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Yue JM, Wang Q, Liu B, Zhou L. Postoperative accurate pain assessment of children and artificial intelligence: A medical hypothesis and planned study. World J Clin Cases 2024; 12:681-687. [PMID: 38322690 PMCID: PMC10841123 DOI: 10.12998/wjcc.v12.i4.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/02/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
Although the pediatric perioperative pain management has been improved in recent years, the valid and reliable pain assessment tool in perioperative period of children remains a challenging task. Pediatric perioperative pain management is intractable not only because children cannot express their emotions accurately and objectively due to their inability to describe physiological characteristics of feeling which are different from those of adults, but also because there is a lack of effective and specific assessment tool for children. In addition, exposure to repeated painful stimuli early in life is known to have short and long-term adverse sequelae. The short-term sequelae can induce a series of neurological, endocrine, cardiovascular system stress related to psychological trauma, while long-term sequelae may alter brain maturation process, which can lead to impair neurodevelopmental, behavioral, and cognitive function. Children's facial expressions largely reflect the degree of pain, which has led to the developing of a number of pain scoring tools that will help improve the quality of pain management in children if they are continually studied in depth. The artificial intelligence (AI) technology represented by machine learning has reached an unprecedented level in image processing of deep facial models through deep convolutional neural networks, which can effectively identify and systematically analyze various subtle features of children's facial expressions. Based on the construction of a large database of images of facial expressions in children with perioperative pain, this study proposes to develop and apply automatic facial pain expression recognition software using AI technology. The study aims to improve the postoperative pain management for pediatric population and the short-term and long-term quality of life for pediatric patients after operational event.
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Affiliation(s)
- Jian-Ming Yue
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Qi Wang
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Bin Liu
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Leng Zhou
- Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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2
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Abstract
Purpose of review: Despite advances in technology and treatment options, over 15,000 neonates die each year in the United States. The majority of the deaths, with some estimates as high as 80%, are the result of a planned redirection of care or comfort measures only approach to care. When curative or life-prolonging interventions are not available or have been exhausted, parents focus on preserving quality of life and eliminating needless suffering. Parents hope their child will have a peaceful death and will not feel pain. A significant component of end-of-life care is high quality symptom evaluation and management. It is important that neonatal providers are knowledgeable in symptom management to address common sources of suffering and distress for babies and their families at the end-of-life (EOL). Recent findings: Medically complex neonates with life-threatening conditions are a unique patient population and there is little research on end-of-life symptom assessment and management. While there are tools available to assess symptoms for adolescents and adults, there is not a recognized set of tools for the neonatal population. Nonetheless, it is widely accepted that neonates experience significant symptoms at end-of-life. Most commonly acknowledged manifestations are pain, dyspnea, agitation, and secretions. In the absence of data and established guidelines, there is variability in their clinical management. This contributes to provider discomfort and inadequate symptom control. Summary: End-of-life symptom assessment and management is an important component of neonatal end-of-life care. While there remains a paucity of studies and data, it is prudent that providers adequately manage symptoms. Likewise, it is important that providers are educated so that they can effectively guide families through the dying process by discussing disease progression, physical changes, and providing empathetic support. In this review, the authors make recommendations for non-pharmacological and pharmacological management of end-of-life symptoms in neonates.
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Affiliation(s)
- DonnaMaria E Cortezzo
- Division of Neonatal and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Mark Meyer
- Division of Pain and Palliative Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Department of Anesthesiology, University of Cincinnati College of Medicine, Cincinnati, OH, United States.,Division of Anesthesia, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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3
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Wei Y, Wu Y, Wen K, Bazybek N, Ma G. Recent research and development of local anesthetic-loaded microspheres. J Mater Chem B 2020; 8:6322-6332. [DOI: 10.1039/d0tb01129k] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
This review introduces the recent research and development in local anesthetic-loaded microsphere, as efficient microspheres formulation, the efficient microspheres: optimum preparation method, high loading efficiency, and ideal release rate.
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Affiliation(s)
- Yi Wei
- State Key Laboratory of Biochemical Engineering
- PLA Key Laboratory of Biopharmaceutical Production & Formulation Engineering
- Institute of Process Engineering
- Chinese Academy of Sciences
- Beijing 100190
| | - Youbin Wu
- Yichang Humanwell Pharmaceutical Co., Ltd
- Yichang 443008
- P. R. China
| | - Kang Wen
- State Key Laboratory of Biochemical Engineering
- PLA Key Laboratory of Biopharmaceutical Production & Formulation Engineering
- Institute of Process Engineering
- Chinese Academy of Sciences
- Beijing 100190
| | - Nardana Bazybek
- State Key Laboratory of Biochemical Engineering
- PLA Key Laboratory of Biopharmaceutical Production & Formulation Engineering
- Institute of Process Engineering
- Chinese Academy of Sciences
- Beijing 100190
| | - Guanghui Ma
- State Key Laboratory of Biochemical Engineering
- PLA Key Laboratory of Biopharmaceutical Production & Formulation Engineering
- Institute of Process Engineering
- Chinese Academy of Sciences
- Beijing 100190
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Deng Q, Li Q, Wang H, Sun H, Xu X. Early father-infant skin-to-skin contact and its effect on the neurodevelopmental outcomes of moderately preterm infants in China: study protocol for a randomized controlled trial. Trials 2018; 19:701. [PMID: 30577818 PMCID: PMC6303962 DOI: 10.1186/s13063-018-3060-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 11/19/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin-to-skin contact (SSC) is an evidence-based intervention that benefits low birth weight /preterm infants. However, China's health institutional policy inhibits parents from visiting their baby in the neonatal intensive care unit (NICU). In addition, the Chinese traditional postpartum behavioral practice of confining women to home raises barriers to mother-infant contact. Thus, to shorten the duration of parent-infant separation, father-infant SSC is considered a possible alternative. This study determines whether it is safe to perform father-infant SSC in the NICU and investigates how paternal SSC affects outcomes compared with traditional care (TC) for moderately preterm infants. METHODS/DESIGN A randomized controlled trial will be used to investigate the effects of paternal-infant SSC in NICU wards in China. Preterm infants born at a gestational age in the range of 320-346 weeks with a birth weight > 1500 g will be eligible. A simple random sampling method will be used to allocate infants to the SSC group (n = 25) or the TC group (n = 25). After medical stability, infants in the SSC group will be provided SSC by fathers for one hour every day until discharged from hospital. The primary outcome is neurodevelopmental measures, specifically salivary cortisol and Premature Infant Pain Profile (PIPP) during hospitalization. At 40 weeks of corrected age, infants will be assessed using the Infant Neurological International Battery (INFANIB) and neuroimaging. Secondary outcomes include infants' physiological stability during SSC and throughout hospitalization and state observation at discharge. The fathers' mental health will be assessed with the State-Trait Anxiety Inventory (STAI) 1 day to 3 days after the infant's admission to the NICU and at discharge. Father-infant attachment will be evaluated at 4 and 6 months after the infants' discharge, measured by the Paternal Postnatal Attachment Scale (PPAS). Statistical analyses will be conducted using a two-sided significance level of 0.05. DISCUSSION The effects of paternal-infant SSC on moderately preterm infants will be assessed. The data gathered in this study may have important implications for medical practice and policy in the NICU regarding the care methods of premature infants in China. TRIAL REGISTRATION Chinese Clinical Trial Registry, ChiCTR-IOR-1701274 . Registered on 20 September 2017. Retrospectively registered.
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Affiliation(s)
- Qingqi Deng
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qiufang Li
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Hua Wang
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Huilian Sun
- Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xinfen Xu
- Haining Maternal and Child Health Hospital, Branch of Women’s Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Galderisi A, Lago P, Steil GM, Ghirardo M, Cobelli C, Baraldi E, Trevisanuto D. Procedural Pain during Insertion of a Continuous Glucose Monitoring Device in Preterm Infants. J Pediatr 2018; 200:261-264.e1. [PMID: 29861315 DOI: 10.1016/j.jpeds.2018.03.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 01/06/2023]
Abstract
Procedural pain was compared between the insertion of a continuous glucose monitoring sensor and heel stick using the Premature Infant Pain Profile in a single-blinded controlled trial in preterm infants (≤32 weeks of gestation or birth weight ≤1500 g) (ClinicalTrials.govNCT02583776). Continuous glucose monitoring insertion was associated with lower pain scores compared with the heel stick.
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Affiliation(s)
- Alfonso Galderisi
- Neonatal Intensive Care Unit, Department of Women and Children's Health, University of Padova, Padova, Italy; Department of Pediatrics, Yale University, New Haven, CT.
| | - Paola Lago
- Neonatal Intensive Care Unit, Department of Women and Children's Health, University of Padova, Padova, Italy
| | - Garry M Steil
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Martina Ghirardo
- Neonatal Intensive Care Unit, Department of Women and Children's Health, University of Padova, Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University Hospital of Padova, Padova, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women and Children's Health, University of Padova, Padova, Italy
| | - Daniele Trevisanuto
- Neonatal Intensive Care Unit, Department of Women and Children's Health, University of Padova, Padova, Italy
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6
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Zamzmi G, Kasturi R, Goldgof D, Zhi R, Ashmeade T, Sun Y. A Review of Automated Pain Assessment in Infants: Features, Classification Tasks, and Databases. IEEE Rev Biomed Eng 2017; 11:77-96. [PMID: 29989992 DOI: 10.1109/rbme.2017.2777907] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Bedside caregivers assess infants' pain at constant intervals by observing specific behavioral and physiological signs of pain. This standard has two main limitations. The first limitation is the intermittent assessment of pain, which might lead to missing pain when the infants are left unattended. Second, it is inconsistent since it depends on the observer's subjective judgment and differs between observers. Intermittent and inconsistent assessment can induce poor treatment and, therefore, cause serious long-term consequences. To mitigate these limitations, the current standard can be augmented by an automated system that monitors infants continuously and provides quantitative and consistent assessment of pain. Several automated methods have been introduced to assess infants' pain automatically based on analysis of behavioral or physiological pain indicators. This paper comprehensively reviews the automated approaches (i.e., approaches to feature extraction) for analyzing infants' pain and the current efforts in automatic pain recognition. In addition, it reviews the databases available to the research community and discusses the current limitations of the automated pain assessment.
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7
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De Clifford-Faugère G, Lavallée A, Aita M. Olfactive stimulation interventions for managing procedural pain in preterm and full-term neonates: a systematic review protocol. Syst Rev 2017; 6:203. [PMID: 29041964 PMCID: PMC5646110 DOI: 10.1186/s13643-017-0589-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/28/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While hospitalized in the NICU, preterm neonates undergo many painful procedures. This may be the same for full-term neonates when longer hospitalization is required. Untreated and repeated pain has short-term as well as long-term consequences for these neonates. Pharmacological pain management methods have many limitations in their applications for both preterm and full-term neonates. A combination of different non-pharmacological methods is recommended for pain management. The effect of olfactive stimulation as a non-pharmacological pain management method was investigated by a few studies in the past years with premature and term neonates, but no systematic review has been conducted. The objective of this systematic review is to evaluate the effect of olfactive stimulation intervention on the pain response of preterm and full-term neonates during painful procedures. METHODS An electronic search will be conducted in various databases such as PubMed (1946 to date), MEDLINE (1946 to date), CINAHL (1981 to date), Embase (1947 to date), PsycINFO (1806 to date), Web of Science (1945 to date), CENTRAL and Scopus (1960 to date), and Proquest, without restriction for the year of publication. Only studies published in English or French will be included. The search will be conducted using the following three concepts: pain, odors, and neonates. Selection of articles, data extraction, and assessment of risk of bias will be conducted by two independent researchers. A third researcher will intervene in case of disagreement. According to the availability of studies and data homogeneity, the results will be combined to perform a meta-analysis, or they will be described by a narrative synthesis. DISCUSSION This systematic review will provide light on the current state of knowledge on the effectiveness of olfactive stimulation interventions for managing pain in preterm and full-term neonates. This review will guide clinical practice as well as research to improve preterm and full-term neonates' pain management and prevent short-term and long-term complications caused by pain. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42017058021.
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Affiliation(s)
- Gwenaëlle De Clifford-Faugère
- Faculty of Nursing, Université de Montréal, C.P. 6128 Succ. Centre-ville, Montreal, H3C 3J7, Canada. .,CHU Sainte-Justine Research Center, Montreal, Canada.
| | - Andréane Lavallée
- Faculty of Nursing, Université de Montréal, C.P. 6128 Succ. Centre-ville, Montreal, H3C 3J7, Canada.,CHU Sainte-Justine Research Center, Montreal, Canada
| | - Marilyn Aita
- Faculty of Nursing, Université de Montréal, C.P. 6128 Succ. Centre-ville, Montreal, H3C 3J7, Canada.,CHU Sainte-Justine Research Center, Montreal, Canada.,Quebec Network of Nursing Intervention Research (RRISIQ), Montreal, Canada
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8
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YU LC, TSE MMY, LAI CKY. Effect of gentle manual pressure on neonatal pain during heel prick: a randomised crossover trial. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjom.2017.25.5.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lisa Chit YU
- Senior Clinical Associate, School of Nursing, Tung Wah College
| | - Mimi Mun Yee TSE
- Assistant Professor, School of Nursing, The Hong Kong Polytechnic University
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9
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Elmekkawi A, Abdelgadir D, Van Dyk J, Choudhury J, Dunn M. Use of naloxone to minimize extubation failure after premedication for INSURE procedure in preterm neonates. J Neonatal Perinatal Med 2016; 9:363-370. [PMID: 27834786 DOI: 10.3233/npm-915141] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A new guideline for the early respiratory management of preterm infants that included early nCPAP and INSURE was recently introduced in our NICU. This case series describes the clinical courses of a group of preterm infants managed according to this guideline, and reports the rates of successful extubation within 30 minutes of surfactant administration with and without the use of naloxone and adverse events encountered. STUDY DESIGN Descriptive case series of all preterm babies admitted to our unit who were candidates for INSURE procedure with premedication from August 2012 to August 2013. RESULTS A total of 31 infants were included with a mean birth weight of 1178 grams and a mean gestational age of 28.4 weeks. Twelve out of thirteen (92%) infants in the naloxone group were extubated within 30 minutes of surfactant administration while only 12/18 (67%) in the non-naloxone group were extubated within the same time frame. No adverse reactions were noted with naloxone usage in this context. CONCLUSION Naloxone can be effective in reversing the respiratory depressive effect of analgesic premedication and in turn facilitates expeditious extubation in some preterm infants intubated for INSURE procedure.
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Affiliation(s)
- A Elmekkawi
- Department of Paediatrics, Queen's University, Kingston, ON, Canada.,Department of Paediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada
| | - D Abdelgadir
- Department of Paediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada
| | - J Van Dyk
- Department of Paediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada.,Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - J Choudhury
- Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - M Dunn
- Department of Paediatrics, Division of Neonatology, University of Toronto, Toronto, ON, Canada.,Department of Newborn and Developmental Paediatrics, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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10
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Staff Nurse Utilization of Kangaroo Care as an Intervention for Procedural Pain in Preterm Infants. Adv Neonatal Care 2016; 16:229-38. [PMID: 27148835 DOI: 10.1097/anc.0000000000000262] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Skin-to-skin contact between mother and infant, commonly referred to as Kangaroo Care (KC), has demonstrated efficacy as a pain-relieving strategy for infants, yet, it remains underutilized in clinical practice. PURPOSE To evaluate changes in neonatal intensive care unit staff nurse beliefs, utilization, and challenges related to practice change in implementing KC as an intervention for management of procedural pain in preterm infants between 2 time points. METHODS Nurses who participated in a larger clinical trial examining the sustained efficacy of KC were asked to complete a questionnaire at 2 time points: 1- and 6 month(s) following study initiation. Identified benefits, expectations, frequency of use, and challenges related to practice change uptake were described using frequencies and percentages. Data from the 2 different time points were compared using χ analysis. RESULTS Of the 40 nurses approached, all completed the questionnaire (19 at the 1-month and 21 at the 6-month time point). Of the sample (n = 40), 97% of participants indicated that they expected KC to provide good pain relief or better. Staff nurses reported significantly improved preconceived ideas (χ = 22.68, P < .01) and significantly fewer concerns (χ = 22.10, P = .01) related to using KC as a pain-relieving intervention between the 2 time points. No significant differences were seen in the frequency of using KC as an intervention between time points. IMPLICATIONS FOR RESEARCH AND PRACTICE Despite increasingly positive preconceived ideas and reduced concerns, the frequency of using KC for procedural pain relief remained unchanged. Further research addressing ways to overcome barriers to utilizing KC as an intervention for procedural pain is warranted.
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Martakis K, Hünseler C, Thangavelu K, Kribs A, Roth B. Pain-Related Reactions among Premature Infants with Gestational Age Less than 26 Weeks: An Observational Cohort Study. Neonatology 2016; 110:261-266. [PMID: 27299745 DOI: 10.1159/000446172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 04/14/2016] [Indexed: 11/19/2022]
Abstract
INTRODUCTION There is insufficient information regarding acute pain reactions among premature infants with a gestational age of less than 26 weeks and no appropriate scale for pain measurement in this age group. We hypothesized that these infants present specific reactions to a standardized pain stimulus within the first 3 days of life. METHODOLOGY Mixed-methods, prospective, open-label, single-arm, observational study. Routine capillary or peripheral blood takes were filmed. The model consisting of a baseline, a preparatory, an interventional and a return-to-baseline phase was filmed. After a pilot evaluation, experienced medical and nursing neonatal intensive care unit (NICU) staff analysed the videos. RESULTS Twenty infants with gestational ages ranging from 22 weeks and 3 days to 26 weeks (mean 24 weeks) were recruited. Nineteen infants showed pain reactions, with a mean latency of 8.3 s (range 2-30). The majority presented eye movements, changes of the breath pattern and a slight increase in the mean SpO2 value. A high degree of interrater and intrarater reliability was found. DISCUSSION Premature infants with a gestational age of up to 26 weeks can present a variety of discrete reactions as response to a pain stimulus within the first 72 h of life. Experienced NICU staff can perform a valid and reliable evaluation of these reactions.
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Affiliation(s)
- Kyriakos Martakis
- Children's and Adolescents' Hospital, University Hospital of Cologne, Cologne, Germany
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Lavoie PM, Stritzke A, Ting J, Jabr M, Jain A, Kwan E, Chakkarapani E, Brooks P, Brant R, McNamara PJ, Holsti L. A Randomized Controlled Trial of the Use of Oral Glucose with or without Gentle Facilitated Tucking of Infants during Neonatal Echocardiography. PLoS One 2015; 10:e0141015. [PMID: 26496361 PMCID: PMC4619855 DOI: 10.1371/journal.pone.0141015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 10/01/2015] [Indexed: 11/18/2022] Open
Abstract
Objective To compare the effect of oral glucose given with or without facilitated tucking (FT), versus placebo (water) to facilitate image acquisition during a targeted neonatal echocardiography (TNE). Design Factorial, double blind, randomized controlled trial. Setting Tertiary neonatal intensive care unit (NICU). Patients Infants born between 26 and 42 weeks of gestation (GA). Interventions One of four treatment groups: oral water (placebo), oral glucose (25%), facilitated tucking with oral water or facilitated tucking with oral glucose, during a single, structured TNE. All infants received a soother. Main Outcome Measure Change in Behavioral Indicators of Infant Pain (BIIP) scores. Results 104 preterm infants were randomized (mean ± SD GA: 33.4 ± 3.5 weeks). BIIP scores remained low during the echocardiography scan (median, [IQ range]: 0, [0 to 1]). There were no differences in the level of agitation of infants amongst the treatment groups, with estimated reductions in mean BIIP relative to control of 0.27 (95%CI -0.40 to 0.94) with use of oral glucose and .04 (-0.63 to 0.70) with facilitated tucking. There were also no differences between treatment groups in the quality and duration of the echocardiography scans. Conclusions In stable infants in the NICU, a TNE can be performed with minimal disruption in a majority of cases, simply by providing a soother. The use of 25% glucose water in this context did not provide further benefit in reducing agitation and improving image acquisition. Clinical Trial Registration Clinical Trials.gov: NCT01253889
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Affiliation(s)
- Pascal M. Lavoie
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
- Child & Family Research Institute, Vancouver, Canada
- * E-mail: (PML); (LH)
| | - Amelie Stritzke
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
| | - Joseph Ting
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
- Child & Family Research Institute, Vancouver, Canada
| | - Mohammad Jabr
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, Canada
| | - Amish Jain
- Department of Pediatrics/Division of Neonatology, University of Toronto, Ontario, Canada
| | - Eddie Kwan
- Department of Pharmacy, Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
| | - Ela Chakkarapani
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
| | - Paul Brooks
- Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
- Department of Pediatrics/Division of Cardiology, University of British Columbia, Vancouver, Canada
| | - Rollin Brant
- Child & Family Research Institute, Vancouver, Canada
- Department of Statistics, University of British Columbia, Vancouver, Canada
| | - Patrick J. McNamara
- Department of Pediatrics/Division of Neonatology, University of Toronto, Ontario, Canada
| | - Liisa Holsti
- Child & Family Research Institute, Vancouver, Canada
- Department of Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, Canada
- * E-mail: (PML); (LH)
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13
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Kucukoglu S, Kurt S, Aytekin A. The effect of the facilitated tucking position in reducing vaccination-induced pain in newborns. Ital J Pediatr 2015; 41:61. [PMID: 26293573 PMCID: PMC4546124 DOI: 10.1186/s13052-015-0168-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 08/11/2015] [Indexed: 11/10/2022] Open
Abstract
Background This study was conducted to evaluate the pain perceptions of newborns during the hepatitis B (HBV) vaccinations performed in the facilitated tucking position and the classical holding position, respectively. Methods The randomized controlled experimental study was conducted between 1 September 2014 and 30 December 2014 at the neonatal intensive care unit of a Turkish university hospital. One group of infants was held in the facilitated tucking position (the treatment group; n = 30) during HBV vaccination; infants in the other group were held in the classical holding position (the control group; n = 30) during HBV vaccination. The Neonatal Infant Pain Scale (NIPS) scores of the infants in the treatment and control groups were compared during procedure. Also, the infants’ physiological parameters were compared before, during, and after the procedure. Descriptive statistics, a chi-square test, and an independent samples t-test were used to assess the data. Results The mean pain scores of infants vaccinated in the facilitated tucking position (2.83 ± 1.18) were significantly statistically lower than the scores of infants vaccinated in the classical holding position (6.47 ± 1.07) (p < 0.05). Conclusions The pain perceptions of newborns held in the facilitated tucking position during HBV vaccination were lower. The facilitated tucking position, a non-pharmacological method, is recommended as an effective and useful method for reducing pain during the procedure.
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Affiliation(s)
- Sibel Kucukoglu
- Department of Child Health Nursing, Faculty of Health Sciences, Atatürk University, 25240, Erzurum, Turkey.
| | - Sirin Kurt
- Neonatal Intensive Care Unit, Hospital of Istanbul Medical Faculty, İstanbul University, 34093, İstanbul, Turkey.
| | - Aynur Aytekin
- Department of Child Health Nursing, Faculty of Health Sciences, Atatürk University, 25240, Erzurum, Turkey.
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14
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Lavoie PM, Stritzke A, Ting J, Jabr M, Jain A, Kwan E, Chakkarapani E, Brooks P, Brant R, McNamara PJ, Holsti L. Oral glucose during targeted neonatal echocardiography: is it useful? Arch Dis Child Fetal Neonatal Ed 2015; 100:F374-5. [PMID: 26054971 PMCID: PMC5050030 DOI: 10.1136/archdischild-2015-308191] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2015] [Indexed: 11/04/2022]
Affiliation(s)
- Pascal M. Lavoie
- Children’s & Women’s Health Centre of British Columbia, Vancouver, British Columbia, Canada,Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Amelie Stritzke
- Department of Pediatrics/Division of Neonatology, University of Calgary, Calgary, Alberta, Canada
| | - Joseph Ting
- Children’s & Women’s Health Centre of British Columbia, Vancouver, British Columbia, Canada,Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mohammad Jabr
- Department of Neonatology, King Saud University, Riyadh, Saudi Arabia
| | - Amish Jain
- Department of Pediatrics/Division of Neonatology, University of Toronto, Toronto, Ontario, Canada
| | - Eddie Kwan
- Children’s & Women’s Health Centre of British Columbia, Vancouver, British Columbia, Canada,Department of Pharmacy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ela Chakkarapani
- Neonatal Neuroscience, School of Clinical Medicine, University of Bristol, Bristol, UK
| | - Paul Brooks
- Department of Pediatrics/Division of Cardiology, University of British Columbia, British Columbia, Canada
| | - Rollin Brant
- Department of Statistics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Patrick J. McNamara
- Department of Pediatrics/Division of Neonatology, University of Toronto, Toronto, Ontario, Canada
| | - Liisa Holsti
- Children’s & Women’s Health Centre of British Columbia, Vancouver, British Columbia, Canada,Department of Pediatrics/Division of Neonatology, University of British Columbia, Vancouver, British Columbia, Canada,Occupational Science and Occupational Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Shen M, El-Chaar G. Reducing pain from heel lances in neonates following education on oral sucrose. Int J Clin Pharm 2015; 37:529-36. [DOI: 10.1007/s11096-015-0090-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 02/24/2015] [Indexed: 11/24/2022]
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16
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Mason K. Challenges in paediatric procedural sedation: political, economic, and clinical aspects. Br J Anaesth 2014; 113 Suppl 2:ii48-62. [DOI: 10.1093/bja/aeu387] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
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Use of analgesic and sedative drugs in VLBW infants in German NICUs from 2003-2010. Eur J Pediatr 2013; 172:1633-9. [PMID: 23877637 DOI: 10.1007/s00431-013-2095-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 07/04/2013] [Indexed: 10/26/2022]
Abstract
UNLABELLED Very low birth weight (VLBW) infants frequently receive analgesia and/or sedation for painful procedures and mechanical ventilation to avoid negative stress. Yet, concerns remain regarding potential adverse long-term effects of these drugs on VLBW infants' neurocognitive outcome. Recent studies have shown that less invasive surfactant application (LISA) and early nasal CPAP treatment reduce the need for mechanical ventilation and painful procedures. Therefore, these measures might also reduce the application of analgesic and/or sedative drugs in VLBW infants. To evaluate this hypothesis and to identify potential changes in analgesic treatment concepts in recent years, we retrospectively analyzed data on analgesia and sedation, respiratory support, and the method of surfactant application in VLBW infants enrolled in the German Neonatal Network (GNN) trial between 2003 and 2009 (period 1) and compared it with data from infants participating in GNN in 2010 (period 2). In both periods, about one third of all infants were treated with analgesic and/or sedative drugs using a wide variety of substances. The administration of novel drugs such as propofol, sufentanil, or intravenous paracetamol was higher in 2010 (6.7 vs. 12.2 %). Infants who were treated with CPAP only received significantly less analgesic/sedative medication than infants who were mechanically ventilated (12 vs. 65 %, p=<0.001). Similarly, infants treated with LISA received less analgesic or sedative drugs as compared to infants who received surfactant via endotracheal intubation (36 vs. 63 %, p=0.001). CONCLUSION Although both avoidances of mechanical ventilation and less invasive surfactant application are associated with reduced analgesic or sedative treatment, the percentage of VLBW infants who received analgesia and/or sedation remained unchanged in Germany in recent years.
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Pain score assessment in babies undergoing laser treatment for retinopathy of prematurity under sub-tenon anaesthesia. Eye (Lond) 2013; 27:1405-10. [PMID: 24051409 DOI: 10.1038/eye.2013.205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2012] [Accepted: 07/12/2013] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To assess the tolerability and outcomes of laser treatment for retinopathy of prematurity (ROP) under sub-tenon anaesthetic with oral or rectal sedation using a reliable, multidimensional, and internationally accepted tool for assessment of neonatal pain. METHODS Sixty-two babies have had ROP laser treatment in our neonatal unit in the 7-year interval between 1 March 2005 and 28 February 2012; 44% (27 of the 62) were performed using sub-tenon anaesthesia. Pain scores were routinely assessed using the Neonatal Pain Agitation and Sedation Scale (N-PASS) every 10 min during laser treatment. The outcome and requirement for re-treatment in this group was compared with that in the intravenous sedation group. RESULTS Pain scores were available in 19 of the 27 babies treated under sub-tenon anaesthesia. The mean pain score during treatment was 2.7 (SD ± 1.7, range 0.5-6.2). There was no statistically significant correlation between the mean pain score and duration of treatment (Spearman correlation coefficient (ρ) = 0.31; P = 0.09), number of laser burns (ρ = 0.32; P = 0.09), or post-menstrual age of the baby at the time of treatment (ρ = 0.38; P = 0.052). Treatments performed under sub-tenon anaesthesia were as successful as those performed under intravenous sedation. The mean pain scores during laser treatment under sub-tenon anaesthesia in our study were lower than those previously reported during ROP screening or heel-stick procedure.Conclusion Our study demonstrated that sub-tenon anaesthesia with oral or rectal sedation provides sufficient pain control for laser treatment for ROP without the need or risks of intravenous sedation and intubation.
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Norman E, Wikström S, Rosén I, Fellman V, Hellström-Westas L. Premedication for intubation with morphine causes prolonged depression of electrocortical background activity in preterm infants. Pediatr Res 2013; 73:87-94. [PMID: 23128421 DOI: 10.1038/pr.2012.153] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Sedative and analgesic medications are used in critically ill newborns, but little is known about their effects on electrocortical activity in preterm infants. We hypothesized that morphine might induce prolonged neurodepression, independent of blood pressure, as compared with rapid sequence induction/intubation(RSI). METHODS Of 34 infants enrolled in a randomized controlled trial (RCT) comparing RSI (including thiopental 2-3 mg/kg and remifentantil 1 mcg/kg) with morphine (0.3 mg/kg) as premedication for intubation, 28 infants (n = 14 + 14; median gestational age 26.1 wk and postnatal age 138 h) had continuous two-channel amplitude-integrated electroencephalogram (aEEG/EEG) and blood pressure monitoring during 24 h after the intubation. Thirteen infants not receiving any additional medication constituted the primary study group. Visual and quantitative analyses of aEEG/EEG and blood pressure were performed in 3-h epochs. RESULTS RSI was associated with aEEG/EEG depression lasting <3 h. Morphine premedication resulted in aEEG/EEG depression with more discontinuous background and less developed cyclicity for 24 h, and during the first 9 h, interburst intervals (IBI) were significantly increased as compared with those of RSI treatment. The difference was not related to blood pressure. CONCLUSION Premedication with morphine is associated with prolonged aEEG/EEG depression independent of blood pressure changes and may not be optimal for short procedures.
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Affiliation(s)
- Elisabeth Norman
- Department of Pediatrics, Lund University and Skåne University Hospital, Lund, Sweden.
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Alves CDO, Duarte ED, Azevedo VMGDO, Nascimento GR, Tavares TS. Emprego de soluções adocicadas no alívio da dor neonatal em recém-nascido prematuro: uma revisão integrativa. Rev Gaucha Enferm 2011; 32:788-96. [DOI: 10.1590/s1983-14472011000400021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
As experiências dolorosas repetida em recém-nascidos podem ter efeito a curto e a longo prazo, especialmente nos prematuros. Como uma medida de alívio da dor, tem sido recomendado o uso de soluções adocicadas em procedimentos dolorosos. Este estudo objetiva avaliar as evidências do efeito da sacarose e da glicose oral no alívio da dor aguda em recém-nascidos prematuros. Realizou-se uma revisão integrativa, nas bases de dados MEDLINE e LILACS, no período de 2005 a 2010, foram selecionados oito artigos. A análise destes revelou o efeito analgésico da glicose e da sacarose em procedimentos agudos. Nenhum efeito colateral foi encontrado nos recém-nascidos que receberam a glicose/sacarose. Ressalta-se a importância do uso da escala de avaliação da dor que mais se identifique com a população predominante nas unidades neonatais, que seja de fácil aplicação e manuseio pelos profissionais de saúde.
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Rapid sequence induction is superior to morphine for intubation of preterm infants: a randomized controlled trial. J Pediatr 2011; 159:893-9.e1. [PMID: 21798556 DOI: 10.1016/j.jpeds.2011.06.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Revised: 04/22/2011] [Accepted: 06/01/2011] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To compare rapid sequence intubation (RSI) premedication with morphine for intubation of preterm infants. STUDY DESIGN Preterm infants needing semi-urgent intubation were enrolled to either RSI (glycopyrrolate, thiopental, suxamethonium, and remifentanil, n = 17) or atropine and morphine (n = 17) in a randomized trial. The main outcome was "good intubation conditions" (score ≤10 assessed with intubation scoring), and secondary outcomes were procedural duration, physiological and biochemical variables, amplitude-integrated electroencephalogram, and pain scores. RESULTS Infants receiving RSI had superior intubation conditions (16/17 versus 1/17, P < .001), the median (IQR) intubation score was 5 (5-6) compared with 12 (10.0-13.5, P < .001), and a shorter procedure duration of 45 seconds (35-154) compared with 97 seconds (49-365, P = .031). The morphine group had prolonged heart rate decrease (area under the curve, P < .009) and mean arterial blood pressure increase (area under the curve, P < .005 and %change: mean ± SD 21% ± 23% versus -2% ± 22%, P < .007) during the intubation, and a subsequent lower mean arterial blood pressure 3 hours after the intubation compared with baseline (P = .033), concomitant with neurophysiologic depression (P < .001) for 6 hours after. Plasma cortisol and stress/pain scores were similar. CONCLUSION RSI with the drugs used can be implemented as medication for semi-urgent intubation in preterm infants. Because of circulatory changes and neurophysiological depression found during and after the intubation in infants given morphine, premedication with morphine should be avoided.
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Kim MK, Kim IA, Jung MH, Han MK, Park KY, Kim BS, Jin HS. Nonpharmacologic Pain Relief with Oral 25% Dextrose or/and Pacifier for Newborn Infants. ACTA ACUST UNITED AC 2011. [DOI: 10.5385/jksn.2011.18.2.353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Min-Kyung Kim
- Department of Pediatrics, College of Medicine, Ulsan University, Seoul Asan Medical Center, Seoul, Korea
| | - In Ah Kim
- Department of Pediatrics, College of Medicine, Ulsan University, Gangneung Asan Medical Center, Gangneung, Korea
| | - Min Hee Jung
- Department of Pediatrics, College of Medicine, Ulsan University, Gangneung Asan Medical Center, Gangneung, Korea
| | - Myung Ki Han
- Department of Pediatrics, College of Medicine, Ulsan University, Gangneung Asan Medical Center, Gangneung, Korea
| | - Kie Young Park
- Department of Pediatrics, College of Medicine, Ulsan University, Gangneung Asan Medical Center, Gangneung, Korea
| | - Bong Seong Kim
- Department of Pediatrics, College of Medicine, Ulsan University, Gangneung Asan Medical Center, Gangneung, Korea
| | - Hyun-Seong Jin
- Department of Pediatrics, College of Medicine, Ulsan University, Gangneung Asan Medical Center, Gangneung, Korea
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