and Psychobiology, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, BRA
| | - Beatriz F Alves de Oliveira
- Epidemiology and Public Health, Fiocruz Regional Office of Piauí, National School of Public Health, Oswaldo Cruz Foundation, Piauí, BRA
| | - Nivaldo R Villela
- Anesthesiology, Pain Medicine, Faculty of Medicine, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, BRA
| | | | - Guilherme C Montes
- Pharmacology and Psycobiology, Instituto de Biologia Roberto Alcantara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, BRA
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Duerden EG, McPherson C. Editorial: Pain in infants: pain management practices and the association with outcome. FRONTIERS IN PAIN RESEARCH 2023; 4:1216764. [PMID: 37383880 PMCID: PMC10295128 DOI: 10.3389/fpain.2023.1216764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 05/29/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Emma G. Duerden
- Western Institute for Neuroscience, Western University, London, ON, Canada
- Applied Psychology, Faculty of Education, & Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Christopher McPherson
- Department of Pharmacy, St. Louis Children’s Hospital, St. Louis, MO, United States
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, United States
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Bueno M, Ballantyne M, Campbell-Yeo M, Estabrooks CA, Gibbins S, Harrison D, McNair C, Riahi S, Squires J, Synnes A, Taddio A, Victor C, Yamada J, Stevens B. The effectiveness of repeated sucrose for procedural pain in neonates in a longitudinal observational study. FRONTIERS IN PAIN RESEARCH 2023; 4:1110502. [PMID: 36824315 PMCID: PMC9941618 DOI: 10.3389/fpain.2023.1110502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 01/13/2023] [Indexed: 02/10/2023] Open
Abstract
Goal To determine the analgesic effectiveness of repeated sucrose administration for skin-breaking (SB) procedures over the Neonatal Intensive Care Unit (NICU) hospitalization of preterm infants. Methods Longitudinal observational study, conducted in four level III Canadian NICUs. Eligible infants were <32 weeks gestational age at birth, and <10 days of life at enrollment. Infants received 24% sucrose (0.12 ml) prior to all painful procedures. The Premature Infant Pain Profile - Revised (PIPP-R) was used at 30 and 60 seconds after a medically-required SB procedure as soon as possible after enrollment and weekly up to three additional times for scheduled procedures. Results 172 infants (57.3% male, gestational age 28.35 (±2.31) weeks) were included. The mean 30 s PIPP-R scores were 6.11 (±3.68), 5.76 (±3.41), 6.48 (±3.67), and 6.81 (±3.69) respectively; there were no statistically significant interactions of study site by time (p = 0.31) or over time (p = 0.15). At 60 s, mean PIPP-R scores were 6.05 (±4.09), 5.74 (±3.67), 6.19 (±3.7), and 5.99 (±3.76) respectively; there were no study site by time interactions (p = 0.14) or differences over time (p = 0.52). There was a statistically significant site difference in the effectiveness of sucrose at 30 and 60 seconds (p < 0.01). Conclusions Consistently low PIPP-R scores following a skin-breaking procedure indicated that the analgesic effectiveness of the minimal dose of sucrose was sustained over time in the NICU. Further research is required to determine the optimal combination of sucrose and other pain management strategies to improve clinical practice and the impact of consistent use of repeated use of sucrose on neurodevelopment.
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Affiliation(s)
- Mariana Bueno
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Marilyn Ballantyne
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada,Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada
| | - Marsha Campbell-Yeo
- Departments of Psychology & Neuroscience and Pediatrics, Faculty of Health, School of Nursing, Dalhousie University, Halifax, NS, Canada,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | | | | | - Denise Harrison
- Department of Nursing, The University of Melbourne, Melbourne, VIC, Australia,Clinical Sciences and Nursing, Murdoch Children's Research Institute and Royal Children's Hospital, Melbourne, VIC, Australia,Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Carol McNair
- Neonatology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Shirine Riahi
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Janet Squires
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, ON, Canada
| | - Anne Synnes
- Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Anna Taddio
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Charles Victor
- The Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Janet Yamada
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Canada
| | - Bonnie Stevens
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada,Correspondence: Bonnie Stevens
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Keshishyan ES, Ziborova MI, Sakharova ES. Premature children and assessment of their capability for school education by 7 years of age (the role of interdisciplinary approach. ROSSIYSKIY VESTNIK PERINATOLOGII I PEDIATRII (RUSSIAN BULLETIN OF PERINATOLOGY AND PEDIATRICS) 2023. [DOI: 10.21508/1027-4065-2022-67-6-7-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In recent decades, there has been a distinct increase in the number of deeply and extremely preterm children without structural organic lesions of the nervous system. A comprehensive study and clinical observations of these children reveal their differences from full-term peers, becoming the most obvious by the beginning of schooling. In this article, we consider the cognitive, behavioral, and socializing features of these children, paying attention to key biosocial factors of their development, such as the long-term influence of the early neonatal period on the formation of brain structures and connections and the «resetting» of the neurohumoral system, the role of genomic polymorphism, the special importance of a favorable environment for the emotional well-being and success of these children among their peers. Knowledge and understanding of extremely preterm infants’ specific development, typical risks of behavioral disorders and social disfavor is of great practical importance for prolonged interdisciplinary follow-up — in the form of appropriate medical, educational, and psychological programs.
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Affiliation(s)
- E. S. Keshishyan
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University
| | - M. I. Ziborova
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University
| | - E. S. Sakharova
- Veltischev Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University
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