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Sutton R, Lemermeyer G. Nonpharmacological Interventions to Mitigate Procedural Pain in the NICU: An Integrative Review. Adv Neonatal Care 2024; 24:364-373. [PMID: 38907705 DOI: 10.1097/anc.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
BACKGROUND Small infants experience a myriad of stimuli while in the Neonatal Intensive Care Unit (NICU), with many being painful or stressful experiences, although medically necessary. PURPOSE To determine what is known about nonpharmacological developmental care interventions used in the NICU to mitigate procedural pain of infants born under 32 weeks gestation. SEARCH/STRATEGY Five electronic databases were searched: Medline, CINAHL, Scopus, Embase and the Cochrane Library. The inclusion criteria were as follows: experimental and nonexperimental studies from all publication years with infants born at less than 32 weeks gestational age; peer-reviewed research articles studying nonpharmacological interventions such as skin-to-skin care, facilitated tucking, nonnutritive sucking, hand hugs, and swaddling; and English language articles. Our search yielded 1435 articles. After the elimination of 736 duplicates, a further 570 were deemed irrelevant based on their abstract/titles. Then, 124 full-text articles were analyzed with our inclusion and exclusion criteria. FINDINGS Twenty-seven studies were reviewed. Sucrose, facilitated tucking, pacifier, skin-to-skin care, and human milk appeared to lessen pain experienced during heel sticks, suctioning, nasogastric tube insertions, and echocardiograms. All nonpharmacological interventions failed to prove efficacious to adequately manage pain during retinopathy of prematurity (ROP) examinations. IMPLICATIONS FOR PRACTICE Evidence review demonstrates that healthcare practitioners should use nonpharmacological measures to help prevent pain from day-to-day procedures in the NICU including heel sticks, nasogastric tube insertions, suctioning, echocardiograms, and subcutaneous injections. IMPLICATIONS FOR RESEARCH Future research is necessary to better understand and measure how pain is manifested by very small premature infants. Specific research on mitigating the pain of examinations for retinopathy of prematurity is also needed.
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Affiliation(s)
- Rana Sutton
- Faculty of Nursing,University of Alberta, Edmonton, Alberta
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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: 22] [Impact Index Per Article: 7.3] [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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Gebuza G, Kaźmierczak M, Leńska K. The effects of kangaroo mother care and music listening on physiological parameters, oxygen saturation, crying, awake state and sleep in infants in NICU. J Matern Fetal Neonatal Med 2020; 35:3659-3669. [PMID: 33081550 DOI: 10.1080/14767058.2020.1836619] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Kangaroo mother care and musical stimulation are recommended nursing interventions in the NICU. However, there is little research on the combination of kangaroo care with musical stimulation and their relationship with the health condition of infants. The aim of the study was to compare the parameters of the physiological state and behavior of infants during kangaroo mother care as well as kangaroo mother care and musical stimulation. STUDY DESIGN The study included 100 infants, with corrected gestational ages of 35 weeks, with an average body weight of 2704 g. During kangaroo care the child was supported by their parent, then musical stimulation was added to kangaroo care. Measurements were made in an incubator after the 1st and the 15th minute of each intervention. RESULTS Neonatal parameters differed in the incubator and during each intervention. During kangaroo care and kangaroo care and musical stimulation, heart rate (p < .0001), respiration rate (p < .0001), crying (p < .0001) and awake state (p < .0001) decreased, oxygen saturation levels (p < .0001) and the number of children who fell asleep (p < .0001) increased. During kangaroo care and musical stimulation significantly fewer children were awake (p = .0003) and more fell asleep (p < .0001) than after kangaroo care alone (p < .0001). CONCLUSIONS This study suggests that kangaroo care and kangaroo care and musical stimulation can be used to stabilize the physiological functions of infants. Kangaroo care and musical stimulation can be one of the most effective nursing interventions in the neonatal intensive care unit for the care of infants.
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Affiliation(s)
- Grażyna Gebuza
- Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Marzena Kaźmierczak
- Faculty of Health Sciences, Nicolaus Copernicus University in Torun, Torun, Poland
| | - Katarzyna Leńska
- Neonatal Intensive Care Unit, University Hospital No 2, Bydgoszcz, Poland
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Revisiting the roots of attachment: A review of the biological and psychological effects of maternal skin-to-skin contact and carrying of full-term infants. Infant Behav Dev 2020; 60:101441. [PMID: 32603951 DOI: 10.1016/j.infbeh.2020.101441] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 12/18/2022]
Abstract
During the early period of hypothesis building and empirical testing of attachment theory, a major emphasis was placed on mother-infant physical contact. In spite of this, mother-infant contact has received scant attention amongst attachment and child development researchers in the past decades. Here, a brief theoretical framework for mother-infant contact is presented, drawing on animal studies as well as human studies of preterm infants and neonates. Salient mechanisms may include an extended sensitive period during early infancy, requiring specific somatosensory stimuli for bio-behavioral homeorhesis; oxytocinergic and epigenetic pathways; kinesthetic stimuli and face-to-face proximity allowing for increased social interaction. Studies of extended human mother-full-term infant physical contact have demonstrated positive effects in multiple domains. For infants, these include sleep organization, temperature and heart rate regulation, behavioral response, crying/colic, socio-emotional development, attachment quality, speech development opportunities and mother-child interactions. For mothers, studies demonstrate improved depressive symptomatology, physiological stress regulation, contingent responsivity, breastfeeding and mother-child interactions. Parent-infant attachment quality has gained prominence as a trauma-resilience factor as well as a predictor of adult physical health. The potential role of mother-infant contact as an attachment promoting intervention as well as future research subjects are discussed. Current evidence supports the original attachment research that early maternal touch provision may influence infant socio-emotional development and attachment quality, with positive implications for mother-child relationship functioning.
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Autonomic maturation from birth to 2 years: normative values. Heliyon 2019; 5:e01300. [PMID: 30899829 PMCID: PMC6407160 DOI: 10.1016/j.heliyon.2019.e01300] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Revised: 02/03/2019] [Accepted: 02/27/2019] [Indexed: 01/11/2023] Open
Abstract
Background While heart rate variability (HRV) constitutes a relevant non-invasive tool to assess the autonomic nervous system (ANS) function with recognized diagnostic or therapeutic implications, there is still a lack of established data on maturation of autonomic control of heart rate during the first months of life. The Autonomic Baby Evaluation (AuBE) cohort was built to establish, the normal autonomic maturation profile from birth up to 2 years, in a healthy population of full-term newborns. Methods Heart rate variability analysis was carried out in 271 full-term newborns (mean gestational age 39 wGA + 5 days) from reliable polysomnographic recordings at 0 (n = 270) and 6 (n = 221) months and from a 24-hour ambulatory electrocardiogram (ECG) at 12 (n = 210), 18 (n = 197), and 24 (n = 190) months. Indices of HRV analysis were calculated through the ANSLabTools software. Results Indices are dissociated according a temporal, geometrical, frequency, Poincaré, empirical mode decomposition, fractal, Chaos and DC/AC and entropy analysis. Each index is presented for five different periods of time, 0, 6, 12, 18 and 24 months and with smoothed values in the 3rd, 10th, 50th, 90th and 97th percentiles. Data are also presented for the full cohort and individualized by sex to account for gender variability. Discussion & conclusion The physiological autonomic maturation profile from birth to 2 years in a healthy population of term neonates results in a fine-tuning autonomic maturation underlying progressively a new equilibrium and privileging the parasympathetic activity over the sympathetic activity.
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Kommers DR, Joshi R, van Pul C, Atallah L, Feijs L, Oei G, Bambang Oetomo S, Andriessen P. Features of Heart Rate Variability Capture Regulatory Changes During Kangaroo Care in Preterm Infants. J Pediatr 2017; 182:92-98.e1. [PMID: 27989406 DOI: 10.1016/j.jpeds.2016.11.059] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 11/01/2016] [Accepted: 11/22/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether heart rate variability (HRV) can serve as a surrogate measure to track regulatory changes during kangaroo care, a period of parental coregulation distinct from regulation within the incubator. STUDY DESIGN Nurses annotated the starting and ending times of kangaroo care for 3 months. The pre-kangaroo care, during-kangaroo care, and post-kangaroo care data were retrieved in infants with at least 10 accurately annotated kangaroo care sessions. Eight HRV features (5 in the time domain and 3 in the frequency domain) were used to visually and statistically compare the pre-kangaroo care and during-kangaroo care periods. Two of these features, capturing the percentage of heart rate decelerations and the extent of heart rate decelerations, were newly developed for preterm infants. RESULTS A total of 191 kangaroo care sessions were investigated in 11 preterm infants. Despite clinically irrelevant changes in vital signs, 6 of the 8 HRV features (SD of normal-to-normal intervals, root mean square of the SD, percentage of consecutive normal-to-normal intervals that differ by >50 ms, SD of heart rate decelerations, high-frequency power, and low-frequency/high-frequency ratio) showed a visible and statistically significant difference (P <.01) between stable periods of kangaroo care and pre-kangaroo care. HRV was reduced during kangaroo care owing to a decrease in the extent of transient heart rate decelerations. CONCLUSION HRV-based features may be clinically useful for capturing the dynamic changes in autonomic regulation in response to kangaroo care and other changes in environment and state.
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Affiliation(s)
- Deedee R Kommers
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands; Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Rohan Joshi
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands; Department of Clinical Physics, Máxima Medical Center, Veldhoven, The Netherlands.
| | - Carola van Pul
- Department of Clinical Physics, Máxima Medical Center, Veldhoven, The Netherlands; Department of Applied Physics, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Louis Atallah
- Patient Care and Measurements Department, Philips Research, Eindhoven, The Netherlands
| | - Loe Feijs
- Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Guid Oei
- Department of Gynecology, Máxima Medical Center, Veldhoven, The Netherlands; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Sidarto Bambang Oetomo
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands; Department of Industrial Design, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Center, Veldhoven, The Netherlands; Department of Pediatrics, Maastricht University Medical Center, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
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A critical analysis of the role of the nurse in the implementation of skin-to-skin on the neonatal unit. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.jnn.2015.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Harrison TM, Ludington-Hoe S. A Case Study of Infant Physiologic Response to Skin-to-Skin Contact After Surgery for Complex Congenital Heart Disease. J Cardiovasc Nurs 2015; 30:506-16. [PMID: 25325374 PMCID: PMC4400181 DOI: 10.1097/jcn.0000000000000202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Infants with complex congenital heart disease requiring surgical intervention within the first days or weeks of life may be the most seriously ill infants needing intensive nursing and medical care. Skin-to-skin contact (SSC) is well accepted and practiced as a positive therapeutic intervention in premature infants but is not routinely offered to infants in cardiac intensive care units. The physiologic effects of SSC in the congenital heart disease population must be examined before recommending incorporation of SSC into standard care routines. OBJECTIVE The purpose of this case study was to describe the physiologic response to a single session of SSC in an 18-day-old infant with hypoplastic left heart syndrome. METHODS Repeated measures of heart rate, respiratory rate, oxygen saturation, blood pressure, and temperature were recorded 30 minutes before SSC, during SSC (including interruptions for bottle and breast feedings), and 10 minutes after SSC was completed. RESULTS All physiologic parameters were clinically acceptable throughout the 135-minute observation. CONCLUSION This case study provides beginning evidence that SSC is safe in full-term infants after surgery for complex congenital heart disease. Further research with a larger sample is needed to examine the effects of SSC on infant physiology before surgery and earlier in the postoperative time period as well as on additional outcomes such as length of stay, maternal-infant interaction, and neurodevelopment.
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Affiliation(s)
- Tondi M Harrison
- Tondi M. Harrison, PhD, RN, CPNP Assistant Professor, School of Nursing, University of Minnesota, Minneapolis. Susan Ludington-Hoe, PhD, CNM, FAAN Carl W. and Margaret Davis Walter Professor of Pediatric Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio
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Feldman R, Rosenthal Z, Eidelman AI. Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry 2014; 75:56-64. [PMID: 24094511 DOI: 10.1016/j.biopsych.2013.08.012] [Citation(s) in RCA: 324] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 08/05/2013] [Accepted: 08/06/2013] [Indexed: 12/01/2022]
Abstract
BACKGROUND Maternal-newborn contact enhances organization of the infant's physiological systems, including stress reactivity, autonomic functioning, and sleep patterns, and supports maturation of the prefrontal cortex and its ensuing effects on cognitive and behavioral control. Premature birth disrupts brain development and is associated with maternal separation and disturbances of contact-sensitive systems. However, it is unknown whether the provision of maternal-preterm contact can improve long-term functioning of these systems. METHODS We used the Kangaroo Care (KC) intervention and provided maternal-newborn skin-to-skin contact to 73 premature infants for 14 consecutive days compared with 73 case-matched control subjects receiving standard incubator care. Children were then followed seven times across the first decade of life and multiple physiologic, cognitive, parental mental health, and mother-child relational measures were assessed. RESULTS KC increased autonomic functioning (respiratory sinus arrhythmia, RSA) and maternal attachment behavior in the postpartum period, reduced maternal anxiety, and enhanced child cognitive development and executive functions from 6 months to 10 years. By 10 years of age, children receiving KC showed attenuated stress response, improved RSA, organized sleep, and better cognitive control. RSA and maternal behavior were dynamically interrelated over time, leading to improved physiology, executive functions, and mother-child reciprocity at 10 years. CONCLUSIONS These findings are the first to demonstrate long-term effects of early touch-based intervention on children's physiologic organization and behavioral control and have salient implications for the care practices of premature infants. Results demonstrate the dynamic cascades of child physiological regulation and parental provisions in shaping developmental outcome and may inform the construction of more targeted early interventions.
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Affiliation(s)
- Ruth Feldman
- Gonda Multi-Disciplinary Brain Research Center, Bar-Ilan University, Ramat-Gan.
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Patural H, Flori S, Pichot V, Barthelemy JC, Roche F. [Autonomic regulation and bradycardia during the neonatal period]. Arch Pediatr 2013; 21:226-30. [PMID: 24290181 DOI: 10.1016/j.arcped.2013.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 08/28/2013] [Accepted: 10/14/2013] [Indexed: 12/16/2022]
Abstract
The high frequency of bradycardia observed during the neonatal period requires cardiac monitoring but also understanding its intrinsic mechanisms, including responsiveness of the autonomic nervous system (ANS). Heart rate variability and spontaneous baroreflex analysis can help understand the autonomic dysregulation of cardiorespiratory control, possibly responsible for sudden infant death. In clinical neonatology practice, neonatal bradycardia does not warrant continuation of monitoring if it remains isolated, asymptomatic, and short (<10 s), followed by a rapid cardiac acceleration indicating an adapted sympathetic response. Further evaluation of ANS responsiveness is possible for newborns including analyzing the complexity of the heart rate and respiratory variability. This allows better targeting children with high risk after discharge. The real-time evaluation of autonomic regulation could become a valuable tool in clinical practice.
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Affiliation(s)
- H Patural
- Réanimation néonatale et pédiatrique, centre hospitalier universitaire de Saint-Étienne, 42005 Saint-Étienne, France; EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France.
| | - S Flori
- EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France
| | - V Pichot
- EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France
| | - J-C Barthelemy
- EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France
| | - F Roche
- EA SNA-Epis 4607, université Jean-Monnet, 42023 Saint-Étienne, France
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Cong X, Ludington-Hoe S, Vazquez V, Zhang D, Zaffetti S. Ergonomic procedure for heel sticks and shots in Kangaroo Care (skin-to-skin) position. Neonatal Netw 2013; 32:353-357. [PMID: 23985473 DOI: 10.1891/0730-0832.32.5.353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Kangaroo Care (KC) has been recommended as a pain-reducing strategy in neonates; however, KC has not been widely used to minimize procedural pain caused in part by nurses'/phlebotomists' discomfort when positioning themselves and the infant for blood drawing and injections. Therefore, an ergonomically designed setup incorporating the use of KC was introduced into clinical practice to facilitate blood draws and injections. The step-by-step procedure used for heel sticks and injections is presented in this manuscript. After implementing the ergonomic step-by-step protocol, complaints of discomfort by nurses and phlebotomists ceased, and an additional benefit was that infant pain responses were significantly reduced.
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Affiliation(s)
- Xiaomei Cong
- University of Connecticut School of Nursing, 231 Glenbrook Road, Unit 2026, Storrs, CT 06269-2026, USA.
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Ishizaki Y, Nagahama T, Kaneko K. Mental health of mothers and their premature infants for the prevention of child abuse and maltreatment. Health (London) 2013. [DOI: 10.4236/health.2013.53a081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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