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Steinbauer P, Lisy T, Monje FJ, Chwala E, Wildner B, Schned H, Deindl P, Berger A, Giordano V, Olischar M. Impact of neonatal pain and opiate administration in animal models: A meta-analysis concerning pain threshold. Early Hum Dev 2024; 193:106014. [PMID: 38701669 DOI: 10.1016/j.earlhumdev.2024.106014] [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] [Received: 02/14/2024] [Revised: 04/16/2024] [Accepted: 04/17/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND AND AIM Neonatal intensive care treatment, including frequently performed painful procedures and administration of analgesic drugs, can have different effects on the neurodevelopment. This systematic review and meta-analysis aimed to investigate the influence of pain, opiate administration, and pre-emptive opiate administration on pain threshold in animal studies in rodents, which had a brain development corresponding to preterm and term infants. METHODS A systematic literature search of electronic data bases including CENTRAL (OVID), CINAHL (EBSCO), Embase.com, Medline (OVID), Web of Science, and PsycInfo (OVID) was conducted. A total of 42 studies examining the effect of pain (n = 38), opiate administration (n = 9), and opiate administration prior to a painful event (n = 5) in rodents were included in this analysis. RESULTS The results revealed that pain (g = 0.42, 95%CI 0.16-0.67, p = 0.001) increased pain threshold leading to hypoalgesia. Pre-emptive opiate administration had the opposite effect, lowering pain threshold, when compared to pain without prior treatment (g = -1.79, 95%CI -2.71-0.86, p = 0.0001). Differences were found in the meta regression for type of stimulus (thermal: g = 0.66, 95%CI 0.26-1.07, p = 0.001; vs. mechanical: g = 0.13, 95%CI -0.98-1.25, p = 0.81) and gestational age (b = -1.85, SE = 0.82, p = 0.027). In addition, meta regression indicated an association between higher pain thresholds and the amount of cumulative pain events (b = 0.06, SE = 0.03, p = 0.05) as well as severity of pain events (b = 0.94, SE = 0.28, p = 0.001). CONCLUSION Neonatal exposure to pain results in higher pain thresholds. However, caution is warranted in extrapolating these findings directly to premature infants. Further research is warranted to validate similar effects in clinical contexts and inform evidence-based practices in neonatal care.
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Affiliation(s)
- Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
| | - Tamara Lisy
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Francisco J Monje
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Eva Chwala
- Information Retrieval Office, University Library of the Medical University of Vienna, Vienna, Austria
| | - Brigitte Wildner
- Information Retrieval Office, University Library of the Medical University of Vienna, Vienna, Austria
| | - Hannah Schned
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg-Eppendorf, Germany
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Vito Giordano
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics and Adolescent Medicine, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
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Canepa ME, Raffini L, Ramenghi LA. Terminology matters: is the International Association for the Study of Pain definition of pain fully satisfactory for fetuses, neonates, and infants? FRONTIERS IN PAIN RESEARCH 2024; 5:1369945. [PMID: 38818234 PMCID: PMC11137166 DOI: 10.3389/fpain.2024.1369945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/08/2024] [Indexed: 06/01/2024] Open
Affiliation(s)
- M. E. Canepa
- Department of Neuroscience, Ophthalmology, Genetics and Mother-Child Health, University of Genoa, Genoa, Italy
| | - L. Raffini
- Department of Political and International Science (DISPI), University of Genoa, Genoa, Italy
| | - L. A. Ramenghi
- Department of Neuroscience, Ophthalmology, Genetics and Mother-Child Health, University of Genoa, Genoa, Italy
- Neonatal Intensive Care Unit and Mother Child Division Chief, IRCCS Giannina Gaslini, Genoa, Italy
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Bernardes LS, Fernandes AM, Carvalho MA, Ottolia J, Hamani M, Oliveira I, Kubota GT, da Silva VA, Veloso A, de Carvalho MHB, de Amorim Filho AG, Arenholt LTS, Leutscher PC, de Andrade DC. Assessment of Human Fetuses Undergoing Acute Pain: Validation of the Fetal-7 Scale. THE JOURNAL OF PAIN 2024:104527. [PMID: 38599264 DOI: 10.1016/j.jpain.2024.104527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/24/2024] [Accepted: 04/02/2024] [Indexed: 04/12/2024]
Abstract
Improvements in fetal ultrasound have allowed for the diagnosis and treatment of fetal diseases in the uterus, often through surgery. However, little attention has been drawn to the assessment of fetal pain. To address this gap, a fetal pain scoring system, known as the Fetal-7 scale, was developed. The present study is a full validation of the Fetal-7 scale. The validation involved 2 steps: 1) 4 fetuses with the indication of surgery were evaluated in 3 conditions perioperatively: acute pain, rest, and under loud sound stimulation. Facial expressions were assessed by 30 raters using screenshots from 4D high-definition ultrasound films; 2) assessment of sensitivity and specificity of the Fetal-7 scale in 54 healthy fetuses and 2 fetuses undergoing acute pain after preoperative anesthetic intramuscular injection. There was high internal consistency with Cronbach's alpha (α) of .99. Intrarater reliability of the Fetal-7 scale (test-retest) calculated by intraclass correlation coefficient was .95, and inter-rater reliability was .99. The scale accurately differentiated between healthy fetuses at rest and those experiencing acute pain (sensitivity of 100% and specificity of 94.4%). The Fetal-7 scale is a valid tool for assessing acute pain-related behavior in third-trimester fetuses and may be of value in guiding analgesic procedures efficacy in these patients. Further research is warranted to explore the presence of postoperative pain in fetuses and its effects after birth. PERSPECTIVE: Recordings with 3-dimensional ultrasound of human fetuses undergoing preoperative anesthetic injections revealed complex facial expressions during acute pain, similar to those collected in newborns. This study presented the validation process and cut-off value of the Fetal-7 scale, paving the way for the study of pain before birth in humans.
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Affiliation(s)
- Lisandra S Bernardes
- Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Gynecology and Obstetrics Department, University of Sao Paulo, São Paulo, Brazil; Gynecology and obstetrics, SEPACO Maternity Hospital, São Paulo, Brazil; Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Hjoerring, Denmark.
| | - Ana M Fernandes
- Pain Center, Department of Neurology, University of Sao Paulo, São Paulo, Brazil
| | - Mariana A Carvalho
- Gynecology and Obstetrics Department, University of Sao Paulo, São Paulo, Brazil; Gynecology and obstetrics, SEPACO Maternity Hospital, São Paulo, Brazil
| | - Juliana Ottolia
- Gynecology and Obstetrics Department, University of Sao Paulo, São Paulo, Brazil; Gynecology and obstetrics, SEPACO Maternity Hospital, São Paulo, Brazil
| | - Michele Hamani
- Pain Center, Department of Neurology, University of Sao Paulo, São Paulo, Brazil
| | - Inaeh Oliveira
- Pain Center, Department of Neurology, University of Sao Paulo, São Paulo, Brazil
| | - Gabriel T Kubota
- Pain Center, Department of Neurology, University of Sao Paulo, São Paulo, Brazil
| | - Valquíria A da Silva
- Pain Center, Department of Neurology, University of Sao Paulo, São Paulo, Brazil
| | - Adriano Veloso
- Computational Science Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Louise T S Arenholt
- Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Gynecology and Obstetrics, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter C Leutscher
- Center for Clinical Research, North Denmark Regional Hospital, Hjoerring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Daniel C de Andrade
- Center for Neuroplasticity and Pain, Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark; Pain Center, Department of Neurology, University of Sao Paulo, São Paulo, Brazil
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Racine N, Chow C, Hamwi L, Bucsea O, Cheng C, Du H, Fabrizi L, Jasim S, Johannsson L, Jones L, Laudiano-Dray MP, Meek J, Mistry N, Shah V, Stedman I, Wang X, Riddell RP. Health Care Professionals' and Parents' Perspectives on the Use of AI for Pain Monitoring in the Neonatal Intensive Care Unit: Multisite Qualitative Study. JMIR AI 2024; 3:e51535. [PMID: 38875686 PMCID: PMC11041412 DOI: 10.2196/51535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/24/2023] [Accepted: 12/17/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND The use of artificial intelligence (AI) for pain assessment has the potential to address historical challenges in infant pain assessment. There is a dearth of information on the perceived benefits and barriers to the implementation of AI for neonatal pain monitoring in the neonatal intensive care unit (NICU) from the perspective of health care professionals (HCPs) and parents. This qualitative analysis provides novel data obtained from 2 large tertiary care hospitals in Canada and the United Kingdom. OBJECTIVE The aim of the study is to explore the perspectives of HCPs and parents regarding the use of AI for pain assessment in the NICU. METHODS In total, 20 HCPs and 20 parents of preterm infants were recruited and consented to participate from February 2020 to October 2022 in interviews asking about AI use for pain assessment in the NICU, potential benefits of the technology, and potential barriers to use. RESULTS The 40 participants included 20 HCPs (17 women and 3 men) with an average of 19.4 (SD 10.69) years of experience in the NICU and 20 parents (mean age 34.4, SD 5.42 years) of preterm infants who were on average 43 (SD 30.34) days old. Six themes from the perspective of HCPs were identified: regular use of technology in the NICU, concerns with regard to AI integration, the potential to improve patient care, requirements for implementation, AI as a tool for pain assessment, and ethical considerations. Seven parent themes included the potential for improved care, increased parental distress, support for parents regarding AI, the impact on parent engagement, the importance of human care, requirements for integration, and the desire for choice in its use. A consistent theme was the importance of AI as a tool to inform clinical decision-making and not replace it. CONCLUSIONS HCPs and parents expressed generally positive sentiments about the potential use of AI for pain assessment in the NICU, with HCPs highlighting important ethical considerations. This study identifies critical methodological and ethical perspectives from key stakeholders that should be noted by any team considering the creation and implementation of AI for pain monitoring in the NICU.
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Affiliation(s)
- Nicole Racine
- School of Psychology, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Cheryl Chow
- Department of Psychology, York University, Toronto, ON, Canada
| | - Lojain Hamwi
- Department of Psychology, York University, Toronto, ON, Canada
| | - Oana Bucsea
- Department of Psychology, York University, Toronto, ON, Canada
| | - Carol Cheng
- Department of Nursing, Mount Sinai Hospital, Toronto, ON, Canada
| | - Hang Du
- Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Sara Jasim
- Department of Psychology, York University, Toronto, ON, Canada
| | | | - Laura Jones
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Maria Pureza Laudiano-Dray
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Judith Meek
- Neonatal Care Unit, University College London Hospitals, London, United Kingdom
| | - Neelum Mistry
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ian Stedman
- School of Public Policy and Administration, York University, Toronto, ON, Canada
| | - Xiaogang Wang
- Department of Mathematics and Statistics, York University, Toronto, ON, Canada
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Wu BY, Ou-Yang MC, Liu CT, Huang HC, Hu WL, Chen IL, Chang HY, Chung MY, Chen FS, Chen YH, Chen CC. Analgesic Effect of Low-Level Laser Therapy before Heel Lance for Pain Management in Healthy Term Neonates: A Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1901. [PMID: 38136103 PMCID: PMC10741995 DOI: 10.3390/children10121901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
Currently, the prevention, assessment, and management of procedural pain in neonates continues to challenge clinicians and researchers. Objective. To investigate the analgesic effect of low-level laser therapy (LLLT) during heel lance compared to breast milk (BM) feeding in healthy term neonates. In this randomized controlled trial, healthy term neonates who underwent heel lance were randomly assigned to an LLLT or a BM group. The LLLT group received laser therapy to the heel lance site for 20 s before heel lance. The BM group received 5 mL expressed BM via a syringe before heel lance. The primary outcomes were behavioral responses. The secondary outcomes were physiological responses and levels of salivary cortisol and α-amylase. A total of 125 neonates were included, of whom 55 in the LLLT group and 59 in the BM group completed the study. There were no significant differences in latency to first cry and cry duration between the two groups. The squeeze time was significantly shorter in the LLLT group than in the BM group (p = 0.047). There were no significant differences in pain scores, heart rate, respiratory rate, oxygen saturation, and blood pressure before and after heel lance between the two groups. There were no significant differences in salivary cortisol and α-amylase levels in the LLLT group before and after heel lance; however, the differences were significant in the BM group. These findings suggest that the analgesic effect of LLLT is similar to that of BM during heel lance in healthy term neonates. LLLT has potential as an analgesic treatment.
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Affiliation(s)
- Bei-Yu Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (B.-Y.W.); (C.-T.L.); (W.-L.H.)
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404333, Taiwan
- College of Nursing, Fooyin University, Kaohsiung 83102, Taiwan
| | - Mei-Chen Ou-Yang
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Chun-Ting Liu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (B.-Y.W.); (C.-T.L.); (W.-L.H.)
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404333, Taiwan
| | - Hsin-Chun Huang
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (B.-Y.W.); (C.-T.L.); (W.-L.H.)
- College of Nursing, Fooyin University, Kaohsiung 83102, Taiwan
- College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - I-Lun Chen
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Hsin-Yu Chang
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Mei-Yung Chung
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Feng-Shun Chen
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404333, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
| | - Chih-Cheng Chen
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
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Turczynowicz A, Jakubów P, Niedźwiecka K, Kondracka J, Pużyńska W, Tałałaj M, Guszczyn T, Grabala P, Kowalczuk O, Kocańda S. Mu-Opioid Receptor 1 and C-Reactive Protein Single Nucleotide Polymorphisms as Biomarkers of Pain Intensity and Opioid Consumption. Brain Sci 2023; 13:1629. [PMID: 38137077 PMCID: PMC10741726 DOI: 10.3390/brainsci13121629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023] Open
Abstract
Children constitute a special group in pain therapy. Single nucleotide polymorphisms that are associated with differences in postoperative, inflammatory pain perception and opioid requirement are the A118G SNP in the mu-opioid receptor 1 (OPRM1) gene and the rs1205 CRP. This study aimed to determine connection between OPRM1 and rs1205 CRP SNPs in pediatric patients postoperatively and pain intensity, the opioid dose needed to control pain after scoliosis correction, and other clinical aspects. Genotypes of rs1205 CRP and OPRM1 polymorphisms in a sample of 31 patients were specified, and statistical analysis was performed in terms of age, genotype frequency, pain assessment, sufentanil flow, post-anesthesia care unit stay, and the use of coanalgesics. The frequency of A/A and A/G genotypes in the OPRM1 gene was in line with 1000Genomes data for the European population. Patients from the AG group of OPRM1 SNP more frequently required coanalgesics for adequate pain control; however, it was of weak statistical significance. Other parameters measured in the study were not statistically significant in relation to OPRM1 and CRP polymorphisms. The effect of SNPs on postoperative pain management and opioid therapy in children was not confirmed by this study. An expansion of the study sample and other opioid-related SNPs is required.
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Affiliation(s)
- Aleksander Turczynowicz
- Department of Anesthesiology and Intensive Care for Children and Adolescents with Postoperative and Pain Treatment Unit, Medical University of Bialystok, 15-274 Bialystok, Poland; (P.J.); (J.K.); (M.T.)
| | - Piotr Jakubów
- Department of Anesthesiology and Intensive Care for Children and Adolescents with Postoperative and Pain Treatment Unit, Medical University of Bialystok, 15-274 Bialystok, Poland; (P.J.); (J.K.); (M.T.)
| | - Karolina Niedźwiecka
- Department of Cardiosurgery, Medical University of Bialystok, 15-276 Bialystok, Poland; (K.N.)
| | - Julia Kondracka
- Department of Anesthesiology and Intensive Care for Children and Adolescents with Postoperative and Pain Treatment Unit, Medical University of Bialystok, 15-274 Bialystok, Poland; (P.J.); (J.K.); (M.T.)
| | - Weronika Pużyńska
- Department of Palliative Medicine, Medical University of Bialystok, 15-276 Bialystok, Poland;
| | - Mariola Tałałaj
- Department of Anesthesiology and Intensive Care for Children and Adolescents with Postoperative and Pain Treatment Unit, Medical University of Bialystok, 15-274 Bialystok, Poland; (P.J.); (J.K.); (M.T.)
| | - Tomasz Guszczyn
- Department of Pediatric Orthopedics and Traumatology, Medical University of Bialystok, 15-274 Bialystok, Poland; (T.G.); (P.G.)
| | - Paweł Grabala
- Department of Pediatric Orthopedics and Traumatology, Medical University of Bialystok, 15-274 Bialystok, Poland; (T.G.); (P.G.)
| | - Oksana Kowalczuk
- Department of Clinical Molecular Biology, Medical University of Bialystok, 15-269 Bialystok, Poland
| | - Szymon Kocańda
- Department of Cardiosurgery, Medical University of Bialystok, 15-276 Bialystok, Poland; (K.N.)
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Nimbalkar SM, Thakkar FA, Thacker JP, Phatak AG, Shinde MK. Comparison of Sucrose vs. Swaddling in Pain Management during Birth Dose of Hepatitis B Vaccine: A Randomized Control Trial. Indian J Pediatr 2023:10.1007/s12098-023-04900-6. [PMID: 37991714 DOI: 10.1007/s12098-023-04900-6] [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: 05/22/2023] [Accepted: 10/05/2023] [Indexed: 11/23/2023]
Abstract
OBJECTIVES To evaluate the efficacy of pain management of 1 ml of 24% sucrose given orally compared to routine care given one minute before vaccination for reduction of pain. METHODS This double-blind randomized controlled trial included term neonates visiting Pediatric OPD for immunization. Neonates were randomly assigned into two groups (Group A- Sucrose, Group B- Swaddling). Commercially available sucrose solution (StayHappi solution 24%) was given in a dose of 1 ml to the neonates. Video recording of the neonate's facial expression was done during the procedure. Duration of cry, latency of onset of cry as well Modified Neonatal Facial Coding Score (MFCS) were the outcome variables. RESULTS The mean (SD) of birth weight and gestational age was 2729 (321.6) g and 38.24 (0.84) d, respectively. Analysis showed significant difference in total MFCS across the groups (P <0.001). Total MFCS was significantly lower in sucrose group [4.88 (1.07) vs. 7.17 (0.95)]. The duration of cry (in seconds) was also found to be significantly lower in sucrose group. CONCLUSIONS Administration of 1 ml 24% sucrose one minute prior to immunization is efficacious in pain management during injectable immunization.
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Affiliation(s)
- Somashekhar M Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India.
| | - Fenil A Thakkar
- Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
| | - Jigar P Thacker
- Department of Pediatrics, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
| | - Ajay G Phatak
- Central Research Services, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
| | - Mayur K Shinde
- Central Research Services, Pramukhswami Medical College, Bhaikaka University, Charutar Arogya Mandal, Karamsad, India
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Luo F, Zhu H, Mei L, Shu Q, Cheng X, Chen X, Zhao Y, Chen S, Pan Y. Evaluation of procedural pain for neonates in a neonatal intensive care unit: a single-centre study. BMJ Paediatr Open 2023; 7:e002107. [PMID: 37821124 PMCID: PMC10582867 DOI: 10.1136/bmjpo-2023-002107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/16/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND To evaluate the procedural pain experienced by neonates in a neonatal intensive care unit (NICU) setting and determine the corresponding pain grades. METHODS Two experienced nurses independently used the Neonatal Infant Pain Scale (NIPS) to evaluate the neonatal pain during procedures taking place in the tertiary NICU and two level-two neonatal care units in the Children's Hospital of Zhejiang University School of Medicine. The mean and distribution of NIPS pain scores and the corresponding pain grades of participants when experiencing clinical painful procedures were analysed. RESULTS A total of 957 neonates exposed to 15 common clinical painful procedures were included in the study. The clinical painful procedures experienced by 957 participants could be divided into three groups: severe pain (NIPS score 5-7: peripheral intravenous cannulation, arterial catheterisation, arterial blood sampling, peripherally inserted central catheter placement and nasopharyngeal suctioning), mild to moderate pain (NIPS score 3-4: finger prick, intramuscular injection, adhesive removal, endotracheal intubation suctioning, heel prick, lumbar puncture and subcutaneous injection) and no pain to mild pain (NIPS score 0-2: gastric tube insertion, enema and intravenous injection). CONCLUSIONS The neonatal pain response to clinical procedures in NICU had certain pattern and preintervention drug analgesia could be taken for painful procedures with clustered high NIPS pain scores. Meanwhile, full coverage non-drug pain relief measures could be taken for procedures that are with scattered pain scores, and real-time pain evaluation should be provided to determine whether further drug analgesia is required.
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Affiliation(s)
- Feixiang Luo
- Neonatal Intensive Care Unit, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China
| | - Huaiyu Zhu
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lingli Mei
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Qi Shu
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaoying Cheng
- Quality Improvement Office, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Xiaofei Chen
- Gastroenterology Department, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yisheng Zhao
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shuohui Chen
- Administration Department of Nosocomial Infection, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Yun Pan
- College of Information Science and Electronic Engineering, Zhejiang University, Hangzhou, Zhejiang, China
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9
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Maroni A, Aubelle MS, Chollat C. Fetal, Preterm, and Term Neonate Exposure to Remifentanil: A Systematic Review of Efficacy and Safety. Paediatr Drugs 2023; 25:537-555. [PMID: 37541994 DOI: 10.1007/s40272-023-00583-w] [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] [Accepted: 06/29/2023] [Indexed: 08/06/2023]
Abstract
BACKGROUND Owing to its pharmacodynamic properties, especially the rapid onset and short duration of its action, the use of remifentanil in obstetric anesthesia, as well as in neonatology, might be increasingly used. OBJECTIVE We conducted a systematic review to assess the efficacy and safety of remifentanil in preterm and term neonates. Outcomes of interest were neonatal adaptation after fetal exposure; neonatal pain, distress, and discomfort control during invasive procedures; and the occurrence of hemodynamic effects or respiratory depression induced by remifentanil infusion. METHODS Given the different contexts of use, we have organized this work into three parts: (A) use of remifentanil for labor or cesarean section, with exposure of the fetus before birth, (B) brief use for neonatal procedural analgesia, and (C) prolonged use for sedation/analgesia of neonates. The bibliographic search was conducted based on keywords using electronic medical databases (DATABASE, Cochrane Library, PubMed, and EMBASE) from 1 January 2000 until 31 December 2022. RESULTS Twenty-two articles were included (10 in part A, 5 in part B and 7 in part C). Prospective, controlled, randomized, blinded, and intention-to-treat trials were retained. Neonates were well adapted after exposure to remifentanil in the fetal period. Pain, stress, and discomfort were controlled during a brief or prolonged invasive procedure when remifentanil was used for sedation/analgesia. The physiological parameters were stable and the procedures were straightforward. Chest wall rigidity appeared to be a common side effect, but this can be managed by slow and continuous infusion and by using the minimum effective dose. CONCLUSIONS Remifentanil appears to be effective and safe in the short term in preterm and full-term neonates. However, its safety is compromised by the risk of chest wall rigidity. It should be used in appropriate neonatal units and in the presence of physicians able to monitor its side effects. Long-term outcomes have not been evaluated, to our knowledge.
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Affiliation(s)
- Arielle Maroni
- Pediatric Intensive Care Unit, Robert Debré University Hospital, APHP, 75019, Paris, France
| | | | - Clément Chollat
- Department of Neonatal Paediatrics, Trousseau Hospital, APHP, Sorbonne Université, 26 Av. du Dr Arnold Netter, 75012, Paris, France.
- Université Paris Cité, Inserm, NeuroDiderot, 75019, Paris, France.
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Kara N, Arman D, Seymen Z, Gül A, Cömert S. Effects of fentanyl and sucrose on pain in retinopathy examinations with pain scale, near-infrared spectroscopy, and ultrasonography: a randomized trial. World J Pediatr 2023; 19:873-882. [PMID: 36976515 DOI: 10.1007/s12519-023-00705-x] [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] [Received: 08/04/2022] [Accepted: 02/12/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND This study aimed to compare the efficacy of intravenous, intranasal fentanyl and oral sucrose in reducing the pain response during retinopathy of prematurity examinations using premature infant pain profile (PIPP) scores. METHOD The study included 42 infants who underwent retinopathy screening examinations. The infants were divided into three groups: oral sucrose, intranasal fentanyl, and intravenous fentanyl. Vital signs (heart rate, arterial oxygen saturation, and mean arterial pressure) were recorded. The PIPP was used to determine pain severity. Cerebral oxygenation and middle cerebral artery blood flow were evaluated using near-infrared spectroscopy and Doppler ultrasonography, respectively. The data obtained were compared between groups. RESULTS There was no significant difference between the three groups regarding postconceptional and postnatal ages or birth weights and weight at the time of examination. All babies had moderate pain during the examination. No correlation was observed between analgesia method and pain scores (P = 0.159). In all three groups, heart rate and mean arterial pressure increased, whereas oxygen saturation decreased during the exam compared with pre-examination values. However, heart rate (HR), mean arterial pressure (MAP) and arterial oxygen saturation (sPO2) values did not differ between groups (HR, P = 0.150; MAP, P = 0.245; sPO2, P = 0.140). The cerebral oxygenation (rSO2) values between the three groups were found to be similar [rSO2: P = 0.545, P = 0.247, P = 0.803; fractional tissue oxygen extraction (FTOE): P = 0.553, P = 0.278]. Regarding cerebral blood flow values, we also did not find any difference between the three groups [mean blood flow velocity (Vmean): P = 0.569, P = 0.975; maximum flow velocity (Vmax): P = 0.820, P = 0.997]. CONCLUSIONS Intravenous and intranasal fentanyl and oral sucrose were not superior to each other in preventing pain during the examination for retinopathy of prematurity (ROP). Sucrose may be a good alternative for pain control during ROP examination. Our findings suggest that ROP exam may not affect cerebral oxygenation or cerebral blood flow. Larger scale studies are needed to determine the best pharmacological option to reduce pain during ROP exams and evaluate the effects of this procedure on cerebral oxygenation and blood flow.
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Affiliation(s)
- Nursu Kara
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Istanbul Research and Training Hospital, Istanbul, Turkey.
| | - Didem Arman
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Zeynep Seymen
- Department of Opthalmology, University of Health Sciences Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Adem Gül
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Istanbul Research and Training Hospital, Istanbul, Turkey
| | - Serdar Cömert
- Department of Pediatrics, Division of Neonatology, University of Health Sciences Istanbul Research and Training Hospital, Istanbul, Turkey
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11
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Xu J, Wang Y, Zuo Y, Lv S, Li D. Repeated neonatal Needle-pricking stimulation alter neurodevelopment in adolescent rats. Brain Dev 2023; 45:413-421. [PMID: 37121792 DOI: 10.1016/j.braindev.2023.04.002] [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] [Received: 12/01/2022] [Revised: 04/11/2023] [Accepted: 04/12/2023] [Indexed: 05/02/2023]
Abstract
OBJECTIVE To explore the repeated pain stimulation in neonatal rats affects their cognitive and memory abilities during puberty, and the proliferation expression of hippocampal neurons. METHODS Postnatal 1 day (P1) SD rats were randomly divided into two groups, and the skin of the needle group was pricked for seven days consecutively while the skin of the control group was stroked for the same period of time. The rats in both groups were weighed every week, and the Morris water maze experiment was performed from P44 to P49 to test the cognitive and memory abilities of the rats. On P50, the hippocampal tissue was extracted for observation of pathological features and the expressions of Ki-67 and caspase 3 were determined. RESULTS With the increase of the days, the body weight of the rats in the needle group increased slightly slower than that of the control group. The escape latency of the needle group was significantly higher than that of the control group in the water maze test at P45 and P48, and the number of times the rats crossing the platform in the needle group was lower than that of the control group. The HE staining of the hippocampal tissue showed that the cells in the needle group were disorganized, with irregular morphology. Under the electron microscope, the structure of neuron cells and organelles is changed in the hippocampal CA1 region of rats. It showed a decrease in the Ki-67 expression and an increase in caspase 3 in the needle group. CONCLUSION Repeated experience of needle-pricking stimulation in neonatal rats can cause cognitive impairment and memory loss in puberty, disrupt hippocampal organization, and diminish neuronal proliferation.
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Affiliation(s)
- Jing Xu
- Department of Neonatology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Youhui Wang
- College of Basic Medical Sciences, Dalian Medical University, Dalian, Liaoning Province, China
| | - Yu Zuo
- Department of Neonatology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Shuai Lv
- Department of Neonatology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Dong Li
- Department of Neonatology, The First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province, China; Department of Neonatology, Dalian Women and Children's Medical Group, Dalian, Liaoning Province, China.
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Thangavelu MU, Wouters B, Kindt A, Reiss IKM, Hankemeier T. Blood microsampling technologies: Innovations and applications in 2022. ANALYTICAL SCIENCE ADVANCES 2023; 4:154-180. [PMID: 38716066 PMCID: PMC10989553 DOI: 10.1002/ansa.202300011] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 06/23/2024]
Abstract
With the development of highly sensitive bioanalytical techniques, the volume of samples necessary for accurate analysis has reduced. Microsampling, the process of obtaining small amounts of blood, has thus gained popularity as it offers minimal-invasiveness, reduced logistical costs and biohazard risks while simultaneously showing increased sample stability and a potential for the decentralization of the approach and at-home self-sampling. Although the benefits of microsampling have been recognised, its adoption in clinical practice has been slow. Several microsampling technologies and devices are currently available and employed in research studies for various biomedical applications. This review provides an overview of the state-of-the-art in microsampling technology with a focus on the latest developments and advancements in the field of microsampling. Research published in the year 2022, including studies (i) developing strategies for the quantitation of analytes in microsamples and (ii) bridging and comparing the interchangeability between matrices and choice of technology for a given application, is reviewed to assess the advantages, challenges and limitations of the current state of microsampling. Successful implementation of microsampling in routine clinical care requires continued efforts for standardization and harmonization. Microsampling has been shown to facilitate data-rich studies and a patient-centric approach to healthcare and is foreseen to play a central role in the future digital revolution of healthcare through continuous monitoring to improve the quality of life.
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Affiliation(s)
| | - Bert Wouters
- Metabolomics and Analytics CentreLeiden UniversityLeidenThe Netherlands
| | - Alida Kindt
- Metabolomics and Analytics CentreLeiden UniversityLeidenThe Netherlands
| | - Irwin K. M. Reiss
- Department of Neonatal and Pediatric Intensive CareDivision of NeonatologyErasmus MCRotterdamThe Netherlands
| | - Thomas Hankemeier
- Metabolomics and Analytics CentreLeiden UniversityLeidenThe Netherlands
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Hughes Née Richardson B, Benoit B, Rutledge K, Dol J, Martin-Misener R, Latimer M, Smit M, McGrath P, Campbell-Yeo M. Impact of parent-targeted eHealth educational interventions on infant procedural pain management: a systematic review. JBI Evid Synth 2023; 21:669-712. [PMID: 36591975 DOI: 10.11124/jbies-21-00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of this review was to determine whether electronic health (eHealth) educational interventions about infant procedural pain and pain management impact parental outcomes (eg, mental health, knowledge uptake), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response). INTRODUCTION Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, such as immunizations, yet infants often receive little to no pain management. Parents are an essential component of effective pain management, although they may not be aware of the roles they play. Despite the increased number of eHealth resources available to educate parents about infant pain management, their impact has yet to be synthesized. INCLUSION CRITERIA This review considered studies that evaluated eHealth educational interventions targeted at parents during pregnancy and up to 1 year postpartum. Interventions included, but were not limited to, mobile applications, web-based applications, websites, videos, interactive training, hands-on direct simulation, short message service (SMS), and desktop applications. Primary outcomes included parental outcomes (eg, stress or anxiety, self-efficacy, knowledge, attitudes), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response). Experimental, quasi-experimental, and observational study designs were included. METHODS MEDLINE, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO were searched for studies published in English up to June 14, 2021. Citation lists of relevant reviews and included studies were also searched for additional peer-reviewed articles. Two independent reviewers conducted critical appraisal using standardized tools from JBI, and data extraction, using a data extraction form designed by the authors. Statistical pooling of quantitative data was not possible due to heterogeneity; thus, the findings were reported narratively. RESULTS A total of 4163 unique studies were screened, with 11 studies ultimately included for synthesis. Five articles were randomized controlled trials, 5 articles were analytical cross-sectional studies, and 1 article was quasi-experimental. Studies reported on 4 unique eHealth educational interventions, all of which used video format and primarily targeted the postnatal period. The findings for all primary outcomes were mixed but suggested either improvements in outcomes or no impact. The certainty of evidence was determined as low or very low across primary outcomes for reasons related to imprecision, risk of bias, and indirectness. CONCLUSIONS Although heterogeneity of findings limited quantitative synthesis of data, this review suggests that short and engaging educational videos have the potential to positively impact parents' knowledge, confidence, and desire to be involved in procedural pain management for their children. Most of the interventions presented in this review describe evidence-based information about procedural pain management strategies that are known to be effective for infant populations. Thus, it is reasonable to assume that infant pain response should be lower when parents appropriately apply the strategies. However, the findings of this review were not able to confirm this assumption. More research is needed to evaluate the impact of parent-targeted pain management education on infant pain response. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020151569.
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Affiliation(s)
- Brianna Hughes Née Richardson
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Centre for Transformative Nursing and Health Research, Halifax, NS, Canada
| | - Britney Benoit
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Centre for Transformative Nursing and Health Research, Halifax, NS, Canada
- Elizabeth and Thomas Rankin School of Nursing, St. Francis Xavier University, NS, Antigonish, Canada
| | - Kallen Rutledge
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Justine Dol
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- The Mothering Transitions Research Lab, St. Michael's Hospital, Toronto, ON, Canada
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Centre for Transformative Nursing and Health Research, Halifax, NS, Canada
| | - Margot Latimer
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Centre for Transformative Nursing and Health Research, Halifax, NS, Canada
| | - Michael Smit
- School of Information Management, Dalhousie University, Halifax, NS, Canada
| | - Patrick McGrath
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Centre for Transformative Nursing and Health Research, Halifax, NS, Canada
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
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Marchetti G, Vittori A, Cascella M, Mascilini I, Piga S, Petrucci E, Castellano A, Caruso R, Francia E, Stocchi F, Marinangeli F, Inserra A, Picardo SG. Pain prevalence and pain management in children and adolescents in an italian third level pediatric hospital: a cross-sectional study. Ital J Pediatr 2023; 49:41. [PMID: 36978099 PMCID: PMC10053721 DOI: 10.1186/s13052-023-01439-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND In 2016, we performed a one-day investigation to analyze the prevalence of pain, pain intensity, and pain therapy in the Departments of Surgery and Onco-Hematology of the Ospedale Pediatrico Bambino Gesù. To improve the knowledge gap highlighted in the previous study, refresher courses and even personalized audits have been carried out during these years. The purpose of this study is to evaluate if, after 5 years, there have been improvements in the management of pain. METHODS The study was conducted on 25 January 2020. Pain assessment, pain therapies, pain prevalence and intensity in the preceding 24 h and during the recovery period were recorded. Pain outcomes were compared with previous audit results. RESULTS Out of the 63 children with at least one documented pain assessment (starting from 100 eligible), 35 (55.4%) experienced pain: 32 children (50.7%) experienced moderate /severe pain while 3 patients (4%) felt mild pain. In the preceding 24 h, 20 patients (31.7%) reported moderate/severe pain while 10 (16%) reported moderate or severe pain during the interview. The average value of the Pain Management Index (PMI) was - 1.3 ± 0.9 with a minimum of -3 and a maximum of 0. 28 patients (87%) undergoing analgesic therapy for moderate/severe pain had a PMI of less than 0 (undertreated pain), while 3 patients (13%) scored value of 0 or higher (adequate pain therapy), 4 patients (12.5%) received multimodal analgesia with opioids and 2 patients (6%) opioids alone. Time-based therapy was prescribed to 20 patients (62.5%), intermittent therapy was prescribed to 7 patients (22%) and 5 patients (15.5%) did not receive any therapy. The prevalence of pain was higher during hospitalization and 24 h before the interview, while at the time of the interview, the proportion was the same. In this audit, the daily prescription modality of the therapy had some improvements (time-based: 62.5% vs. 44%; intermittent: 22%vs 25%; no therapy: 15.5% vs. 31%). CONCLUSION Pain management in hospitalized children constantly requires special daily attention from health professionals aimed at mitigating the components of intractable pain and resolving those of treatable pain. TRIAL REGISTRATION This study is registered with ClinicalTrials.gov, number (NCT04209764), registered 24 December 2019, https://clinicaltrials.gov/ct2/show/NCT04209764?term=NCT04209764&draw=2&rank=1 .
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Affiliation(s)
- Giuliano Marchetti
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Marco Cascella
- Department of Anesthesia and Critical Care, Istituto Nazionale Tumori-IRCCS, Fondazione Pascale, Naples, Italy
| | - Ilaria Mascilini
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Simone Piga
- Unit of Clinical Epidemiology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Emiliano Petrucci
- Department of Anesthesia and Intensive Care Unit, San Salvatore Academic Hospital of L'Aquila, L'Aquila, Italy
| | - Aurora Castellano
- Division of Oncohematology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Roberta Caruso
- Division of Oncohematology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Elisa Francia
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Francesca Stocchi
- Division of Oncohematology, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Franco Marinangeli
- Department of Anesthesiology, Intensive Care and Pain Treatment, University of L'Aquila, L'Aquila, Italy
| | - Alessandro Inserra
- Surgical Department, General and Thoracic Unit, Ospedale Pediatrico Bambino Gesù IRCCS, Rome, Italy
| | - Sergio Giuseppe Picardo
- Department of Anesthesia and Critical care, ARCO Roma, Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
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Walravens C, Gupta A, Cohen RS, Kim JL, Frymoyer A. Fewer glucose checks and decreased supplementation using dextrose gel for asymptomatic neonatal hypoglycemia. J Perinatol 2023; 43:532-537. [PMID: 36871107 DOI: 10.1038/s41372-023-01638-z] [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: 12/07/2022] [Revised: 02/07/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE Evaluate the impact of a neonatal hypoglycemia (NH) clinical pathway implementing buccal dextrose gel in late preterm and term infants. STUDY DESIGN Quality improvement study at a children's hospital associated birth center. Number of blood glucose checks, use of supplemental milk, and need for IV glucose were followed for 26-months after implementation of dextrose gel and compared to previous 16-month period. RESULTS After QI implementation, 2703 infants were screened for hypoglycemia. Of these, 874 (32%) received at least one dose of dextrose gel. Special cause shifts with reductions in mean number of blood glucose checks per infant (pre 6.6 vs. post 5.6), use of supplemental milk (pre 42% vs. post 30%), and need for IV glucose (pre 4.8% vs. post 3.5%) were found. CONCLUSION Incorporating dextrose gel into a clinical pathway for NH was associated with a sustained reduction in number of interventions, use of supplemental milk and need for IV glucose.
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Affiliation(s)
| | - Arun Gupta
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
| | - Ronald S Cohen
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
| | | | - Adam Frymoyer
- Department of Pediatrics, Stanford School of Medicine, Stanford, CA, USA
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Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy Diagnostic Criteria for Acute Needle Pain. THE JOURNAL OF PAIN 2023; 24:387-402. [PMID: 36243317 DOI: 10.1016/j.jpain.2022.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 09/15/2022] [Accepted: 09/19/2022] [Indexed: 11/05/2022]
Abstract
Needle procedures are among the most common causes of pain and distress for individuals seeking health care. While needle pain is especially problematic for children needle pain and associated fear also has significant impact on adults and can lead to avoidance of appropriate medical care. Currently there is not a standard definition of needle pain. A taxonomy, or classification system, for acute needle pain would aid research efforts and enhance clinical care. To meet this need, the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks public-private partnership with the U.S. Food and Drug Administration, the American Pain Society, and the American Academy of Pain Medicine formed the Analgesic, Anesthetic, and Addiction Clinical Trial Translations, Innovations, Opportunities, and Networks-American Pain Society-American Academy of Pain Medicine Pain Taxonomy initiative. One of the goals of this initiative was to develop taxonomies for acute pain disorders, including needle pain. To accomplish this, a working group of experts in needle pain was convened. Based on available literature and expert opinion, the working group used a 5-dimenional structure (diagnostic criteria, common features, modulating factors, impact and/or functional consequences, and putative mechanisms) to develop an acute pain taxonomy that is specific needle pain. As part of this, a set of 4 diagnostic criteria, with 2 modifiers to account for the influence of needle associated fear, are proposed to define the types of acute needle pain. PERSPECTIVE: This article presents a taxonomy for acute needle pain. This taxonomy could help to standardize definitions of acute pain in clinical studies of patients undergoing needle procedures.
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Escobar-Castellanos M, Míguez-Navarro MC, García-Mancebo J, Fernández-Monteagudo B, Pascual-García P, Guerrero-Márquez G, Rivas-García A. How Much Do Parents Know About Pain in Their Children? Pediatr Emerg Care 2023; 39:40-44. [PMID: 36580891 DOI: 10.1097/pec.0000000000002585] [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: 01/03/2023]
Abstract
OBJECTIVES Adequate pain control is essential to the comprehensive management of pediatric patients within the emergency department.The aim of this study is to evaluate parents' knowledge about pain in the pediatric population patient and secondarily describe erroneous concepts that can affect a correct children's pain management. METHODS A single-center descriptive study of cross-sectional surveys was performed between October and December 2018, with a previously validated ad hoc and anonymous questionnaire consisting of 9 items. All parents/guardians participating in the study had a child aged 0 to 18 years who had been admitted to the emergency department. RESULTS Sixty-nine percent (n = 315) were women, 49.9% (n = 226) had university degrees and only 11% (n = 50) had professions related to the healthcare system. A linear association was observed between the number of correct answers and the level of education (β = 1.04; 95% confidence interval, 0.76-1.32; P < 0.001), as well as between parents with professions related to the healthcare system compared with other professions (61.4% vs 51.2% with P = 0.005). The responses of Spanish parents offered better results than answers obtained from parents from the American continent (56.4% vs 41.4% with P < 0.001). No differences were observed between parents of children with chronic diseases. CONCLUSIONS In our study, we observed that a considerable percentage of parents hold misconceptions about how children express pain, and therefore, it would be necessary to encourage formation programs for parents to help identify, evaluate, and correctly treat pain in their children.
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Intravenous acetaminophen for postoperative pain control after open abdominal and thoracic surgery in pediatric patients: a systematic review and meta-analysis. Pediatr Surg Int 2022; 39:7. [PMID: 36441255 DOI: 10.1007/s00383-022-05282-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/29/2022]
Abstract
Pediatric opioid exposure increases short- and long-term adverse events (AE). The addition of intravenous acetaminophen (IVA) to pediatric pain regimes to may reduce opioids but is not well studied postoperatively. Our objective was to quantify the impact of IVA on postoperative pain, opioid use, and AEs in pediatric patients after major abdominal and thoracic surgery. Medline, Embase, CINAHL, Web of Science, and Cochrane Library were searched systematically for randomized controlled trials (RCTs) comparing IVA to other modalities. Five RCTs enrolling 443 patients with an average age of 2.12 years (± 2.81) were included. Trials comparing IVA with opioids to opioids alone were meta-analyzed. Low to very low-quality evidence demonstrated equivalent pain scores between the groups (-0.23, 95% CI -0.88 to 0.40, p 0.47) and a reduction in opioid consumption (-1.95 morphine equivalents/kg/48 h, 95% CI -3.95 to 0.05, p 0.06) and minor AEs (relative risk 0.39, 95% CI 0.11 to 1.43, p 0.15). We conclude that the addition of IVA to opioid-based regimes in pediatric patients may reduce opioid use and minor AEs without increasing postoperative pain. Given the certainty of evidence, further research featuring patient-important outcomes and prolonged follow-up is necessary to confirm these findings.
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Karunanayake A, Devanarayana NM, Rajindrajith S. Early life events in functional abdominal pain disorders in children. PLoS One 2022; 17:e0275419. [PMID: 36322579 PMCID: PMC9629606 DOI: 10.1371/journal.pone.0275419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/18/2022] [Indexed: 11/05/2022] Open
Abstract
Objectives Functional abdominal pain disorders (FAPDs) are common gastrointestinal problems in children, and the pathophysiology is thought to be multifactorial. Adverse early life events (ELE) induce alterations in the central nervous system, perhaps predisposing individuals to develop FAPDs. We aimed to study the potential adverse ELE that are associated with FAPDs. Methods We steered a school-based survey involving 1000 children from 4 randomly selected schools. FAPDs were assessed using the translated Rome III questionnaire, and ELE were identified using a pre-tested, parental questionnaire. FAPDs were diagnosed using the Rome III criteria. Results Hundred and eighty-two (182) children had FAPDs (62.1% girls, mean age 8.5, SD 2.1). ELE of them were compared with 571 children without FAPDs (51.1% girls, mean age 8.8, SD 1.9). According to the binary logistic regression analysis, family members with abdominal pain, family member with chronic pain other than abdominal pain, prenatal maternal complications and interventional deliveries, were recognized as potential risk factors for the development of FAPDs. Breast feeding over two years has shown to reduce the prevalence of FAPDs.a. Conclusions Prenatal maternal medical problems are associated a with higher prevalence of FAPDs later in life. Prolonged breastfeeding and normal vaginal delivery could be considered as factors that reduce the vulnerability of developing FAPDs in children. Therefore, minimizing pregnancy-related complications, encouraging vaginal deliveries, and encouraging breastfeeding are potentially valuable measures to prevent FAPDs during childhood.
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Reddy S, Nesargi SV, Stevens S, Jose J, Babu H. Procedural Analgesia in the Neonatal Intensive Care Unit: A Quality Improvement Initiative. Am J Perinatol 2022; 39:1688-1692. [PMID: 33706395 DOI: 10.1055/s-0041-1726121] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Neonates perceive pain which also has adverse long-term consequences. Newborns experience several painful procedures a day. Various methods of analgesia may be used but are underutilized. The SMART aim of this project was to increase the use of procedural analgesia from 11.5 to 75% in 6 months by using quality improvement principles. STUDY DESIGN After a baseline audit, a root cause analysis was done. Based on this, a series of interventions were done as Plan-Do-Study-Act (PDSA) cycles. These included posters on analgesia, display of the pain protocol, orders for analgesia, a written test, small power point presentations on the importance of analgesia, and reminders on the trays used for procedures. At the end of each PDSA cycle, an audit was done to determine the proportion of times analgesia was used. Process indicators were also used when possible. Analysis was done by using the Chi-square test and the paired t-test. RESULTS At baseline 11% of procedures were done after giving analgesia. This significantly improved to 40% at the end of the first PDSA, and 81% after third PDSA. This was sustained at 75% over the next 2 months. CONCLUSION Procedural analgesia can improve and be sustained by using simple interventions. KEY POINTS · Procedural pain in neonates can be decreased by the use of analgesia.. · However, most units do not utilize analgesia appropriately.. · This QI showed that simple interventions can optimize use of procedural analgesia..
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Affiliation(s)
- Sushma Reddy
- Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India
| | - Saudamini V Nesargi
- Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India
| | - Sofia Stevens
- Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India
| | - Jiya Jose
- Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India
| | - Hindumati Babu
- Department of Neonatology, St. Johns Medical College Hospital, Bangalore, Karnataka, India
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Postoperative Osteopathic Manipulative Treatment in Children with Esophageal Atresia: Potential Benefits on the Anthropometric Parameters. Pediatr Rep 2022; 14:434-443. [PMID: 36278555 PMCID: PMC9590049 DOI: 10.3390/pediatric14040051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 10/09/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022] Open
Abstract
Esophageal atresia (EA) is a congenital malformation that affects the normal esophageal development. Surgical treatment, although restoring the integrity of the alimentary tract, may lead to long-term sequelae-like developmental abnormalities and musculoskeletal deformities. We evaluated the effects of osteopathic manipulative treatment (OMT) on the recovery of the range of the right upper limb movement and on the rise of the auxological parameters. A case series of five children affected by type C EA were described. Six OMT sessions were performed over a 4-month period. At each treatment, height, weight, body mass index (BMI) and range of motion (ROM) in elevation of the right upper limb were assessed. OMT was applied to improve scar, larynx, rib cage, and sternum mobility. An average change of 2.3 cm in height and an average increase of 8° in the ROM of the upper limb in the period of study were detected. Additionally, OMT could improve the anthropometric data and the mobility of the right upper limb of children surgically treated for EA. Further studies that evaluate the effectiveness of OMT in post surgical treatment of congenital malformations of the thorax can be considered in the future.
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Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101568. [PMID: 36291504 PMCID: PMC9600280 DOI: 10.3390/children9101568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022]
Abstract
Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain.
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Popowicz H, Kwiecień-Jaguś K, Mędrzycka-Dąbrowska W, Kopeć M, Dyk D. Evidence-Based Nursing Practices for the Prevention of Newborn Procedural Pain in Neonatal Intensive Therapy-An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12075. [PMID: 36231377 PMCID: PMC9566416 DOI: 10.3390/ijerph191912075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 09/09/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Due to the progress in neonatology, in particular, in the past three decades, the mortality rate among patients of intensive care units has decreased. However, this is connected not only with newborns needing to stay longer in the unit, but also with the exposure of newborns to many painful procedures and stresses. Lack of or insufficient pain prevention has a negative impact on the sensory or locomotor development of newborns. Despite the presence of guidelines based on scientific evidence, the use of pharmacological and non-pharmacological pain-management methods in newborns is still insufficient. AIM The aim of the study was to: identify the knowledge nurses/midwives have of recommended non-pharmacological and/or pharmacological methods, in particular, in relation to medical intervention procedures; assess the interventions for pain relief applied by midwives/nurses most often in their clinical practice; examine the role of age, general work experience, education level and years of work of medical professionals on a neonatal ward, as well as the referral level of a unit, versus the application of pharmacological and non-pharmacological methods. METHODS A descriptive and quantitative study conducted in 2019 among Polish nurses/midwives working at neonatal intensive care units. RESULTS The analysis of the material reflected the deficit of knowledge and the insufficient daily use of recommended pain-relief measures among the respondents. CONCLUSIONS The interpretation of data indicates that despite the clear and easily available recommendations of scientific societies concerning the mode of conduct in particular medical procedures, medical personnel do not apply those recommendations in their everyday practice. It is necessary to plan and implement education strategies for nurses/midwives on standard pain-management interventions during painful medical procedures.
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Affiliation(s)
- Hanna Popowicz
- Department of Obstetric and Gynecological Nursing, Medical University of Gdańsk, 80-211 Gdansk, Poland
| | - Katarzyna Kwiecień-Jaguś
- Department of Anesthesiology Nursing and Intensive Care, Medical University of Gdańsk, 80-211 Gdansk, Poland
| | | | - Monika Kopeć
- Department of Human Nutrition, University of Warmia and Mazury, 10-718 Olsztyn, Poland
| | - Danuta Dyk
- Department of Anesthesiology and Intensive Care Nursing, Poznań University of Medical Sciences, 60-806 Poznan, Poland
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de Barros GAM, Kraychete DC, Lineburger EB, Módolo NSP. Anesthesiology and pain medicine. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2022; 72:549-552. [PMID: 35914623 PMCID: PMC9515681 DOI: 10.1016/j.bjane.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Duerden EG, Mclean MA, Chau C, Guo T, Mackay M, Chau V, Synnes A, Miller SP, Grunau RE. Neonatal pain, thalamic development and sensory processing behaviour in children born very preterm. Early Hum Dev 2022; 170:105617. [PMID: 35760006 DOI: 10.1016/j.earlhumdev.2022.105617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 06/16/2022] [Accepted: 06/17/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Altered sensory processing is commonly reported in children born very preterm (≤32 weeks' gestational age [GA]). The immature nervous system, particularly the development of connections from the thalamus to the cortex, may show enhanced vulnerability to excessive sensory stimulation, and may contribute to altered sensory processing. Our objective was to determine whether sensory processing assessed at preschool-aged in children born very preterm was predicted by neonatal procedural pain and thalamic development. METHODS In a prospective longitudinal cohort study, N = 140 very preterm infants (median GA at birth 28 weeks) underwent MRI early-in-life and again at term-equivalent age. Children returned for assessment at 4.5 years. Parents reported on child sensory processing behaviors on the Short Sensory Profile. General linear models were used to assess factors associated with sensory processing behaviors, adjusting for clinical and demographic factors. RESULTS Among extremely preterm neonates (born 24-28 weeks' GA), but not very-preterm neonates (29-32 weeks' GA), more invasive procedures were associated with poorer sensory processing (B = -0.09, 95%CI [-0.17, -0.01] p = 0.03). In the overall cohort, fewer sensory processing problems were associated with greater thalamic growth between birth and term-equivalent age (B = 0.3, 95%CI [0.11, 0.42], p < 0.001). Extremely preterm neonates exposed to a high number of skin-breaking procedures who exhibited slower neonatal thalamic growth displayed the highest sensory processing problems (B = -26.2, 95%CI [-45.96, -6.38], p = 0.01). CONCLUSION Early exposure to pain and related alterations in the developing thalamus may be a key factor underlying later sensory problems in children born extremely preterm.
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Affiliation(s)
- Emma G Duerden
- Applied Psychology, Faculty of Education, Western University, London, Canada
| | - Mia A Mclean
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Cecil Chau
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Ting Guo
- Department of Paediatrics, the Hospital for Sick Children and the University of Toronto, Toronto, Canada
| | | | - Vann Chau
- Department of Paediatrics, the Hospital for Sick Children and the University of Toronto, Toronto, Canada
| | - Anne Synnes
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; BC Women's Hospital, Vancouver, Canada; BC Children's Hospital Research Institute, Vancouver, Canada
| | - Steven P Miller
- Department of Paediatrics, the Hospital for Sick Children and the University of Toronto, Toronto, Canada
| | - Ruth E Grunau
- Department of Pediatrics, University of British Columbia, Vancouver, Canada; BC Women's Hospital, Vancouver, Canada; BC Children's Hospital Research Institute, Vancouver, Canada.
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Del Campo Cano I, Alarza Cano R, Encinas Padilla B, Lacámara Ornaechea N, Royuela Vicente A, Marín Gabriel MÁ. A prospective study among neonates born to mothers with active or past Graves disease. Gynecol Endocrinol 2022; 38:495-498. [PMID: 35548945 DOI: 10.1080/09513590.2022.2073347] [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: 10/18/2022] Open
Abstract
OBJECTIVE The aim of this prospective study was to describe demographic and clinical characteristics of neonates born to mothers with active or past Graves disease and to assess compliance since implementation of a new protocol in our center. METHODS We prospectively followed up neonates born to mothers with active or past Graves disease in a tertiary hospital in Spain between August 2019 and September 2021 according to our protocol. We reviewed maternal and neonatal history of these neonates, and we followed up newborns at risk of neonatal hyperthyroidism. RESULTS Among 5808 births, 33 neonates were born to mothers with active or past Graves disease (0.57%). Six mothers (18.2%) had positive levels of thyroid-stimulating hormone receptor antibodies during pregnancy and five mothers (15.1%) between weeks 20 and 24 of pregnancy. Two of them had received definitive therapy for Graves disease before pregnancy. Two neonates (7.1%) were at high risk of neonatal hyperthyroidism and were followed-up until two months, without hyperthyroidism signs or abnormal thyroid hormone levels. Compliance of protocol during pregnancy was 84.9% and 75.8% at birth. CONCLUSIONS Prevalence of Graves disease among pregnant women was 0.57%, with no cases of neonatal hyperthyroidism. Compliance of protocol was adequate during pregnancy (84.9%) and acceptable at birth (75.8%).
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Affiliation(s)
- Iván Del Campo Cano
- Department of Pediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Raquel Alarza Cano
- Department of Obstetric and Gynecology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Begoña Encinas Padilla
- Department of Obstetric and Gynecology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Ana Royuela Vicente
- Biostatistics Unit; Puerta de Hierro Biomedical Research Institute (IDIPHISA); CIBERESP, Madrid, Spain
| | - Miguel Ángel Marín Gabriel
- Department of Pediatrics, Section of Neonatology, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
- Pediatric Deparment Associate Professor, Autónoma University, Madrid, Spain
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Evaluation of the Premature Infant Pain Profile-Revised (PIPP-R) e-Learning Module: Immediate and Sustained Competency. Adv Neonatal Care 2022; 22:246-252. [PMID: 34334673 DOI: 10.1097/anc.0000000000000922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Electronic health (e-health) learning is a potential avenue to educate health professionals about accurately using infant pain assessment tools, although little is known about the impact of e-health interventions on clinical competence. PURPOSE To evaluate whether an e-health learning module for teaching the accurate use of the Premature Infant Pain Profile-Revised (PIPP-R) pain assessment tool results in immediate and sustained competency to assess infant pain. METHODS Neonatal intensive care unit (NICU) nurses who participated in a larger study across 2 tertiary NICUs in Canada examining the implementation and clinical utility of the PIPP-R e-learning module completed 2 follow-up evaluations at 1 week and 3 months. Participants were asked to view a video recording of an infant undergoing a painful procedure and to assess the infant's pain intensity response using the PIPP-R measure. Immediate and sustained competency was assessed via interrater consensus of participant-reported PIPP-R scores compared with those of an experienced trained coder. RESULTS Of the 25 eligible nurses, 22 completed 1-week and 3-month follow-up evaluations. At the 1-week follow-up, 84% of nurses scored the video accurately compared with 50% at 3 months. Behavioral pain indicators were more likely to be scored incorrectly than physiological indicators. IMPLICATIONS FOR PRACTICE Follow-up training after completion of the initial e-learning module training may improve competency related to the clinical use of the PIPP-R tool to assess infant pain over time. IMPLICATIONS FOR RESEARCH Additional study regarding the need and timing of e-health training to optimize sustained competency in infant pain assessment is warranted.
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Butkevich IP, Mikhailenko VA, Vershinina EA. Sexual Dimorphism in the Effect of Neonatal Inflammatory Pain on Stress Reactivity of Hormonal Response and Cognitive Functions in Adult Rats. J EVOL BIOCHEM PHYS+ 2022; 58:353-363. [PMID: 35599637 PMCID: PMC9109674 DOI: 10.1134/s0022093022020053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 11/23/2022]
Abstract
The effect of moderate neonatal stress induced by inflammatory
pain in rat pups of both sexes on the hormonal response and cognitive
processes in adult animals was studied in the Morris water maze.
No significant differences in spatial learning and memory were found
in experimental rats exposed to neonatal inflammatory pain vs. control
animals. However, experimental rats exhibited sex differences in
long-term spatial memory whose efficiency was higher in males vs.
females. After long-term memory testing, stress responsiveness of
the hypothalamic-pituitary-adrenocortical axis, as assessed by the
plasma corticosterone level in the formalin test, was higher in
experimental males vs. females. Only experimental females exhibited
differences between short-term and long-term memory, with the efficiency
being higher in the former. Thus, sexual dimorphism was found in
the effect of neonatal nociceptive stress on long-term spatial memory
in adult rats: experimental males vs. females demonstrated more
effective long-term memory combined with a higher stress reactivity
of the hormonal response.
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Affiliation(s)
- I. P. Butkevich
- Pavlov Institute of Physiology,
Russian Academy of Sciences, St. Petersburg, Russia
| | - V. A. Mikhailenko
- Pavlov Institute of Physiology,
Russian Academy of Sciences, St. Petersburg, Russia
| | - E. A. Vershinina
- Pavlov Institute of Physiology,
Russian Academy of Sciences, St. Petersburg, Russia
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Sasidharan R, Gupta N, Yadav B, Chawla D, Singh K, Kumarendu Singh A. 25% Dextrose Versus 24% Sucrose for Heel Lancing in Preterm Infants: A Noninferiority RCT. Pediatrics 2022; 149:186819. [PMID: 35451020 DOI: 10.1542/peds.2021-054618] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/24/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the efficacy of 25% dextrose with 24% sucrose for heel-lance analgesia in preterm infants admitted to the NICU. METHODS In this noninferiority, double-blind, randomized controlled trial, preterm infants born at 28 weeks and 0 days to 35 weeks and 6 days of gestation who were due for a scheduled heel-lance procedure were enrolled. Infants randomly assigned to the intervention arm received 0.5 mL 25% dextrose, whereas infants in the active control group received 0.5 mL 24% sucrose orally just 2 minutes before the heel-lance procedure. The primary outcome was Premature Infant Pain Profile (PIPP) score 30 seconds after the procedure. Secondary outcomes included PIPP scores at 60 and 120 seconds, PIPP-Revised scores at 30, 60, and 120 seconds, and any adverse events. RESULTS Sixty-four infants were enrolled (32 in each group). The mean (SD) PIPP score at 30 seconds was 6.41 (2.56) in the dextrose group and 7.03 (2.23) in the sucrose group (mean difference, -0.63 (95% confidence interval, -1.85 to 0.60; P = .31). The upper margin of the confidence interval did not cross the predefined noninferiority margin of 2. The mean PIPP scores at 60 (5.03 [2.18] vs 5.39 [1.48]) and 120 (4.75 [1.97] vs 4.94 [1.46]) seconds were also similar. The PIPP-Revised scores between the 2 groups at all time intervals were comparable. One infant in the intervention group had a transient coughing episode. CONCLUSIONS In preterm infants under intensive care, 25% dextrose is noninferior to 24% sucrose for heel-lance analgesia as assessed by PIPP score.
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Affiliation(s)
| | | | | | - Deepak Chawla
- Department of Neonatology, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Kuldeep Singh
- Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Zaitoon H, Riskin A, Hemo M, Toropine A, Gover A. Utilizing umbilical cord blood - Minimizing blood sampling and pain in healthy infants at risk for polycythemia. Early Hum Dev 2022; 168:105573. [PMID: 35468574 DOI: 10.1016/j.earlhumdev.2022.105573] [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: 12/09/2021] [Revised: 03/20/2022] [Accepted: 04/12/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Exposure to pain in early life was associated with long term consequences, therefore strategies for minimizing painful procedures in newborns should be employed. The utility and reliability of cord blood CBC was demonstrated before, however data regarding use of cord blood in healthy infants at risk for polycythemia are lacking. METHODS A single-center, paired-sampling prospective laboratory study including all healthy asymptomatic infants born after 36 weeks gestation who were SGA (<2500 g), LGA (>4000 g), or born to mothers with diabetes in pregnancy. Blood count indices were compared between umbilical and neonatal capillary or venous blood samples. In order to predict cut-off values for neonatal polycythemia using umbilical hematocrit, receiver operator curves (ROC) were plotted. RESULTS Paired samples were collected from 433 infants. Mean gestational age and birth-weight were 39.0 ± 1.3 weeks and 3489 ± 682 g. Hemoglobin, hematocrit and WBC values were lower in cord blood compared to neonatal, but PLT count was higher. Pearson r showed only modest correlation between peripheral capillary and umbilical or venous Hct - 0.35 (p < 0.001), and 0.44 (p < 0.001), respectively. In order to try and capture clinically significant polycythemia ROC was plotted for hematocrit >70% and <40%. In our cohort, using the calculated cutoff values (>51% and <35%) could have resulted in a decrease of 72% of neonatal blood draws. CONCLUSION This analysis should be interpreted with caution, as currently it cannot support the routine use of umbilical samples' hematocrits for making treatment decision in newborns at risk for polycythemia. Further larger studies are needed.
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Affiliation(s)
- Hussein Zaitoon
- Department of Pediatrics, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.
| | - Arieh Riskin
- Department of Neonatology, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Miri Hemo
- Department of Neonatology, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Arina Toropine
- Department of Neonatology, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Ayala Gover
- Department of Neonatology, Bnai Zion Medical Center, Ruth & Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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Dutriez-Casteloot I, Emmanuelli V, Wiart JF, Tavernier A, Besengez C, Storme L, Houfflin-Debarge V. Long-Lasting Analgesia With Transdermal Fentanyl: A New Approach in Rat Neonatal Research. Front Pharmacol 2022; 13:798011. [PMID: 35370716 PMCID: PMC8968727 DOI: 10.3389/fphar.2022.798011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background: With advances in neonatal care, management of prolonged pain in newborns is a daily concern. In addition to ethical considerations, pain in early life would have long-term effects and consequences. However, its treatment remains inadequate. It was therefore important to develop an experimental model of long-lasting analgesia for neonatal research. Materials and Methods: Experiments were performed in six groups of rats with transdermal fentanyl 0, 3, 12, 50, 100, or 200 μg/kg/h from second postnatal day (P2) until weaning. Assessment of analgesia was carried out at P21, with behavioral scores (ranging from 0 to 3) using a 4% formalin test. Plasma levels of fentanyl were determined by UPLC/TQD at P22. Growth rate was investigated. Results: Fentanyl 100 and 200 μg/kg/h reduced scores of formalin-evoked behavioral pain. They increased time spent in pain score 0 (8 min 55 s and 6 min 34 s versus 23 s in controls) as in low pain scores 1 and 2, and decreased time in the most severe pain score 3 (19 min 56 s and 17 min 39 s versus 44 min 15 s). Fentanylemia increased in a dose-dependent manner from 50 μg/kg/h (2.36 ± 0.64 ng/ml) to 200 μg/kg/h (8.66 ± 1.80 ng/ml). Concerning growth, no difference was observed except weaker growth from P17 to P22 with 200 μg/kg/h. Clinically, we noticed no visible side effect from 3 to 100 μg/kg/h. Concomitantly, 200 μg/kg/h was responsible for ophthalmological side effects with appearance of corneal bilateral clouding in 90% pups. No difference was observed between male and female rats. Conclusion: Altogether, results indicate that transdermal fentanyl 100 μg/kg/h is an efficient therapeutic for long-lasting analgesia in lactating pups. This new model provides a useful tool for protection and welfare, and future opportunity for studying long-term health consequences of sustainable neonatal analgesia.
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Affiliation(s)
- Isabelle Dutriez-Casteloot
- ULR2694 METRICS-Perinatal Environment and Health, University of Lille, Lille, France.,Department of Biology, Faculty of Sciences and Technology, University of Lille, Lille, France
| | - Virginie Emmanuelli
- Department of Obstetrics, Jeanne de Flandre Hospital, University Hospital Center of Lille, Lille, France
| | - Jean-François Wiart
- Department of Toxicology, University Hospital Center of Lille, Lille, France
| | - Annabelle Tavernier
- Department of Biology, Faculty of Sciences and Technology, University of Lille, Lille, France
| | - Capucine Besengez
- ULR2694 METRICS-Perinatal Environment and Health, University of Lille, Lille, France
| | - Laurent Storme
- ULR2694 METRICS-Perinatal Environment and Health, University of Lille, Lille, France
| | - Véronique Houfflin-Debarge
- ULR2694 METRICS-Perinatal Environment and Health, University of Lille, Lille, France.,Department of Obstetrics, Jeanne de Flandre Hospital, University Hospital Center of Lille, Lille, France
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Bellieni CV. Neonatal Infant Pain Scale in assessing pain and pain relief for newborn male circumcision. Int J Impot Res 2022; 35:282-285. [PMID: 35352017 DOI: 10.1038/s41443-022-00551-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/09/2022]
Abstract
Circumcision-partial or total removal of the penile prepuce-requires cutting nerve-laden, sensitive genital tissue and is therefore liable to be painful. The aim of this review is to evaluate the evidence concerning pain felt by newborns during circumcision and to determine whether current analgesic methods can eliminate such pain. I performed a search in medical databases, selecting the trials published in the last 20 years that assessed pain in neonatal circumcision. Twenty-three trials have been retrieved. To get reliable findings, those trials that used validated pain scales were selected; then it was investigated which trials had comparable data for using the same pain scale. The only pain scale that was used in more than two trials was the modified Neonatal Infant Pain Scale (mNIPS) that ranges 0-6. The results of these trials show that none of the analgesic strategies used obtained the absence of pain. Some differences between circumcision techniques can be noticed, but most assessments exceed the score of 3, chosen as the clinically significant pain.
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Affiliation(s)
- Carlo V Bellieni
- Department of Pediatrics, University of Siena, Viale M Bracci 36, 53100, Siena, 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: 5] [Impact Index Per Article: 2.5] [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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Ferraz LPL, Fernandes AM, Gameiro MGH. CUIDADOS CENTRADOS NO DESENVOLVIMENTO DO RECÉM-NASCIDO PREMATURO: ESTUDO SOBRE AS PRÁTICAS EM UNIDADES NEONATAIS PORTUGUESAS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0235pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: analisar a frequência da aplicação das medidas centrais dos cuidados desenvolvimentais ao recém-nascido prematuro em unidades de cuidados neonatais portuguesas e identificar a sua relação com variáveis organizacionais. Método: estudo transversal, descritivo-correlacional. Utilizando técnica de amostragem não probabilística em rede, foi obtida uma amostra de 217 enfermeiros de unidades neonatais portuguesas que responderam online ao questionário Quantum Caring Practice Self-Assessment, traduzido e validado para enfermeiros portugueses. Resultados: os resultados revelaram que para 65,4% dos enfermeiros as práticas de cuidados centrados no desenvolvimento são realizadas às vezes e 14,3% consideram que raramente são realizadas. Somente 18,9% dos enfermeiros inquiridos consideram que essas práticas são realizadas frequentemente. Destacaram-se como práticas mais frequentes, as ligadas ao Ambiente terapêutico e Prevenção da dor e stress. As menos frequentes foram as medidas de Posicionamento e Cuidados à pele. Os resultados demonstraram ainda que a frequência das práticas de cuidados desenvolvimentais difere consoante a localização geográfica das unidades e é mais elevada nas unidades com maior nível de diferenciação de cuidados e que têm instituído um programa/protocolo específico de cuidados desenvolvimentais. Conclusão: as práticas de cuidados centrados no desenvolvimento não são realizadas de forma consistente nas unidades de cuidados neonatais portuguesas, apesar de serem exequíveis. É necessária uma mudança global na cultura das equipas, mais formação, implementação de protocolos e investimento organizacional nesta área.
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Ferraz LPL, Fernandes AM, Gameiro MGH. DEVELOPMENTAL CARE OF PREMATURE NEWBORNS: STUDY ON PRACTICES IN PORTUGUESE NEONATAL UNITS. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0235en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: the present and future well-being of hospitalized newborns and their parents are connected to analyze the application frequency of the central practices of developmental care to premature newborns in Portuguese neonatal care units and to identify their relationship with organizational variables. Method: cross-sectional, descriptive-correlational study. Using a non-probabilistic network sampling technique, a sample of 217 nurses from Portuguese neonatal units who answered the Quantum Caring Practice Self-Assessment online questionnaire was obtained, previously translated and validated for Portuguese nurses. Results: the results revealed that for 65.4% of nurses, Developmental Care practices are sometimes performed and 14.3% consider that they are rarely performed. Only 18.9% of the nurses in the study consider that these practices are performed frequently. The most frequent practices were those related to the therapeutic environment and prevention of pain and stress. The least frequent was positioning and skin care. The results also showed that the frequency of developmental care practices differs depending on the geographical location of the units and is higher in units with a higher level of treatment differentiation and that have established a specific program/protocol of developmental care. Conclusion: although feasible, Developmental Care practices are not performed consistently in Portuguese neonatal care units. A global change in team culture, more training, implementation of protocols and organizational investment in this area is needed.
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Urfer A, Turpin H, Dimitrova N, Borghini A, Plessen KJ, Morisod Harari M, Urben S. Consequences of Prematurity on Cortisol Regulation and Adjustment Difficulties: A 9-Year Longitudinal Study. CHILDREN (BASEL, SWITZERLAND) 2021; 9:9. [PMID: 35053633 PMCID: PMC8774148 DOI: 10.3390/children9010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 12/20/2021] [Accepted: 12/22/2021] [Indexed: 11/17/2022]
Abstract
A preterm birth represents a stressful event having potentially negative long-term consequences. Thirty-three children born preterm (<33 weeks gestational age) and eleven full-term children participated in a nine-year longitudinal study. Perinatal Risk Inventory (PERI) was used at birth to assess the perinatal stress. Salivary cortisol, collected four times a day over two consecutive days, was measured with radioimmunoassay technique at six months and nine years to assess the hypothalamic-pituitary-adrenal (HPA) axis. Mothers reported post-traumatic symptoms on a self-report questionnaire 12 months after their child's birth and children's adjustment problems at 9 years of child age on the Child Behavior Checklist. Results showed a significant difference in cortisol regulation at nine years between preterm and full-term children but no differences in adjustment problems. Whereas biological factors (i.e., PERI, cortisol regulation at six months) explained cortisol at nine years, maternal post-traumatic symptoms were predictive of adjustment problems in their child. In conclusion, very preterm birth has some long-term consequences on the HPA-axis regulation at nine years. Although cortisol regulation is mostly influenced by biological factors, the presence of maternal post-traumatic symptoms predicts the manifestation of adjustment problems in both groups. This shows the importance of maternal psychological well-being for child development. Further research is needed to understand the exact consequences of premature birth on cortisol regulation and the implication for the child's development and health.
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Abdelmageed RI, Youssef AM, El-Farrash RA, Mohamed HM, Abdelaziz AW. Measurement of Cumulative Preterm Neonatal and Maternal Stressors During Neonatal Intensive Care Unit Admission. J Pediatr Psychol 2021; 47:595-605. [PMID: 34865092 DOI: 10.1093/jpepsy/jsab124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES By nature, the neonatal intensive care unit (NICU) environment is stressful for both infants and mothers. This study aimed to explore and quantify the severity of early life stressors in premature infants admitted to the NICU and evaluate the effect of cumulative neonatal stressors on maternal mental health. METHODS This cross-sectional study included 100 preterm infants admitted to the NICU for at least 10 days. Daily experiences with painful/stressful procedures for 10 days were determined using the Neonatal Infant Stressor Scale. The included mothers were assessed for their psychological well-being 1 week after NICU admission using the Parental Stressor Scale: NICU and Edinburgh Postnatal Depression Scale. RESULTS During the first 10 days of NICU admission, preterm infants experienced an average of 350.76 ± 84.43 acute procedures and an average of 44.84 ± 11.12 cumulative hours of chronic events, with the highest scores recorded on first 3 days of admission. Although intravenous flushing for patency was the most frequent acute procedure, blood gas sampling was the most painful. Forty-five percent of the mothers showed significant depressive symptoms, with the maternal role alteration reported as the most stressful experience, especially for young and new mothers (p < .001). The cumulative stressors experienced by infants were significantly associated with elevated maternal perception of psychological maladjustment (p < .001). CONCLUSION This study confirmed that the NICU environment is stressful for both infants and mothers, with the total cumulative stressors experienced by preemies in the NICU having an negative impact on maternal mental health.
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Affiliation(s)
| | - Azza M Youssef
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Egypt
| | | | | | - Asmaa W Abdelaziz
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Egypt
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Badiee Z, Zandi H, Armanian A, Sadeghnia A, Barekatain B. Premedication with intravenous midazolam for neonatal endotracheal intubation: A double blind randomized controlled trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:57. [PMID: 34729065 PMCID: PMC8506249 DOI: 10.4103/jrms.jrms_546_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/21/2020] [Accepted: 03/01/2021] [Indexed: 11/04/2022]
Abstract
Background Pain during the neonatal period has been associated with immediate and long-term adverse effects. One of the most frequent painful procedures that neonates face in neonatal intensive care unit is the endotracheal intubation. Midazolam has been a candidate for premedication before neonatal intubation. Our aim was to evaluate the effects of midazolam as the premedication on endotracheal intubation of premature infants during surfactant administration. Materials and Methods In a double-blind clinical trial, 80 preterm infants were undertaken for tracheal intubation following the use of atropine associated to either midazolam or placebo. Patient's vital signs and general conditions were constantly monitored, and pain was assessed using premature infant pain profile (PIPP) score. Results The mean ± standard deviation for postnatal age was 95.38 ± 50.04 and 111.63 ± 49.4 min in control and midazolam groups, respectively. The patients in the midazolam group had significantly better outcomes across several intubation outcome measures such as duration of endotracheal intubation (23.5 ± 6.7 vs. 18.8 ± 4.8 s, P = 0.001), oxygen saturation level (88.05% ±13.7 vs. 95.1 ± 1.8%, P = 0.002), intubation failure (34.2% vs. 2.5%, P = 0.0001), awake and resistance during intubation (95% vs. 20%, P = 0.0001), and excellent patient condition during intubation (0% vs. 82.5%, P = 0.0001). In addition, PIPP score was significantly lower in the midazolam group (5.2 ± 2.06 vs. 12.9 ± 2.9, P = 0.0001). Conclusion Premedication with midazolam in newborns before intubation, can hold promising effects that manifests as better overall outcomes, less complications, better vital signs, more comfortable situation, and lesser pain for these patients.
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Affiliation(s)
- Zohreh Badiee
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Zandi
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirmohammad Armanian
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Sadeghnia
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Barekatain
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Shiff I, Bucsea O, Pillai Riddell R. Psychosocial and Neurobiological Vulnerabilities of the Hospitalized Preterm Infant and Relevant Non-pharmacological Pain Mitigation Strategies. Front Pediatr 2021; 9:568755. [PMID: 34760849 PMCID: PMC8573383 DOI: 10.3389/fped.2021.568755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Preterm pain is common in the Neonatal Intensive Care Unit (NICU), with multiple invasive procedures occurring daily. Objective: To review the psychosocial and neurobiological vulnerabilities of preterm infants and to provide an updated overview of non-pharmacological strategies for acute procedural pain in hospitalized preterm infants. Methods: We utilized a narrative review methodology, which also included a synthesis of key pieces of published systematic reviews that are relevant to the current work. Results and Conclusions: Preterm infants are uniquely susceptible to the impact of painful procedures and prolonged separation from caregivers that are often inherent in a NICU stay. Non-pharmacological interventions can be efficacious for mitigating procedural pain for preterm infants. Interventions should continue to be evaluated with high quality randomized controlled trials, and should endeavor to take into account the neurobiological and psychosocial aspects of preterm vulnerability for pain prevention and management strategies.
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Affiliation(s)
- Ilana Shiff
- Department of Psychology, York University, Toronto, ON, Canada
| | - Oana Bucsea
- Department of Psychology, York University, Toronto, ON, Canada
| | - Rebecca Pillai Riddell
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Psychiatry Research, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Stimulating and maintaining spontaneous breathing during transition of preterm infants. Pediatr Res 2021; 90:722-730. [PMID: 31216570 DOI: 10.1038/s41390-019-0468-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 05/25/2019] [Accepted: 06/03/2019] [Indexed: 01/30/2023]
Abstract
Most preterm infants breathe at birth, but need additional respiratory support due to immaturity of the lung and respiratory control mechanisms. To avoid lung injury, the focus of respiratory support has shifted from invasive towards non-invasive ventilation. However, applying effective non-invasive ventilation is difficult due to mask leak and airway obstruction. The larynx has been overlooked as one of the causes for obstruction, preventing face mask ventilation from inflating the lung. The larynx remains mostly closed at birth, only opening briefly during a spontaneous breath. Stimulating and supporting spontaneous breathing could enhance the success of non-invasive ventilation by ensuring that the larynx remains open. Maintaining adequate spontaneous breathing and thereby reducing the need for invasive ventilation is not only important directly after birth, but also in the first hours after admission to the NICU. Respiratory distress syndrome is an important cause of respiratory failure. Traditionally, treatment of RDS required intubation and mechanical ventilation to administer exogenous surfactant. However, new ways have been implemented to administer surfactant and preserve spontaneous breathing while maintaining non-invasive support. In this narrative review we aim to describe interventions focused on stimulation and maintenance of spontaneous breathing of preterm infants in the first hours after birth.
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Gomes CI, Barr GA. Local injury and systemic infection in infants alter later nociception and pain affect during early life and adulthood. Brain Behav Immun Health 2021; 9:100175. [PMID: 34589906 PMCID: PMC8474633 DOI: 10.1016/j.bbih.2020.100175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Accepted: 11/06/2020] [Indexed: 10/25/2022] Open
Abstract
Newborns in intensive care are regularly exposed to minor painful procedures at developmental time points when noxious stimulation would be normally absent. Pain from these interventions is inconsistently treated and often exists concurrently with systemic infection, a common comorbidity of prematurity. Our understanding of the independent and combined effects of early painful experiences and infection on pain response is incomplete. The main goals of this research therefore were to understand how pain and infection experienced early in life influence future nociceptive and affective responses to painful stimuli. Rat pups were infected with E-coli on postnatal day 2 (PN2) and had left hind paw injury with carrageenan on PN3. Standard thermal tests for acute pain, formalin tests for inflammatory pain, and conditioned place aversion testing were performed at different ages to assess the nociceptive and affective components of the pain response. Early E-coli infection and early inflammatory injury with carrageenan both independently increased pain scores following hind paw reinjury with formalin on PN8, with effects persisting into adulthood in the carrageenan exposed group. When experienced concurrently, early E-coli infection and carrageenan exposure also increased conditioned aversion to pain in adults. Effect of sex was significant only in formalin testing, with males showing higher pain scores in infancy and females showing higher pain scores as adults. These findings demonstrate that infection experienced early in life can alter both the nociceptive and affective components of the pain response and that there is a cumulative effect of local and systemic pro-inflammatory processes on the aversive component of pain.
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Affiliation(s)
- Carly I Gomes
- Department of Neonatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Gordon A Barr
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania, 3615 Civic Center Boulevard, Philadelphia, PA, 19104, USA.,Department of Psychology, University of Pennsylvania, 425 S. University Avenue, Stephen A. Levin Building, Philadelphia, PA, USA
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Davis SM, Burman MA. Maternal separation with neonatal pain influences later-life fear conditioning and somatosenation in male and female rats. Stress 2021; 24:504-513. [PMID: 33043804 PMCID: PMC8039057 DOI: 10.1080/10253890.2020.1825674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Early life adversity, including that which occurs in a medical setting, has been increasingly shown to have lasting consequences on both physical and mental health. In order to understand the lasting effects of early-life adversity, such as that might occur in the neonatal intensive care unit (NICU), several rodent models have been developed including maternal separation, neonatal handling, and repeated needle prick pain. However, in the clinical scenario, these stressors are often combined. Thus, the current study seeks to observe the lasting impacts of both neonatal pain and maternal separation in a rodent model. Rats were separated from their dam for 6 h per day during the first 7 days of life, during which they were subjected to repeated needle prick pain or handling. A separate group was left undisturbed. All rats were subsequently tested for threat processing using a 3-day Pavlovian fear conditioning model and for somatosensation using measures of mechanical and thermal thresholds. Results indicated that rats subjected to maternal separation and pain had enhanced fear conditioning in adolescence as well as displaying a modest age-independent tactile hypersensitivity compared to undisturbed controls. These data show that experiencing combined neonatal pain and maternal separation may create a latent vulnerability to subsequent stressors.
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Affiliation(s)
- Seth M. Davis
- Department of Psychology, University of New England
- Center for Excellence in the Neurosciences, University of
New England
| | - Michael A. Burman
- Department of Psychology, University of New England
- Center for Excellence in the Neurosciences, University of
New England
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Filippa M, Monaci MG, Spagnuolo C, Serravalle P, Daniele R, Grandjean D. Maternal speech decreases pain scores and increases oxytocin levels in preterm infants during painful procedures. Sci Rep 2021; 11:17301. [PMID: 34453088 PMCID: PMC8397753 DOI: 10.1038/s41598-021-96840-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/11/2021] [Indexed: 12/28/2022] Open
Abstract
Preterm infants undergo early separation from parents and are exposed to frequent painful clinical procedures, with resultant short- and long-term effects on their neurodevelopment. We aimed to establish whether the mother's voice could provide an effective and safe analgesia for preterm infants and whether endogenous oxytocin (OXT) could be linked to pain modulation. Twenty preterm infants were exposed to three conditions-mother's live voice (speaking or singing) and standard care-in random order during a painful procedure. OXT levels (pg/mL) in saliva and plasma cortisol levels were quantified, and the Premature Infant Pain Profile (PIPP) was blindly coded by trained psychologists. During the mother's live voice, PIPP scores significantly decreased, with a concomitant increase in OXT levels over baseline. The effect on pain perception was marginally significant for singing. No effects on cortisol levels were found. The mother's live voice modulated preterm infants' pain indicators. Endogenous OXT released during vocal contact is a promising protective mechanism during early painful interventions in at-risk populations.
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Affiliation(s)
- Manuela Filippa
- Swiss Center of Affective Sciences, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
- Department of Social Sciences, University of Valle D'Aosta, Aosta, Italy.
| | | | | | | | - Roberta Daniele
- Department of Clinical Pathology, Parini Hospital, Aosta, Italy
| | - Didier Grandjean
- Swiss Center of Affective Sciences, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
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Butkevich IP, Mikhailenko VA, Vershinina EA, Barr GA. The Long-Term Effects of Neonatal Inflammatory Pain on Cognitive Function and Stress Hormones Depend on the Heterogeneity of the Adolescent Period of Development in Male and Female Rats. Front Behav Neurosci 2021; 15:691578. [PMID: 34366805 PMCID: PMC8334561 DOI: 10.3389/fnbeh.2021.691578] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/21/2021] [Indexed: 11/21/2022] Open
Abstract
Exposure to stress at an early age programs the HPA axis which can lead to cognitive deficits in adults. However, it is not known whether these deficits emerge in adulthood or are expressed earlier in life. The aims of the study were to investigate (1) the immediate effects of early injury-induced stress in one-day-old (P1) and repeated stress on at P1 and P2 rat pups on plasma corticosterone levels; and (2) examine the subsequent long-term effects of this early stress on spatial learning and memory, and stress reactivity in early P26-34 and late P45-53 adolescent male and female rats. Intra-plantar injection of formalin induced prolonged and elevated levels of corticosterone in pups and impaired spatial learning and short- and long-term memory in late adolescent males and long-term memory in early adolescent females. There were sex differences in late adolescence in both learning and short-term memory. Performance on the long-term memory task was better than that on the short-term memory task for all early adolescent male and female control and stressed animals. Short-term memory was better in the late age control rats of both sexes and for formalin treated females as compared with the early age rats. These results are consistent with an impaired function of structures involved in memory (the hippocampus, amygdala, prefrontal cortex) after newborn pain. However, activation of the HPA axis by neonatal pain did not directly correlate with spatial learning and memory outcomes and the consequences of neonatal pain remain are likely multi-determined.
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Affiliation(s)
- Irina P. Butkevich
- Laboratory of Ontogenesis of the Nervous System, Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Petersburg, Russia
| | - Viktor A. Mikhailenko
- Laboratory of Ontogenesis of the Nervous System, Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Petersburg, Russia
| | - Elena A. Vershinina
- Department of Information Technologies and Mathematical Modeling, Pavlov Institute of Physiology, Russian Academy of Sciences, Saint Petersburg, Russia
| | - Gordon A. Barr
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia and the Perelman School of Medicine, Philadelphia, PA, United States
- Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States
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Knudsen K, McGill G, Ann Waitzman K, Powell J, Carlson M, Shaffer G, Morris M. Collaboration to Improve Neuroprotection and Neuropromotion in the NICU: Team Education and Family Engagement. Neonatal Netw 2021; 40:212-223. [PMID: 34330871 DOI: 10.1891/11-t-680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2020] [Indexed: 11/25/2022]
Abstract
The number of babies born extremely low birth weight surviving to be discharged home after experiencing the NICU continues to improve. Unfortunately, early sensory development for these babies occurs in an environment vastly different from the intended in-utero environment and places them at high risk of long-term neurodevelopmental and neurocognitive challenges. Our goal in the NICU must transition from simply discharge home to supporting the neurosensory development necessary for a thriving lifetime. To accomplish a goal of thriving families and thriving babies, it is clear the NICU interprofessional team must share an understanding of neurosensory development, the neuroprotective strategies safeguarding development, the neuropromotive strategies supporting intended maturational development, and the essential nature of family integration in these processes. We share the educational endeavors of 11 center collaboratives in establishing the foundational knowledge necessary to support preterm babies and their families.
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Carlsen Misic M, Andersen RD, Strand S, Eriksson M, Olsson E. Nurses' perception, knowledge, and use of neonatal pain assessment. PAEDIATRIC & NEONATAL PAIN 2021; 3:59-65. [PMID: 35547593 PMCID: PMC8975217 DOI: 10.1002/pne2.12050] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 03/21/2021] [Accepted: 04/11/2021] [Indexed: 01/10/2023]
Abstract
Preterm and sick newborn infants undergo several painful procedures during their hospital stay, potentially leading to short‐ and long‐term negative consequences. Pain assessment should be performed regularly to provide optimal pain management. Nurses' knowledge of and attitude toward neonatal pain assessment affect how pain is assessed and managed in the clinical situation. The aim of this study was to explore Swedish nurses' perception, knowledge, and use of neonatal pain assessment. This descriptive, cross‐sectional questionnaire study was conducted across all Swedish neonatal units (n = 38). Respondents were chosen through convenience sampling by the head nurses at each unit. Ten nurses from each unit were asked to complete the survey, which contained both closed and open questions. A majority of the units (30/38; 79%) participated and 232 surveys were returned, a response rate of 61%. Of the nurses, 91% thought that neonatal pain assessment was important. Many nurses mentioned various difficulties with pain assessment and concerns that the scales used might not assess pain correctly. About half of the nurses considered themselves to have enough knowledge of neonatal pain assessment. Those who reported having enough knowledge of pain assessment viewed the pain scales used at their units more positively. Of the nurses, 74% reported using a pain assessment scale several times per work shift. Pain management guidelines were available according to 75% of nurses, but only 53% reported that the guidelines were followed. Although nurses in general expressed a positive attitude toward pain assessment scales, this was not necessarily evident in their clinical practice. Lack of knowledge, available or accessible guidelines, or concerns regarding the validity of available pain scales seemed to limit their use.
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Affiliation(s)
- Martina Carlsen Misic
- Department of Pediatrics Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden.,Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
| | - Randi Dovland Andersen
- Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden.,Department of Research Telemark Hospital Trust Skien Norway
| | - Sofia Strand
- Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
| | - Emma Olsson
- Department of Pediatrics Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden.,Faculty of Medicine and Health School of Health Sciences Örebro University Örebro Sweden
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47
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Baxter L, Moultrie F, Fitzgibbon S, Aspbury M, Mansfield R, Bastiani M, Rogers R, Jbabdi S, Duff E, Slater R. Functional and diffusion MRI reveal the neurophysiological basis of neonates' noxious-stimulus evoked brain activity. Nat Commun 2021; 12:2744. [PMID: 33980860 PMCID: PMC8115252 DOI: 10.1038/s41467-021-22960-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/05/2021] [Indexed: 11/20/2022] Open
Abstract
Understanding the neurophysiology underlying neonatal responses to noxious stimulation is central to improving early life pain management. In this neonatal multimodal MRI study, we use resting-state and diffusion MRI to investigate inter-individual variability in noxious-stimulus evoked brain activity. We observe that cerebral haemodynamic responses to experimental noxious stimulation can be predicted from separately acquired resting-state brain activity (n = 18). Applying this prediction model to independent Developing Human Connectome Project data (n = 215), we identify negative associations between predicted noxious-stimulus evoked responses and white matter mean diffusivity. These associations are subsequently confirmed in the original noxious stimulation paradigm dataset, validating the prediction model. Here, we observe that noxious-stimulus evoked brain activity in healthy neonates is coupled to resting-state activity and white matter microstructure, that neural features can be used to predict responses to noxious stimulation, and that the dHCP dataset could be utilised for future exploratory research of early life pain system neurophysiology.
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Affiliation(s)
- Luke Baxter
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Fiona Moultrie
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Sean Fitzgibbon
- FMRIB, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | | | | | - Matteo Bastiani
- FMRIB, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
- Sir Peter Mansfield Imaging Centre, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Richard Rogers
- Nuffield Department of Anaesthetics, John Radcliffe Hospital, Oxford, UK
| | - Saad Jbabdi
- FMRIB, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Eugene Duff
- Department of Paediatrics, University of Oxford, Oxford, UK
- FMRIB, Wellcome Centre for Integrative Neuroimaging, University of Oxford, Oxford, UK
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, UK.
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Davis SM, Zuke JT, Berchulski MR, Burman MA. Amygdalar Corticotropin-Releasing Factor Signaling Is Required for Later-Life Behavioral Dysfunction Following Neonatal Pain. Front Physiol 2021; 12:660792. [PMID: 34045975 PMCID: PMC8144524 DOI: 10.3389/fphys.2021.660792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Neonatal pain such as that experienced by infants in the neonatal intensive care unit is known to produce later-life dysfunction including heightened pain sensitivity and anxiety, although the mechanisms remain unclear. Both chronic pain and stress in adult organisms are known to influence the corticotropin-releasing factor (CRF) system in the Central Nucleus of the Amygdala, making this system a likely candidate for changes following neonatal trauma. To examine this, neonatal rats were subjected to daily pain, non-painful handling or left undisturbed for the first week of life. Beginning on postnatal day, 24 male and female rats were subjected to a 4-day fear conditioning and sensory testing protocol. Some subjects received intra-amygdalar administration of either Vehicle, the CRF receptor 1 (CRF1) receptor antagonist Antalarmin, or the CRF receptor 2 (CRF2) receptor antagonist Astressin 2B prior to fear conditioning and somatosensory testing, while others had tissue collected following fear conditioning and CRF expression in the CeA and BLA was assessed using fluorescent in situ hybridization. CRF1 antagonism attenuated fear-induced hypersensitivity in neonatal pain and handled rats, while CRF2 antagonism produced a general antinociception. In addition, neonatal pain and handling produced a lateralized sex-dependent decrease in CRF expression, with males showing a diminished number of CRF-expressing cells in the right CeA and females showing a similar reduction in the number of CRF-expressing cells in the left BLA compared to undisturbed controls. These data show that the amygdalar CRF system is a likely target for alleviating dysfunction produced by early life trauma and that this system continues to play a major role in the lasting effects of such trauma into the juvenile stage of development.
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Affiliation(s)
- Seth M Davis
- Department of Psychology, University of New England, Biddeford, ME, United States.,Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, United States
| | - Jared T Zuke
- Department of Psychology, University of New England, Biddeford, ME, United States.,Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, United States
| | - Mariah R Berchulski
- Department of Psychology, University of New England, Biddeford, ME, United States.,Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, United States
| | - Michael A Burman
- Department of Psychology, University of New England, Biddeford, ME, United States.,Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, United States
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Filippa M, Della Casa E, D’amico R, Picciolini O, Lunardi C, Sansavini A, Ferrari F. Effects of Early Vocal Contact in the Neonatal Intensive Care Unit: Study Protocol for a Multi-Centre, Randomised Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083915. [PMID: 33917889 PMCID: PMC8068283 DOI: 10.3390/ijerph18083915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022]
Abstract
Preterm infants are at risk for developing altered trajectories of cognitive, social, and linguistic competences compared to a term population. This is mainly due to medical and environmental factors, as they are exposed to an atypical auditory environment and simultaneously, long periods of early separation from their parents. The short-term effects of early vocal contact (EVC) on an infant’s early stability have been investigated. However, there is limited evidence of its impact on the infant’s autonomic nervous system maturation, as indexed by heart rate variability, and its long-term impact on infant neurodevelopment. Our multi-centric study aims to investigate the effects of EVC on a preterm infant’s physiology, neurobehaviour, and development. Eighty stable preterm infants, born at 25–32 weeks and 6 days gestational age, without specific abnormalities, will be enrolled and randomised to either an intervention or control group. The intervention group will receive EVC, where mothers will talk and sing to their infants for 10 min three times per week for 2 weeks. Mothers in the control group will be encouraged to spend the same amount of time next to the incubator and observe the infant’s behaviour through a standard cluster of indicators. Infants will be assessed at baseline; the end of the intervention; term equivalent age; and 3, 6, 12, and 24 months corrected age, with a battery of physiological, neurobehavioral, and developmental measures. Early interventions in the neonatal intensive care unit have demonstrated effects on the neurodevelopment of preterm infants, thereby lowering the negative long-term effects of an atypical auditory and interactional environment. Our proposed study will provide new insight into mother–infant early contact as a protective intervention against the sequelae of prematurity during this sensitive period of development. Early intervention, such as EVC, is intuitive and easy to implement in the daily care of preterm infants. However, its long-term effects on infant neurodevelopment and maternal sensitivity and stress are still unclear. Trial Registration: NCT04759573, retrospectively registered, 17 February 2021.
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Affiliation(s)
- Manuela Filippa
- Department of Psychology and Educational Sciences, University of Geneva, 24, rue General Dufour, 1211 Geneva, Switzerland
- Department of Social Sciences, University of Valle d’Aosta, Str. Cappuccini, 2, 11100 Aosta, Italy
- Correspondence:
| | - Elisa Della Casa
- Neonatal Intensive Care Unit, Department of Medical and Surgical Science of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy; (E.D.C.); (F.F.)
| | - Roberto D’amico
- Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy;
| | - Odoardo Picciolini
- Pediatric Physical Medicine & Rehabilitation Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy;
| | - Clara Lunardi
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy;
| | - Alessandra Sansavini
- Department of Psychology “Renzo Canestrari”, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy;
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Science of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy; (E.D.C.); (F.F.)
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50
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Gouin S, Alix-Séguin L, Desjardins MP, Gravel J, Lebel D, Gaucher N. Effect on Pain of an Oral Sucrose Solution vs. Placebo in Children 1 to 3 Months Old Needing Nasopharyngeal Aspiration: A Randomized Controlled Trial. J Emerg Med 2021; 61:151-156. [PMID: 33795167 DOI: 10.1016/j.jemermed.2021.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 01/25/2021] [Accepted: 02/06/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Oral sweet solutions have been proposed as effective pain-reducing agents for procedures. OBJECTIVES To compare the efficacy of an oral sucrose solution vs. placebo in alleviating pain in children (1-3 months) during nasopharyngeal aspiration (NPA). METHODS A randomized, double-blind, controlled clinical trial was conducted in a pediatric hospital emergency department. Participants (aged 1-3 months) requiring NPA were randomly allocated to receive 2 mL of 88% sucrose (SUC) or 2 mL of a placebo (PLA) 2 min prior to the procedure. The primary outcome was the mean difference in pain scores at 1 min post NPA as assessed by the Face, Legs, Activity, Cry and Consolability (FLACC) Pain Scale. RESULTS Seventy-two participants completed the study, 37 receiving SUC and 35 PLA. The mean difference in FLACC scores compared with baseline was 3.3 (2.5-4.1) for SUC vs. 3.2 (2.3-4.1) for PLA (p = .094) at 1 min and -1.2 (-1.7-0.7) for SUC vs. -0.8 (-1.5 to -0.1) for PLA (p = 0.66) at 3 min after NPA. For the Neonatal Infant Pain Scale scores, it was 2.3 (1.6-3.0) (SUC) vs. 2.5 (1.8-3.2) (PLA) (p = .086) at 1 min and -1.2 (-1.6 to -0.8) (SUC) vs. -0.8 (-1.3 to 0.2) (PLA) (p = 0.59) 3 min after NPA. There was no difference in the mean crying time, 114 (98-130) s, SUC vs. 109 (92-126) s, PLA (p = 0.81). No significant difference was found in participants' heart rate at 1 min 174 (154-194) beats/min in SUC vs. 179 (160-198) beats/min in PLA (p = 0.32). CONCLUSIONS In infants (1-3 months) undergoing NPA, administration of an oral sweet solution did not statistically decrease pain scores.
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Affiliation(s)
- Serge Gouin
- Departments of Pediatric Emergency Medicine & Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Laurence Alix-Séguin
- Departments of Pediatric Emergency Medicine & Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Marie Pier Desjardins
- Departments of Pediatric Emergency Medicine & Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Jocelyn Gravel
- Departments of Pediatric Emergency Medicine & Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Denis Lebel
- Department of Pharmacy, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Nathalie Gaucher
- Departments of Pediatric Emergency Medicine & Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
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