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Breton-Piette A, De Clifford-Faugère G, Aita M. Prolonged pain in premature neonates hospitalised in neonatal intensive care units: A scoping review. Int J Nurs Stud 2024; 155:104773. [PMID: 38718692 DOI: 10.1016/j.ijnurstu.2024.104773] [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: 10/04/2023] [Revised: 03/26/2024] [Accepted: 04/04/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Exposure to repetitive pain during the neonatal period has been shown to have important short and long-term effects on the neurodevelopment of the premature neonate and can contribute to experienced prolonged pain. A uniform taxonomy of neonatal prolonged pain is still lacking to this day which contributes to suboptimal prolonged pain management in neonatal intensive care units. Accordingly, a scoping review exploring the state of knowledge about prolonged pain in preterm neonates hospitalised in the neonatal intensive care unit will contribute to the developing field of neonatal prolonged pain and provide recommendations for clinical prolonged pain management. OBJECTIVE To determine the scope, extent, and nature of the available literature on prolonged pain in premature neonates hospitalised in neonatal intensive care units. DESIGN Scoping review. METHODS An electronic search was conducted from inception to November 2023 in the databases of CINAHL, PubMed, Medline, Web of Science, GeryLit.org and Grey Source Index. Included studies discussed concepts related to neonatal prolonged pain such as definitions of prolonged pain, indicators of prolonged pain, contexts that result in prolonged pain, prolonged pain evaluation tools, consequences of prolonged pain and interventions for prolonged pain management. RESULTS Key concepts of neonatal prolonged pain were identified in the 86 included articles of this scoping review such as definitions (n = 26), indicators (n = 39), contexts (n = 49), scales (n = 56), consequences of prolonged pain (n = 30) and possible interventions for prolonged pain management (n = 22). Whilst a consensus on a definition has yet to be achieved, no proximate event was shown to cause prolonged pain and a time criterion was identified by authors as being relevant in defining prolonged pain. Interestingly, the context of hospitalisation was identified as being the most indicative of prolonged pain in premature neonates and should guide its evaluation and management, whilst only limited pain management interventions and consequences were discussed. CONCLUSION The findings of this scoping review contribute to the foundation of growing knowledge in neonatal prolonged pain and shed light on the ambiguity that currently exists on this topic in the scientific literature. This review summarises knowledge of key concepts necessary for a better understanding of prolonged pain and stresses the importance of considering contexts of hospitalisation for prolonged pain evaluation and management in neonatal intensive care units, with the objective of improving developmental outcomes of premature neonates. TWEETABLE ABSTRACT A scoping review reveals that the contexts of prolonged pain in premature neonates hospitalised in the neonatal intensive care unit are essential in guiding its evaluation and management.
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Affiliation(s)
- Alexandra Breton-Piette
- Faculty of Nursing, Université de Montréal, Canada; Research Centre, CHU Sainte-Justine, Canada.
| | | | - Marilyn Aita
- Faculty of Nursing, Université de Montréal, Canada; Research Centre, CHU Sainte-Justine, Canada; Quebec Network on Nursing Intervention Research (RRISIQ), Canada
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Zhu N, Long B, Zhan X, Zhang L, Wang Z, Wang L, Huang Y, Chen J, Huang C, Xiong L, Fu Z, Deng R. Development of the neonatal pain response variable set: a mixed methods consensus process. Eur J Pediatr 2024:10.1007/s00431-024-05559-7. [PMID: 38850331 DOI: 10.1007/s00431-024-05559-7] [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: 01/30/2024] [Revised: 03/31/2024] [Accepted: 04/04/2024] [Indexed: 06/10/2024]
Abstract
While over 40 neonatal pain assessment scales have been published, owing to a lack of consensus and standardized metrics, there are more than 100 assessment indicators with varying descriptors and quality differences. This study aims to reach a consensus on optimal and comprehensive variables for neonatal pain assessment, leading to the development of a multidimensional neonatal pain response variable set. This study consisted of three phases: (1) A literature review was conducted to identify influencing factors and assessment indicators of neonatal pain response. (2) Panel meetings involving neonatal healthcare professionals evaluated and screened factors and indicators to develop an initial draft of the variable set. (3) Through two rounds of Delphi study achieved consensus, and determined the neonatal pain response variable set. Through a literature review and a panel meeting, the identified factors and indicators were categorized into contextual, physiological, and behavioral variables, forming an initial draft of the variable set. Sixteen professionals participated in two rounds of the Delphi study, with response rates exceeding 70%, and authority coefficients surpassing 0.7 in both rounds. The final iteration of the variable set includes 9 contextual variables, 2 physiological variables, and 5 behavioral variables. Conclusion: Neonatal pain response variable set developed in this study is scientific, comprehensive, and multidimensional, aligning with the characteristics of neonatal pain response and clinically applicable. The inclusion of contextual variables enhances the ability to confront the complexity of clinical environments and individual differences. It can provide a practical and theoretical basis for clinical research on neonatal pain assessment. What is Known: • Neonatal pain assessment relies on scales used by healthcare professionals currently. But there is no "gold standard" for neonatal pain assessment. • While over 40 neonatal pain assessment scales have been published, owing to a lack of consensus and standardized metrics, there are more than 100 assessment indicators with varying descriptors and quality differences. Most of scales overlook the clinical environment complexity individual differences in pain responses, diminishing the accuracy and applicability. What is New: • In addition to the commonly used physiological and behavioral variables in the scales, we have incorporated contextual variables to better address the complexity of clinical environments and individual differences in pain responses. • Through an evidence-based approach, developed a neonatal pain response variable set comprising 9 contextual variables, 2 physiological variables, and 5 behavioral variables.
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Affiliation(s)
- Nanxi Zhu
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Bingjie Long
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Xinling Zhan
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Lanxin Zhang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Zechuan Wang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Lianhong Wang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China
- Nursing School, Zunyi Medical University, Zunyi, China
| | - Yi Huang
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
| | - Juan Chen
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chi Huang
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Lu Xiong
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhenyan Fu
- Department of Neonatology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Renli Deng
- Department of Nursing, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
- Nursing School, Zunyi Medical University, Zunyi, China.
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Amornjiraporn I, Rugsapol S, Thanasarnpaiboon P, Paes B, Kitsommart R. A comparison of the effect of procedural pain on cerebral oxygen saturation between late preterm and term infants. J Perinatol 2024:10.1038/s41372-024-01978-4. [PMID: 38789794 DOI: 10.1038/s41372-024-01978-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 04/14/2024] [Accepted: 04/16/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVES We prospectively compared cerebral oxygen saturation (CrSO2) and pain score changes during procedures in late preterm (LPT) versus term infants. METHODS Near-infrared spectroscopy, pulse oximetry, Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Profile-Revised (PIPP-R) scores were assessed and CrSO2 data analyzed. RESULTS Thirty infants in each group were evaluated. LPT infants displayed a milder significant drop in Minimum post-procedural CrSO2 and smaller Maximum-Minimum post-procedural CrSO2 disparity. CrSO2 minute changes between the groups were non-significant. Moderate correlations were observed in both groups between NIPS and Minimum post-procedural CrSO2, and a moderate correlation was found in the Maximum-Minimum post-procedural CrSO2 difference in LPT infants. No correlation between PIPP-R and CrSO2 values was noted. CONCLUSION LPT and term infants demonstrated decreased CrSO2 in response to painful procedures. Correlations between CrSO2 and PIPP-R or NIPS scores were poor to moderate, reflecting the complex nature of these associations relative to gestational age.
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Affiliation(s)
- Ittichote Amornjiraporn
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Supranee Rugsapol
- Nursing Division, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Peerawit Thanasarnpaiboon
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Ratchada Kitsommart
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Babaie E, Hassanpour K, Aldaghi M, Sahebkar M. Comparison of the effect of ursodeoxycholic acid and multistrain synbiotic on indirect hyperbilirubinemia among neonates treated with phototherapy: A double-blind, randomized, placebo-controlled clinical trial study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2023; 28:40. [PMID: 37213445 PMCID: PMC10199377 DOI: 10.4103/jrms.jrms_894_21] [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: 10/09/2021] [Revised: 12/07/2022] [Accepted: 12/25/2022] [Indexed: 05/23/2023]
Abstract
Background This study was aimed at evaluating the effect of ursodeoxycholic acid (UDCA) and multistrain synbiotic on indirect hyperbilirubinemia among neonates treated with phototherapy. Materials and Methods This double-blind, randomized clinical trial was conducted on 120 subjects presenting with indirect hyperbilirubinemia in 2019. Subjects were randomly divided into three groups of synbiotic, UDCA, and control. The synbiotic group received five drops/day of synbiotic in addition to phototherapy. UDCA group received 10 mg/kg/day of Ursobil divided every 12 h in addition to phototherapy. The Control group received a placebo (water) in addition to phototherapy. Phototherapy was discontinued when the bilirubin levels reached <10 mg/dL. Total bilirubin levels were measured using the diazo method at 12, 24, and 36 h after hospitalization. This study used repeated measure analysis of variance and post hoc tests. Results The mean total of bilirubin was substantially decreased in both synbiotic and UDCA groups as compared to the control group at 24 h after hospitalization (P < 0.001). Moreover, the Bonferroni post hoc test showed significant differences regarding the mean total of bilirubin between the three groups (P < 0.05) except for the association between UDCA and synbiotic at 24 h after hospitalization (P > 0.99). Conclusion Findings suggest that UDCA and synbiotic administration alongside phototherapy are more effective in reducing bilirubin levels as compared to phototherapy alone.
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Affiliation(s)
- Elahe Babaie
- Department of Paediatric, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Kazem Hassanpour
- Department of Paediatric, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Mitra Aldaghi
- Department of Paediatric, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Address of correspondence: Dr. Mitra Aldaghi, Department of Paediatric, School of Medicine, Sabzevar University of Medical Sciences, Sabzevar, Iran. E-mail:
| | - Mohammad Sahebkar
- Department of Nursing, School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
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Comparison of Pain Score in Patients with Brain Disorders Using Care Pain Observation Tool (CPOT) and Nonverbal Pain Scale (NVPS). ARCHIVES OF NEUROSCIENCE 2022. [DOI: 10.5812/ans-123099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Traumatic brain injury (TBI) is one of the leading causes of death, which ranges from mild and irreversible to severe and life-threatening injuries. Objectives: This study aimed to compare the pain score in patients with brain disorders using Care Pain Observation Tool (CPOT) and Nonverbal Pain Scale (NVPS). Methods: A descriptive comparative study was performed in Ilam province, Iran, in a group of head trauma patients admitted to the intensive care unit who were intubated. One hundred twenty observations of nurses’ practice were performed. A purposive sampling method was utilized. The CPOT and NVPS assessed the pain, and the Glasgow Coma Scale (GCS) assessed the state of consciousness. Data were analyzed by SPSS version 16 software. Results: Patients’ mean ± SD age was 38.45 ± 4.2 years. The mean ± SD pain score on the CPOT before the procedure was 0.39 ± 0.49 in the facial expression dimension, 0.56 ± 0.49 in activity, 0.54 ± 0.50 in muscle tension, and 0.55 ± 0.49 in compatibility with the ventilator. The mean ± SD pain score on the NVPS before the procedure was 0.97 ± 0.20 in facial expression dimension, 0.94 ± 0.49 in activity, 0.95 ± 0.31 in guarding, 0.64 ± 0.49 in vital signs, and 0.92 ± 0.53 in excitement. Conclusions: Both CPOT and NVPS were effective in diagnosing patients’ pain, but the CPOT was more appropriate for diagnosing pain in intubated patients.
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Llerena A, Tran K, Choudhary D, Hausmann J, Goldgof D, Sun Y, Prescott SM. Neonatal pain assessment: Do we have the right tools? Front Pediatr 2022; 10:1022751. [PMID: 36819198 PMCID: PMC9932268 DOI: 10.3389/fped.2022.1022751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 12/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The assessment and management of neonatal pain is crucial for the development and wellbeing of vulnerable infants. Specifically, neonatal pain is associated with adverse health outcomes but is often under-identified and therefore under-treated. Neonatal stress may be misinterpreted as pain and may therefore be treated inappropriately. The assessment of neonatal pain is complicated by the non-verbal status of patients, age-dependent variation in pain responses, limited education on identifying pain in premature infants, and the clinical utility of existing tools. OBJECTIVE We review research surrounding neonatal pain assessment scales currently in use to assess neonatal pain in the neonatal intensive care unit. METHODS We performed a systematic review of original research using PRISMA guidelines for literature published between 2016 and 2021 using the key words "neonatal pain assessment" in the databases Web of Science, PubMed, and CINAHL. Fifteen articles remained after review, duplicate, irrelevant, or low-quality articles were eliminated. RESULTS We found research evaluating 13 neonatal pain scales. Important measurement categories include behavioral parameters, physiological parameters, continuous pain, acute pain, chronic pain, and the ability to distinguish between pain and stress. Provider education, inter-rater reliability and ease of use are important factors that contribute to an assessment tool's success. Each scale studied had strengths and limitations that aided or hindered its use for measuring neonatal pain in the neonatal intensive care unit, but no scale excelled in all areas identified as important for reliably identifying and measuring pain in this vulnerable population. CONCLUSION A more comprehensive neonatal pain assessment tool and more provider education on differences in pain signals in premature neonates may be needed to increase the clinical utility of pain scales that address the different aspects of neonatal pain.
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Affiliation(s)
- Amelia Llerena
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Krystal Tran
- Biobehavioral Lab, College of Nursing, University of South Florida, Tampa, FL, United States
| | - Danyal Choudhary
- Department of Chemistry, College of Arts and Sciences, University of South Florida, Tampa, FL, United States
| | - Jacqueline Hausmann
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, United States
| | - Dmitry Goldgof
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, United States
| | - Yu Sun
- Department of Computer Science and Engineering, University of South Florida, Tampa, FL, United States
| | - Stephanie M Prescott
- Morsani College of Medicine, University of South Florida, Tampa, FL, United States.,Biobehavioral Lab, College of Nursing, University of South Florida, Tampa, FL, United States.,College of Nursing, University of South Florida, Tampa, FL, United States
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