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Deniz B, Sarıalioğlu A. The Effect of Breast Milk Odor on the Pain and Stress Levels of the Newborn During the Endotracheal Suction Procedure. Breastfeed Med 2024; 19:459-466. [PMID: 38526230 DOI: 10.1089/bfm.2023.0325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
Objective: The study aimed to determine the effect of the breast milk odor on the pain and stress levels of the newborn during the endotracheal suction procedure. Method: The study was conducted in the randomized-controlled experimental design at the neonatal intensive care unit of the hospital in eastern Turkey between March 2022 and December 2023. The study population included newborns at the 37th to 41st gestational weeks who were receiving mechanical ventilation treatment in the neonatal intensive care unit of a hospital in eastern Turkey. All newborns who met the inclusion criteria during the data collection phase were included in the study. The study was completed with 88 newborns (44 in the intervention group and 44 in the control group). The Newborn Introductory Information Form, ALPS-Neo Newborn Pain and Stress Assessment Scale, and follow-up form were used to collect the study data. The breast milk odor of the mothers of the newborns was used as the intervention group in the study. The mothers of the newborns were contacted to obtain breast milk, and the information was obtained from the mother on the day of the procedure. One milliliter of breast milk was taken and dropped into a sterile sponge, and it was held 10 cm away from the baby's nose from 5 minutes before to 5 minutes after endotracheal suction. A routine endotracheal suction process was performed in the control group. Ethical principles were followed in the study. Results: We found that the intervention group's pain and stress score averages were lower than the control group during and after the endotracheal suction procedure (p < 0.05). Conclusion: We found that the breast milk odor reduced the pain, stress levels, and crying duration of newborns during the endotracheal suction process.
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Affiliation(s)
- Büşra Deniz
- Department of Child Health and Diseases Nursing, Şanlıurfa Training and Research Hospital, Erzurum, Turkey
| | - Arzu Sarıalioğlu
- Department of Child Health and Diseases Nursing, Atatürk University, Erzurum, Turkey
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Arribas C, Cavallaro G, Gonzalez JL, Lagares C, Raffaeli G, Smits A, Simons SHP, Villamor E, Allegaert K, Garrido F. Global cross-sectional survey on neonatal pharmacologic sedation and analgesia practices and pain assessment tools: impact of the sociodemographic index (SDI). Pediatr Res 2024:10.1038/s41390-024-03032-7. [PMID: 38351093 DOI: 10.1038/s41390-024-03032-7] [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: 08/17/2023] [Revised: 12/22/2023] [Accepted: 01/02/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND There is variability in the use of sedatives and analgesics in neonatal intensive care units (NICUs). We aimed to investigate the use of analgesics and sedatives and the management of neonatal pain and distress. METHODS This was a global, prospective, cross-sectional study. A survey was distributed May-November 2022. The primary outcome of this research was to compare results between countries depending on their socio-sanitary level using the sociodemographic index (SDI). We organized results based on geographical location. RESULTS The survey collected 1304 responses, but we analyzed 924 responses after database cleaning. Responses from 98 different countries were analyzed. More than 60% of NICUs reported having an analgosedation guideline, and one-third of respondents used neonatal pain scales in more than 80% of neonates. We found differences in the management of sedation and analgesia between NICUs on different continents, but especially between countries with different SDIs. Countries with a higher SDI had greater availability of and adherence to analgosedation guidelines, as well as higher rates of analgosedation for painful or distressing procedures. Countries with different SDIs reported differences in analgosedation for neonatal intubation, invasive ventilation, and therapeutic hypothermia, among others. CONCLUSIONS Socio-economic status of countries impacts on neonatal analgosedation management. IMPACT There is significant variability in the pain management practices in neonates. There is a lack of knowledge related to how neonatal pain management practices differ between regions. Sociodemographic index is a key factor associated with differences in neonatal pain management practices across global regions.
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Affiliation(s)
- Cristina Arribas
- Department of Pediatrics, Neonatal Intensive Care Unit, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta, 1, Madrid, 28027, Spain
| | - Giacomo Cavallaro
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy.
| | - Juan-Luis Gonzalez
- Department of Statistics and Operations Research, Faculty of Medicine, University of Cadiz, 11003, Cádiz, Spain
| | - Carolina Lagares
- Department of Statistics and Operations Research, Faculty of Medicine, University of Cadiz, 11003, Cádiz, Spain
| | - Genny Raffaeli
- Neonatal Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, 20122, Milan, Italy
| | - Anne Smits
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
| | - Sinno H P Simons
- Department of Pediatrics, Division of Neonatology, Erasmus University Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Eduardo Villamor
- MosaKids Children's Hospital, Maastricht University Medical Center (MUMC + ), School for Oncology and Reproduction (GROW), Maastricht University, 6202AZ, Maastricht, The Netherlands
| | - Karel Allegaert
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Hospital Pharmacy, Erasmus MC, Rotterdam, The Netherlands
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Felipe Garrido
- Department of Pediatrics, Neonatal Intensive Care Unit, Clínica Universidad de Navarra, Calle Marquesado de Santa Marta, 1, Madrid, 28027, Spain
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Laguna A, Pusil S, Acero-Pousa I, Zegarra-Valdivia JA, Paltrinieri AL, Bazán À, Piras P, Palomares i Perera C, Garcia-Algar O, Orlandi S. How can cry acoustics associate newborns' distress levels with neurophysiological and behavioral signals? Front Neurosci 2023; 17:1266873. [PMID: 37799341 PMCID: PMC10547902 DOI: 10.3389/fnins.2023.1266873] [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] [Received: 07/27/2023] [Accepted: 09/07/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Even though infant crying is a common phenomenon in humans' early life, it is still a challenge for researchers to properly understand it as a reflection of complex neurophysiological functions. Our study aims to determine the association between neonatal cry acoustics with neurophysiological signals and behavioral features according to different cry distress levels of newborns. Methods Multimodal data from 25 healthy term newborns were collected simultaneously recording infant cry vocalizations, electroencephalography (EEG), near-infrared spectroscopy (NIRS) and videos of facial expressions and body movements. Statistical analysis was conducted on this dataset to identify correlations among variables during three different infant conditions (i.e., resting, cry, and distress). A Deep Learning (DL) algorithm was used to objectively and automatically evaluate the level of cry distress in infants. Results We found correlations between most of the features extracted from the signals depending on the infant's arousal state, among them: fundamental frequency (F0), brain activity (delta, theta, and alpha frequency bands), cerebral and body oxygenation, heart rate, facial tension, and body rigidity. Additionally, these associations reinforce that what is occurring at an acoustic level can be characterized by behavioral and neurophysiological patterns. Finally, the DL audio model developed was able to classify the different levels of distress achieving 93% accuracy. Conclusion Our findings strengthen the potential of crying as a biomarker evidencing the physical, emotional and health status of the infant becoming a crucial tool for caregivers and clinicians.
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Affiliation(s)
| | | | | | - Jonathan Adrián Zegarra-Valdivia
- Facultad de Medicina, Universidad Señor de Sipán, Chiclayo, Peru
- Global Brain Health Institute, University of California, San Francisco, San Francisco, CA, United States
- Achucarro Basque Center for Neuroscience, Leioa, Spain
| | - Anna Lucia Paltrinieri
- Neonatology Department, Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | | | | | - Clàudia Palomares i Perera
- Neonatology Department, Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Oscar Garcia-Algar
- Neonatology Department, Barcelona Center for Maternal-Fetal and Neonatal Medicine (BCNatal), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
- Department de Cirurgia I Especialitats Mèdico-Quirúrgiques, Universitat de Barcelona, Barcelona, Spain
| | - Silvia Orlandi
- Department of Electrical, Electronic and Information Engineering “Guglielmo Marconi” (DEI), University of Bologna, Bologna, Italy
- Health Sciences and Technologies Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
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Campbell-Yeo M, Eriksson M, Benoit B. Assessment and Management of Pain in Preterm Infants: A Practice Update. CHILDREN (BASEL, SWITZERLAND) 2022; 9:244. [PMID: 35204964 PMCID: PMC8869922 DOI: 10.3390/children9020244] [Citation(s) in RCA: 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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Knowledge and Practices in Neonatal Pain Management of Nurses Employed in Hospitals with Different Levels of Referral-Multicenter Study. Healthcare (Basel) 2021; 9:healthcare9010048. [PMID: 33466529 PMCID: PMC7824971 DOI: 10.3390/healthcare9010048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background: One of the key elements of patient care is the relief and prevention of pain sensations. The importance of pain prevention and treatment has been emphasized by many international organizations. Despite the recommendations and guidelines based on evidence, contemporary research shows that the problem of pain among patients in neonatal intensive care units (NICUs) in various centers is still an important and neglected problem. Aim: The aim of this study was to assess the level of knowledge of the medical personnel and their perception of the issue of pain in neonatal patients. Methods: A quantitative descriptive study carried out in 2019. The study used a nurses’ perceptions of neonatal pain questionnaire. Results: A total of 43 Polish hospitals and 558 respondents participated in the project. 60.9% (n = 340) and 39.1% (n = 218) of respondents were employed in secondary and tertiary referral departments, respectively. Conclusion: Our analyses indicate that despite the availability of pain assessment tools for neonatal patients, only a few centers use standardized tools. The introduction of strategies to promote and extend the personnel’s awareness of neonatal pain monitoring scales is necessary.
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Tristão RM, Vilela LR, Marques LA, Neiva ER, Costa KN, de Jesus JAL, Fournier-Charrière E. Adaptation and validation of the EVENDOL scale to assess pain in neonates in Portuguese language. Early Hum Dev 2021; 152:105285. [PMID: 33264724 DOI: 10.1016/j.earlhumdev.2020.105285] [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] [Received: 09/02/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND EVENDOL scale (from the French Evaluation Enfant Douleur) is used to evaluate pain in children in any situation covering a wider age group than other pain scales (birth up to seven years). This study aimed to evaluate pain in hospitalized newborns, to adapt and validate the EVENDOL to Brazilian Portuguese. STUDY DESIGN Cross-sectional, cross-cultural adaptation and validation study in a convenience sample from a tertiary hospital, Brazil. EVENDOL was translated and tested for reliability and validity using the PIPP and NFCS scales for comparison. For reliability testing, two observers independently evaluated 117 nociceptive procedures from 87 newborns. Internal consistency coefficient Cronbach's alpha, internal class agreement coefficient, and Kappa factor were appropriately measured. RESULTS The scale's internal consistency reached a value of 0.82, and the estimates of internal consistency and reliability also reached acceptable or very good values. Two-way ANOVA determined statistically significant effect of gestational age on the total score of the EVENDOL (F = 4.14; p = 0.045), younger infants had the lowest values, as lower values of Apgar-5° minute lowered the indicator "Interaction with the Environment" (F = 5.066; p = 0.027). CONCLUSIONS EVENDOL proved to be an easily applied tool and it was psychometrically robust, reliable and valid for use with both premature and term hospitalized newborns, who were clinically stable, being Apgar score and gestational age relevant factors. It is a reliable method of identifying pain in babies who need more support from the hospital staff and now is available for use in Portuguese language. TWEETABLE ABSTRACT The EVENDOL pain scale is now validated for babies born at term and prematurely in Portuguese Language allowing its use in all Lusophone countries.
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Affiliation(s)
- Rosana M Tristão
- Faculty of Medicine and University Hospital, Medicine of Child and Adolescent Area, Faculty of Medicine and University Hospital of University of Brasilia, Brasilia - Federal District 70910-900, Brazil.
| | - Laura R Vilela
- Faculty of Medicine and University Hospital, Medicine of Child and Adolescent Area, Faculty of Medicine and University Hospital of University of Brasilia, Brasilia - Federal District 70910-900, Brazil
| | - Luísa A Marques
- Faculty of Medicine and University Hospital, Medicine of Child and Adolescent Area, Faculty of Medicine and University Hospital of University of Brasilia, Brasilia - Federal District 70910-900, Brazil
| | - Elaine R Neiva
- Psychology Institute, University of Brasilia, Brasilia -Federal District 70910-900, Brazil
| | - Karina N Costa
- Faculty of Medicine and University Hospital, Medicine of Child and Adolescent Area, Faculty of Medicine and University Hospital of University of Brasilia, Brasilia - Federal District 70910-900, Brazil
| | - José Alfredo L de Jesus
- Faculty of Medicine and University Hospital, Medicine of Child and Adolescent Area, Faculty of Medicine and University Hospital of University of Brasilia, Brasilia - Federal District 70910-900, Brazil
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Abushanab D, Abounahia FF, Alsoukhni O, Abdelaal M, Al-Badriyeh D. Clinical and Economic Evaluation of the Impact of Midazolam on Morphine Therapy for Pain Relief in Critically Ill Ventilated Infants with Respiratory Distress Syndrome. Paediatr Drugs 2021; 23:143-157. [PMID: 33354750 PMCID: PMC7755454 DOI: 10.1007/s40272-020-00432-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 10/31/2022]
Abstract
BACKGROUND The impact of midazolam on the overall performance of morphine therapy for pain in ventilated neonates with respiratory distress syndrome (RDS) has never been investigated. OBJECTIVE This study is a clinical and economic analysis of morphine monotherapy versus morphine plus midazolam in ventilated infants with RDS. METHODS A decision-analytic model from the hospital perspective was developed to follow the consequences of the use of the study drugs. Clinical and resource utilization data were extracted based on a retrospective cohort study of 104 neonates with RDS receiving morphine alone versus in combination with midazolam at the main neonatal intensive care unit (NICU) in Qatar, from 2014 to 2019. Primary outcome measures were the analgesia success rate, via the Premature Infant Pain Profile scale, and overall costs of therapies. Multivariate statistical analyses confirmed no significant variations in baseline characteristics between study groups. RESULTS With 0.05 significance and 80% power, morphine had a higher rate of successful analgesia (65.4 vs. 34.6%; risk ratio 1.91; 95% confidence interval 1.11-3.28; p = 0.019). Overall costs were also in favor of morphine compared with its combination with midazolam, with cost savings of 40,959 Qatari Riyal ($US11,222), year 2019/20 values. The Monte Carlo analyses confirmed the economic advantage of morphine alone in 100% of cases and demonstrated that it is not sensitive to uncertainties in study model inputs. CONCLUSIONS Morphine monotherapy enabled enhanced pain relief over its combination with midazolam in the NICU, at a reduced overall cost. Morphine alone, therefore, seems to be a dominant analgesia strategy.
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Affiliation(s)
- Dina Abushanab
- grid.413548.f0000 0004 0571 546XDrug Information Department, Hamad Medical Corporation, Doha, Qatar
| | - Fouad F. Abounahia
- grid.413548.f0000 0004 0571 546XNeonatal Intensive Care Unit Department, Hamad Medical Corporation, Doha, Qatar
| | - Omar Alsoukhni
- Pharmacy Department, Al Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
| | - Mohammed Abdelaal
- grid.498619.bPharmacy and Drug Control, Ministry of Public Health, Doha, Qatar
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Salekin MS, Zamzmi G, Goldgof D, Kasturi R, Ho T, Sun Y. Multimodal spatio-temporal deep learning approach for neonatal postoperative pain assessment. Comput Biol Med 2020; 129:104150. [PMID: 33348218 DOI: 10.1016/j.compbiomed.2020.104150] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
The current practice for assessing neonatal postoperative pain relies on bedside caregivers. This practice is subjective, inconsistent, slow, and discontinuous. To develop a reliable medical interpretation, several automated approaches have been proposed to enhance the current practice. These approaches are unimodal and focus mainly on assessing neonatal procedural (acute) pain. As pain is a multimodal emotion that is often expressed through multiple modalities, the multimodal assessment of pain is necessary especially in case of postoperative (acute prolonged) pain. Additionally, spatio-temporal analysis is more stable over time and has been proven to be highly effective at minimizing misclassification errors. In this paper, we present a novel multimodal spatio-temporal approach that integrates visual and vocal signals and uses them for assessing neonatal postoperative pain. We conduct comprehensive experiments to investigate the effectiveness of the proposed approach. We compare the performance of the multimodal and unimodal postoperative pain assessment, and measure the impact of temporal information integration. The experimental results, on a real-world dataset, show that the proposed multimodal spatio-temporal approach achieves the highest AUC (0.87) and accuracy (79%), which are on average 6.67% and 6.33% higher than unimodal approaches. The results also show that the integration of temporal information markedly improves the performance as compared to the non-temporal approach as it captures changes in the pain dynamic. These results demonstrate that the proposed approach can be used as a viable alternative to manual assessment, which would tread a path toward fully automated pain monitoring in clinical settings, point-of-care testing, and homes.
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Affiliation(s)
- Md Sirajus Salekin
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA.
| | - Ghada Zamzmi
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
| | - Dmitry Goldgof
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
| | - Rangachar Kasturi
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
| | - Thao Ho
- College of Medicine Pediatrics, USF Health, University of South Florida, Tampa, FL, USA
| | - Yu Sun
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, USA
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Popowicz H, Kwiecień-Jaguś K, Olszewska J, Mędrzycka-Dąbrowska WA. Pain Scales in Neonates Receiving Mechanical Ventilation in Neonatal Intensive Care Units - Systematic Review. J Pain Res 2020; 13:1883-1897. [PMID: 32801846 PMCID: PMC7399469 DOI: 10.2147/jpr.s248042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Recently, interest in the problem of proper prevention and monitoring of pain, especially acute, has been increasing in relation to various age groups. Greater awareness of the problem prompts discussion about the purpose of analgesia in newborns treated with mechanical ventilation. AIM The purpose of the systematic review was to analyze current research on the use of pain scales in newborns treated with mechanical ventilation in the Neonatal Intensive Care Unit. METHODS Medline databases: PubMed, OVID, EBSCO, Web of Science and Cochrane Library were traced using the appropriate keywords. The search was limited to studies in English. The review took into account the years 2006-2019. Considering the criteria, 12 articles were included in further analysis, to which full access was obtained. RESULTS The analyzed scientific research showed differences in beliefs about the validity and credibility of the scales used. Researchers indicated that staff with practical experience in using scales in their daily practice was very skeptical of the results obtained on their basis. CONCLUSION Based on this review, no explicit evidence can be obtained to support the use of one proper scale in pain assessment. It can be inferred that the COMFORT and N-PASS scales are effective for pain assessment and for determining the need for analgesics in mechanically ventilated neonates. These scales may be equally effective in assessing chronic pain, especially in mechanically ventilated children. On the other hand, the PIPP and CRIES scales are most commonly recommended for assessing acute and postoperative pain.
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Affiliation(s)
- Hanna Popowicz
- Department of Obstetric and Gynaecological Nursing, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Kwiecień-Jaguś
- Department of Anaesthesiology Nursing and Intensive Care, Medical University of Gdansk, Gdansk, Poland
| | - Jolanta Olszewska
- Department of Obstetric and Gynaecological Nursing, Medical University of Gdansk, Gdansk, Poland
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Gimenez IL, Arakaki VDSNM, Correa RM, dos Santos RS, Peres RT, Sant’Anna CC, Ferreira HC. NEONATAL PAIN: CHARACTERIZATION OF THE PHYSIOTHERAPIST'S PERCEPTION IN THE NEONATAL INTENSIVE CARE UNIT. REVISTA PAULISTA DE PEDIATRIA : ORGAO OFICIAL DA SOCIEDADE DE PEDIATRIA DE SAO PAULO 2019; 38:e2018178. [PMID: 31778412 PMCID: PMC6909228 DOI: 10.1590/1984-0462/2020/38/2018178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Accepted: 10/07/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the perception of physiotherapists in neonatal units regarding pain, the use of measurement scales and strategies that minimize pain. METHODS Interviews were conducted with physiotherapists in hospitals with neonatal units between 2013 and 2015 in Rio de Janeiro. The questions concerned the knowledge of the feeling of pain, from its recognition to its care or treatment. The description of the results was done by comparing public and private hospitals (Fisher''s Exact exact Testtest), considering p<0.05 as significant. RESULTS 27 hospitals were visited. All the professionals interviewed (n=27) stated that the newborns feel pain, with facial expression being the most cited and known sign for pain. 26% of physiotherapists believe that newborns experience pain at the same magnitude as adults. Among the scales, the Neonatal Infant Pain Scale (NIPS) was the most well known, but only 37% of the units had routine pain assessment protocols. IV cannulation and blood collection were the most mentioned procedures as a cause of pain and there was no difference between public and private hospitals. CONCLUSIONS There is a gap in the knowledge about neonatal pain and how to evaluate it among the participating physiotherapists, with no systematization of care routines involving this assessment.
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Affiliation(s)
| | | | | | | | - Rodrigo Tosta Peres
- Centro Federal de Educação Tecnológica Celso Suckow da Fonseca do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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The Indonesian version of the Premature Infant Pain Profile-Revised: Translation and adaptation of a neonatal pain assessment. Int J Nurs Sci 2019; 6:439-444. [PMID: 31728398 PMCID: PMC6838999 DOI: 10.1016/j.ijnss.2019.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 06/12/2019] [Accepted: 06/26/2019] [Indexed: 11/24/2022] Open
Abstract
Purpose Pain assessment is a key component of good pain management in hospitalized infants. This study aimed to translate and adapt a version of pain measurement in infants, the Premature Infant Pain Profile Revised (PIPP-R) into Indonesian. Method The adaptation process of the measuring instrument used a modified Brislin method which included forward translation, back translation 1, group discussion 1, back translation 2, group discussion 2, and pilot testing on neonatal nurses: feasibility test, inter-rater reliability using intraclass correlation (ICC), and internal consistency using Cronbach's α coefficient. Results The PIPP-R version in English has been translated into Indonesian. In general, nurses assessed this measuring instrument as feasible. The inter-rater reliability showed a high agreement (ICC = 0.968, P = 0.001) and this measuring instrument had good internal consistency (Cronbach's α = 0.856). Conclusion The Indonesian version of PIPP-R is easy to use and shows good psychometric properties. The use of this measuring instrument will help nurses and researchers obtain accurate infant pain intensity measurement values.
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Effects of hammock positioning in behavioral status, vital signs, and pain in preterms: a case series study. Braz J Phys Ther 2018; 22:304-309. [PMID: 29598896 DOI: 10.1016/j.bjpt.2018.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/26/2018] [Accepted: 03/02/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The hammock positioning within the incubators simulates the intrauterine environment, however, there is little evidence of its benefits and possible risks. OBJECTIVES The aim of this study was to assess the effects of hammock positioning on behavioral status, vital signs, and pain in very low birth weight preterm newborns. METHODS This is a quasi-experimental/case series study in which premature infants (<1500g) were positioned in supine for one hour in a hammock. The preterm newborns were assessed 10min before, during (2, 20, 40, and 60min), and 10min after hammock positioning with the Brazelton Neonatal Behavioral Assessment Scale, vital signs and pain by the Neonatal Facial Coding System. RESULTS 28 preterm infants between 28 and 36 weeks of gestational age were evaluated. Regarding the behavioral state, the preterm newborns progressively evolved to light or deep sleep during hammock positioning. There was a statistically significant reduction of the heart and respiratory rate from 2 to 60th minute in a hammock, which was maintained after the positioning. The oxygen saturation remained within normal values. No changes in pain scores were observed. CONCLUSION The hammock positioning can be considered a safe method of positioning that can be used to reduce the stress levels in very low birth weight preterm newborns. We did not observe worsening in either pain or vital signs.
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Validation of the Persian Version of Premature Infant Pain Profile-Revised in Hospitalized Infants at the Neonatal Intensive Care Units. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijp.10056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Zimmerman KO, Smith PB, Benjamin DK, Laughon M, Clark R, Traube C, Stürmer T, Hornik CP. Sedation, Analgesia, and Paralysis during Mechanical Ventilation of Premature Infants. J Pediatr 2017; 180:99-104.e1. [PMID: 27522446 PMCID: PMC5183489 DOI: 10.1016/j.jpeds.2016.07.001] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 05/31/2016] [Accepted: 07/01/2016] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To characterize administration of sedatives, analgesics, and paralytics in a large cohort of mechanically ventilated premature infants. STUDY DESIGN Retrospective cohort study including all infants <1500 g birth weight and <32 weeks gestational age (GA) mechanically ventilated at 348 Pediatrix Medical Group neonatal intensive care units from 1997 to 2012. The primary outcome is the proportion of mechanically ventilated days in which infants were administered drugs of interest. Multivariable logistic regression was used to evaluate the predictors of administration of drugs of interest. RESULTS We identified 85 911 mechanically ventilated infants. Infants received a drug of interest (opioids, benzodiazepines, other sedatives, and paralytics) on 433 587/1 305 413 (33%) of mechanically ventilated infant days. The administration of opioids increased during the study period from 5% of infant days in 1997 to 32% in 2012. The administration of benzodiazepines increased during the study period from 5% of infant days in 1997 to 24% in 2012. Use of paralytics and other drugs remained ≤1% throughout the study period. Predictors of drug administration included younger GA, small for GA status, male sex, presence of a major congenital anomaly, older postnatal age at intubation, exposure to high-frequency ventilation, exposure to inotropes, more recent year of discharge, and neonatal intensive care unit site. CONCLUSIONS Administration of opioids and benzodiazepines in mechanically ventilated premature infants increased over time. Because infant characteristics were unchanged, site-specific differences in practice likely explain our observations. Increased administration over time is concerning given limited evidence of benefit and potential for harm.
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Affiliation(s)
- Kanecia O Zimmerman
- Department of Pediatrics, Duke Clinical Research Institute, Duke University, Durham, NC
| | - P Brian Smith
- Department of Pediatrics, Duke Clinical Research Institute, Duke University, Durham, NC
| | | | - Matthew Laughon
- Department of Pediatrics, Division of Neonatology, The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Reese Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, FL
| | - Chani Traube
- Department of Pediatrics, Division of Critical Care Medicine, Weill Cornell Medical College, New York, NY
| | - Til Stürmer
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Christoph P Hornik
- Department of Pediatrics, Duke Clinical Research Institute, Duke University, Durham, NC.
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Akcan E, Polat S. Comparative Effect of the Smells of Amniotic Fluid, Breast Milk, and Lavender on Newborns' Pain During Heel Lance. Breastfeed Med 2016; 11:309-314. [PMID: 27315487 DOI: 10.1089/bfm.2015.0174] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The aim of this randomized controlled experimental study was to evaluate the effect of the smells of amniotic fluid, breast milk, and lavender on the pain of newborns during heel lance. METHODS The sample of the study consisted of 102 newborn infants who complied with the sampling criteria between August and November, 2011. The newborns smelled the samples (lavender, breast milk, amniotic fluid, and distilled water) for 5 minutes before the heel lance until 5 minutes afterward. The Neonatal Infant Pain Scale (NIPS), heart rate, and oxygen saturation were evaluated 1 minute before, during, and 1 minute after the heel lance. Data were evaluated by descriptive statistics, chi-square, intraclass correlation analysis, Spearman's rho correlation, Bonferroni's advanced analysis, Shapiro-Wilk, Kruskal-Wallis, Mann-Whitney U, Friedman, and Dunnett's tests. RESULTS The newborns in the control group had severe pain and the newborns in the breast milk, amniotic fluid, and lavender groups had moderate pain during the heel lance (p < 0.05). While the NIPS score of the newborns in the lavender group was lower than the breast milk and amniotic fluid groups during the heel lance, it was lower in the breast milk and amniotic fluid groups than the lavender group afterward. The lowest falls in oxygen saturation and increased in heart rate were in the breast milk and lavender groups during heel the lance. CONCLUSION The smells of lavender and breast milk prevent the increased heart rates, NIPS, falling oxygen saturation, and reduced pain during the invasive procedures in newborns more than amniotic fluid or control group.
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Affiliation(s)
- Esma Akcan
- 1 Department of Pediatric Nursing, Faculty of Kumluca Health Sciences, Akdeniz University , Antalya, Turkey
| | - Sevinç Polat
- 2 Department of Pediatric Nursing, School of Health, Bozok University , Yozgat, Turkey
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