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Shah PS, Torgalkar R, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 2023; 8:CD004950. [PMID: 37643989 PMCID: PMC10464660 DOI: 10.1002/14651858.cd004950.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Pain in the neonate is associated with acute behavioural and physiological changes. Cumulative pain is associated with morbidities, including adverse neurodevelopmental outcomes. Studies have shown a reduction in changes in physiological parameters and pain score measurements following pre-emptive analgesic administration in neonates experiencing pain or stress. Non-pharmacological measures (such as holding, swaddling and breastfeeding) and pharmacological measures (such as acetaminophen, sucrose and opioids) have been used for analgesia. This is an update of a review first published in 2006 and updated in 2012. OBJECTIVES The primary objective was to evaluate the effectiveness of breastfeeding or supplemental breast milk in reducing procedural pain in neonates. The secondary objective was to conduct subgroup analyses based on the type of control intervention, gestational age and the amount of supplemental breast milk given. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registries (ICTRP, ISRCTN and clinicaltrials.gov) in August 2022; searches were limited from 2011 forwards. We checked the reference lists of included studies and relevant systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs of breastfeeding or supplemental breast milk versus no treatment/other measures in neonates. We included both term (≥ 37 completed weeks postmenstrual age) and preterm infants (< 37 completed weeks' postmenstrual age) up to a maximum of 44 weeks' postmenstrual age. The study must have reported on either physiological markers of pain or validated pain scores. DATA COLLECTION AND ANALYSIS We assessed the methodological quality of the trials using the information provided in the studies and by personal communication with the authors. We extracted data on relevant outcomes, estimated the effect size and reported this as a mean difference (MD). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS Of the 66 included studies, 36 evaluated breastfeeding, 29 evaluated supplemental breast milk and one study compared them against each other. The procedures conducted in the studies were: heel lance (39), venipuncture (11), intramuscular vaccination (nine), eye examination for retinopathy of prematurity (four), suctioning (four) and adhesive tape removal as procedure (one). We noted marked heterogeneity in the control interventions and pain assessment measures amongst the studies. Since many studies included multiple arms with breastfeeding/supplemental breast milk as the main comparator, we were not able to synthesise all interventions together. Individual interventions are compared to breastfeeding/supplemental breast milk and reported. The numbers of studies/participants presented with the findings are not taken from pooled analyses (as is usual in Cochrane Reviews), but are the overall totals in each comparison. Overall, the included studies were at low risk of bias except for masking of intervention and outcome assessment, where nearly one-third of studies were at high risk of bias. Breastfeeding versus control Breastfeeding may reduce the increase in heart rate compared to holding by mother, skin-to-skin contact, bottle feeding mother's milk, moderate concentration of sucrose/glucose (20% to 33%) with skin-to-skin contact (low-certainty evidence, 8 studies, 784 participants). Breastfeeding likely reduces the duration of crying compared to no intervention, lying on table, rocking, heel warming, holding by mother, skin-to-skin contact, bottle feeding mother's milk and moderate concentration of glucose (moderate-certainty evidence, 16 studies, 1866 participants). Breastfeeding may reduce percentage time crying compared to holding by mother, skin-to-skin contact, bottle feeding mother's milk, moderate concentration sucrose and moderate concentration of sucrose with skin-to-skin contact (low-certainty evidence, 4 studies, 359 participants). Breastfeeding likely reduces the Neonatal Infant Pain Scale (NIPS) score compared to no intervention, holding by mother, heel warming, music, EMLA cream, moderate glucose concentration, swaddling, swaddling and holding (moderate-certainty evidence, 12 studies, 1432 participants). Breastfeeding may reduce the Neonatal Facial Coding System (NFCS) score compared to no intervention, holding, pacifier and moderate concentration of glucose (low-certainty evidence, 2 studies, 235 participants). Breastfeeding may reduce the Douleur Aigue Nouveau-né (DAN) score compared to positioning, holding or placebo (low-certainty evidence, 4 studies, 709 participants). In the majority of the other comparisons there was little or no difference between the breastfeeding and control group in any of the outcome measures. Supplemental breast milk versus control Supplemental breast milk may reduce the increase in heart rate compared to water or no intervention (low-certainty evidence, 5 studies, 336 participants). Supplemental breast milk likely reduces the duration of crying compared to positioning, massage or placebo (moderate-certainty evidence, 11 studies, 1283 participants). Supplemental breast milk results in little or no difference in percentage time crying compared to placebo or glycine (low-certainty evidence, 1 study, 70 participants). Supplemental breast milk results in little or no difference in NIPS score compared to no intervention, pacifier, moderate concentration of sucrose, eye drops, gentle touch and verbal comfort, and breast milk odour and verbal comfort (low-certainty evidence, 3 studies, 291 participants). Supplemental breast milk may reduce NFCS score compared to glycine (overall low-certainty evidence, 1 study, 40 participants). DAN scores were lower when compared to massage and water; no different when compared to no intervention, EMLA and moderate concentration of sucrose; and higher when compared to rocking or pacifier (low-certainty evidence, 2 studies, 224 participants). Due to the high number of comparator interventions, other measures of pain were assessed in a very small number of studies in both comparisons, rendering the evidence of low certainty. The majority of studies did not report on adverse events, considering the benign nature of the intervention. Those that reported on adverse events identified none in any participants. Subgroup analyses were not conducted due to the small number of studies. AUTHORS' CONCLUSIONS Moderate-/low-certainty evidence suggests that breastfeeding or supplemental breast milk may reduce pain in neonates undergoing painful procedures compared to no intervention/positioning/holding or placebo or non-pharmacological interventions. Low-certainty evidence suggests that moderate concentration (20% to 33%) glucose/sucrose may lead to little or no difference in reducing pain compared to breastfeeding. The effectiveness of breast milk for painful procedures should be studied in the preterm population, as there are currently a limited number of studies that have assessed its effectiveness in this population.
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Affiliation(s)
- Prakeshkumar S Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto and Mount Sinai Hospital, Toronto, Canada
| | - Ranjit Torgalkar
- Department of Paediatrics, Division of Neonatology, Kentucky Children's Hospital, University of Kentucky, Lexington, USA
| | - Vibhuti S Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto and Mount Sinai Hospital, Toronto, Canada
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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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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: 22] [Impact Index Per Article: 11.0] [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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Eissler AB, Zwakhalen S, Stoffel L, Hahn S. Systematic Review of the Effectiveness of Involving Parents During Painful Interventions for Their Preterm Infants. J Obstet Gynecol Neonatal Nurs 2022; 51:6-15. [PMID: 34627734 DOI: 10.1016/j.jogn.2021.08.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To systematically review the literature related to the effectiveness of parents' active involvement during painful interventions for their preterm infants. DATA SOURCES We performed a systematic search of PubMed, EMBASE/Ovid, CINAHL, Livivio, and PsycInfo using the keywords "preterm infants," "pain," and "parents." STUDY SELECTION Articles were eligible for inclusion if they were published between 2000 and 2021 and reported randomized controlled trials (RCTs) in which preterm infants underwent painful interventions, and parents were present and actively involved in pain-reducing measures. DATA EXTRACTION We used the Consolidated Standards of Reporting Trials (CONSORT) checklist for RCTs for data extraction. We assessed methodologic quality using critical appraisal for RCTs according to the Joanna Briggs Institute. DATA SYNTHESIS In total, 22 articles met the inclusion criteria. These articles reported 19 studies focused on kangaroo/skin-to-skin care, one focused on breastfeeding, and two focused on facilitated tucking. The methods used to evaluate pain in the infant varied substantially. Overall, kangaroo/skin-to-skin care and facilitated tucking resulted in clinically and statistically significant decreases in pain. For breastfeeding, effectiveness was linked to a more mature sucking pattern of the preterm infant. CONCLUSION The current evidence suggests that involving parents in pain-reducing measures during painful interventions for their preterm infants is beneficial. However, more research is needed for the different methods of involving parents in pain-reducing measures.
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Ullsten A, Andreasson M, Eriksson M. State of the Art in Parent-Delivered Pain-Relieving Interventions in Neonatal Care: A Scoping Review. Front Pediatr 2021; 9:651846. [PMID: 33987153 PMCID: PMC8112545 DOI: 10.3389/fped.2021.651846] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Parents' active involvement during painful procedures is considered a critical first step in improving neonatal pain practices. Of the non-pharmacological approaches in use, the biopsychosocial perspective supports parent-delivered interventions, in which parents themselves mediate pain relief, consistent with modern family-integrated care. This scoping review synthesizes the available research to provide an overview of the state of the art in parent-delivered pain-relieving interventions. Methods: A scoping review was performed to achieve a broad understanding of the current level of evidence and uptake of parent-driven pain- and stress-relieving interventions in neonatal care. Results: There is a strong evidence for the efficacy of skin-to-skin contact and breastfeeding, preferably in combination. These parent-delivered interventions are safe, valid, and ready for prompt introduction in infants' pain care globally. Research into parents' motivations for, and experiences of, alleviating infant pain is scarce. More research on combined parent-delivered pain alleviation, including relationship-based interventions such as the parent's musical presence, is needed to advance infant pain care. Guidelines need to be updated to include infant pain management, parent-delivered interventions, and the synergistic effects of combining these interventions and to address parent involvement in low-income and low-tech settings. Conclusions: A knowledge-to-practice gap currently remains in parent-delivered pain management for infants' procedure-related pain. This scoping review highlights the many advantages of involving parents in pain management for the benefit not only of the infant and parent but also of health care.
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Affiliation(s)
- Alexandra Ullsten
- Center for Clinical Research, Region Värmland, Karlstad, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Matilda Andreasson
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Rad ZA, Aziznejadroshan P, Amiri AS, Ahangar HG, Valizadehchari Z. The effect of inhaling mother's breast milk odor on the behavioral responses to pain caused by hepatitis B vaccine in preterm infants: a randomized clinical trial. BMC Pediatr 2021; 21:61. [PMID: 33522927 PMCID: PMC7849099 DOI: 10.1186/s12887-021-02519-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 01/21/2021] [Indexed: 12/01/2022] Open
Abstract
Background Nowadays, it is generally assumed that non-pharmacologic pain relief in preterm infants is an important measure to consider. Research findings suggest that familiar odors have soothing effects for neonates. The aim of this study was to compare the effect of maternal breast milk odor (MBMO) with that of another mother’s breast milk odor (BMO) on the behavioral responses to pain caused by hepatitis B (HB) vaccine injection in preterm infants. Methods This single-blind randomized clinical trial was performed over the period between February 2019 and March 2020 in the neonatal intensive care unit of Babol Rouhani Hospital, Iran. Ninety preterm infants, who were supposed to receive their HB vaccine, were randomly assigned into three groups: MBMO (A), another mother’s BMO (B), and control with distilled water(C). Oxygen saturation (SaO2), blood pressure (BP) and heart rate (HR) were recorded for all participants through electronic monitoring. In addition, premature infant pain profiles (PIPP) were determined through video recording for all three groups during intervention. The chi-square, ANOVA and ANCOVA were used for analyzing the data, and P < 0.05 was considered significant in this study. Results No significant differences were found between the three groups in mean ± SD of HR, BP, and Sao2 before the intervention (P > 0.05). After the intervention, however, the means for heart rate in groups A, B, and C were 146 ± 14.3, 153 ± 17.5 and 155 ± 17.7, respectively (P = 0.012). Moreover, the means for PIPP scores in groups A, B and C were 6.6 ± 1.3, 10 ± 2, and 11.4 ± 1.9, respectively (P < 0.001). There was no significant difference found between groups in their means of SaO2, systolic and diastolic blood pressure after the intervention (P > 0.05). Conclusions The results indicate that stimulation with MBMO is effective in reducing pain in preterm infants; therefore, it can be postulated that this technique can be considered in less invasive procedures such as needling. Trial registration IRCT, IRCT20190220042771N1. Registered 18 May 2019- Retrospectively registered,
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Affiliation(s)
- Zahra Akbarian Rad
- Non-Communicable Pediatric Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R, Iran
| | - Parvin Aziznejadroshan
- Non-Communicable Pediatric Disease Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R, Iran.
| | - Adeleh Saebi Amiri
- Student Research Committee, Babol University of Medical Sciences, Babol, I.R, Iran
| | | | - Zahra Valizadehchari
- Clinical Research development unit of Rohani hospital, Health Research Institute, Babol University of Medical Sciences, Babol, I.R, Iran
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Cortical Pain Response of Newborn Infants to Venepuncture: A Randomized Controlled Trial Comparing Analgesic Effects of Sucrose Versus Breastfeeding. Clin J Pain 2019; 34:650-656. [PMID: 29298184 DOI: 10.1097/ajp.0000000000000581] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Sucrose administration and breastfeeding decrease behavioral expressions of pain in neonates. However, recent studies indicated that there is a persistent cortical response with sucrose. This study compared the efficacy of sucrose administration versus breastfeeding to decrease cortical responses to pain during venepuncture. PATIENTS AND METHODS A randomized, prospective, controlled trial was conducted in a tertiary level maternity ward. Healthy, 3-day-old term neonates, undergoing venepuncture for neonatal screening, were randomly assigned to receive sucrose solution or be breastfed before venepuncture. Variations in the total hemoglobin concentration [HbT] in the contralateral somatosensory cortex were assessed with near infrared spectroscopy. The Neonatal Facial Coding System (NFCS) was used to assess reactions. RESULTS There were 114 term neonates included, with 102 included for the primary outcome (breastfed group: 48; sucrose group: 54). Similar maximum increases in [HbT] were observed in both groups (mean±SD: sucrose group: 31.2±58.1 μmol/L; breastfed group: 38.9±61.4 μmol/L; P=0.70). Breastfed neonates presented more behavioral expressions that indicated pain compared with sucrose-administered neonates (46.8% vs. 26.8% of NFCS ≥1, P=0.04). The maximum increase in [HbT] was persistent, although newborn infants who did not express behavioral signs of pain had lower concentrations than neonates who did (mean±SD: 21.2±29.1 vs. 60.0±89.8 μmol/L, P<0.01). DISCUSSION There was no difference in the cortical responses to pain during venepuncture in newborn infants who were administered sucrose versus those who were breastfed.
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Williams N, MacLean K, Guan L, Collet JP, Holsti L. Pilot Testing a Robot for Reducing Pain in Hospitalized Preterm Infants. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2019; 39:108-115. [PMID: 30770034 DOI: 10.1177/1539449218825436] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Optimizing neurodevelopment is a key goal of neonatal occupational therapy. In preterm infants, repeated procedural pain is associated with adverse effects on neurodevelopment long term. Calmer is a robot designed to reduce infant pain. The objective of this study was to examine the effects of Calmer on heart rate variability (HRV) during routine blood collection in preterm infants. In a randomized controlled pilot trial, 10 infants were assigned to either standard care ( n = 5, facilitated tucking [FT]) or Calmer treatment ( n = 5). HRV was recorded continuously and quantified using the area (power) of the spectrum in high and low frequency (HF: 0.15-0.40Hz/ms2; LF: 0.04-0.15 Hz/ms2) regions. Changes in HRV during three, 2-min phases (Baseline, Heel Poke, and Recovery) were compared between groups. Calmer infants had 90% greater parasympathetic activation ([PS] reduced stress) during Baseline, 82% greater PS activation during Poke, and 24% greater PS activation during Recovery than FT infants. Calmer reduced physiological preterm infant pain reactivity during blood collection.
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Affiliation(s)
| | - Karon MacLean
- The University of British Columbia, Vancouver, Canada
| | - Ling Guan
- The University of British Columbia, Vancouver, Canada
| | | | - Liisa Holsti
- The University of British Columbia, Vancouver, Canada
- BC Children’s Hospital Research Institute, Vancouver, Canada
- BC Women’s Hospital Research Institute, Vancouver, Canada
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Vazquez V, Cong X, DeJong A. Maternal and Paternal Knowledge and Perceptions Regarding Infant Pain in the NICU. Neonatal Netw 2017; 34:337-44. [PMID: 26803015 DOI: 10.1891/0730-0832.34.6.337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate parents' knowledge, self-efficacy, and satisfaction about infant pain in the NICU. DESIGN AND SAMPLE A survey was conducted, and 80 parents (57 mothers and 23 fathers) participated in the study. MAIN OUTCOME VARIABLE A researcher-developed questionnaire composed of 3 dimensions: parents' knowledge about infant pain, perception of self-efficacy regarding infant pain, and satisfaction with infant pain management. RESULTS Most parents had adequate knowledge and moderate to high self-efficacy and were satisfied with infant pain management in the NICU. Mothers and fathers responded differently regarding self-efficacy and satisfaction, and parents' perceptions were correlated with infants' correct age and parents' own age. Most important, most parents wanted to be present and to be given the opportunity to comfort their infant during and after a painful procedure. Parents also preferred to receive formal/written information on infant pain.
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Abstract
To provide an updated synthesis of the current state of the evidence for the effectiveness of breast-feeding and expressed breast milk feeding in reducing procedural pain in preterm and full-term born infants. A systematic search of key electronic databases (PubMed, CINAHL, EMBASE) was completed. Of the 1032 abstracts screened, 21 were found eligible for inclusion. Fifteen studies reported on the use of breast-feeding or expressed breast milk in full-term infants and 6 reported on preterm infants. Direct breast-feeding was more effective than maternal holding, maternal skin-to-skin contact, topical anesthetics, and music therapy, and was as or more effective than sweet tasting solutions in full-term infants. Expressed breast milk was not consistently found to reduce pain response in full-term or preterm infants. Studies generally had moderate to high risk of bias. There is sufficient evidence to recommend direct breast-feeding for procedural pain management in full-term infants. Based on current evidence, expressed breast milk alone should not be considered an adequate intervention.
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Aita M, Goulet C, Oberlander TF, Snider L, Johnston C. A randomized controlled trial of eye shields and earmuffs to reduce pain response of preterm infants. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.jnn.2014.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Bellieni CV, Tei M, Buonocore G. Should we assess pain in newborn infants using a scoring system or just a detection method? Acta Paediatr 2015; 104:221-4. [PMID: 25429731 DOI: 10.1111/apa.12882] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Revised: 09/13/2014] [Accepted: 11/25/2014] [Indexed: 11/29/2022]
Abstract
UNLABELLED Newborn infants' pain should be scored indirectly using dedicated pain scales. Unfortunately, while some scales for prolonged pain have given good results, a gold standard to assess acute pain does not exist. Acute pain scales still have weak points, most are complex and are scarcely used in neonatal departments. Moreover, carefully scoring pain in clinical practice seems redundant, because any avoidable pain is a concern. This suggests that researchers must find new ways to assess acute pain. A possible approach is to settle for pain detection instead of pain scoring in selected cases. Here, we describe a two-point method that illustrates this approach. CONCLUSION For everyday practice, detecting pain is more useful than scoring it; acute pain scales should be reserved for research, for those clinical settings where the personnel has received a careful training and where overcrowding and hurry are absent.
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Affiliation(s)
- Carlo Valerio Bellieni
- Department of Pediatrics; Obstetrics and Reproduction Medicine; University of Siena; Siena Italy
| | - Monica Tei
- Department of Pediatrics; Obstetrics and Reproduction Medicine; University of Siena; Siena Italy
| | - Giuseppe Buonocore
- Department of Pediatrics; Obstetrics and Reproduction Medicine; University of Siena; Siena Italy
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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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Linhares MBM, Gaspardo CM, Souza LO, Valeri BO, Martinez FE. Examining the side effects of sucrose for pain relief in preterm infants: a case-control study. ACTA ACUST UNITED AC 2014; 47:527-32. [PMID: 24820067 PMCID: PMC4086181 DOI: 10.1590/1414-431x20143659] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Accepted: 02/27/2014] [Indexed: 12/01/2022]
Abstract
Sucrose solution is recommended as relevant pain relief management in neonates during
acute painful procedures; however, only a few studies have analyzed the potentially
adverse effects of sucrose administration to preterm neonates. The goal of this study
was to examine the potential side effects of sucrose for pain relief in preterm
infants, assessing feeding and weight gain during hospitalization and their feeding
patterns postdischarge. The study sample consisted of 43 preterm neonates divided
into two groups: a sucrose group (SG, n=18) and a control group (CG, n=25) in which
no sucrose was administered. The SG received 0.5 mL/kg 25% oral sucrose for 2 min
prior to all acute painful procedures during three consecutive days. A prospective
review of medical charts was performed for all samples. The study was done prior to
implementation of the institutional sucrose guidelines as a routine service, and
followed all ethical requirements. There were no statistically significant
differences between groups in terms of weight gain, length of stay with orogastric
tubes, and parenteral feeding. Postdischarge, infant nutritional intake included
feeding human milk to 67% of the SG and 74% of the CG. There were no statistically
significant differences between groups regarding human milk feeding patterns
postdischarge. Neonate feeding patterns and weight gain were unaffected following the
short-term use of sucrose for pain relief.
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Affiliation(s)
- M B M Linhares
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - C M Gaspardo
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - L O Souza
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - B O Valeri
- Departamento de Neurociências e Ciências do Comportamento, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - F E Martinez
- Departamento de Puericultura e Pediatria, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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15
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Arias MCC, Guinsburg R. Differences between uni-and multidimensional scales for assessing pain in term newborn infants at the bedside. Clinics (Sao Paulo) 2012; 67:1165-70. [PMID: 23070343 PMCID: PMC3460019 DOI: 10.6061/clinics/2012(10)08] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Accepted: 06/15/2012] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES This study sought to determine the level of agreement between behavioral and multidimensional pain assessment scales in term newborn infants submitted to an acute nociceptive stimulus. METHODS This cross-sectional study was performed on 400 healthy term newborns who received an intramuscular injection of vitamin K during the first 6 hours of life. Two behavioral pain scales (the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain) and one multidimensional tool (the Premature Infant Pain Profile) were applied by a single observer before the procedure, during cleansing, during injection and two minutes after injection. The Cochran Q, McNemar and kappa tests were used to compare the presence and degree of agreement between the three scales. The Hotelling T2 test was used to compare the groups of newborns for which the scales showed agreement or disagreement. A generalized linear regression was used to compare the results of the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain across the four study time points. RESULTS The neonates studied had a gestational age of 39±1 weeks, a birth weight of 3169±316 g and and postnatal age of 67±45 minutes. During the stimulus procedure, 80% of the newborns exhibited pain behaviors according to the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain, and 70% experienced pain according to the Premature Infant Pain Profile (p<0.001). The frequencies of the detection of pain using the Behavioral Indicators of Infant Pain and the Neonatal Facial Coding System were similar. The characteristics of the neonates were not associated with the level of agreement between the scales. CONCLUSION The Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain behavioral scales are more sensitive for the identification of pain in healthy term newborn infants than the multidimensional Premature Infant Pain Profile scale.
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Affiliation(s)
- Maria Carmenza Cuenca Arias
- Escola Paulista de Medicina, Division of Neonatal Medicine, Federal University of São Paulo (UNIFESP), São Paulo/SP, Brazil
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16
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Badr LK. Pain Interventions in Premature Infants: What Is Conclusive Evidence and What Is Not. ACTA ACUST UNITED AC 2012. [DOI: 10.1053/j.nainr.2012.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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