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Ullsten A, Campbell-Yeo M, Eriksson M. Parent-led neonatal pain management-a narrative review and update of research and practices. FRONTIERS IN PAIN RESEARCH 2024; 5:1375868. [PMID: 38689885 PMCID: PMC11058235 DOI: 10.3389/fpain.2024.1375868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 04/02/2024] [Indexed: 05/02/2024] Open
Abstract
Introduction Research related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents' vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills. Methods In this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research. Results Parents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain-reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent's and infant's needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals' attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants' procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change. Conclusion Parent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management.
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Affiliation(s)
- Alexandra Ullsten
- Center for Clinical Research and Education, Region Värmland, Karlstad, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
- MOM-LINC Lab, IWK Health Halifax, Halifax, NS, Canada
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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2
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Fini C, Bardi L, Bolis D, Fusaro M, Lisi MP, Michalland AH, Era V. The social roots of self development: from a bodily to an intellectual interpersonal dialogue. PSYCHOLOGICAL RESEARCH 2023:10.1007/s00426-022-01785-6. [PMID: 36595049 DOI: 10.1007/s00426-022-01785-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 12/22/2022] [Indexed: 01/04/2023]
Abstract
In this paper, we propose that interpersonal bodily interactions represent a fertile ground in which the bodily and psychological self is developed, gradually allowing for forms of more abstract and disembodied interactions. We start by focusing on how early infant-caregiver bodily interactions play a crucial role in shaping the boundaries of the self but also in learning to predict others' behavior. We then explore the social function of the sense of touch in the entire life span, highlighting its role in promoting physical and psychological well-being by supporting positive interpersonal exchanges. We go on by introducing the concept of implicit theory of mind, as the early ability to interpret others' intentions, possibly grounded in infant-caregiver bodily exchanges (embodied practices). In the following part, we consider so-called higher level forms of social interaction: intellectual exchanges among individuals. In this regard, we defend the view that, beside the apparent private dimension of "thinking abstractly", using abstract concepts is intrinsically a social process, as it entails the re-enactment of the internalized dialogue through which we acquired the concepts in the first place. Finally, we describe how the hypothesis of "dialectical attunement" may explain the development of abstract thinking: to effectively transform the world according to their survival needs, individuals co-construct structured concepts of it; by doing so, humans fundamentally transform not merely the world they are being in, but their being in the world.
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Affiliation(s)
- Chiara Fini
- Department of Dynamic and Clinical Psychology and Health Studies, Sapienza University of Rome, Rome, Italy.
| | - Lara Bardi
- Institute of Cognitive Neuroscience Marc Jeannerod, CNRS/UMR 5229, Bron, France.,Université Claude Bernard, Lyon 1, Villeurbanne, France
| | - Dimitris Bolis
- Independent Max Planck Research Group for Social Neuroscience, Max Planck Institute of Psychiatry,Kraepelinstrasse 2-10, 80804, Muenchen-Schwabing, Germany.,Centre for Philosophy of Science, Faculty of Science, University of Lisbon, Campo Grande, 1749-016, Lisbon, Portugal.,Department of System Neuroscience, National Institute for Physiological Sciences (NIPS), Okazaki, 444-0867, Japan
| | | | - Matteo P Lisi
- IRCCS Fondazione Santa Lucia, Rome, Italy.,Fondazione Istituto Italiano Di Tecnologia (IIT), Sapienza University of Rome and Center for Life Nano- & Neuroscience, Rome, Italy
| | - Arthur Henri Michalland
- Department of Psychology, Université Paul Valéry Montpellier, EPSYLON EA 4556, 34199, Montpellier, France.,University of Montpellier - LIFAM, Montpellier, France
| | - Vanessa Era
- Department of Psychology, Sapienza University, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy.,Fondazione Istituto Italiano Di Tecnologia (IIT), Sapienza University of Rome and Center for Life Nano- & Neuroscience, Rome, Italy
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3
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Shayani LA, Marães VRFDS. Manual and alternative therapies as non-pharmacological interventions for pain and stress control in newborns: a systematic review. World J Pediatr 2023; 19:35-47. [PMID: 36100797 DOI: 10.1007/s12519-022-00601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND Supporting therapies that provide stress and pain control of preterm and term newborns infants contribute positively to the neuropsychomotor development. Non-pharmacological interventions that involve manual techniques are described, considering protocols that can be reproduced by physical therapists, with positive and negative outcomes reports. DATA SOURCES Systematic review follows PRISMA 2020 statements guidelines. Primary and specific health sciences databases (Science Direct, Pubmed, Scielo, Embase and Scopus) were consulted between October 2021 and May 2022. Articles considered were clinical trials, randomized or not, that included descriptions of the type of intervention as non-pharmacological and that studied the following outcomes: "pain" and "stress". RESULTS Fifteen articles were selected for analysis, reaching a methodological quality of at least 3 on the Jadad Scale for the Quality of Researched Sources. The non-pharmacological therapies most applied in isolation were massage, swaddling or wrapping, gentle touch and kinesthetic stimulation, and the combined therapies were non-nutritive sucking and swaddling, oral sucrose and swaddling, sensory stimulation and familiar odors, and sensory saturation. The outcomes found were relaxation, pain, and stress reduction after the application of painful procedures. The behavioral changes included crying, grimacing, yawning, sneezing, jerky arm or leg movements, startles, and finger flaring. The vital signs included heart rate, blood oxygen saturation level, and pulse respiration. CONCLUSIONS Combined techniques lead to better results in controlling neonatal pain when compared to isolated techniques. They can be applied both in preterm and term infants in a safe way and are reproducible in any health unit in a simple and economical way.
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Mencía S, Alonso C, Pallás-Alonso C, López-Herce J. Evaluation and Treatment of Pain in Fetuses, Neonates and Children. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1688. [PMID: 36360416 PMCID: PMC9689143 DOI: 10.3390/children9111688] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 10/25/2022] [Accepted: 10/28/2022] [Indexed: 08/03/2023]
Abstract
The perception of pain is individual and differs between children and adults. The structures required to feel pain are developed at 24 weeks of gestation. However, pain assessment is complicated, especially in neonates, infants and preschool-age children. Clinical scales adapted to age are the most used methods for assessing and monitoring the degree of pain in children. They evaluate several behavioral and/or physiological parameters related to pain. Some monitors detect the physiological changes that occur in association with painful stimuli, but they do not yet have a clear clinical use. Multimodal analgesia is recommended for pain treatment with non-pharmacological and pharmacological interventions. It is necessary to establish pharmacotherapeutic protocols for analgesia adjusted to the acute or chronic, type and intensity of pain, as well as age. The most used analgesics in children are paracetamol, ibuprofen, dipyrone, opioids (morphine and fentanyl) and local anesthetics. Patient-controlled analgesia is an adequate alternative for adolescent and older children in specific situations, such as after surgery. In patients with severe or persistent pain, it is very important to consult with specific pain services.
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Affiliation(s)
- Santiago Mencía
- Pediatric Intensive Care Service, Gregorio Marañón General University Hospital, Health Research Institute of Gregorio Marañón Madrid, 28029 Madrid, Spain
- Departamento de Salud Pública y Maternoinfantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Carlos III Institute, 28029 Madrid, Spain
| | - Clara Alonso
- Carlos III Institute, 28029 Madrid, Spain
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Carmen Pallás-Alonso
- Departamento de Salud Pública y Maternoinfantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Carlos III Institute, 28029 Madrid, Spain
- Department of Neonatology, 12 de Octubre University Hospital, 28041 Madrid, Spain
| | - Jesús López-Herce
- Pediatric Intensive Care Service, Gregorio Marañón General University Hospital, Health Research Institute of Gregorio Marañón Madrid, 28029 Madrid, Spain
- Departamento de Salud Pública y Maternoinfantil, Facultad de Medicina, Universidad Complutense de Madrid, 28040 Madrid, Spain
- Carlos III Institute, 28029 Madrid, Spain
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Bellieni CV. Neonatal Infant Pain Scale in assessing pain and pain relief for newborn male circumcision. Int J Impot Res 2022; 35:282-285. [PMID: 35352017 DOI: 10.1038/s41443-022-00551-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 11/09/2022]
Abstract
Circumcision-partial or total removal of the penile prepuce-requires cutting nerve-laden, sensitive genital tissue and is therefore liable to be painful. The aim of this review is to evaluate the evidence concerning pain felt by newborns during circumcision and to determine whether current analgesic methods can eliminate such pain. I performed a search in medical databases, selecting the trials published in the last 20 years that assessed pain in neonatal circumcision. Twenty-three trials have been retrieved. To get reliable findings, those trials that used validated pain scales were selected; then it was investigated which trials had comparable data for using the same pain scale. The only pain scale that was used in more than two trials was the modified Neonatal Infant Pain Scale (mNIPS) that ranges 0-6. The results of these trials show that none of the analgesic strategies used obtained the absence of pain. Some differences between circumcision techniques can be noticed, but most assessments exceed the score of 3, chosen as the clinically significant pain.
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Affiliation(s)
- Carlo V Bellieni
- Department of Pediatrics, University of Siena, Viale M Bracci 36, 53100, Siena, Italy.
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6
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Lin CH, Liaw JJ, Chen YT, Yin T, Yang L, Lan HY. Efficacy of Breast Milk Olfactory and Gustatory Interventions on Neonates’ Biobehavioral Responses to Pain during Heel Prick Procedures. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031240. [PMID: 35162263 PMCID: PMC8834920 DOI: 10.3390/ijerph19031240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Revised: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 01/27/2023]
Abstract
This study aimed to evaluate the efficacy of breast milk odor either alone or in combination with breast milk taste (via syringe-feeding) to alleviate neonates’ biobehavioral responses to pain during heel-prick procedures. This prospective randomized controlled trial recruited 114 neonates by convenience sampling from a newborn unit of a medical center in Taiwan. Neonates were randomly assigned to three groups: control (gentle touch + human voice), control + breast milk odor, and control + breast milk odor + breast milk taste. Heart rate, oxygen saturation, and voice recordings of crying were measured across heel-prick procedures: baseline, no stimuli (stage 0); during heel prick (Stages 1–4); and recovery (Stages 5–10). Generalized estimating equations and Kaplan–Meier survival analysis compared differences in changes between groups for heart rate, oxygen saturation, and time to crying cessation. Changes in mean heart rate and oxygen saturation in neonates receiving breast milk odor or breast milk odor + breast milk taste were significantly less than those at the corresponding stage for the control group. Among neonates receiving breast milk odor or breast milk odor + breast milk taste, hazard rate ratios for crying cessation were 3.016 and 6.466, respectively. Mother’s breast milk olfactory and gustatory interventions could stabilize the biobehavioral responses to pain during heel prick procedures in neonates.
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Affiliation(s)
- Chiao-Hsuan Lin
- Department of Nursing, Tri-Service General Hospital, Taipei 11490, Taiwan; (C.-H.L.); (T.Y.)
| | - Jen-Jiuan Liaw
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Yu-Ting Chen
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Ti Yin
- Department of Nursing, Tri-Service General Hospital, Taipei 11490, Taiwan; (C.-H.L.); (T.Y.)
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan;
| | - Luke Yang
- Department of Social Work, Hsuan Chuang University, Taipei 30092, Taiwan;
| | - Hsiang-Yun Lan
- School of Nursing, National Defense Medical Center, Taipei 11490, Taiwan;
- Correspondence:
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Breastmilk as a Multisensory Intervention for Relieving Pain during Newborn Screening Procedures: A Randomized Control Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182413023. [PMID: 34948633 PMCID: PMC8701293 DOI: 10.3390/ijerph182413023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/07/2021] [Accepted: 12/08/2021] [Indexed: 11/17/2022]
Abstract
The study aim was to explore the effects of multisensory breastmilk interventions on short-term pain of infants during newborn screening. This is a randomized controlled trial. A total of 120 newborns were recruited and assigned by randomization to one of three treatment conditions: Condition 1 = routine care (gentle touch + verbal comfort); Condition 2 = breastmilk odor + routine care; or Condition 3 = breastmilk odor + taste + routine care. Pain was scored with the Neonatal Infant Pain Scale (NIPS). Data were collected from video recordings at 1 min intervals over the 11 phases of heel sticks: phase 1, 5 min before heel stick without stimuli (baseline); phase 2 to phase 6 (during heel stick); and phase 7 to phase 11 (recovery). Generalized estimating equations compared differences in pain scores for newborns over phases among the three conditions. Compared with the routine care, provision of the odor and taste of breastmilk reduce NIPS scores during heel sticks (B = −4.36, SE = 0.45, p < 0.001 [phase6]), and during recovery (B = −3.29, SE = 0.42, p < 0.001 [phase7]). Our findings provide new data, which supports the use of multisensory interventions that include breastmilk odor and taste in combination with gentle touch and verbal comfort to relieve pain in infants undergoing newborn screening.
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8
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Pain Management in Pediatric Trauma. CURRENT TRAUMA REPORTS 2021. [DOI: 10.1007/s40719-021-00216-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kassab M, Joseph R, Alhammad N, Mohammad KI. Oral Sucrose for Neonatal Pain: Perception of Jordanian Nurses. Neonatal Netw 2021; 40:25-30. [PMID: 33479008 DOI: 10.1891/0730-0832/11-t-663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neonatal pain management using sucrose has been an established practice in Western countries. However, in the developing world, the practice is still not widely accepted. Neonatal nurses' perceptions about the neonatal pain experience and efficacy of oral sucrose may influence that decision. PURPOSE To investigate Jordanian neonatal nurses' perceptions about the use of oral sucrose for neonatal pain. DESIGN AND SAMPLE A cross-sectional descriptive design was used to collect data from 191 neonatal nurses working in 3 different hospital settings in northern and middle central Jordan. MAIN OUTCOME VARIABLES Knowledge and perception of Jordanian nurses about neonatal pain and oral sucrose and their relationship to demographic variables. RESULTS More than half of nurses had knowledge deficit about pain management. Fifty-five percent of the nurses had a positive perception toward pain assessment tools, and the majority indicated positive opinion toward oral sucrose usage. Demographic factors can impact their perceptions.
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Rossi S, Buonocore G, Bellieni CV. Management of pain in newborn circumcision: a systematic review. Eur J Pediatr 2021; 180:13-20. [PMID: 32748017 PMCID: PMC7782363 DOI: 10.1007/s00431-020-03758-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 12/15/2022]
Abstract
Male circumcision (MC) is one of the most common surgical procedures performed on neonates. In the last decades, there have been consistent advances in the understanding of pain mechanisms in newborns, and analgesia has become a fundamental part of neonatal care. MC is still often performed with inappropriate analgesic methods, and there is still great variability among the various centers about surgical and anesthethic techniques to do it. The purpose of this review is to summarize the findings in the literature about pain management and analgesia during newborn MC. We performed a systematic review of neonatal MC studies published in the last 20 years. The most effective technique appeared to be the combination of pharmacological and non-pharmacological methods of analgesia.Conclusion: Combining local anesthesia with non-pharmacological analgesic strategies appears to be effective preventing procedural pain during MC. However, a standardized protocol for analgesia during MC is yet to be determined. Sensorial saturation appeared to help when used in conjunction with the local anesthesia techniques. What is Known: • Male circumcision is a painful procedure and it is frequently performed with inappropriate analgesic methods. • A gold standard practice in analgesia during male circumcision is still lacking and there is a great variability in the modus operandi between centers. What is New: • The combination of RB + EMLA + sucrose appears to be an analgesic strategy superior to other approaches. • We advocate for the integration of sensorial saturation during male circumcision in order to improve the efficacy of current analgesic practices.
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Affiliation(s)
- Serena Rossi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giuseppe Buonocore
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
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Castillo Barrio B, Rasines Rodríguez A, Aneiros Suanzes C, Royuela Vicente A, Ortiz Movilla R, Marín Gabriel MA. A survey of procedural pain assessment and non-pharmacologic analgesic interventions in neonates in Spanish public maternity units. J Perinatol 2020; 40:1764-1769. [PMID: 32873906 DOI: 10.1038/s41372-020-00800-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 07/27/2020] [Accepted: 08/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To qualify and quantify clinical practices related to pain assessment and non-pharmacologic analgesia (NPA) in newborns in Spanish public maternity hospitals STUDY DESIGN: We surveyed providers online regarding their use of pain assessment scales, NPA interventions in neonates undergoing procedures, as well parents' presence or absence during interventions. RESULTS The number of painful procedures and the subjective grading of pain from the responding physicians were similar in all hospitals. Only 12.5% of hospitals used pain scales. No NPA was employed in 37.7% of procedures, with less NPA used in the lower complexity hospitals for venous extraction (p < 0.001) and gastric lavage (p = 0.001). Respondents reported parents' absence during 56.1% of procedures. CONCLUSIONS Available pain assessment scales and NPA interventions to mitigate pain are being underused. The presence of the parents during painful interventions is low despite the evidence that this may help to reduce newborns' perception of pain.
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Affiliation(s)
| | | | | | - Ana Royuela Vicente
- Clinical Biostatistics Unit, Puerta de Hierro Majadahonda University Hospital, Instituto de Investigación Puerta de Hierro (IDIPHIM), Madrid, Spain
| | - Roberto Ortiz Movilla
- Department of Pediatrics, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain
| | - Miguel A Marín Gabriel
- Department of Pediatrics, Puerta de Hierro Majadahonda University Hospital, Madrid, Spain. .,Department of Pediatrics, Autónoma University, Madrid, Spain.
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Wu HP, Yang L, Lan HY, Peng HF, Chang YC, Jeng MJ, Liaw JJ. Effects of Combined Use of Mother's Breast Milk, Heartbeat Sounds, and Non-Nutritive Sucking on Preterm Infants' Behavioral Stress During Venipuncture: A Randomized Controlled Trial. J Nurs Scholarsh 2020; 52:467-475. [PMID: 32564489 DOI: 10.1111/jnu.12571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Even routine procedures can cause pain and stress, and can be harmful to the fast-growing brain of preterm infants. Mitigating pain and stress with sucrose and analgesics has side effects; thus, an alternate choice is the use of natural breast milk and infants' sensory capabilities. Therefore, this study examined the effects of different integrations of sensory experiences-mother's breast milk odor and taste (BM-OT), heartbeat sounds (HBs), and non-nutritive sucking (NNS)-on preterm infant's behavioral stress during venipuncture. DESIGN This study was a prospective, randomized controlled trial. METHODS Infants born preterm (<37 weeks' gestational age) were enrolled in the study through convenience sampling, and randomly assigned to the following conditions: (condition 1) routine care (n = 36); (condition 2) BM-OT (n = 33); (condition 3) BM-OT + HBs (n = 33); or (condition 4) BM-OT + HBs + NNS (n = 36). Crying duration from puncture to recovery period was recorded using a voice recorder. Facial actions and body movements were measured using an infant behavioral coding scheme and transformed into frequencies during seven stages: baseline (stage 0), disinfecting (stage 1), venipuncture (stage 2), and the recovery period for 10 minutes (stages 3-6). FINDINGS Data were analyzed for 138 preterm infants. The corresponding median times to stop crying for conditions 1, 2, 3, and 4 were 137, 79, 81, and 39 s, respectively; the instantaneous occurrence rates of stopping crying for conditions 2, 3, and 4 were 1.469, 1.574, and 2.996 times greater than for condition 1, respectively. Infants receiving conditions 3 and 4 had significantly fewer occurrences of facial actions (stage 6 and stages 4-6, respectively) and body movements (stages 3-6 for both); however, there were no significant reductions in stress behaviors for condition 2 (BM-OT). CONCLUSIONS The combination of BM-OT, HBs, and NNS could be provided to preterm infants as interventions to prevent and reduce behavioral stress, and facilitate pain recovery during venipuncture procedures. CLINICAL RELEVANCE Clinicians should be educated about how to recognize preterm infants' behavioral stress, and to incorporate different sensory combinations of respective mothers' BM, HBs, and NNS into painful procedures to help preterm infants recover from distress.
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Affiliation(s)
- Hsiang-Ping Wu
- Lambda Beta-At-Large, Doctoral Student, Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei City, Taiwan, R.O.C, and Lecturer, Department of Nursing, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chiayi, Taiwan, R.O.C
| | - Luke Yang
- Associate Professor, Department of Social Work, Hsuan Chuang University, Hsinchu, Taiwan, R.O.C
| | - Hsiang-Yun Lan
- Lambda Beta-At-Large, Assistant Professor, School of Nursing, National Defense Medical Center, Taipei, Taiwan, R.O.C
| | - Hsueh-Fang Peng
- Registered Nurse, Department of Nursing, Taipei Veteran General Hospital, Taipei, Taiwan, R.O.C
| | - Yue-Cune Chang
- Professor, Department of Mathematics, Tamkang University, Taipei City, Taiwan, R.O.C
| | - Mei-Jy Jeng
- Professor, Department of Pediatrics, Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
| | - Jen-Jiuan Liaw
- Lambda Beta-At-Large, Professor, School of Nursing, National Defense Medical Center, Taipei City, Taiwan, R.O.C
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Jani P, Lowe K, Hinder M, Galea C, D'Çruz D, Badawi N, Tracy M. Liberal hemoglobin threshold affects cerebral arterial pulsed Doppler and cardiac output, not cerebral tissue oxygenation: a prospective cohort study in anemic preterm infants. Transfusion 2019; 59:3093-3101. [DOI: 10.1111/trf.15452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 06/15/2019] [Accepted: 06/22/2019] [Indexed: 12/19/2022]
Affiliation(s)
- Pranav Jani
- Westmead Hospital, Department of Neonatology Westmead New South Wales Australia
- The University of Sydney Sydney New South Wales Australia
| | - Krista Lowe
- Westmead Hospital, Department of Neonatology Westmead New South Wales Australia
| | - Murray Hinder
- Westmead Hospital, Department of Neonatology Westmead New South Wales Australia
- The University of Sydney Sydney New South Wales Australia
| | - Claire Galea
- The Children's Hospital at Westmead, Grace Centre for Newborn Care Westmead New South Wales Australia
- The University of Sydney Sydney New South Wales Australia
- Cerebral Palsy Alliance Research Institute Sydney New South Wales Australia
| | - Daphne D'Çruz
- Westmead Hospital, Department of Neonatology Westmead New South Wales Australia
| | - Nadia Badawi
- The Children's Hospital at Westmead, Grace Centre for Newborn Care Westmead New South Wales Australia
- The University of Sydney Sydney New South Wales Australia
- Cerebral Palsy Alliance Research Institute Sydney New South Wales Australia
| | - Mark Tracy
- Westmead Hospital, Department of Neonatology Westmead New South Wales Australia
- The University of Sydney Sydney New South Wales Australia
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Oji-Mmuo CN, Speer RR, Gardner FC, Marvin MM, Hozella AC, Doheny KK. Prenatal opioid exposure heightens sympathetic arousal and facial expressions of pain/distress in term neonates at 24-48 hours post birth. J Matern Fetal Neonatal Med 2019; 33:3879-3886. [PMID: 30821185 PMCID: PMC7197408 DOI: 10.1080/14767058.2019.1588876] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The rising issue of opioid use during pregnancy poses an increased risk of fetal exposure to opioids in-utero and the development of neonatal abstinence syndrome (NAS). The cessation of exposure to opioids upon birth causes elevated levels of norepinephrine in the circulation enhancing sympathetic arousal. Skin conductance (SC) detects sympathetic-mediated sweating while the Neonatal Facial Coding System (NFCS) depicts facial expressions of stress and pain. We hypothesize that there will be a direct correlation between SC and NFCS scores, such that neonates with prenatal opioid exposure will have higher SC and facial responses to pain/stress as compared with healthy neonates without prenatal opioid exposure.Objective: This study evaluates the utility of SC and the NFCS in the objective assessment of early postnatal pain response in opioid-exposed and non-opioid exposed neonates.Methods: This prospective, single-center, pilot study enrolled opioid-exposed term neonates (>37 weeks) and healthy controls. Subjects were observed within 24-48 hours post-birth (and prior to opioid withdrawal) for pain at baseline, during, and post-heel lance/squeeze (HLS) with simultaneously measured SC and videotaped facial expressions. SC data included electro-dermal responses over time (EDR/second) and the average amplitude of responses (mean of peaks [MP]). Video data were scored using the NFCS by two trained coders with inter-rater agreement >85%.Results: SC and NFCS scores were significantly associated with both groups. The opioid-exposed neonates had significantly higher skin conductance indices, EDR/sec for the HLS phase, and MP for HLS and post phases as compared with controls (p < .05). Opioid-exposed neonates demonstrated higher NFCS at baseline (p = .003).Conclusions: Prenatal opioid exposure was associated with heightened sympathetic arousal during both pain and recovery phases and higher facial expressions of pain/distress at baseline only. A multimodal system of assessment may be useful in understanding the complexity and severity of opioid withdrawal associated with NAS.
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Affiliation(s)
- Christiana N. Oji-Mmuo
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | - Rebecca R. Speer
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | | | - Megan M. Marvin
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | - Alexia C. Hozella
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA
| | - Kim K. Doheny
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA.,Department of Pediatrics, Penn State College of Medicine, Hershey, PA.,Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA
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