1
|
Unesi Z, Amouzeshi Z, Jamavar J, Mahmoudzadeh Zarandi F. The Effect of a Combination of Vibration and External Cold on Pain Caused during Vaccine Injection in Infants: A Randomized Clinical Trial. Int J Clin Pract 2024; 2024:7170927. [PMID: 38469171 PMCID: PMC10927340 DOI: 10.1155/2024/7170927] [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] [Received: 12/09/2023] [Revised: 01/14/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024] Open
Abstract
Aim This study was conducted to determine the effect of combining vibration and external cold on pain caused by vaccine injection among six-month-old infants. Design Randomized controlled trial. Methods In this clinical trial, 80 eligible infants were selected from the infants referred to a health center as per the inclusion criteria. The infants were assigned to either a control group or an intervention group by block randomization. In the intervention group, a vibrating and cold device was placed above the injection site from one minute before to 15 seconds after the pentavalent vaccine injection. In the control group, no intervention was performed, and they were vaccinated according to the routine procedure. The pain status in the two groups was measured using the Modified Behavioral Pain Scale (MBPS) 15 seconds after the injection, and the crying duration was assessed from the injection of the vaccine till the end of it. Data were analyzed in SPSS 23 software using Mann-Whitney, t, Spearman, and chi-square tests. The level of significance was set to p < 0.05. Results Most participants in the control (55%) and intervention (55%) groups were girls. Statistical data analysis of 80 infants showed that the mean pain intensity (p = 0.032) and duration of crying (p = 0.0001) in the intervention group (6.1 ± 1.8, 32.47 ± 16.78) were lower than those of the control group (7.2 ± 0.1, 51.02 ± 25.9), respectively. Conclusion Because the intensity of pain, especially the duration of crying, was lower in the intervention group than in the control group, we may suggest that nurses use simple pain relief solutions in vaccination centers, such as a combination of vibration and cold. This trial is registered with IRCT201207157130N2.
Collapse
Affiliation(s)
- Zahra Unesi
- Faculty of Nursing and Midwifery, Birjand University of Medical Sciences, Birjand, Iran
| | - Zahra Amouzeshi
- Department of Nursing, School of Nursing and Midwifery, Cardiovascular Diseases Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Javad Jamavar
- Science and Research Branch Islamic Azad University of Medical Sciences, Birjand, Iran
| | | |
Collapse
|
2
|
Vicente‐Perez S, Robleda G, Gich I, Nolla T, Ponce‐Taylor J, Verd S, Ginovart G. Physiological responses and behavioural organization of very low birth weight infants during swaddled versus traditional weighing. Nurs Open 2023; 10:6896-6902. [PMID: 37458256 PMCID: PMC10495735 DOI: 10.1002/nop2.1943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 02/20/2023] [Accepted: 07/07/2023] [Indexed: 09/13/2023] Open
Abstract
AIM Despite the consequences of neonatal distress and agitation, preterm infants undergo stress owing to weighing procedures. The objective of this study was to enable very low birth weight infants to maintain adequate self-regulation during weighing. DESIGN This prospective crossover study utilizes a within-subjects design, where intervention days were compared to control days. METHOD Infants were exposed to both swaddled and unswaddled weighing in an intensive care nursery setting. Nineteen very low birth weight infants were weighed on two consecutive days. Variables of heart rate, respiratory rate and ALPS-Neo score were recorded. RESULTS Stress score decreased significantly from 1.65 (pre-weight) to 0.23 (weight measurement) in swaddled-intervention periods; conversely, it increased significantly from 1.26 (pre-weight) to 4.97 (weight measurement) in control periods. During weight measurement, heart and respiratory rate were significantly lower for swaddled-intervention days when compared to control days. Given the significant impact of swaddled weighing in reducing stress, this method can be used as an appropriate weighing procedure in intensive care. This research has no patient or public contribution.
Collapse
Affiliation(s)
| | - Gemma Robleda
- Campus docent Sant Joan de DéuBarcelona UniversityBarcelonaSpain
- Iberoamerican Cochrane CentreHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Ignasi Gich
- Clinical Epidemiology UnitHospital de la Santa Creu i Sant PauBarcelonaSpain
| | - Tania Nolla
- Orthopedic & Neuroscience UnitsHospital de la Santa Creu i Sant PauBarcelonaSpain
| | | | - Sergio Verd
- Department of Primary CareBalearic Health Authority, La Vileta surgeryMajorcaSpain
| | - Gemma Ginovart
- Neonatal Intensive Care UnitHospital Germans TriasBarcelonaSpain
| |
Collapse
|
3
|
Stróżyk A, Paraskevas T, Romantsik O, Calevo MG, Banzi R, Ley D, Bruschettini M. Pharmacological pain and sedation interventions for the prevention of intraventricular hemorrhage in preterm infants on assisted ventilation - an overview of systematic reviews. Cochrane Database Syst Rev 2023; 8:CD012706. [PMID: 37565681 PMCID: PMC10421735 DOI: 10.1002/14651858.cd012706.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
BACKGROUND Germinal matrix hemorrhage and intraventricular hemorrhage (GMH-IVH) may contribute to neonatal morbidity and mortality and result in long-term neurodevelopmental sequelae. Appropriate pain and sedation management in ventilated preterm infants may decrease the risk of GMH-IVH; however, it might be associated with harms. OBJECTIVES To summarize the evidence from systematic reviews regarding the effects and safety of pharmacological interventions related to pain and sedation management in order to prevent GMH-IVH in ventilated preterm infants. METHODS We searched the Cochrane Library August 2022 for reviews on pharmacological interventions for pain and sedation management to prevent GMH-IVH in ventilated preterm infants (< 37 weeks' gestation). We included Cochrane Reviews assessing the following interventions administered within the first week of life: benzodiazepines, paracetamol, opioids, ibuprofen, anesthetics, barbiturates, and antiadrenergics. Primary outcomes were any GMH-IVH (aGMH-IVH), severe IVH (sIVH), all-cause neonatal death (ACND), and major neurodevelopmental disability (MND). We assessed the methodological quality of included reviews using the AMSTAR-2 tool. We used GRADE to assess the certainty of evidence. MAIN RESULTS We included seven Cochrane Reviews and one Cochrane Review protocol. The reviews on clonidine and paracetamol did not include randomized controlled trials (RCTs) matching our inclusion criteria. We included 40 RCTs (3791 infants) from reviews on paracetamol for patent ductus arteriosus (3), midazolam (3), phenobarbital (9), opioids (20), and ibuprofen (5). The quality of the included reviews was high. The certainty of the evidence was moderate to very low, because of serious imprecision and study limitations. Germinal matrix hemorrhage-intraventricular hemorrhage (any grade) Compared to placebo or no intervention, the evidence is very uncertain about the effects of paracetamol on aGMH-IVH (risk ratio (RR) 0.89, 95% confidence interval (CI) 0.38 to 2.07; 2 RCTs, 82 infants; very low-certainty evidence); midazolam may result in little to no difference in the incidence of aGMH-IVH (RR 1.68, 95% CI 0.87 to 3.24; 3 RCTs, 122 infants; low-certainty evidence); the evidence is very uncertain about the effect of phenobarbital on aGMH-IVH (RR 0.99, 95% CI 0.83 to 1.19; 9 RCTs, 732 infants; very low-certainty evidence); opioids may result in little to no difference in aGMH-IVH (RR 0.85, 95% CI 0.65 to 1.12; 7 RCTs, 469 infants; low-certainty evidence); ibuprofen likely results in little to no difference in aGMH-IVH (RR 0.99, 95% CI 0.81 to 1.21; 4 RCTs, 759 infants; moderate-certainty evidence). Compared to ibuprofen, the evidence is very uncertain about the effects of paracetamol on aGMH-IVH (RR 1.17, 95% CI 0.31 to 4.34; 1 RCT, 30 infants; very low-certainty evidence). Compared to midazolam, morphine may result in a reduction in aGMH-IVH (RR 0.28, 95% CI 0.09 to 0.87; 1 RCT, 46 infants; low-certainty evidence). Compared to diamorphine, the evidence is very uncertain about the effect of morphine on aGMH-IVH (RR 0.65, 95% CI 0.40 to 1.07; 1 RCT, 88 infants; very low-certainty evidence). Severe intraventricular hemorrhage (grade 3 to 4) Compared to placebo or no intervention, the evidence is very uncertain about the effect of paracetamol on sIVH (RR 1.80, 95% CI 0.43 to 7.49; 2 RCTs, 82 infants; very low-certainty evidence) and of phenobarbital (grade 3 to 4) (RR 0.91, 95% CI 0.66 to 1.25; 9 RCTs, 732 infants; very low-certainty evidence); opioids may result in little to no difference in sIVH (grade 3 to 4) (RR 0.98, 95% CI 0.71 to 1.34; 6 RCTs, 1299 infants; low-certainty evidence); ibuprofen may result in little to no difference in sIVH (grade 3 to 4) (RR 0.82, 95% CI 0.54 to 1.26; 4 RCTs, 747 infants; low-certainty evidence). No studies on midazolam reported this outcome. Compared to ibuprofen, the evidence is very uncertain about the effects of paracetamol on sIVH (RR 2.65, 95% CI 0.12 to 60.21; 1 RCT, 30 infants; very low-certainty evidence). Compared to midazolam, the evidence is very uncertain about the effect of morphine on sIVH (grade 3 to 4) (RR 0.08, 95% CI 0.00 to 1.43; 1 RCT, 46 infants; very low-certainty evidence). Compared to fentanyl, the evidence is very uncertain about the effect of morphine on sIVH (grade 3 to 4) (RR 0.59, 95% CI 0.18 to 1.95; 1 RCT, 163 infants; very low-certainty evidence). All-cause neonatal death Compared to placebo or no intervention, the evidence is very uncertain about the effect of phenobarbital on ACND (RR 0.94, 95% CI 0.51 to 1.72; 3 RCTs, 203 infants; very low-certainty evidence); opioids likely result in little to no difference in ACND (RR 1.12, 95% CI 0.80 to 1.55; 5 RCTs, 1189 infants; moderate-certainty evidence); the evidence is very uncertain about the effect of ibuprofen on ACND (RR 1.00, 95% CI 0.38 to 2.64; 2 RCTs, 112 infants; very low-certainty evidence). Compared to midazolam, the evidence is very uncertain about the effect of morphine on ACND (RR 0.31, 95% CI 0.01 to 7.16; 1 RCT, 46 infants; very low-certainty evidence). Compared to diamorphine, the evidence is very uncertain about the effect of morphine on ACND (RR 1.17, 95% CI 0.43 to 3.19; 1 RCT, 88 infants; very low-certainty evidence). Major neurodevelopmental disability Compared to placebo, the evidence is very uncertain about the effect of opioids on MND at 18 to 24 months (RR 2.00, 95% CI 0.39 to 10.29; 1 RCT, 78 infants; very low-certainty evidence) and at five to six years (RR 1.6, 95% CI 0.56 to 4.56; 1 RCT, 95 infants; very low-certainty evidence). No studies on other drugs reported this outcome. AUTHORS' CONCLUSIONS None of the reported studies had an impact on aGMH-IVH, sIVH, ACND, or MND. The certainty of the evidence ranged from moderate to very low. Large RCTs of rigorous methodology are needed to achieve an optimal information size to assess the effects of pharmacological interventions for pain and sedation management for the prevention of GMH-IVH and mortality in preterm infants. Studies might compare interventions against either placebo or other drugs. Reporting of the outcome data should include the assessment of GMH-IVH and long-term neurodevelopment.
Collapse
Affiliation(s)
- Agata Stróżyk
- Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
| | | | - Olga Romantsik
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Maria Grazia Calevo
- Epidemiology and Biostatistics Unit, Scientific Directorate, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Rita Banzi
- Center for Health Regulatory Policies, Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - David Ley
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Matteo Bruschettini
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
4
|
The Effect of Vibration on Pain During Heel Lance Procedures in Newborns: A Randomized Controlled Trial. Adv Neonatal Care 2022; 22:E43-E47. [PMID: 34334677 DOI: 10.1097/anc.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/SIGNIFICANCE The pain-reducing effect of applying vibration, which is used as a nonpharmacological method in pain management, is explained by the gate control theory developed by Melzack and Wall. Studies that are based on this theory have shown similar results to those of Melzack and Wall, indicating that pain-transmitting nerves are suppressed by vibrations, leading to higher pain thresholds. PURPOSE The study aimed to evaluate the effect of applying vibration to manage pain during heel lance procedures in newborns. METHODS This is a randomized, controlled experimental study. The study sample included 56 newborns determined using power analysis (vibration group = 28; control group = 28). For those in the vibration group, a vibrating device was used for approximately 30 seconds before the heel lance procedure and then continued throughout the procedure. No interventions were provided to the newborns in the control group. Pain in the newborns was evaluated by the nurse who performed the heel lance procedures, before the procedures and 15 to 20 seconds and 5 minutes after procedures, and by 2 specialists who viewed the video footage and conducted the Neonatal Infant Pain Scale examination. RESULTS The pain scores were significantly lower at 15 to 20 seconds and 5 minutes after the heel lance procedures in the group that received vibrations than in the control group (P < .05). IMPLICATIONS FOR PRACTICE The application of vibration, which is effective, nonpharmacological, and noninvasive, could help nurses manage pain in newborns as a nonpharmacological method. IMPLICATIONS FOR RESEARCH The number of studies that examine the effect that vibration has on pain associated with heel lance procedures in newborns is very limited, and it is recommended that further studies be conducted with larger sample sizes.
Collapse
|
5
|
Multisensory Stimulation and Soft Tissue Therapy on Pain and Neurodevelopment Among Preterm Neonates. Pediatr Phys Ther 2022; 34:277-282. [PMID: 35385466 DOI: 10.1097/pep.0000000000000887] [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] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the combined effects of multisensory stimulation (MSS) and soft tissue therapy (STT) in managing procedural pain and promoting neurodevelopment in neonates undergoing repetitive painful procedures during their neonatal intensive care unit (NICU) stay. METHODS Total of 104 preterm neonates admitted in NICU will be recruited for this trial. The intervention will be given for 5 consecutive days to both the groups. Experimental group will receive both MSS and STT; control group will receive routine NICU care. The premature infant pain profile and Neonatal Pain, Agitation, and Sedation Scale will be used for assessing procedural pain, and Infant Neurological International Battery and Premie-Neuro will be used for assessing neurodevelopmental maturity. Relevant parametric or nonparametric test will be used to analyze the data for all outcomes. DISCUSSION This is a study protocol analyzing the combined effects of nonpharmacological interventions (MSS and STT) in preterm neonates.
Collapse
|
6
|
Akbari N, Mutlu B, Nadali J. Effect of Non-nutritive Sucking during Heel-stick Procedure in Pain Management of Term Infants in the Neonatal Intensive Care Unit: A Systematic Review and Meta-analysis. Curr Pediatr Rev 2022; 19:90-98. [PMID: 35410609 DOI: 10.2174/1573396318666220410225908] [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: 10/06/2021] [Revised: 12/13/2021] [Accepted: 12/23/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND This study aimed to evaluate the efficacy of non-nutritive sucking for analgesia in term infants undergoing heel-stick procedures. METHODS Randomized controlled trials and non-randomized studies based on the PICO framework were included in the study. Review articles, commentary, pilot, and non-English articles were excluded. Databases, such as PubMed/MEDLINE, Embase, Scopus, Web of Science, and Cochrane, were searched until January 31st, 2021, using the keywords "Pain management", 'Non-nutritive sucking", and "Heel stick". All studies were reviewed and retrieved by two authors independently using a standardized form according to the inclusion criteria, and any disagreements were examined by a third scholar. Quality assessment was evaluated by using the ROB-2 tool. Data were analyzed using Stata version 12.0 software, and a random-effects model was used for analysis. RESULTS A total of 5,629 articles were retrieved from all databases, and after the screening, finally, 6 relevant articles were included in the analysis. The tools used to control pain in infants in the articles included PIPP, NFCS, NIPS, and NPASS. The results showed that the pain scores were significantly lower in the NNS group compared to the control group (MD, -1.05; 95% CI, -1.53 to -0.57) and NNS had a significant effect on oxygen saturation (O2 Sat) increasing in newborns compared to the control group, but no significant reduction in the heart rate (HR) between two groups was observed. CONCLUSION NNS effectively provides analgesia in full-term neonates undergoing heel-stick procedures; however, its effects on the long-term outcomes of infants are unclear. The results showed that NNS was effective in improving heel-stick pain in infants.
Collapse
Affiliation(s)
- Negarin Akbari
- Pediatric Nursing Doctorate Program, Institute of Graduate Studies, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Birsen Mutlu
- Pediatric Nursing Department, Florence Nightingale Nursing Faculty, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Javad Nadali
- School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| |
Collapse
|
7
|
Maya-Enero S, Fàbregas-Mitjans M, Llufriu-Marquès RM, Candel-Pau J, Garcia-Garcia J, López-Vílchez MÁ. Analgesic effect of inhaled lavender essential oil for frenotomy in healthy neonates: a randomized clinical trial. World J Pediatr 2022; 18:398-403. [PMID: 35377106 PMCID: PMC8978507 DOI: 10.1007/s12519-022-00531-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 02/21/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND Neonatal pain may affect long-term neurodevelopment and must be treated. Frenotomy is a painful procedure wherein a common strategy to relieve pain (sucking) cannot be used because the technique is performed on the tongue. Lavender essential oil (LEO) has sedative and antispasmodic properties and has been successfully used to treat pain during heel puncture and vaccination. Our aim was to demonstrate if the use of inhaled LEO is effective in reducing pain during frenotomy in healthy, full-term neonates. METHODS We conducted a randomized clinical trial in neonates who underwent a frenotomy between August 2020 and April 2021. We assessed pain using pre and post-procedure heart rate and oxygen saturation, crying time and Neonatal Infant Pain Scale (NIPS) score. Patients with type 3 tongue tie were randomized into the "experimental group" and "control group". In both groups, we performed swaddling, administered oral sucrose, and let the newborn suck for two minutes. In the experimental group, we also placed a gauze pad with one drop of LEO under the neonate's nose for two minutes prior to and during the frenotomy. RESULTS We enrolled 142 patients (71 per group). The experimental group showed significantly lower NIPS scores (1.88 vs 2.92) and cried almost half the amount of time (14.8 vs. 24.6 seconds, P = 0.006). Comparing with the control group, we observed no side effects in either of the groups. CONCLUSIONS We observed a significant decrease in crying time and lower NIPS scores in the neonates who received inhaled LEO and underwent a frenotomy for type 3 tongue-ties. Thus, we recommend using inhaled LEO during neonatal frenotomies.
Collapse
Affiliation(s)
- Silvia Maya-Enero
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - Montserrat Fàbregas-Mitjans
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Rosa Maria Llufriu-Marquès
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Júlia Candel-Pau
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - Jordi Garcia-Garcia
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Passeig Marítim 25-29, 08003 Barcelona, Spain
| | - María Ángeles López-Vílchez
- Department of Neonatology, Service of Pediatrics, Hospital del Mar, Parc de Salut Mar, Universitat Pompeu Fabra, Passeig Marítim 25-29, 08003 Barcelona, Spain
| |
Collapse
|
8
|
Salekin MS, Mouton PR, Zamzmi G, Patel R, Goldgof D, Kneusel M, Elkins SL, Murray E, Coughlin ME, Maguire D, Ho T, Sun Y. Future roles of artificial intelligence in early pain management of newborns. PAEDIATRIC AND NEONATAL PAIN 2021; 3:134-145. [PMID: 35547946 PMCID: PMC8975206 DOI: 10.1002/pne2.12060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 07/07/2021] [Accepted: 07/19/2021] [Indexed: 12/14/2022]
Affiliation(s)
- Md Sirajus Salekin
- Computer Science and Engineering Department University of South Florida Tampa FL USA
| | | | - Ghada Zamzmi
- Computer Science and Engineering Department University of South Florida Tampa FL USA
| | - Raj Patel
- Muma College of Business University of South Florida Tampa FL USA
| | - Dmitry Goldgof
- Computer Science and Engineering Department University of South Florida Tampa FL USA
| | - Marcia Kneusel
- College of Medicine Pediatrics USF Health University of South Florida Tampa FL USA
| | | | | | | | - Denise Maguire
- College of Nursing USF Health University of South Florida Tampa FL USA
| | - Thao Ho
- College of Medicine Pediatrics USF Health University of South Florida Tampa FL USA
| | - Yu Sun
- Computer Science and Engineering Department University of South Florida Tampa FL USA
| |
Collapse
|
9
|
Fitri SYR, Nasution SK, Nurhidayah I, Maryam NNA. Massage therapy as a non-pharmacological analgesia for procedural pain in neonates: A scoping review. Complement Ther Med 2021; 59:102735. [PMID: 33974990 DOI: 10.1016/j.ctim.2021.102735] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/11/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Neonates who undergo painful medical procedures should be given analgesics to reduce future adverse risks. The evidence for massage therapy (MT) as an analgesic method still varies, both in its terminology and implementation. Only a few studies on this topic have been conducted using a standardised trial approach. This review can thus become the basis for better future research. OBJECTIVE This review aims to identify literature on MT practices as a method to manage or control pain in neonates undergoing painful procedures. METHODS The methodology for this review followed the JBI scoping review methodology guidelines. Searches were performed in several databases: MEDLINE (PubMed), CINAHL (EBSCO), Scopus (Elsevier) and EMBASE. Data collected were then extracted by two independent reviewers, synthesised and presented in the form of tables and narratives. RESULTS Fifteen studies involving a total of 1,058 neonates in nine countries were identified in the search as meeting the criteria set for this review. One study was a comparative study, five were quasi-experiment studies and nine were randomised control trials (RCT). CONCLUSION The implementation of massage as a non-pharmacological analgesic method for neonates undergoing painful procedures varied among the reviewed studies. Differences were identified in terms of the body part massaged, the duration and intensity of the massage, the level of pressure and the combination of massage with other methods. All studies presented positive results for reducing pain intensity in neonates undergoing procedural pain. Therefore, it is crucial that the method used for giving massage should be practical, accurate and safe.
Collapse
Affiliation(s)
| | | | - Ikeu Nurhidayah
- Faculty of Nursing, Universitas Padjadjaran Bandung, Indonesia
| | | |
Collapse
|
10
|
Bellù R, Romantsik O, Nava C, de Waal KA, Zanini R, Bruschettini M. Opioids for newborn infants receiving mechanical ventilation. Cochrane Database Syst Rev 2021; 3:CD013732. [PMID: 33729556 PMCID: PMC8121090 DOI: 10.1002/14651858.cd013732.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Mechanical ventilation is a potentially painful and discomforting intervention that is widely used in neonatal intensive care. Newborn infants demonstrate increased sensitivity to pain, which may affect clinical and neurodevelopmental outcomes. The use of drugs that reduce pain might be important in improving survival and neurodevelopmental outcomes. OBJECTIVES To determine the benefits and harms of opioid analgesics for neonates (term or preterm) receiving mechanical ventilation compared to placebo or no drug, other opioids, or other analgesics or sedatives. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2020, Issue 9), in the Cochrane Library; MEDLINE via PubMed (1966 to 29 September 2020); Embase (1980 to 29 September 2020); and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 29 September 2020). We searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA We included randomised and quasi-randomised controlled trials comparing opioids to placebo or no drug, to other opioids, or to other analgesics or sedatives in newborn infants on mechanical ventilation. We excluded cross-over trials. We included term (≥ 37 weeks' gestational age) and preterm (< 37 weeks' gestational age) newborn infants on mechanical ventilation. We included any duration of drug treatment and any dosage given continuously or as bolus; we excluded studies that gave opioids to ventilated infants for procedures. DATA COLLECTION AND ANALYSIS For each of the included trials, we independently extracted data (e.g. number of participants, birth weight, gestational age, types of opioids) using Cochrane Effective Practice and Organisation of Care Group (EPOC) criteria and assessed the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow-up). We evaluated treatment effects using a fixed-effect model with risk ratio (RR) for categorical data and mean difference (MD) for continuous data. We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS We included 23 studies (enrolling 2023 infants) published between 1992 and 2019. Fifteen studies (1632 infants) compared the use of morphine or fentanyl versus placebo or no intervention. Four studies included both term and preterm infants, and one study only term infants; all other studies included only preterm infants, with five studies including only very preterm infants. We are uncertain whether opioids have an effect on the Premature Infant Pain Profile (PIPP) Scale in the first 12 hours after infusion (MD -5.74, 95% confidence interval (CI) -6.88 to -4.59; 50 participants, 2 studies) and between 12 and 48 hours after infusion (MD -0.98, 95% CI -1.35 to -0.61; 963 participants, 3 studies) because of limitations in study design, high heterogeneity (inconsistency), and imprecision of estimates (very low-certainty evidence - GRADE). The use of morphine or fentanyl probably has little or no effect in reducing duration of mechanical ventilation (MD 0.23 days, 95% CI -0.38 to 0.83; 1259 participants, 7 studies; moderate-certainty evidence because of unclear risk of bias in most studies) and neonatal mortality (RR 1.12, 95% CI 0.80 to 1.55; 1189 participants, 5 studies; moderate-certainty evidence because of imprecision of estimates). We are uncertain whether opioids have an effect on neurodevelopmental outcomes at 18 to 24 months (RR 2.00, 95% CI 0.39 to 10.29; 78 participants, 1 study; very low-certainty evidence because of serious imprecision of the estimates and indirectness). Limited data were available for the other comparisons (i.e. two studies (54 infants) on morphine versus midazolam, three (222 infants) on morphine versus fentanyl, and one each on morphine versus diamorphine (88 infants), morphine versus remifentanil (20 infants), fentanyl versus sufentanil (20 infants), and fentanyl versus remifentanil (24 infants)). For these comparisons, no meta-analysis was conducted because outcomes were reported by one study. AUTHORS' CONCLUSIONS We are uncertain whether opioids have an effect on pain and neurodevelopmental outcomes at 18 to 24 months; the use of morphine or fentanyl probably has little or no effect in reducing the duration of mechanical ventilation and neonatal mortality. Data on the other comparisons planned in this review (opioids versus analgesics; opioids versus other opioids) are extremely limited and do not allow any conclusions. In the absence of firm evidence to support a routine policy, opioids should be used selectively - based on clinical judgement and evaluation of pain indicators - although pain measurement in newborns has limitations.
Collapse
Affiliation(s)
- Roberto Bellù
- Neonatal Intensive Care Unit, Ospedale "A. Manzoni", Lecco, Italy
| | - Olga Romantsik
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Chiara Nava
- Neonatal Intensive Care Unit, Ospedale "A. Manzoni", Lecco, Italy
| | - Koert A de Waal
- Neonatology, John Hunter Children's Hospital, New Lambton, Australia
| | - Rinaldo Zanini
- Neonatal Intensive Care Unit, Ospedale "A. Manzoni", Lecco, Italy
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Lund University, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
11
|
Melchior M, Kuhn P, Poisbeau P. The burden of early life stress on the nociceptive system development and pain responses. Eur J Neurosci 2021; 55:2216-2241. [PMID: 33615576 DOI: 10.1111/ejn.15153] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/27/2021] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
For a long time, the capacity of the newborn infant to feel pain was denied. Today it is clear that the nociceptive system, even if still immature, is functional enough in the newborn infant to elicit pain responses. Unfortunately, pain is often present in the neonatal period, in particular in the case of premature infants which are subjected to a high number of painful procedures during care. These are accompanied by a variety of environmental stressors, which could impact the maturation of the nociceptive system. Therefore, the question of the long-term consequences of early life stress is a critical question. Early stressful experience, both painful and non-painful, can imprint the nociceptive system and induce long-term alteration in brain function and nociceptive behavior, often leading to an increase sensitivity and higher susceptibility to chronic pain. Different animal models have been developed to understand the mechanisms underlying the long-term effects of different early life stressful procedures, including pain and maternal separation. This review will focus on the clinical and preclinical data about early life stress and its consequence on the nociceptive system.
Collapse
Affiliation(s)
- Meggane Melchior
- Centre National de la Recherche Scientifique and University of Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Pierre Kuhn
- Centre National de la Recherche Scientifique and University of Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France.,Service de Médecine et Réanimation du Nouveau-né, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
| | - Pierrick Poisbeau
- Centre National de la Recherche Scientifique and University of Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| |
Collapse
|
12
|
Sen E, Manav G. Effect of Kangaroo Care and Oral Sucrose on Pain in Premature Infants: A Randomized Controlled Trial. Pain Manag Nurs 2020; 21:556-564. [PMID: 32768272 DOI: 10.1016/j.pmn.2020.05.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 04/28/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Premature infants hospitalized in the neonatal intensive care unit are routinely exposed to many painful procedures. Pain experienced during the neonatal period may lead to negative outcomes, especially in preterm neonates, hence pain in infants should be reduced. Kangaroo care and oral sucrose are some of the methods that can help reduce pain. AIM This study aimed to compare the effects of kangaroo care and oral sucrose on pain relief in preterm infants during heel lancing. METHODS Our study involved 64 infants. The infants were randomly divided into two groups using a randomized block design of drawing out slips from a thick, non-transparent envelope. There were 64 slips in this envelope (32 for kangaroo care and 32 for oral sucrose). Kangaroo care was given to the preterm infants in the first group and oral sucrose to those in the second group. In both groups, heart rate and oxygen saturation were measured and pain score was evaluated by two observers using the Premature Infant Pain Profile (PIPP) before, during, and 2 minutes after blood sampling by heel lancing. RESULTS There was a statistically significant difference between the groups in favor of the kangaroo group in terms of change in the PIPP values after heel lancing. Kangaroo care is more effective than oral sucrose in pain relief during heel lancing in preterm infants. CONCLUSIONS In addition to many benefits it offers to infants, kangaroo care can be used to reduce pain during painful procedures in premature infants.
Collapse
Affiliation(s)
- Elif Sen
- Health Sciences Institute, University of Uskudar, Istanbul, Turkey.
| | - Gulay Manav
- Faculty of Health Sciences Department of Nursing, University of Uskudar, Istanbul, Turkey
| |
Collapse
|
13
|
Amiri Shadmehri E, Yaghoobi H, Sajjadi M, Abbasian M. The Effect of the Smell of Breast Milk and Non-Nutritious Sucking on Pain Behavioral Response and to First-Time Hepatitis B Vaccine in Term Newborns. Open Nurs J 2020. [DOI: 10.2174/1874434602014010141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The issue of Pain Management finds special significance in infants who are unable to verbally express pain. Studies have shown that the use of non-pharmacological pain control techniques can be effective in reducing neonatal pain. The aim of this study was to compare the effects of olfactory stimulation (with breast milk) and non-nutritive sucking (with a pacifier) on the physiological and behavioral responses in term neonates to the hepatitis B vaccine.
Methods:
In this clinical trial, which was done in 2015 at the Nohom-e Dey Hospital of Torbat Heidariyeh, 90 eligible infants were randomly selected and divided into two intervention and one control groups. In the breast-milk odor group (n = 30), the neonates were exposed to the mother's odor during vaccination. In the non-nutritive sucking group (n = 30), a standard soft pacifier was used, whereas, in the control group (n = 30), no intervention was carried out. Data collection tools included demographic information forms and the Neonatal Pain Response Scale. Data were edited and analyzed using SPSS 20 software.
Results:
This study showed that there was a statistically significant difference between the mean scores of neonatal behavioral responses after intervention in the three groups (p <0.05). The mean behavioral response was 0.73 lower in the breast-milk odor group than in the control group, and the mean behavioral response in the non-nutritive sucking group was 0.6 lower than that of the control group.
Conclusion:
The results of the study showed that both olfactory stimulations with breast milk and non-nutritive sucking have a positive impact on neonatal pain reduction, nearly equally.
Collapse
|
14
|
Johnson Rolfes J, Christensen K, Gershan LA. Acceptance of Traditional Chinese Medicine in the Neonatal Intensive Care Unit: A Launching Point. Glob Adv Health Med 2020; 9:2164956120924644. [PMID: 32426181 PMCID: PMC7218323 DOI: 10.1177/2164956120924644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 03/06/2020] [Accepted: 04/07/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Because neonatology is a relatively new medical specialty, it is host to on-going, rapid adaptation and evolution of medical treatments and practices. This process has almost exclusively focused on Western, biomedical treatment modalities, without inclusion of potentially beneficial Traditional Chinese Medicine practices. It is unclear how receptive health-care providers in the neonatal intensive care unit (NICU) and families of NICU patients would be to the introduction of adapted Traditional Chinese Medicine treatments into the NICU environment. OBJECTIVE To assess the potential for engagement of patients, families, and staff in the NICU with Traditional Chinese Medicine therapies and to provide targeted education and low-risk Traditional Chinese Medicine treatments to support the health and well-being of those 3 groups. METHODS A feasibility pilot study including weekly walk-in Traditional Chinese Medicine sessions within the NICU for parents and staff, and neonatal patient consultations, both of which included hands-on therapies and education tailored to each participant's unique needs. Pre- and postsurveys were administered over 3 phases. RESULTS Walk-in sessions were attended by 83 adults and participants reported benefits, with no ill effects. There were 5 neonatal consultations with staff expressing an interest in more. Several obstacles to accessing Traditional Chinese Medicine modalities were identified in pre-surveys and were addressed with education and preemptive modifications to the therapies offered. CONCLUSION Acceptance of Traditional Chinese Medicine modalities in the NICU opens the door to future studies implementing integrative health services into the NICU care model.
Collapse
Affiliation(s)
- Julie Johnson Rolfes
- Division of Neonatology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Kimberly Christensen
- Division of Hematology-Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
- Pediatric Integrative Health and Wellbeing, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| | - Lynn A Gershan
- Division of Hematology-Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
- Pediatric Integrative Health and Wellbeing, University of Minnesota Masonic Children’s Hospital, Minneapolis, Minnesota
| |
Collapse
|
15
|
Abstract
BACKGROUND Critically ill newborn infants undergo a variety of painful procedures or experience a variety of painful conditions during their early life in the neonatal unit. In the critically ill paediatric and neonatal population, clonidine is prescribed as an adjunct to opioids or benzodiazepines aiming to reduce the doses of these drugs that are required for analgesia or sedation, or to facilitate weaning from mechanical ventilation. It has been shown that clonidine premedication might have a positive effect on postoperative pain in children. OBJECTIVES To assess the benefit and harms of clonidine for the prevention or treatment of procedural pain; postoperative pain; or pain associated with clinical conditions in non-ventilated neonates. SEARCH METHODS We used the standard search strategy of Cochrane Neonatal to search the CENTRAL, MEDLINE via PubMed, Embase, and CINAHL to December 2018. We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. We ran an updated search from 1 January 2018 to 11 March 2020 in CENTRAL via CRS Web, MEDLINE via Ovid, and CINAHL via EBSCOhost. SELECTION CRITERIA Randomised controlled trials, quasi-randomised controlled trials, and cluster trials comparing clonidine to placebo or no treatment, opioids, paracetamol, dexmedetomidine, or non-pharmacological pain-reducing interventions for the management of procedural pain, postoperative pain, and pain associated with clinical conditions in preterm and term newborns. DATA COLLECTION AND ANALYSIS Two review authors independently planned to extract data (e.g. number of participants, birth weight, gestational age, modality of administration, and dose of clonidine) and assess the risk of bias (e.g. adequacy of randomisation, blinding, completeness of follow-up). The primary outcome considered was pain: for procedural pain, the mean values of each analgesia scale assessed during the procedure and at one to two hours after the procedure; for postoperative pain and for pain associated with clinical conditions, the mean values of each analgesia scale assessed at 30 minutes, three hours, and 12 hours after the administration of the intervention. We planned to use the GRADE approach to assess the quality of evidence. MAIN RESULTS Our search strategy yielded 3383 references. Two review authors independently assessed all references for inclusion. We did not find any completed studies for inclusion. We excluded three trials where clonidine was administered for spinal anaesthesia. AUTHORS' CONCLUSIONS We did not find any studies that met our inclusion criteria and hence there is no evidence to recommend or refute the use of clonidine for the prevention or treatment of procedural or postoperative pain, or pain associated with clinical conditions in neonates.
Collapse
Affiliation(s)
- Olga Romantsik
- Lund University, Skåne University HospitalDepartment of Clinical Sciences Lund, PaediatricsLundSweden
| | - Maria Grazia Calevo
- Istituto Giannina GasliniEpidemiology, Biostatistics Unit, IRCCSGenoaItaly16147
| | - Elisabeth Norman
- Lund University, Skåne University HospitalDepartment of PaediatricsLundSweden
| | - Matteo Bruschettini
- Lund University, Skåne University HospitalDepartment of Clinical Sciences Lund, PaediatricsLundSweden
- Skåne University HospitalCochrane SwedenWigerthuset, Remissgatan 4, First FloorRoom 11‐221LundSweden22185
| | | |
Collapse
|
16
|
Vu-Ngoc H, Uyen NCM, Thinh OP, Don LD, Danh NVT, Truc NTT, Vi VT, Vuong NL, Huy NT, Duong PDT. Analgesic effect of non-nutritive sucking in term neonates: A randomized controlled trial. Pediatr Neonatol 2020; 61:106-113. [PMID: 31474462 DOI: 10.1016/j.pedneo.2019.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 05/15/2019] [Accepted: 07/25/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Newborns commonly experience pain due to a variety of reasons. Non-nutritive sucking (NNS) is thought to be an effective non-pharmacological method of pain-relief. However, the significant heterogeneity in some systematic reviews limited the certainty of the findings about NNS. Hence, this study was aimed at evaluating the analgesic effect and safety of NNS in healthy term neonates during the heel prick test, using the Neonatal Pain Agitation and Sedation Scale (N-PASS). METHODS In this randomized controlled trial, 42 term infants were included: 22 infants in the intervention group (receiving NNS) and 20 infants in the control group (not receiving NNS). In the intervention group, neonates were given a silicone pacifier 120 s before, during, and 120 s after the heel puncture, while neonates in the control group received routine care. Pain-related outcomes were assessed using the N-PASS at 30s, 60s, 90s, and 120s after the heel prick. Any adverse events during the procedure were noted. The Spearman correlation coefficients between the pain scores on the N-PASS and two other scales (NFCS and NIPS) were calculated at all four moments of evaluation. RESULTS The mean N-PASS pain scores at 30s, 60s, 90s, and 120s after heel prick were significantly lower in the NNS group than in the control group: 4.73 ± 2.78 vs. 7.90 ± 1.52 (p = 0.0002); 3.64 ± 3.06 vs. 5.55 ± 2.95 (p = 0.052); 2.59 ± 3.08 vs. 5.25 ± 3.51 (p = 0.011); and 2.05 ± 2.94 vs. 4.90 ± 3.99 (p = 0.013), respectively. No adverse events were detected in either group. Our findings revealed a strong positive correlation between the pain scores on the N-PASS and two other scales (NFCS and NIPS), which was statistically significant (p < 0.01). CONCLUSIONS NNS is considered a safe and effective pain-relief method during the heel prick procedure in term neonates, demonstrated using the N-PASS. These findings were correlated with the pain evaluation by NFCS and NIPS.
Collapse
Affiliation(s)
- Hai Vu-Ngoc
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam; Faculty of Medicine, University Paris Descartes, Paris 75006, Ile-de-France, France
| | - Nguyen Cao Minh Uyen
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Ong Phuc Thinh
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Le Duc Don
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Vo Tan Danh
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Tran Thanh Truc
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Vu Tuong Vi
- Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Lam Vuong
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Nguyen Tien Huy
- Institute of Research and Development, Duy Tan University, Da Nang 550000, Viet Nam.
| | - Pham Diep Thuy Duong
- Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam.
| |
Collapse
|
17
|
Stadler J, Raith W, Mileder LP, Schmölzer GM, Urlesberger B. Invasive and non-invasive acupuncture techniques for pain management in neonates: a systematic review. Acupunct Med 2019; 37:201-210. [PMID: 31271304 DOI: 10.1136/acupmed-2017-011549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Neonatal pain is an extensive research field and there are many possibilities to treat pain in neonates. Acupuncture is one new and non-pharmacological option and a promising tool to reduce pain in neonates undergoing minor painful interventions during routine medical care. OBJECTIVES This review summarises trials of acupuncture for pain reduction in neonates undergoing painful interventions during routine medical care. DATA SOURCE MEDLINE, Embase, CINAHL, electronic clinical trials registry platforms and reference lists were systematically screened for trials from their dates of inception to February 2017 (English language database search). STUDY SELECTION Inclusion criteria were (1) preterm or term neonates, (2) acupuncture for painful medical interventions and (3) formal pain assessment as a primary or secondary study outcome. We included only randomised controlled trials. DATA EXTRACTION Data were extracted using a standardised protocol and individual risk of bias was assessed. RESULTS The literature search revealed a total of 12 196 records. After application of inclusion criteria, five studies were included in this review. Two studies demonstrated significant pain reduction, one found equal outcomes in comparison to standard care, and two showed significantly higher pain scores with acupuncture alone. LIMITATIONS The main limitation of the results is the heterogeneity across trials in acupuncture modality, acupuncture point selection, control groups and pain assessment (heterogeneity: I2=87%). CONCLUSION The results of this review suggest that acupuncture may have a positive pain-relieving effect in neonates. However, due to the low number of available high-quality trials and heterogeneity across the studies it is not possible to state clear recommendations.
Collapse
Affiliation(s)
- Jasmin Stadler
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2 Research Group for Paediatric Traditional Chinese Medicine, TCM Research Center Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
| | - Wolfgang Raith
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2 Research Group for Paediatric Traditional Chinese Medicine, TCM Research Center Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
| | - Lukas P Mileder
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Georg M Schmölzer
- 3 Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada.,4 Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Berndt Urlesberger
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2 Research Group for Paediatric Traditional Chinese Medicine, TCM Research Center Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
| |
Collapse
|
18
|
Perry M, Tan Z, Chen J, Weidig T, Xu W, Cong XS. Neonatal Pain: Perceptions and Current Practice. Crit Care Nurs Clin North Am 2019; 30:549-561. [PMID: 30447813 DOI: 10.1016/j.cnc.2018.07.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neonates may experience more than 300 painful procedures throughout their hospitalizations. Prior to 1980, there was a longstanding misconception that neonates do not experience pain. Current studies demonstrate that not only do neonates experience pain but also, due to their immature nervous systems, they are hypersensitive to painful stimuli. Poorly treated pain may lead to negative long-term consequences. Proper assessment of neonate pain is vital. The use of nonpharmacologic treatments may be beneficial in alleviating neonate pain. Pharmacologic treatments in the neonate have been well established. Pharmacologic and nonpharmacologic interventions can be used in conjunction to increase the efficacy of analgesia.
Collapse
Affiliation(s)
- Mallory Perry
- School of Nursing, University of Connecticut, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269, USA
| | - Zewen Tan
- Department of Molecular and Cell Biology, University of Connecticut, 91 North Eagleville Road, Unit 3125, Storrs, CT 06269-3125, USA
| | - Jie Chen
- School of Nursing, University of Connecticut, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269, USA
| | - Tessa Weidig
- School of Nursing, University of Connecticut, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269, USA
| | - Wanli Xu
- School of Nursing, University of Connecticut, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269, USA
| | - Xiaomei S Cong
- Center for Advancement in Managing Pain, School of Nursing, University of Connecticut, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269, USA.
| |
Collapse
|
19
|
The Effect of Pain Management Training on the Severity of Pain in Patients with Cancer: A Clinical Trial Study. IRANIAN RED CRESCENT MEDICAL JOURNAL 2019. [DOI: 10.5812/ircmj.61469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
20
|
Ramesh G, Gerstbacher D, Arruda J, Golianu B, Mark J, Yeh AM. Pediatric Integrative Medicine in Academia: Stanford Children's Experience. CHILDREN (BASEL, SWITZERLAND) 2018; 5:E168. [PMID: 30545081 PMCID: PMC6306866 DOI: 10.3390/children5120168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023]
Abstract
Pediatric integrative medicine is an emerging field which, to date, has not been described in detail in academic medical centers in the United States. Early research of pediatric integrative medicine modalities shows promise for the treatment of common pediatric conditions such as irritable bowel syndrome, acute and chronic pain, headache, and allergy, among others. In light of the growing prevalence of pediatric illnesses and patient complexity, it is crucial to emphasize the patient's overall well-being. As academic centers around the world start to develop pediatric integrative medicine programs, the aim of this manuscript is to briefly highlight evidence of effective integrative treatments in pediatric subspecialties, to describe the establishment of our integrative medicine program, to summarize its early efforts, and to discuss potential barriers and keys to success.
Collapse
Affiliation(s)
- Gautam Ramesh
- School of Medicine, University of California, San Diego, La Jolla, CA 92093, USA.
| | - Dana Gerstbacher
- Division of Rheumatology, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA 94304, USA.
| | - Jenna Arruda
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA 94304, USA.
| | - Brenda Golianu
- Division of Pediatric Anesthesia and Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Palo Alto, CA 94304, USA.
| | - John Mark
- Division of Pulmonary Medicine, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA 94304, USA.
| | - Ann Ming Yeh
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, CA 94304, USA.
| |
Collapse
|
21
|
Bembich S, Cont G, Causin E, Paviotti G, Marzari P, Demarini S. Infant Analgesia With a Combination of Breast Milk, Glucose, or Maternal Holding. Pediatrics 2018; 142:peds.2017-3416. [PMID: 30166366 DOI: 10.1542/peds.2017-3416] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES We studied neonatal cortical brain response to 4 types of nonpharmacological analgesia (oral glucose, expressed breast milk, maternal holding plus oral glucose, breastfeeding). We aimed to assess the differential effect of oral solutions (glucose, breast milk) given alone or combined with the maternal-infant relationship (holding, breastfeeding). METHODS Eighty healthy term newborns undergoing a heel stick were randomly assigned to 4 parallel groups of 20 infants each: group 1, infants received a glucose solution on a changing table; group 2, infants received expressed breast milk on a changing table; group 3, infants received a glucose solution in their mothers' arms; and group 4, infants were breastfed by their mothers. Cortical activation in parietal, temporal, and frontal cortices was assessed by multichannel near-infrared spectroscopy. Pain expression was also evaluated. RESULTS Oral glucose alone or combined with maternal holding was associated with no cortical activation during heel stick. Expressed breast milk was associated with localized bilateral activation of somatosensory and motor cortices (P < .01). Breastfeeding was associated with extensive bilateral activation of somatomotor, somatosensory, and right parietal cortices (P < .01). Pain expression was lower with the maternal-infant relationship (P = .007). CONCLUSIONS Oral glucose, either alone or combined with maternal holding, appears to block or weaken cortical pain processing. Breast milk alone is associated with localized cortical activation. Breastfeeding is associated with extensive activation and may act by extending cortical processing. Maternal relationship, both combined with oral glucose and in breastfeeding, shows the greatest analgesic effect, although the neural patterns involved are distributed differently.
Collapse
Affiliation(s)
- Stefano Bembich
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Gabriele Cont
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Enrica Causin
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Giulia Paviotti
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Patrizia Marzari
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| | - Sergio Demarini
- Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
| |
Collapse
|
22
|
|
23
|
Kaiser P, Kohen DP, Brown ML, Kajander RL, Barnes AJ. Integrating Pediatric Hypnosis with Complementary Modalities: Clinical Perspectives on Personalized Treatment. CHILDREN (BASEL, SWITZERLAND) 2018; 5:E108. [PMID: 30087271 PMCID: PMC6111600 DOI: 10.3390/children5080108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 07/30/2018] [Accepted: 07/31/2018] [Indexed: 02/06/2023]
Abstract
While pediatric integrative medicine (PIM) emphasizes an "evidence-based practice using multiple therapeutic modalities"; paradoxically, literature reviews examining the prevalence and/or efficacy of such mind⁻body approaches often address PIM modalities separately. Such contributions are relevant, yet documentation of how to deliver combined complementary approaches in children and youth are scarce. Nevertheless, integrative practitioners in clinical practice routinely mix approaches to meet the individual needs of each patient. Best practices are flexible, and include blending and augmenting services within the same session, and/or connecting modalities sequentially for an incremental effect, and/or referring to outside resources for additional interventions. Resonating with integrative medicine's definition, this article's goal is to demonstrate paradigms that "bring together complementary approaches in a coordinated way within clinical practice" by linking clinical hypnosis, the trail-blazer modality in PIM's history, with mindfulness, biofeedback, acupuncture, and yoga. Following the consideration of the overlap of guided imagery with hypnosis and an abridged literature report, this clinical perspective considers the selection of modalities within a collaborative relationship with the child/teen and parents, emphasizing goodness-of-fit with patients' contexts, e.g., symptoms, resources, interests, goals, and developmental stage. Case vignettes illustrate practical strategies for mixing approaches.
Collapse
Affiliation(s)
- Pamela Kaiser
- National Pediatric Hypnosis Training Institute (NPHTI), 29 Western Terrace, Minneapolis, MN 55426, USA.
| | - Daniel P Kohen
- National Pediatric Hypnosis Training Institute (NPHTI), 29 Western Terrace, Minneapolis, MN 55426, USA.
- Partners-in-Healing, 10505 Wayzata Blvd #200, Minnetonka, MN 55305, USA.
- Department of Pediatrics, University of Minnesota, 717 Delaware St SE #353, Minneapolis, MN 55414, USA.
| | - Melanie L Brown
- Department of Pediatrics, University of Minnesota, 717 Delaware St SE #353, Minneapolis, MN 55414, USA.
- Children's Hospitals and Clinics of Minnesota, 2525 Chicago Ave, Minneapolis, MN 55404, USA.
| | - Rebecca L Kajander
- National Pediatric Hypnosis Training Institute (NPHTI), 29 Western Terrace, Minneapolis, MN 55426, USA.
| | - Andrew J Barnes
- National Pediatric Hypnosis Training Institute (NPHTI), 29 Western Terrace, Minneapolis, MN 55426, USA.
- Department of Pediatrics, University of Minnesota, 717 Delaware St SE #353, Minneapolis, MN 55414, USA.
| |
Collapse
|
24
|
Fan AY, Miller DW, Bolash B, Bauer M, McDonald J, Faggert S, He H, Li YM, Matecki A, Camardella L, Koppelman MH, Stone JAM, Meade L, Pang J. Acupuncture's Role in Solving the Opioid Epidemic: Evidence, Cost-Effectiveness, and Care Availability for Acupuncture as a Primary, Non-Pharmacologic Method for Pain Relief and Management-White Paper 2017. JOURNAL OF INTEGRATIVE MEDICINE-JIM 2018; 15:411-425. [PMID: 29103410 DOI: 10.1016/s2095-4964(17)60378-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The United States (U.S.) is facing a national opioid epidemic, and medical systems are in need of non-pharmacologic strategies that can be employed to decrease the public's opioid dependence. Acupuncture has emerged as a powerful, evidence-based, safe, cost-effective, and available treatment modality suitable to meeting this need. Acupuncture has been shown to be effective for the management of numerous types of pain conditions, and mechanisms of action for acupuncture have been described and are understandable from biomedical, physiologic perspectives. Further, acupuncture's cost-effectiveness can dramatically decrease health care expenditures, both from the standpoint of treating acute pain and through avoiding addiction to opioids that requires costly care, destroys quality of life, and can lead to fatal overdose. Numerous federal regulatory agencies have advised or mandated that healthcare systems and providers offer non-pharmacologic treatment options for pain. Acupuncture stands out as the most evidence-based, immediately available choice to fulfil these calls. Acupuncture can safely, easily, and cost-effectively be incorporated into hospital settings as diverse as the emergency department, labor and delivery suites, and neonatal intensive care units to treat a variety of commonly seen pain conditions. Acupuncture is already being successfully and meaningfully utilized by the Veterans Administration and various branches of the U.S. Military, in some studies demonstrably decreasing the volume of opioids prescribed when included in care.
Collapse
Affiliation(s)
| | - David W Miller
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA.,Pacific College of Oriental Medicine, Chicago, IL 60601, USA
| | - Bonnie Bolash
- The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA
| | - Matthew Bauer
- The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA.,The Acupuncture Now Foundation, La Verne, CA 91750, USA
| | - John McDonald
- The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA.,The Acupuncture Evidence Project, Providence, RI 02860, USA
| | - Sarah Faggert
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,The Acupuncture Society of Virginia, Vienna, VA 22182, USA
| | - Hongjian He
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,The National Federation of Chinese TCM Organizations, New York, NY 11501, USA.,The American Alliance for Professional Acupuncture Safety, Greenwich, CT 06878, USA
| | - Yong Ming Li
- The American Traditional Chinese Medicine Society, New York, NY 11501, USA
| | - Amy Matecki
- The American Alliance for Professional Acupuncture Safety, Greenwich, CT 06878, USA.,Highland Hospital, Alameda Health System, Oakland, CA 94602, USA
| | - Lindy Camardella
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA
| | - Mel Hopper Koppelman
- The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA.,The Acupuncture Evidence Project, Providence, RI 02860, USA
| | - Jennifer A M Stone
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Lindsay Meade
- The American Society of Acupuncturists, Chicago, IL 60618, USA.,The Joint Acupuncture Opioid Task Force, La Verne, CA 91750, USA
| | - John Pang
- University of California, San Diego School of Medicine, San Diego, CA 92093, USA
| |
Collapse
|
25
|
Laser Acupuncture at Large Intestine 4 Compared with Oral Glucose Administration for Pain Prevention in Healthy Term Neonates Undergoing Routine Heel Lance: Study Protocol for an Observer-Blinded, Randomised Controlled Clinical Trial. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:8406138. [PMID: 29707034 PMCID: PMC5863283 DOI: 10.1155/2018/8406138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 01/06/2018] [Accepted: 01/11/2018] [Indexed: 01/23/2023]
Abstract
Background Nonpharmacological strategies have actually become more important in neonatal pain management during routinely applied minor painful procedures. However, commonly used nonpharmacological strategies are inferior to orally administered sweet solutions. Therefore, we will compare laser acupuncture, as a recent nonpharmacological method, with the standard care of oral glucose solution for pain prevention. Methods Ninety-five healthy term neonates will be allocated into one of two groups. Before routine heel lance for metabolic screening, one group will receive laser acupuncture at acupuncture point Large Intestine 4 (LI 4) bilaterally for 60 seconds per point (acupuncture group) and the other will receive the standard care with orally administered glucose solution (glucose group). The complete procedure of blood sampling will be recorded on video, excluding the intervention before heel lance. A paediatric nurse, blinded with respect to the allocation, will evaluate these video recordings and determine the Premature Infant Pain Profile (PIPP) for each neonate. Primary outcome will be the mean difference in PIPP scores between groups. Discussion This observer-blinded randomised controlled trial has been designed to explore potential advantages of laser acupuncture in the management of neonatal pain because more data are required to provide information about its efficacy and safety. Trial Registration This trial is registered with DRKS00010122.
Collapse
|
26
|
Lee YN, Shin H. Analysis of Nurses’ Soothing Behaviors in Neonatal Intensive Care Unit: Focused on Babies with Bronchopulmonary Dysplasia. CHILD HEALTH NURSING RESEARCH 2017. [DOI: 10.4094/chnr.2017.23.4.494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
27
|
Acupuncture in the neonatal intensive care unit-using ancient medicine to help today's babies: a review. J Perinatol 2017; 37:749-756. [PMID: 27977013 DOI: 10.1038/jp.2016.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/21/2016] [Accepted: 11/01/2016] [Indexed: 11/08/2022]
Abstract
Acupuncture has been used for thousands of years in Eastern medicine for a variety of conditions and illnesses, including pain. Neonatal intensive care, on the other hand, is a relatively new branch of medicine that has emerged as the pivotal influence in increasing survival of critically ill newborn infants only within the last 50 years. Unfortunately, pain is an inevitable part of treatment in a neonatal intensive care unit (NICU). The control and prevention of pain remains a major issue for clinicians despite recognition and understanding of the myriad of short- and long-term problems that are associated with both pain and its treatment within the NICU environment. In this review, we examine the potential role of acupuncture to decrease and treat pain in babies requiring neonatal intensive care and discuss future therapeutic and research implications for the use of this ancient therapy within the modern environment of the NICU.
Collapse
|
28
|
Romantsik O, Bruschettini M, Calevo MG, Banzi R, Ley D. Pharmacological pain and sedation interventions for the prevention of intraventricular hemorrhage in preterm infants on assisted ventilation - an overview of systematic reviews. Hippokratia 2017. [DOI: 10.1002/14651858.cd012706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Olga Romantsik
- Lund University, Skåne University Hospital; Department of Paediatrics; Lund Sweden
| | - Matteo Bruschettini
- Lund University, Skåne University Hospital; Department of Paediatrics; Lund Sweden
- Skåne University Hospital; Research & Development, Section for HTA Analysis; Wigerthuset, Remissgatan 4, first floor room 11-221 Lund Sweden 22185
| | - Maria Grazia Calevo
- Istituto Giannina Gaslini; Epidemiology, Biostatistics and Committees Unit; Genoa Italy 16147
| | - Rita Banzi
- IRCCS - Mario Negri Institute for Pharmacological Research; Laboratory of Regulatory Policies; via G La Masa 19 Milan Italy 20156
| | - David Ley
- Lund University, Skåne University Hospital; Department of Paediatrics; Lund Sweden
| |
Collapse
|
29
|
Brown ML, Rojas E, Gouda S. A Mind-Body Approach to Pediatric Pain Management. CHILDREN (BASEL, SWITZERLAND) 2017; 4:E50. [PMID: 28632194 PMCID: PMC5483625 DOI: 10.3390/children4060050] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/11/2017] [Accepted: 06/13/2017] [Indexed: 12/19/2022]
Abstract
Pain is a significant public health problem that affects all populations and has significant financial, physical and psychological impact. Opioid medications, once the mainstay of pain therapy across the spectrum, can be associated with significant morbidity and mortality. Centers for Disease and Control (CDC) guidelines recommend that non-opioid pain medications are preferred for chronic pain outside of certain indications (cancer, palliative and end of life care). Mindfulness, hypnosis, acupuncture and yoga are four examples of mind-body techniques that are often used in the adult population for pain and symptom management. In addition to providing significant pain relief, several studies have reported reduced use of opioid medications when mind-body therapies are implemented. Mind-body medicine is another approach that can be used in children with both acute and chronic pain to improve pain management and quality of life.
Collapse
Affiliation(s)
- Melanie L Brown
- Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA (E.R.).
- Department of Pain, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN 55404, USA.
| | - Enrique Rojas
- Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA (E.R.).
| | - Suzanne Gouda
- Department of Pediatrics, The University of Chicago, Chicago, IL 60637, USA (E.R.).
| |
Collapse
|
30
|
Romantsik O, Calevo MG, Norman E, Bruschettini M. Clonidine for sedation and analgesia for neonates receiving mechanical ventilation. Cochrane Database Syst Rev 2017; 5:CD012468. [PMID: 28488361 PMCID: PMC6481534 DOI: 10.1002/14651858.cd012468.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although routine administration of pharmacologic sedation or analgesia during mechanical ventilation in preterm neonates is not recommended, its use in clinical practice remains common. Alpha-2 agonists, mainly clonidine and dexmedetomidine, are used as adjunctive (or alternative) sedative agents alongside opioids and benzodiazepines. Clonidine has not been systematically assessed for use in neonatal sedation during ventilation. OBJECTIVES To assess whether clonidine administered to term and preterm newborn infants receiving mechanical ventilation reduces morbidity and mortality rates. To compare the intervention versus placebo, no treatment, and dexmedetomidine; and to assess the safety of clonidine infusion for potential harms.To perform subgroup analyses according to gestational age; birth weight; administration method (infusion or bolus therapy); dose, duration, and route of clonidine administration; and pharmacologic sedation as a co-intervention. SEARCH METHODS We used the standard search strategy of the Cochrane Neonatal Review Group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 12) in the Cochrane Library, MEDLINE via PubMed (1966 to January 10, 2017), Embase (1980 to January 10, 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL; 1982 to January 10, 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA We searched for randomized controlled trials, quasi-randomized controlled trials, and cluster trials comparing clonidine versus placebo, no treatment, or dexmedetomidine administered to term and preterm newborns receiving mechanical ventilation via an endotracheal tube. DATA COLLECTION AND ANALYSIS For the included trial, two review authors independently extracted data (e.g. number of participants, birth weight, gestational age, all-cause death during initial hospitalization, duration of respiratory support, sedation scale, duration of hospital stay) and assessed risk of bias (e.g. adequacy of randomization, blinding, completeness of follow-up). This review considered primary outcomes of all-cause neonatal death, all-cause death during initial hospitalization, and duration of mechanical ventilation in days. MAIN RESULTS One trial, which included 112 infants, met the inclusion criteria for this review. Term newborn infants on mechanical ventilation with the need for continuous analgesia and sedation with fentanyl and midazolam were eligible for enrollment during the first 96 hours of ventilation. Study authors administered clonidine 1 μg/kg/h or placebo on day 4 after intubation.We found no differences between the two groups in all-cause death during hospitalization (risk ratio [RR] 0.69, 95% confidence interval [CI] 0.12 to 3.98). The quality of the evidence supporting these findings is low owing to imprecision of the estimates (one study; few events). The median (interquartile range) duration of mechanical ventilation was 7.1 days (5.7 to 9.1 days) in the clonidine group and 5.8 days (4.9 to 7.9 days) in the placebo group, respectively (P = 0.070). Among secondary outcomes, we found no differences in terms of duration of stay in the intensive care unit. Sedation scale values (COMFORT) and analgesia scores (Hartwig) during the first 72 hours of infusion of study medication were lower in the clonidine group than in the placebo group. AUTHORS' CONCLUSIONS At present, evidence is insufficient to show the efficacy and safety of clonidine for sedation and analgesia in term and preterm newborn infants receiving mechanical ventilation.
Collapse
Affiliation(s)
- Olga Romantsik
- Lund University, Skåne University HospitalDepartment of PaediatricsLundSweden
| | - Maria Grazia Calevo
- Istituto Giannina GasliniEpidemiology, Biostatistics and Committees UnitGenoaItaly16147
| | - Elisabeth Norman
- Lund University, Skane University HospitalDepartment of PaediatricsLundSweden
| | - Matteo Bruschettini
- Lund University, Skåne University HospitalDepartment of PaediatricsLundSweden
- Skåne University HospitalResearch & Development, Section for HTA AnalysisLasarettsgatan 40LundSweden
| | | |
Collapse
|
31
|
Mooney-Leber SM, Brummelte S. Neonatal pain and reduced maternal care: Early-life stressors interacting to impact brain and behavioral development. Neuroscience 2016; 342:21-36. [PMID: 27167085 DOI: 10.1016/j.neuroscience.2016.05.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/22/2016] [Accepted: 05/02/2016] [Indexed: 12/21/2022]
Abstract
Advances in neonatal intensive care units (NICUs) have drastically increased the survival chances of preterm infants. However, preterm infants are still exposed to a wide range of stressors during their stay in the NICU, which include painful procedures and reduced maternal contact. The activation of the hypothalamic-pituitary-adrenal (HPA) axis, in response to these stressors during this critical period of brain development, has been associated with many acute and long-term adverse biobehavioral outcomes. Recent research has shown that Kangaroo care, a non-pharmacological analgesic based on increased skin-to-skin contact between the neonate and the mother, negates the adverse outcomes associated with neonatal pain and reduced maternal care, however the biological mechanism remains widely unknown. This review summarizes findings from both human and rodent literature investigating neonatal pain and reduced maternal care independently, primarily focusing on the role of the HPA axis and biobehavioral outcomes. The physiological and positive outcomes of Kangaroo care will also be discussed in terms of how dampening of the HPA axis response to neonatal pain and increased maternal care may account for positive outcomes associated with Kangaroo care.
Collapse
Affiliation(s)
- Sean M Mooney-Leber
- Department of Psychology, Wayne State University, Detroit, MI, United States
| | - Susanne Brummelte
- Department of Psychology, Wayne State University, Detroit, MI, United States.
| |
Collapse
|
32
|
Kothari SY, Dongara AR, Nimbalkar SM, Phatak AG, Nimbalkar AS. Missed Opportunities for Sedation and Pain Management at a Level III Neonatal Intensive Care Unit, India. Front Pediatr 2016; 4:7. [PMID: 26942166 PMCID: PMC4763094 DOI: 10.3389/fped.2016.00007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/01/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Neonates in the neonatal intensive care unit (NICU) undergo a multitude of painful and stressful procedures during the first days of life. Stress from this pain can lead to neurodevelopmental problems that manifest in later childhood and should be prevented. OBJECTIVE To determine the number of painful procedures performed per day for each neonate, to verify documentation of painful procedures performed, and to, subsequently, note missed opportunities for providing pain relief to neonates. METHODS We conducted a cross-sectional study at a level III NICU located in a rural part of western India. A total of 69 neonates admitted for more than 24 h were included. Twenty-nine neonates were directly observed for a total of 24 h each, and another 40 neonatal records were retrospectively reviewed for the neonate's first 7 days of admission. All stressful and painful procedures performed on the neonate were recorded. Also recorded were any pharmaceutical pain relief agents or central nervous system depressants administered to the neonate before or at the time of the procedures. Average nurse-patient ratio was also calculated. Data were analyzed using descriptive statistics. RESULTS A documentation deficit of 2.2% was observed. The average nurse-patient ratio was 1.53:1. A total of 13711 procedures were recorded, yielding 44.1 (38.1 stressful, 3.8 mildly painful, and 2.2 moderately painful) procedures per patient day. Common stressful procedures were position changing (2501) and temperature recording (2208). Common mildly and moderately painful procedures were heel prick (757) and endotracheal suctioning (526), respectively. Use of pharmacological agents coincided with 33.48% of the procedures. The choice of drug and time of administration were inappropriate, indicating that the pharmacological agents were intended not for pain relief but rather for a coexisting pathology or as sedation from ventilation with no analgesia. CONCLUSION Stressful procedures are common in the NICU; mildly and moderately painful procedures fairly common. Almost two-thirds of the times, no pharmaceutical pain relief methods were used, and when administered, the pharmaceutical agents were seldom intended for pain relief; this implies poor pain management practices and emphasizes the imperative need for educating NICU nurses, residents, fellows, and attendings.
Collapse
Affiliation(s)
- Shikha Y Kothari
- Department of Pediatrics, Pramukhswami Medical College , Karamsad-Anand , India
| | - Ashish R Dongara
- Department of Pediatrics, Pramukhswami Medical College , Karamsad-Anand , India
| | - Somashekhar M Nimbalkar
- Department of Pediatrics, Pramukhswami Medical College, Karamsad-Anand, India; Central Research Services, Charutar Arogya Mandal, Karamsad-Anand, India
| | - Ajay G Phatak
- Central Research Services, Charutar Arogya Mandal , Karamsad-Anand , India
| | - Archana S Nimbalkar
- Department of Physiology, Pramukhswami Medical College , Karamsad-Anand , India
| |
Collapse
|
33
|
Kabataş EU, Dursun A, Beken S, Dilli D, Zenciroğlu A, Okumuş N. Efficacy of Single Dose Oral Paracetamol in Reducing Pain During Examination for Retinopathy of Prematurity: A Blinded Randomized Controlled Trial. Indian J Pediatr 2016; 83:22-6. [PMID: 25947264 DOI: 10.1007/s12098-015-1765-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 04/02/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the efficacy of paracetamol in reducing pain during examination for retinopathy of prematurity (ROP) in preterm infants. METHODS A total of 114 infants undergoing eye examination for retinopathy of prematurity screening were prospectively randomized. Topical anesthetic (Proparacaine; Alcaine® drop 0.5%) was applied 30 s before the eye examination in all the infants. The infants in the intervention group (Group 1, n = 58) received 15 mg/kg of oral paracetamol, 60 min before the examination. The control group (Group 2, n = 56) received the same volume of sterile water per oral with an opaque syringe. Primary outcome measurement was pain assessed by Premature Infant Pain Profile (PIPP) score. Secondary outcome measurements were tachycardia (>180 bpm)/bradycardia (<100 bpm), desaturations (<85% for >10 s), and crying time. RESULTS The groups were similar for gestational age, birthweight or postnatal age at examination. The intervention group had a significantly lower mean PIPP score during eye examination, following insertion of the speculum [Group 1:12 (9-13) vs. Group 2:14 (13-15), p 0.001]. There were no significant differences between the groups with regard to crying time and the number of the patients with tachycardia/bradycardia and desaturation. CONCLUSIONS Oral paracetamol modestly reduces pain scores during eye examinations. Further cross-over trials on dose and frequency of paracetamol and combination of pharmacological with non-pharmacological approaches and paracetamol alone as a single agent in significant pain reduction are needed.
Collapse
Affiliation(s)
- Emrah Utku Kabataş
- Pediatric Ophtalmology Unit, Department of Ophtalmology, Dr. Sami Ulus Maternity and Children Research and Training Hospital, Ankara, Turkey
| | - Arzu Dursun
- Neonatal Intensive Care Unit, Department of Neonatology, Dr. Sami Ulus Maternity and Children Research and Training Hospital, 06080, Ankara, Turkey
| | - Serdar Beken
- Neonatal Intensive Care Unit, Department of Neonatology, Dr. Sami Ulus Maternity and Children Research and Training Hospital, 06080, Ankara, Turkey
| | - Dilek Dilli
- Neonatal Intensive Care Unit, Department of Neonatology, Dr. Sami Ulus Maternity and Children Research and Training Hospital, 06080, Ankara, Turkey.
| | - Ayşegül Zenciroğlu
- Neonatal Intensive Care Unit, Department of Neonatology, Dr. Sami Ulus Maternity and Children Research and Training Hospital, 06080, Ankara, Turkey
| | - Nurullah Okumuş
- Neonatal Intensive Care Unit, Department of Neonatology, Dr. Sami Ulus Maternity and Children Research and Training Hospital, 06080, Ankara, Turkey
| |
Collapse
|
34
|
Messerer B, Krauss-Stoisser B, Urlesberger B. [Non-pharmaceutical measures, topical analgesics and oral administration of glucose in pain management: Austrian interdisciplinary recommendations on pediatric perioperative pain management]. Schmerz 2015; 28:31-42. [PMID: 24550025 DOI: 10.1007/s00482-014-1391-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Non-pharmaceutical procedures are increasingly being used in pediatric pain therapy in addition to pharmaceutical procedures and have a supporting function. This article describes the non-pharmaceutical procedures which have an influence on perioperative and posttraumatic pain in children and adolescents. Prerequisites for every adequate pain therapy are affection, imparting a feeling of security, distraction and the creation of a child-oriented environment. Topical analgesics are indicated for application to intact skin for surface anesthesia. For a safe use consideration must be given to the duration of application, the dose and the maximum area of skin treated in an age-dependent manner. For simple but painful procedures in premature infants, neonates and infants, pain can be effectively reduced by the oral administration of glucose. The positive effect is guaranteed particularly for the use in a once only pain stimulation. Non-nutritive sucking, swaddling, facilitated tucking and kangaroo mother care, for example can be used as supportive measures during slightly painful procedures. There is insufficient evidence for a pain reducing effect in older infants and small children. Physical therapeutic procedures can be used as accompanying measures for acute pain and are individually adapted. However, the limited amount of currently available data is insufficient to make a critical scientific assessment of the individual measures. The effects can, however, be observed in the daily routine practice. Psychological methods can facilitate coping with pain. In situations with mental and psychiatric comorbidities or psychosocial impairment, a psychologist should be consulted. Acupuncture and hypnosis are also a meaningful addition within the framework of multimodal pain therapy.
Collapse
Affiliation(s)
- B Messerer
- Universitätsklinik für Anästhesiologie und Intensivmedizin, Medizinische Universität Graz, Auenbruggerplatz 29, 8036, Graz, Österreich,
| | | | | |
Collapse
|
35
|
Changes of locoregional skin temperature in neonates undergoing laser needle acupuncture at the acupuncture point large intestine 4. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:571857. [PMID: 25922612 PMCID: PMC4398935 DOI: 10.1155/2015/571857] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/06/2015] [Indexed: 12/15/2022]
Abstract
Laser acupuncture bears a potential risk for the skin surface, especially in neonates whose skin has histological and physiological peculiarities. We evaluated thermal changes of skin temperature in neonates during laser acupuncture by using a thermal camera (Flir i5, Flir Systems Inc., Portland, USA). Laserneedles (Laserneedle GmbH, Glienicke/Nordbahn, Germany) were fixed to the skin at Large Intestine 4 (LI 4, Hegu), bilaterally. Before application of laser acupuncture (685 nm, 15 mW, 500 μm), as well as after 1, 5, and 10 min, thermographic pictures of both hands were taken. The measuring was carried out on the 23rd day after birth (20 neonates, mean postmenstrual gestational age 38 + 2, mean weight 2604 g). Compared to the initial temperature of 34.2°C on the right hand, the skin temperature had increased to 35.3°C (P < 0.05) after 5 min and up to 36.1°C (P < 0.05) after 10 min of stimulation. Equally, on the left hand, an increase of the skin temperature from 34.5°C to 35.9°C (P < 0.05) and 35.9°C (P < 0.05) was measured. The highest measured skin temperature after 10 min of stimulation amounted to 38.7°C, without any clinically visible changes on the skin surface.
Collapse
|
36
|
Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: A randomized controlled trial. Midwifery 2015; 31:365-72. [DOI: 10.1016/j.midw.2014.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 10/25/2014] [Accepted: 11/01/2014] [Indexed: 11/17/2022]
|
37
|
Abstract
Neonates are exposed to repetitive pain and stress during their stay in a NICU, which can lead to chronic complications related to their neurodevelopment and neurobehavior. Approximately 20 percent of all neonates in a NICU are intubated, mechanically ventilated, and require suctioning, which can cause both acute and chronic pain. Pain management in the neonate can be challenging. Nurses and other caregivers need to be well trained to assess pain in the neonate to effectively identify and provide appropriate pain management strategies. There is a lack of evidence to support routine administration of opiates in the neonate. As with any medication, the possibility of short- and long-term adverse reactions must be considered. Nonpharmacologic therapy should be used as much as possible.
Collapse
|
38
|
Abstract
The assessment and treatment of pain in the neonate, especially preterm neonates, has been a challenge in the NICU for many years. Nurses caring for these vulnerable patients are in a key position to not only recognize when the neonate is experiencing pain but to also work collaboratively with other health care providers in determining the best method to treat and help prevent pain associated with procedures and routine caregiving activities. The American Academy of Pediatrics along with parent groups has recognized the importance of pain-prevention programs in treating pain in the neonate. Nurses, by anticipating and reducing both painful procedures and bedside interruptions, along with innovative nonpharmacologic interventions, can dramatically decrease the neonate's exposure to pain and the potential for long-term effects. An overview of nonpharmacologic interventions in the treatment of neonatal pain is provided for NICU nurses to help them effectively reduce their patient's pain and discomfort.
Collapse
|
39
|
Golianu B, Seybold J, Almgren C. Acupuncture Helps Reduce Need for Sedative Medications in Neonates and Infants Undergoing Treatment in the Intensive Care Unit: A Prospective Case Series. Med Acupunct 2014. [DOI: 10.1089/acu.2014.1048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Brenda Golianu
- Department of Anesthesiology, Stanford University, Stanford, CA
| | - Jeannie Seybold
- Department of Anesthesiology, Stanford University, Stanford, CA
| | | |
Collapse
|
40
|
Asadi-Noghabi F, Tavassoli-Farahi M, Yousefi H, Sadeghi T. Neonate pain management: what do nurses really know? Glob J Health Sci 2014; 6:284-93. [PMID: 25168978 PMCID: PMC4825505 DOI: 10.5539/gjhs.v6n5p284] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 06/05/2014] [Accepted: 07/14/2014] [Indexed: 11/12/2022] Open
Abstract
PURPOSE The purpose of this study was to determine knowledge, attitude, and performance vis-à-vis pain management in neonates by nurses working in neonatal units in Bandar Abbas University hospitals. METHOD This descriptive and analytical study was executed from March-August 2011 in the neonatal units and NICU in Bandar Abbas educational hospitals. A total of 50 nurses and nurse assistants working in the neonatal units participated in the study. The data collection tool was a structured questionnaire investigating knowledge (28 items), attitude (20 items) and practices (5 items). Data was analyzed using descriptive statistical tests (Frequency, Mean and Standard deviation tables) and inferential statistic (T-test, Variance analysis). RESULTS The knowledge scores of participants had a mean value of 13.51 (48.2%) out of 28. The mean score of attitude was 54.22 out of 60 and the mean score for the nurses' level of practices was found to be 4.22 out of 10. There was a significant relationship between nurses' knowledge scores and the level of education, i.e. nurses with more education had more knowledge. CONCLUSION Results showed that the nurses had poor performance regarding the assessment, measurement, and relief of pain. However, they showed positive attitudes towards pain control in neonates.
Collapse
|
41
|
Abstract
Pain control in newborns is poorly understood and often neglected in neonatal practice in many settings in our environment. Managing pain among newborns can be quite challenging and the effectiveness of various interventions used to ameliorate pain in this category of patients are either unknown or poorly understood by many a people engaged in the care of newborns in one way or the other. A search for published works on neonatal analgesia was performed using Google and PubMed. The Cochrane Database of Systematic Reviews was also searched. The areas of focus were definition, pathophysiology and management of pain in neonates. Relevant information was extracted and processed. Contrary to what is widely believed in many quarters, howbeit erroneously, there is compelling evidence that newborns do indeed feel pain. Supportive care, comprising of use of sucrose, glucose, breastfeeding, kangaroo mother care are worthwhile measures in ameliorating pain in the newborn. Novel therapies (such as sensorial saturation and swaddling) have been evaluated and proven useful. The use of sedation did not show any beneficial results.
Collapse
Affiliation(s)
- Herbert A Obu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu 01129, Nigeria
| | - Josephat M Chinawa
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu 01129, Nigeria
| |
Collapse
|
42
|
Shay JE, Kattail D, Morad A, Yaster M. The postoperative management of pain from intracranial surgery in pediatric neurosurgical patients. Paediatr Anaesth 2014; 24:724-33. [PMID: 24924339 DOI: 10.1111/pan.12444] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
Pain following intracranial surgery has historically been undertreated because of the concern that opioids, the analgesics most commonly used to treat moderate-to-severe pain, will interfere with the neurologic examination and adversely affect postoperative outcome. Over the past decade, accumulating evidence, primarily in adult patients, has revealed that moderate-to-severe pain is common in neurosurgical patients following surgery. Using the neurophysiology of pain as a blueprint, we have highlighted some of the drugs and drug families used in multimodal pain management. This analgesic method minimizes opioid-induced adverse side effects by maximizing pain control with smaller doses of opioids supplemented with neural blockade and nonopioid analgesics, such nonsteroidal antiinflammatory drugs, local anesthetics, corticosteroids, N-methyl-D-aspartate (NMDA) antagonists, α2 -adrenergic agonists, and/or anticonvulsants (gabapentin and pregabalin).
Collapse
Affiliation(s)
- Joanne E Shay
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | | | | |
Collapse
|
43
|
Alinejad-Naeini M, Mohagheghi P, Peyrovi H, Mehran A. The effect of facilitated tucking during endotracheal suctioning on procedural pain in preterm neonates: a randomized controlled crossover study. Glob J Health Sci 2014; 6:278-84. [PMID: 24999148 PMCID: PMC4825219 DOI: 10.5539/gjhs.v6n4p278] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 03/20/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Premature infants not only feel and understand the pain, but also respond more intensively compared with term infants. Non-pharmacological methods of pain control are suitable to relieve pain in painful procedures. The facilitated tucking position is considered as a non-pharmacological method of pain control in infants; however, its impact on frequent and repeated procedural pain such as endotracheal suctioning remains to be studied. OBJECTIVES This paper is the report of a study that examined the impact of facilitated tucking position on behavioral pain during suctioning in premature neonates. DESIGN This was a clinical trial study with a crossover design. SETTINGS The study was conducted in a level II Neonatal Intensive Care Unit, located in a teaching hospital, affiliated to Tehran University of Medical Sciences, Tehran, Iran. PARTICIPANTS Thirty four infants were enrolled in this study based on the following inclusion criteria: age between 29 to 37 weeks of gestational age, birth weight 1200 grams or more, having an endotracheal tube, no congenital anomalies, no seizures diagnosis, no chest tubes, no intracranial hemorrhage higher than degree II, not receiving opiates and sedatives four hours before intervention and not receiving any painful procedure at least half an hour before the intervention. METHODS The samples were randomly received a sequence of suctioning with/without or suctioning without/with facilitated tucking. Preterm Infant Pain Profile (PIPP) was used to collect the data. SPSS version 16.0 for Windows (SPSS Inc., Chicago, IL, USA) was used for statistical analysis. RESULTS While 38.2% of infants experienced severe pain during suctioning without intervention, only 8.8% of them experienced severe pain during suctioning with intervention. The results of the paired t-test show that there is a statistically significant difference in the mean scores of pain between non-intervention and intervention cases (p < 0.001), and the mean pain score substantially reduced in cases with intervention. CONCLUSIONS Given the multiplicity of endotracheal suctioning frequency and the impossibility of frequent use of pharmacological methods of pain relief, the facilitated tucking position can be used as a safe non-pharmacological method for procedural pain management.
Collapse
Affiliation(s)
| | - Parisa Mohagheghi
- Assistant Professor, Department of Pediatrics, Division of Neonatology, Newborn Intensive Care Unit (NICU), Hazrat Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | | | | |
Collapse
|
44
|
Abstract
Preclinical and clinical studies have demonstrated the adverse consequences of untreated pain and stress on brain development in the preterm infant. Sucrose has widely been implemented as standard therapy for minor procedural pain. Anesthetics are commonly utilized in preterm infants during major surgery. Pharmacologic agents (benzodiazepines and opioids) have been examined in clinical trials of preterm infants requiring invasive mechanical ventilation. Controversy exists regarding the safety and long-term impact of these interventions. Ongoing multidisciplinary research will help define the impact of these agents and identify potential alternative therapies.
Collapse
|
45
|
Bergomi P, Chieppi M, Maini A, Mugnos T, Spotti D, Tzialla C, Scudeller L. Nonpharmacological Techniques to Reduce Pain in Preterm Infants Who Receive Heel-Lance Procedure: A Randomized Controlled Trial. Res Theory Nurs Pract 2014; 28:335-48. [DOI: 10.1891/1541-6577.28.4.335] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Introduction: The heel-lance (HL) method for blood collection from the newborn is controversial for the pain it causes. This is the first randomized controlled trial on the management and reduction of pain using the music of Wolfgang Amadeus Mozart (“Sonata K. 448”) in premature infants hospitalized in a neonatal intensive care unit (NICU). This study has compared nonpharmacological techniques with standard procedure for reducing pain during HL procedure. Methods: Thirty-five premature infants were enrolled, each for 3 HL procedures, of which each was randomized to 1 of the 3 study arms. Arms were then compared in terms of the Premature Infant Pain Profile (PIPP) changes by analysis of variance (ANOVA). Results: One hundred five HL procedures were available for analysis (35 standard procedure, 35 music, 35 glucose). Median baseline PIPP was 3, and median PIPP after the HL procedure was 5. PIPP scale change was +3 in the control arm, +1 in the glucose arm, +2 in the music arm (p = .008). Discussion: Both glucose and music were safe and effective in limiting pain increase when compared to standard procedure in HL procedures in preterm infants.
Collapse
|
46
|
Yates CC, Mitchell AJ, Lowe LM, Lee A, Hall RW. Safety of Noninvasive Electrical Stimulation of Acupuncture Points During a Routine Neonatal Heel Stick. Med Acupunct 2013; 25:285-290. [PMID: 24761178 DOI: 10.1089/acu.2012.0952] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Hospitalized infants may undergo frequent painful procedures with inadequate pain relief. Alternative pain relief interventions are needed. OBJECTIVE The aim of this research was to determine the safety of noninvasive electrical stimulation of acupuncture points (NESAP) in neonates who were receiving routine heel sticks. DESIGN This was a descriptive study performed to assess the safety of using a transcutaneous electrical nerve stimulation (TENS) unit to deliver NESAP to neonates. SETTING/SUBJECTS The subjects were healthy newborn infants<3 days old before hospital discharge. INTERVENTION The intervention was NESAP delivered via a TENS unit, administered before, during, and after heel stick. The electrodes of the TENS unit were applied at four acupuncture points. Settings were gradually increased: 6 infants received 1.0 mA, 2 Hz; the second 6 infants received 2.0 mA, 10 Hz; and the last 18 infants received 3.5 mA, 10 Hz. MAIN OUTCOME MEASURES THREE MAIN MEASURES WERE USED: (1) skin assessment (2) vital signs; (3) pain scores using the Premature Infant Pain Profile (PIPP). RESULTS There were no significant changes in vital signs during and after NESAP. There were no changes in PIPP scores in the first 12 infants after initiation of NESAP. A slight but nonsignificant increase in PIPP scores (from 2.65 to 3.5 on a scale of 0-18) occurred in the last 18 infants. There were no adverse events during or after NESAP. CONCLUSIONS NESAP is safe for infants with low settings on a TENS unit.
Collapse
Affiliation(s)
- Charlotte C Yates
- Department of Physical Therapy, University of Central Arkansas , Conway, AR. ; Department of Neurobiology, Center for Translational Neuroscience, University of Arkansas for Medical Sciences , Little Rock, AR
| | - Anita J Mitchell
- Department of Nursing, University of Arkansas for Medical Sciences , Little Rock, AR
| | - Leah M Lowe
- Department of Physical Therapy, University of Central Arkansas , Conway, AR
| | - Amy Lee
- Department of Neurobiology, Center for Translational Neuroscience, University of Arkansas for Medical Sciences , Little Rock, AR
| | - Richard W Hall
- Department of Neurobiology, Center for Translational Neuroscience, University of Arkansas for Medical Sciences , Little Rock, AR. ; Department of Pediatrics and Neonatology, College of Medicine, University of Arkansas for Medical Sciences , Little Rock, AR
| |
Collapse
|
47
|
Kostandy R, Anderson GC, Good M. Skin-to-skin contact diminishes pain from hepatitis B vaccine injection in healthy full-term neonates. Neonatal Netw 2013; 32:274-280. [PMID: 23835546 DOI: 10.1891/0730-0832.32.4.274] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE This study was conducted to test the hypothesis that skin-to-skin contact (SSC) would reduce hepatitis B vaccine injection pain in full-term neonates. DESIGN Randomized controlled trial (RCT). SAMPLE Thirty-six mother-;neonate dyads were randomly assigned to SSC or control groups. MAIN OUTCOMES Cry time (CT ), behavioral state (BSt), and heart rate (HR ) were measured throughout the 16-minute protocol. HR and BSt were measured every 30 seconds; CT was recorded continuously. RESULTS SSC neonates cried less compared with controls (23 vs 32 seconds during injection; 16 vs 72 seconds during recovery), reached calmer BSts sooner (M = 2.8 vs M = 6.5 time points), and trended toward more rapid HR decrease. SSC as described was safe and effective and merits further testing.
Collapse
|
48
|
Schwartz SM, Anand KJS, Portman MA, Crow S, Nelson DP, Zimmerman JJ. Endocrinopathies in the cardiac ICU. World J Pediatr Congenit Heart Surg 2013; 2:400-10. [PMID: 23803992 DOI: 10.1177/2150135111406941] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The past several years have seen an increased appreciation of the potential role of the endocrine system in the recovery process following surgery for congenital heart disease. Many of the hormonal changes following cardiac surgery are adaptive and necessary, whereas activation of proinflammatory cytokine and chemokine responses and some of the metabolic changes following surgery are likely mediators leading to detrimental outcomes. Additionally, other hormonal perturbations may contribute to adverse outcomes. This review examines the pain and the stress response, thyroid function and hyperglycemia following cardiopulmonary bypass (CPB), and the potential role of corticosteroids in the pediatric cardiac critical care unit.
Collapse
Affiliation(s)
- Steven M Schwartz
- Department of Critical Care Medicine and The Labatt Family Heart Centre, The Hospital for Sick Children, Toronto, ON, Canada
| | | | | | | | | | | |
Collapse
|
49
|
Near-infrared spectroscopy for objectifying cerebral effects of laser acupuncture in term and preterm neonates. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:346852. [PMID: 23762122 PMCID: PMC3671269 DOI: 10.1155/2013/346852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/22/2013] [Accepted: 04/26/2013] [Indexed: 12/22/2022]
Abstract
Laser acupuncture (LA) becomes more and more relevant in neonates and infants. With near-infrared spectroscopy (NIRS), a continuous and noninvasive measurement of tissue oxygenation is possible. Aim was to investigate, whether the application of LA was associated with any changes in regional cerebral oxygen saturation (rcSO2) in term and preterm neonates. The study included 20 neonates (12 males, 8 females). The Large Intestine 4 acupuncture point (LI 4, Hegu) was stimulated by a microlaser needle (10 mW, 685 nm laser needle EG GmbH, Germany) for 5 minutes, bilaterally. All neonates underwent polygraphic recording during undisturbed daytime sleep, including heart rate (HR), peripheral oxygen saturation (SpO2), and measurement of nasal flow. Using NIRS, rcSO2 was measured continuously. Cerebral fractional tissue oxygen extraction (cFTOE) was calculated. We did not observe any significant changes in SpO2 and HR values during the whole observation period. However, there was a significant decrease in rcSO2 (P = 0.003) within postintervention period, accompanied by a significant increase in cFTOE (P = 0.010) in postintervention period.
Collapse
|
50
|
Efficacy and safety of acupuncture in preterm and term infants. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:739414. [PMID: 23878607 PMCID: PMC3710611 DOI: 10.1155/2013/739414] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/13/2013] [Accepted: 05/28/2013] [Indexed: 12/20/2022]
Abstract
The aim of the paper was to review the literature about safety and efficiency of acupuncture therapy in term and preterm infants. We searched Medline, EMBASE, and Cochrane Central Register of Controlled Trials using a predefined algorithm, reviewed abstracts from the Pediatric Academic Society annual meetings (2000–2012), and performed a manual search of references in narrative and systematic reviews. A total of 26 studies identified met our search criteria. Only 6 of these studies met our inclusion criteria; however, two studies had to be excluded because the manuscripts were published in Chinese. Hence, only four studies were included in our analysis. Three of the four studies evaluated the effects of acupuncture on infantile colic, and one assessed pain reduction during minor painful procedures in preterm babies. The limited data available suggests that acupuncture could be a safe nonpharmacologic treatment option for pain reduction in term and preterm infants and could also be a non-pharmacologic treatment option to treat infantile colic. Currently acupuncture in infants should be limited to clinical trials and studies evaluating short- and long-term effects and should be performed only by practitioners with adequate training and experience in neonatal/pediatric acupuncture.
Collapse
|