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Sutton R, Lemermeyer G. Nonpharmacological Interventions to Mitigate Procedural Pain in the NICU: An Integrative Review. Adv Neonatal Care 2024; 24:364-373. [PMID: 38907705 DOI: 10.1097/anc.0000000000001164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2024]
Abstract
BACKGROUND Small infants experience a myriad of stimuli while in the Neonatal Intensive Care Unit (NICU), with many being painful or stressful experiences, although medically necessary. PURPOSE To determine what is known about nonpharmacological developmental care interventions used in the NICU to mitigate procedural pain of infants born under 32 weeks gestation. SEARCH/STRATEGY Five electronic databases were searched: Medline, CINAHL, Scopus, Embase and the Cochrane Library. The inclusion criteria were as follows: experimental and nonexperimental studies from all publication years with infants born at less than 32 weeks gestational age; peer-reviewed research articles studying nonpharmacological interventions such as skin-to-skin care, facilitated tucking, nonnutritive sucking, hand hugs, and swaddling; and English language articles. Our search yielded 1435 articles. After the elimination of 736 duplicates, a further 570 were deemed irrelevant based on their abstract/titles. Then, 124 full-text articles were analyzed with our inclusion and exclusion criteria. FINDINGS Twenty-seven studies were reviewed. Sucrose, facilitated tucking, pacifier, skin-to-skin care, and human milk appeared to lessen pain experienced during heel sticks, suctioning, nasogastric tube insertions, and echocardiograms. All nonpharmacological interventions failed to prove efficacious to adequately manage pain during retinopathy of prematurity (ROP) examinations. IMPLICATIONS FOR PRACTICE Evidence review demonstrates that healthcare practitioners should use nonpharmacological measures to help prevent pain from day-to-day procedures in the NICU including heel sticks, nasogastric tube insertions, suctioning, echocardiograms, and subcutaneous injections. IMPLICATIONS FOR RESEARCH Future research is necessary to better understand and measure how pain is manifested by very small premature infants. Specific research on mitigating the pain of examinations for retinopathy of prematurity is also needed.
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Affiliation(s)
- Rana Sutton
- Faculty of Nursing,University of Alberta, Edmonton, Alberta
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Kinoshita M, Olsson E, Borys F, Bruschettini M. Opioids for procedural pain in neonates. Cochrane Database Syst Rev 2023; 6:CD015056. [PMID: 37350685 PMCID: PMC10292809 DOI: 10.1002/14651858.cd015056.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
BACKGROUND Neonates might be exposed to numerous painful procedures due to diagnostic reasons, therapeutic interventions, or surgical procedures. Options for pain management include opioids, non-pharmacological interventions, and other drugs. Morphine, fentanyl, and remifentanil are the opioids most often used in neonates. However, negative impact of opioids on the structure and function of the developing brain has been reported. OBJECTIVES To evaluate the benefits and harms of opioids in term or preterm neonates exposed to procedural pain, compared to placebo or no drug, non-pharmacological intervention, other analgesics or sedatives, other opioids, or the same opioid administered by a different route. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was December 2021. SELECTION CRITERIA We included randomized controlled trials conducted in preterm and term infants of a postmenstrual age (PMA) up to 46 weeks and 0 days exposed to procedural pain where opioids were compared to 1) placebo or no drug; 2) non-pharmacological intervention; 3) other analgesics or sedatives; 4) other opioids; or 5) the same opioid administered by a different route. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were pain assessed with validated methods and any harms. We used a fixed-effect model with risk ratio (RR) for dichotomous data and mean difference (MD) for continuous data, and their confidence intervals (CI). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 13 independent studies (enrolling 823 newborn infants): seven studies compared opioids to no treatment or placebo (the main comparison in this review), two studies to oral sweet solution or non-pharmacological intervention, and five studies (of which two were part of the same study) to other analgesics and sedatives. All studies were performed in a hospital setting. Opioids compared to placebo or no drug Compared to placebo, opioids probably reduce pain score assessed with the Premature Infant Pain Profile (PIPP)/PIPP-Revised (PIPP-R) scale during the procedure (MD -2.58, 95% CI -3.12 to -2.03; 199 participants, 3 studies; moderate-certainty evidence); may reduce Neonatal Infant Pain Scale (NIPS) during the procedure (MD -1.97, 95% CI -2.46 to -1.48; 102 participants, 2 studies; low-certainty evidence); and may result in little to no difference in pain score assessed with the Douleur Aiguë du Nouveau-né (DAN) scale one to two hours after the procedure (MD -0.20, 95% CI -2.21 to 1.81; 42 participants, 1 study; low-certainty evidence). The evidence is very uncertain about the effect of opioids on pain score assessed with the PIPP/PIPP-R scale up to 30 minutes after the procedure (MD 0.14, 95% CI -0.17 to 0.45; 123 participants, 2 studies; very low-certainty evidence) or one to two hours after the procedure (MD -0.83, 95% CI -2.42 to 0.75; 54 participants, 2 studies; very low-certainty evidence). The evidence is very uncertain about the effect of opioids on episodes of bradycardia (RR 3.19, 95% CI 0.14 to 72.69; 172 participants, 3 studies; very low-certainty evidence). Opioids may result in an increase in episodes of apnea compared to placebo (RR 3.15, 95% CI 1.08 to 9.16; 199 participants, 3 studies; low-certainty evidence): with one study reporting a concerning increase in severe apnea (RR 7.44, 95% CI 0.42 to 132.95; 31 participants, 1 study; very low-certainty). The evidence is very uncertain about the effect of opioids on episodes of hypotension (RR not estimable, risk difference 0.00, 95% CI -0.06 to 0.06; 88 participants, 2 studies; very low-certainty evidence). No studies reported parent satisfaction with care provided in the neonatal intensive care unit (NICU). Opioids compared to non-pharmacological intervention The evidence is very uncertain about the effect of opioids on pain score assessed with the Crying Requires oxygen Increased vital signs Expression Sleep (CRIES) scale during the procedure when compared to facilitated tucking (MD -4.62, 95% CI -6.38 to -2.86; 100 participants, 1 study; very low-certainty evidence) or sensorial stimulation (MD 0.32, 95% CI -1.13 to 1.77; 100 participants, 1 study; very low-certainty evidence). The other main outcomes were not reported. Opioids compared to other analgesics or sedatives The evidence is very uncertain about the effect of opioids on pain score assessed with the PIPP/PIPP-R during the procedure (MD -0.29, 95% CI -1.58 to 1.01; 124 participants, 2 studies; very low-certainty evidence); up to 30 minutes after the procedure (MD -1.10, 95% CI -2.82 to 0.62; 12 participants, 1 study; very low-certainty evidence); and one to two hours after the procedure (MD -0.17, 95% CI -2.22 to 1.88; 12 participants, 1 study; very low-certainty evidence). No studies reported any harms. The evidence is very uncertain about the effect of opioids on episodes of apnea during (RR 3.27, 95% CI 0.85 to 12.58; 124 participants, 2 studies; very low-certainty evidence) and after the procedure (RR 2.71, 95% CI 0.11 to 64.96; 124 participants, 2 studies; very low-certainty evidence) and on hypotension (RR 1.34, 95% CI 0.32 to 5.59; 204 participants, 3 studies; very low-certainty evidence). The other main outcomes were not reported. We identified no studies comparing different opioids (e.g. morphine versus fentanyl) or different routes for administration of the same opioid (e.g. morphine enterally versus morphine intravenously). AUTHORS' CONCLUSIONS Compared to placebo, opioids probably reduce pain score assessed with PIPP/PIPP-R scale during the procedure; may reduce NIPS during the procedure; and may result in little to no difference in DAN one to two hours after the procedure. The evidence is very uncertain about the effect of opioids on pain assessed with other pain scores or at different time points. The evidence is very uncertain about the effect of opioids on episodes of bradycardia, hypotension or severe apnea. Opioids may result in an increase in episodes of apnea. No studies reported parent satisfaction with care provided in the NICU. The evidence is very uncertain about the effect of opioids on any outcome when compared to non-pharmacological interventions or to other analgesics. We identified no studies comparing opioids to other opioids or comparing different routes of administration of the same opioid.
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Affiliation(s)
- Mari Kinoshita
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Franciszek Borys
- II Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Matteo Bruschettini
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
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Pillai Riddell RR, Bucsea O, Shiff I, Chow C, Gennis HG, Badovinac S, DiLorenzo-Klas M, Racine NM, Ahola Kohut S, Lisi D, Turcotte K, Stevens B, Uman LS. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev 2023; 6:CD006275. [PMID: 37314064 PMCID: PMC10265939 DOI: 10.1002/14651858.cd006275.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Despite evidence of the long-term implications of unrelieved pain during infancy, it is evident that infant pain is still under-managed and unmanaged. Inadequately managed pain in infancy, a period of exponential development, can have implications across the lifespan. Therefore, a comprehensive and systematic review of pain management strategies is integral to appropriate infant pain management. This is an update of a previously published review update in the Cochrane Database of Systematic Reviews (2015, Issue 12) of the same title. OBJECTIVES To assess the efficacy and adverse events of non-pharmacological interventions for infant and child (aged up to three years) acute pain, excluding kangaroo care, sucrose, breastfeeding/breast milk, and music. SEARCH METHODS For this update, we searched CENTRAL, MEDLINE-Ovid platform, EMBASE-OVID platform, PsycINFO-OVID platform, CINAHL-EBSCO platform and trial registration websites (ClinicalTrials.gov; International Clinical Trials Registry Platform) (March 2015 to October 2020). An update search was completed in July 2022, but studies identified at this point were added to 'Awaiting classification' for a future update. We also searched reference lists and contacted researchers via electronic list-serves. We incorporated 76 new studies into the review. SELECTION CRITERIA: Participants included infants from birth to three years in randomised controlled trials (RCTs) or cross-over RCTs that had a no-treatment control comparison. Studies were eligible for inclusion in the analysis if they compared a non-pharmacological pain management strategy to a no-treatment control group (15 different strategies). In addition, we also analysed studies when the unique effect of adding a non-pharmacological pain management strategy onto another pain management strategy could be assessed (i.e. additive effects on a sweet solution, non-nutritive sucking, or swaddling) (three strategies). The eligible control groups for these additive studies were sweet solution only, non-nutritive sucking only, or swaddling only, respectively. Finally, we qualitatively described six interventions that met the eligibility criteria for inclusion in the review, but not in the analysis. DATA COLLECTION AND ANALYSIS: The outcomes assessed in the review were pain response (reactivity and regulation) and adverse events. The level of certainty in the evidence and risk of bias were based on the Cochrane risk of bias tool and the GRADE approach. We analysed the standardised mean difference (SMD) using the generic inverse variance method to determine effect sizes. MAIN RESULTS: We included total of 138 studies (11,058 participants), which includes an additional 76 new studies for this update. Of these 138 studies, we analysed 115 (9048 participants) and described 23 (2010 participants) qualitatively. We described qualitatively studies that could not be meta-analysed due to being the only studies in their category or statistical reporting issues. We report the results of the 138 included studies here. An SMD effect size of 0.2 represents a small effect, 0.5 a moderate effect, and 0.8 a large effect. The thresholds for the I2 interpretation were established as follows: not important (0% to 40%); moderate heterogeneity (30% to 60%); substantial heterogeneity (50% to 90%); considerable heterogeneity (75% to 100%). The most commonly studied acute procedures were heel sticks (63 studies) and needlestick procedures for the purposes of vaccines/vitamins (35 studies). We judged most studies to have high risk of bias (103 out of 138), with the most common methodological concerns relating to blinding of personnel and outcome assessors. Pain responses were examined during two separate pain phases: pain reactivity (within the first 30 seconds after the acutely painful stimulus) and immediate pain regulation (after the first 30 seconds following the acutely painful stimulus). We report below the strategies with the strongest evidence base for each age group. In preterm born neonates, non-nutritive sucking may reduce pain reactivity (SMD -0.57, 95% confidence interval (CI) -1.03 to -0.11, moderate effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.61, 95% CI -0.95 to -0.27, moderate effect; I2 = 81%, considerable heterogeneity), based on very low-certainty evidence. Facilitated tucking may also reduce pain reactivity (SMD -1.01, 95% CI -1.44 to -0.58, large effect; I2 = 93%, considerable heterogeneity) and improve immediate pain regulation (SMD -0.59, 95% CI -0.92 to -0.26, moderate effect; I2 = 87%, considerable heterogeneity); however, this is also based on very low-certainty evidence. While swaddling likely does not reduce pain reactivity in preterm neonates (SMD -0.60, 95% CI -1.23 to 0.04, no effect; I2 = 91%, considerable heterogeneity), it has been shown to possibly improve immediate pain regulation (SMD -1.21, 95% CI -2.05 to -0.38, large effect; I2 = 89%, considerable heterogeneity), based on very low-certainty evidence. In full-term born neonates, non-nutritive sucking may reduce pain reactivity (SMD -1.13, 95% CI -1.57 to -0.68, large effect; I2 = 82%, considerable heterogeneity) and improve immediate pain regulation (SMD -1.49, 95% CI -2.20 to -0.78, large effect; I2 = 92%, considerable heterogeneity), based on very low-certainty evidence. In full-term born older infants, structured parent involvement was the intervention most studied. Results showed that this intervention has little to no effect in reducing pain reactivity (SMD -0.18, 95% CI -0.40 to 0.03, no effect; I2 = 46%, moderate heterogeneity) or improving immediate pain regulation (SMD -0.09, 95% CI -0.40 to 0.21, no effect; I2 = 74%, substantial heterogeneity), based on low- to moderate-certainty evidence. Of these five interventions most studied, only two studies observed adverse events, specifically vomiting (one preterm neonate) and desaturation (one full-term neonate hospitalised in the NICU) following the non-nutritive sucking intervention. The presence of considerable heterogeneity limited our confidence in the findings for certain analyses, as did the preponderance of evidence of very low to low certainty based on GRADE judgements. AUTHORS' CONCLUSIONS Overall, non-nutritive sucking, facilitated tucking, and swaddling may reduce pain behaviours in preterm born neonates. Non-nutritive sucking may also reduce pain behaviours in full-term neonates. No interventions based on a substantial body of evidence showed promise in reducing pain behaviours in older infants. Most analyses were based on very low- or low-certainty grades of evidence and none were based on high-certainty evidence. Therefore, the lack of confidence in the evidence would require further research before we could draw a definitive conclusion.
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Affiliation(s)
| | - Oana Bucsea
- Department of Psychology, York University, Toronto, Canada
| | - Ilana Shiff
- Department of Psychology, York University, Toronto, Canada
| | - Cheryl Chow
- Department of Psychology, York University, Toronto, Canada
| | | | | | | | - Nicole M Racine
- Department of Psychology, University of Calgary, Calgary, Canada
| | - Sara Ahola Kohut
- Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Toronto, Canada
| | - Diana Lisi
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
| | - Kara Turcotte
- Department of Psychology, University of British Columbia Okanagan, Kelowna, Canada
| | - Bonnie Stevens
- Nursing Research, The Hospital for Sick Children, Toronto, Canada
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Abstract
BACKGROUND Neonates might be exposed to numerous painful procedures due to diagnostic reasons, therapeutic interventions, or surgical procedures. Options for pain management include opioids, non-pharmacological interventions, and other drugs. Morphine, fentanyl, and remifentanil are the opioids most often used in neonates. However, negative impact of opioids on the structure and function of the developing brain has been reported. OBJECTIVES To evaluate the benefits and harms of opioids in term or preterm neonates exposed to procedural pain, compared to placebo or no drug, non-pharmacological intervention, other analgesics or sedatives, other opioids, or the same opioid administered by a different route. SEARCH METHODS We used standard, extensive Cochrane search methods. The latest search date was December 2021. SELECTION CRITERIA We included randomized controlled trials conducted in preterm and term infants of a postmenstrual age (PMA) up to 46 weeks and 0 days exposed to procedural pain where opioids were compared to 1) placebo or no drug; 2) non-pharmacological intervention; 3) other analgesics or sedatives; 4) other opioids; or 5) the same opioid administered by a different route. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were pain assessed with validated methods and any harms. We used a fixed-effect model with risk ratio (RR) for dichotomous data and mean difference (MD) for continuous data, and their confidence intervals (CI). We used GRADE to assess the certainty of the evidence for each outcome. MAIN RESULTS We included 13 independent studies (enrolling 823 newborn infants): seven studies compared opioids to no treatment or placebo (the main comparison in this review), two studies to oral sweet solution or non-pharmacological intervention, and five studies (of which two were part of the same study) to other analgesics and sedatives. All studies were performed in a hospital setting. Opioids compared to placebo or no drug Compared to placebo, opioids probably reduce pain score assessed with the Premature Infant Pain Profile (PIPP)/PIPP-Revised (PIPP-R) scale during the procedure (MD -2.58, 95% CI -3.12 to -2.03; 199 participants, 3 studies; moderate-certainty evidence); may reduce Neonatal Infant Pain Scale (NIPS) during the procedure (MD -1.97, 95% CI -2.46 to -1.48; 102 participants, 2 studies; low-certainty evidence); and may result in little to no difference in pain score assessed with the Douleur Aiguë du Nouveau-né (DAN) scale one to two hours after the procedure (MD -0.20, 95% CI -2.21 to 1.81; 42 participants, 1 study; low-certainty evidence). The evidence is very uncertain about the effect of opioids on pain score assessed with the PIPP/PIPP-R scale up to 30 minutes after the procedure (MD 0.14, 95% CI -0.17 to 0.45; 123 participants, 2 studies; very low-certainty evidence) or one to two hours after the procedure (MD -0.83, 95% CI -2.42 to 0.75; 54 participants, 2 studies; very low-certainty evidence). No studies reported any harms. The evidence is very uncertain about the effect of opioids on episodes of bradycardia (RR 3.19, 95% CI 0.14 to 72.69; 172 participants, 3 studies; very low-certainty evidence). Opioids may result in an increase in episodes of apnea compared to placebo (RR 3.15, 95% CI 1.08 to 9.16; 199 participants, 3 studies; low-certainty evidence). The evidence is very uncertain about the effect of opioids on episodes of hypotension (RR not estimable, risk difference 0.00, 95% CI -0.06 to 0.06; 88 participants, 2 studies; very low-certainty evidence). No studies reported parent satisfaction with care provided in the neonatal intensive care unit (NICU). Opioids compared to non-pharmacological intervention The evidence is very uncertain about the effect of opioids on pain score assessed with the Crying Requires oxygen Increased vital signs Expression Sleep (CRIES) scale during the procedure when compared to facilitated tucking (MD -4.62, 95% CI -6.38 to -2.86; 100 participants, 1 study; very low-certainty evidence) or sensorial stimulation (MD 0.32, 95% CI -1.13 to 1.77; 100 participants, 1 study; very low-certainty evidence). The other main outcomes were not reported. Opioids compared to other analgesics or sedatives The evidence is very uncertain about the effect of opioids on pain score assessed with the PIPP/PIPP-R during the procedure (MD -0.29, 95% CI -1.58 to 1.01; 124 participants, 2 studies; very low-certainty evidence); up to 30 minutes after the procedure (MD -1.10, 95% CI -2.82 to 0.62; 12 participants, 1 study; very low-certainty evidence); and one to two hours after the procedure (MD -0.17, 95% CI -2.22 to 1.88; 12 participants, 1 study; very low-certainty evidence). No studies reported any harms. The evidence is very uncertain about the effect of opioids on episodes of apnea during (RR 3.27, 95% CI 0.85 to 12.58; 124 participants, 2 studies; very low-certainty evidence) and after the procedure (RR 2.71, 95% CI 0.11 to 64.96; 124 participants, 2 studies; very low-certainty evidence) and on hypotension (RR 1.34, 95% CI 0.32 to 5.59; 204 participants, 3 studies; very low-certainty evidence). The other main outcomes were not reported. We identified no studies comparing different opioids (e.g. morphine versus fentanyl) or different routes for administration of the same opioid (e.g. morphine enterally versus morphine intravenously). AUTHORS' CONCLUSIONS Compared to placebo, opioids probably reduce pain score assessed with PIPP/PIPP-R scale during the procedure; may reduce NIPS during the procedure; and may result in little to no difference in DAN one to two hours after the procedure. The evidence is very uncertain about the effect of opioids on pain assessed with other pain scores or at different time points. No studies reported if any harms occurred. The evidence is very uncertain about the effect of opioids on episodes of bradycardia or hypotension. Opioids may result in an increase in episodes of apnea. No studies reported parent satisfaction with care provided in the NICU. The evidence is very uncertain about the effect of opioids on any outcome when compared to non-pharmacological interventions or to other analgesics. We identified no studies comparing opioids to other opioids or comparing different routes of administration of the same opioid.
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Affiliation(s)
- Mari Kinoshita
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Franciszek Borys
- II Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Matteo Bruschettini
- Paediatrics, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Department of Research and Education, Lund University, Skåne University Hospital, Lund, Sweden
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The effects of different procedures on pain levels in preterm and term infants in neonatal intensive care unit: a cross‐sectional survey of pain assessment in newborns. Ir J Med Sci 2022:10.1007/s11845-022-03183-8. [DOI: 10.1007/s11845-022-03183-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
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Cai Q, Luo W, Zhou Y, Yin Y, Zhu K, Shi H, Liao Y. Efficacy and safety of non-pharmacological interventions for endotracheal suctioning pain in preterm infants: A systematic review. Nurs Open 2022; 10:424-434. [PMID: 36100551 PMCID: PMC9834158 DOI: 10.1002/nop2.1364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 08/13/2022] [Accepted: 08/30/2022] [Indexed: 01/16/2023] Open
Abstract
AIM To review and analyse the evidence on the efficacy and safety of non-pharmacological interventions for preterm infants to relieve endotracheal suctioning (ES) pain. DESIGN A systematic review per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS Six databases were searched with a retrieval strategy. Parallel and crossover randomized controlled trials reporting non-pharmacological interventions for relieving ES pain in preterm infants were identified from inception to 1 September 2021. The protocol was published in PROSPERO (CRD42021276058). RESULTS Ten studies were retrieved, including nine different non-pharmacological interventions. Seven studies reported that non-pharmacological interventions in relieving pain were more effective than conventional care during ES, and three trials reported its safety. Due to the heterogeneity of pain assessment tools, time of assessment and population, only Facilitated tucking had sufficient evidence that it is a safe and effective non-pharmacological intervention.
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Affiliation(s)
- Qian Cai
- School of Nursing, School of Public HealthYangzhou UniversityYangzhouChina
| | - Wen Luo
- School of Nursing, School of Public HealthYangzhou UniversityYangzhouChina
| | - You Zhou
- School of Nursing, School of Public HealthYangzhou UniversityYangzhouChina
| | - Yue Yin
- School of Nursing, School of Public HealthYangzhou UniversityYangzhouChina
| | - Kai Zhu
- School of Nursing, School of Public HealthYangzhou UniversityYangzhouChina
| | - Huan Shi
- School of Nursing, School of Public HealthYangzhou UniversityYangzhouChina
| | - Yuexia Liao
- School of Nursing, School of Public HealthYangzhou UniversityYangzhouChina
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Eissler AB, Zwakhalen S, Stoffel L, Hahn S. Systematic Review of the Effectiveness of Involving Parents During Painful Interventions for Their Preterm Infants. J Obstet Gynecol Neonatal Nurs 2022; 51:6-15. [PMID: 34627734 DOI: 10.1016/j.jogn.2021.08.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To systematically review the literature related to the effectiveness of parents' active involvement during painful interventions for their preterm infants. DATA SOURCES We performed a systematic search of PubMed, EMBASE/Ovid, CINAHL, Livivio, and PsycInfo using the keywords "preterm infants," "pain," and "parents." STUDY SELECTION Articles were eligible for inclusion if they were published between 2000 and 2021 and reported randomized controlled trials (RCTs) in which preterm infants underwent painful interventions, and parents were present and actively involved in pain-reducing measures. DATA EXTRACTION We used the Consolidated Standards of Reporting Trials (CONSORT) checklist for RCTs for data extraction. We assessed methodologic quality using critical appraisal for RCTs according to the Joanna Briggs Institute. DATA SYNTHESIS In total, 22 articles met the inclusion criteria. These articles reported 19 studies focused on kangaroo/skin-to-skin care, one focused on breastfeeding, and two focused on facilitated tucking. The methods used to evaluate pain in the infant varied substantially. Overall, kangaroo/skin-to-skin care and facilitated tucking resulted in clinically and statistically significant decreases in pain. For breastfeeding, effectiveness was linked to a more mature sucking pattern of the preterm infant. CONCLUSION The current evidence suggests that involving parents in pain-reducing measures during painful interventions for their preterm infants is beneficial. However, more research is needed for the different methods of involving parents in pain-reducing measures.
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Mariani Wigley ILC, Mascheroni E, Fontana C, Giorda R, Morandi F, Bonichini S, McGlone F, Fumagalli M, Montirosso R. The role of maternal touch in the association between SLC6A4 methylation and stress response in very preterm infants. Dev Psychobiol 2021; 63 Suppl 1:e22218. [PMID: 34964498 DOI: 10.1002/dev.22218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 10/11/2021] [Accepted: 11/01/2021] [Indexed: 12/15/2022]
Abstract
Very preterm (VPT) infants requiring hospitalization in the Neonatal Intensive Care Unit (NICU) are exposed to several stressful procedural experiences. One consequence of NICU-related stress is a birth-to-discharge increased serotonin transporter gene (SLC6A4) methylation that has been associated with poorer stress regulation at 3 months of age. Maternal touch is thought to support infants' stress response, but its role in moderating the effects of SLC6A4 methylation changes is unknown. The aim of this study was to assess the role of maternal touch in moderating the association between increased SLC6A4 methylation and stress response in 3-month-old VPT infants. Twenty-nine dyads were enrolled and at 3 months (age corrected for prematurity), participated in the Face-to-Face Still-Face paradigm to measure infants' stress response (i.e., negative emotionality) and the amount of maternal touch (i.e., dynamic and static). Results showed that low level of maternal touch is associated with high level of negative emotionality during social stress. Furthermore, during NICU stay SLC6A4 methylation in VPT exposed to low level of maternal touch at 3 months was associated with increased negative emotionality. Thus, low levels of maternal static touch can intensify the negative effects of SLC6A4 epigenetic changes on stress response in 3-month-old VPT infants.
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Affiliation(s)
| | - Eleonora Mascheroni
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS "Eugenio Medea", Bosisio Parini, Lecco, Italy
| | - Camilla Fontana
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy
| | - Roberto Giorda
- Molecular Biology Laboratory, Scientific Institute IRCCS "Eugenio Medea", Lecco, Italy
| | | | - Sabrina Bonichini
- Department of Developmental and Social Psychology, University of Padua, Padua, Italy
| | - Francis McGlone
- School of Natural Sciences and Psychology, Liverpool John Moores University, Liverpool, UK.,Institute of Psychology Health & Society, University of Liverpool, Liverpool, UK
| | - Monica Fumagalli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Rosario Montirosso
- 0-3 Center for the at-Risk Infant, Scientific Institute IRCCS "Eugenio Medea", Bosisio Parini, Lecco, Italy
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9
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Badiee Z, Zandi H, Armanian A, Sadeghnia A, Barekatain B. Premedication with intravenous midazolam for neonatal endotracheal intubation: A double blind randomized controlled trial. JOURNAL OF RESEARCH IN MEDICAL SCIENCES 2021; 26:57. [PMID: 34729065 PMCID: PMC8506249 DOI: 10.4103/jrms.jrms_546_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 01/21/2020] [Accepted: 03/01/2021] [Indexed: 11/04/2022]
Abstract
Background Pain during the neonatal period has been associated with immediate and long-term adverse effects. One of the most frequent painful procedures that neonates face in neonatal intensive care unit is the endotracheal intubation. Midazolam has been a candidate for premedication before neonatal intubation. Our aim was to evaluate the effects of midazolam as the premedication on endotracheal intubation of premature infants during surfactant administration. Materials and Methods In a double-blind clinical trial, 80 preterm infants were undertaken for tracheal intubation following the use of atropine associated to either midazolam or placebo. Patient's vital signs and general conditions were constantly monitored, and pain was assessed using premature infant pain profile (PIPP) score. Results The mean ± standard deviation for postnatal age was 95.38 ± 50.04 and 111.63 ± 49.4 min in control and midazolam groups, respectively. The patients in the midazolam group had significantly better outcomes across several intubation outcome measures such as duration of endotracheal intubation (23.5 ± 6.7 vs. 18.8 ± 4.8 s, P = 0.001), oxygen saturation level (88.05% ±13.7 vs. 95.1 ± 1.8%, P = 0.002), intubation failure (34.2% vs. 2.5%, P = 0.0001), awake and resistance during intubation (95% vs. 20%, P = 0.0001), and excellent patient condition during intubation (0% vs. 82.5%, P = 0.0001). In addition, PIPP score was significantly lower in the midazolam group (5.2 ± 2.06 vs. 12.9 ± 2.9, P = 0.0001). Conclusion Premedication with midazolam in newborns before intubation, can hold promising effects that manifests as better overall outcomes, less complications, better vital signs, more comfortable situation, and lesser pain for these patients.
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Affiliation(s)
- Zohreh Badiee
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamed Zandi
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirmohammad Armanian
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Sadeghnia
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Behzad Barekatain
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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Rheel E, Malfliet A, Van Ryckeghem DML, Pas R, Vervoort T, Ickmans K. The Impact of Parental Presence on their Children during Painful Medical Procedures:A Systematic Review. PAIN MEDICINE 2021; 23:912-933. [PMID: 34453832 DOI: 10.1093/pm/pnab264] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Whether parental presence during their children's painful medical procedures is advantageous with regard to child's pain-related outcomes is questionable. Research regarding this topic is equivocal and additional questions, such as whether levels of parental involvement may play a role as well, remain to be assessed. The purpose of this systematic review is to summarize and critically appraise the literature regarding the impact of parental presence versus absence during their children's painful medical procedures on the child's pain-related outcomes. METHODS The review protocol was registered on Prospero (ID CRD42018116614). A systematic search in PubMed, Web of Science, and PsycArticles resulted in 22 eligible studies incorporating 2157 participants. Studies were considered eligible if they included children (≤ 18 years old) undergoing a painful medical procedure and compared parental presence and/or involvement with parental absence during the procedure. RESULTS The children's pain-related outcomes included self-reported pain intensity, self-reported fear, anxiety and distress, observed pain-related behavior, and physiological parameters. Overall, evidence points in the direction of beneficial effects of parental presence versus absence with regard to children's self-reported pain intensity and physiological parameters, whereas mixed findings were recorded for children's self-reported fears, anxiety and distress, and observed pain-related behaviors. CONCLUSIONS : In order to provide clear recommendations on how to involve the parent during the procedure, as well as for which type of children and parents parental presence has the best effects, further research is needed, as indicated in this review.
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Affiliation(s)
- Emma Rheel
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.,Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium
| | - Anneleen Malfliet
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
| | - Dimitri M L Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium.,Section Experimental Health Psychology, Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.,Institute for Health and Behavior, INSIDE, University of Luxembourg, Luxembourg City, Luxembourg
| | - Roselien Pas
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Tine Vervoort
- Department of Experimental-Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, 9000 Gent, Belgium
| | - Kelly Ickmans
- Pain in Motion research group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium.,Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium.,Research Foundation - Flanders (FWO), Brussels, Belgium
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11
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Silveira ALDD, Christoffel MM, Velarde LGC, Rodrigues EDC, Magesti BN, Souza RDO. Effect of glucose and non-nutritive sucking on puncture pain in premature infants: a crossover clinical trial. Rev Esc Enferm USP 2021; 55:e03732. [PMID: 34076179 DOI: 10.1590/s1980-220x2020018303732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 11/18/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To compare the effect of non-nutritive sucking, 25% oral glucose and 25% oral glucose combined with non-nutritive sucking in pain relief in premature infants submitted to heel puncture for blood glucose monitoring. METHOD This is a randomized crossover clinical trial with 34 preterm infants who randomly received interventions: non-nutritive sucking, 25% oral glucose and the two interventions combined for three consecutive days in heel puncture for blood glucose monitoring. Assessment by the Premature Infant Pain Profile for 30 seconds before the intervention, called the baseline period and for 5 minutes after puncture. RESULTS The combination of interventions made the premature infants return to baseline, with 1 minute and 30 seconds after heel puncture, promoting a 2.2% percentage reduction in the scale. CONCLUSION Comparing the effect of isolated and combined interventions showed that, when offered in combination, preterm infants were able to return to baseline parameters more quickly. Brazilian Clinical Trials Registry: RBR-3gm6w5.
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Affiliation(s)
- Ana Luiza Dorneles da Silveira
- Universidade Federal Fluminense, Escola de Enfermagem Aurora de Afonso Costa, Departamento de Enfermagem Materno-Infantil e Psiquiátrico, Niterói, RJ, Brasil
| | - Marialda Moreira Christoffel
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem Materno-Infantil, Rio de Janeiro, RJ, Brasil
| | | | - Elisa da Conceição Rodrigues
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Departamento de Enfermagem Materno-Infantil, Rio de Janeiro, RJ, Brasil
| | - Bruna Nunes Magesti
- Universidade Federal do Rio de Janeiro, Escola de Enfermagem Anna Nery, Programa de Pós-Graduação em Enfermagem, Rio de Janeiro, RJ, Brasil
| | - Rebecca de Oliveira Souza
- Universidade Federal do Rio de Janeiro, Programa de Pós-Graduação em Estatística do Instituto de Matemática, Rio de Janeiro, RJ, Brasil
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12
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Ullsten A, Andreasson M, Eriksson M. State of the Art in Parent-Delivered Pain-Relieving Interventions in Neonatal Care: A Scoping Review. Front Pediatr 2021; 9:651846. [PMID: 33987153 PMCID: PMC8112545 DOI: 10.3389/fped.2021.651846] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Parents' active involvement during painful procedures is considered a critical first step in improving neonatal pain practices. Of the non-pharmacological approaches in use, the biopsychosocial perspective supports parent-delivered interventions, in which parents themselves mediate pain relief, consistent with modern family-integrated care. This scoping review synthesizes the available research to provide an overview of the state of the art in parent-delivered pain-relieving interventions. Methods: A scoping review was performed to achieve a broad understanding of the current level of evidence and uptake of parent-driven pain- and stress-relieving interventions in neonatal care. Results: There is a strong evidence for the efficacy of skin-to-skin contact and breastfeeding, preferably in combination. These parent-delivered interventions are safe, valid, and ready for prompt introduction in infants' pain care globally. Research into parents' motivations for, and experiences of, alleviating infant pain is scarce. More research on combined parent-delivered pain alleviation, including relationship-based interventions such as the parent's musical presence, is needed to advance infant pain care. Guidelines need to be updated to include infant pain management, parent-delivered interventions, and the synergistic effects of combining these interventions and to address parent involvement in low-income and low-tech settings. Conclusions: A knowledge-to-practice gap currently remains in parent-delivered pain management for infants' procedure-related pain. This scoping review highlights the many advantages of involving parents in pain management for the benefit not only of the infant and parent but also of health care.
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Affiliation(s)
- Alexandra Ullsten
- Center for Clinical Research, Region Värmland, Karlstad, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Matilda Andreasson
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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13
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Ozawa M. Commentary: Interprofessional Collaboration and Involvement of Parents in the Management of Painful Procedures in Newborns. Front Pediatr 2020; 8:599759. [PMID: 33224910 PMCID: PMC7674607 DOI: 10.3389/fped.2020.599759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 10/07/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mio Ozawa
- Division of Nursing Sciences, Graduate School of Biomedical & Health Sciences, University of Hiroshima, Hiroshima, Japan
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14
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Yasmeen I, Krewulak KD, Zhang C, Stelfox HT, Fiest KM. The Effect of Caregiver-Facilitated Pain Management Interventions in Hospitalized Patients on Patient, Caregiver, Provider, and Health System Outcomes: A Systematic Review. J Pain Symptom Manage 2020; 60:1034-1046.e47. [PMID: 32615297 DOI: 10.1016/j.jpainsymman.2020.06.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/10/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Alternative pain management interventions involving caregivers may be valuable adjuncts to conventional pain management interventions. OBJECTIVES Use systematic review methodology to examine caregiver-facilitated pain management interventions in a hospital setting and whether they improve patient, caregiver, provider, or health system outcomes. METHODS We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and Scopus databases from inception to April 2020. Original research on caregiver-facilitated pain management interventions in hospitalized settings (i.e., any age) were included and categorized into three caregiver engagement strategies: inform (e.g., pain education), activate (e.g., prompt caregiver action), and collaborate (encourage caregiver's interaction with providers). RESULTS Of 61 included studies, most investigated premature (n = 27 of 61; 44.3%) and full-term neonates (n = 19 of 61; 31.1%). Interventions were classified as activate (n = 46 of 61; 75.4%), inform-activate-collaborate (n = 6 of 61; 9.8%), inform-activate (n = 5 of 61; 8.2%), activate-collaborate (n = 3 of 61; 4.9%), or inform (n = 1 of 61; 1.6%) caregiver engagement strategies. Interventions that included an activate engagement strategy improved pain outcomes in adults (18-64 years) (e.g., self-reported pain, n = 4 of 5; 80%) and neonates (e.g., crying, n = 32 of 41; 73.0%) but not children or older adults (65 years and older). Caregiver outcomes (e.g., pain knowledge) were improved by inform-activate engagement strategies (n = 3 of 3). Interventions did not improve provider (e.g., satisfaction) or health system (e.g., hospital length of stay) outcomes. Most studies were of low (n = 36 of 61; 59.0%) risk of bias. CONCLUSION Caregiver-facilitated pain management interventions using an activate engagement strategy may be effective in reducing pain of hospitalized neonates. Caregiver-facilitated pain management interventions improved pain outcomes in most adult studies; however, the number of studies of adults is small warranting caution pending further studies.
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Affiliation(s)
- Israt Yasmeen
- Department of Critical Care Medicine, Alberta Health Services & Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karla D Krewulak
- Department of Critical Care Medicine, Alberta Health Services & Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cherri Zhang
- Department of Critical Care Medicine, Alberta Health Services & Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Henry T Stelfox
- Department of Critical Care Medicine, Alberta Health Services & Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Kirsten M Fiest
- Department of Critical Care Medicine, Alberta Health Services & Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences & O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada; Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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15
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Francisco ASPG, Montemezzo D, Ribeiro SNDS, Frata B, Menegol NA, Okubo R, Sonza A, Sanada LS. Positioning Effects for Procedural Pain Relief in NICU: Systematic Review. Pain Manag Nurs 2020; 22:121-132. [PMID: 32863161 DOI: 10.1016/j.pmn.2020.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 07/07/2020] [Accepted: 07/24/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To systematically review the literature regarding the effectiveness of different positioning methods for procedural pain relief in neonates admitted to the Neonatal Intensive Care Unit (NICU). DESIGN A systemized search of the literature was carried out by means of two independent evaluators through the systematic search of electronic index databases. DATA SOURCES A search for relevant studies was performed in four databases (Medline, Web of Science, Scopus, and BVS-BIREME). REVIEW/ANALYSIS METHODS Manual searches were conducted on suitable references from the included articles, and 1,941 publications were eligible for the analysis. The flowchart for the articles' selection was based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, and in relation to bias risks according to the Physiotherapy Evidence Database (PEDro) scale. RESULTS Based on the inclusion criteria, only 20 publications remained. According to the PEDro scale, 75% of the studies presented good methodological quality, with scores between 6 and 8, and 5% scored ≤4 points. None of them were blinded in relation to the therapies, but all of them performed intergroup statistical comparisons. According to the results of this review, we recommend facilitated tucking by parents (FTP) in NICU of at least 30 minutes duration, starting 15 minutes before, during the painful procedure, and 15 minutes after to relieve pain and to stabilize the physiological, hormonal, and behavioral responses of the newborns. CONCLUSIONS Positioning should be used as a nonpharmacological strategy for procedural pain relief in newborns. This review showed that facilitated tucking by parents for 30 minutes was the best position for pain relief in premature newborns during procedures in the NICU. Positioning is recommended as a nonpharmacological method for pain relief; FTP of at least 30 minutes duration should be the first positioning choice during procedures in the NICU.
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Affiliation(s)
| | - Dayane Montemezzo
- Department of Physical Therapy at Santa Catarina State University, Brazil
| | | | - Bruna Frata
- Department of Physical Therapy at Santa Catarina State University, Brazil
| | | | - Rodrigo Okubo
- Department of Physical Therapy at Santa Catarina State University, Brazil
| | - Anelise Sonza
- Department of Physical Therapy at Santa Catarina State University, Brazil
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16
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Laudiano-Dray MP, Pillai Riddell R, Jones L, Iyer R, Whitehead K, Fitzgerald M, Fabrizi L, Meek J. Quantification of neonatal procedural pain severity: a platform for estimating total pain burden in individual infants. Pain 2020; 161:1270-1277. [PMID: 31977932 DOI: 10.1097/j.pain.0000000000001814] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
There is increasing evidence that long-term outcomes for infants born prematurely are adversely affected by repeated exposure to noxious procedures. These interventions vary widely, for example, in the extent of damage caused and duration. Neonatal intensive care unit (NICU) procedures are therefore likely to each contribute differently to the overall pain burden of individual neonates, ultimately having a different impact on their development. For researchers to quantify the procedural pain burden experienced by infants on NICU, we aimed to estimate the pain severity of common NICU procedures using published pain scores. We extracted pain scores over the first minute (pain reactivity) from the literature, using 59 randomized controlled trials for 15 different procedures. Hierarchical cluster analysis of average pain scores resulted in 5 discrete severity groups; mild (n = 1), mild to moderate (n = 3), moderate (n = 7), severe (n = 3), and very severe (n = 1). The estimate of the severity of individual procedures provided new insight into infant pain reactivity which is not always directly related to the invasiveness and duration of a procedure; thus, both heel lance and skin tape removal are moderately painful procedures. This estimate of procedural pain severity, based on pain reactivity scores, provides a novel platform for retrospective quantification of an individual neonate's pain burden due to NICU procedures. The addition of measures that reflect the recovery from each procedure, such as brain activity and behavioural regulation, would further improve estimates of the pain burden of neonatal intensive care.
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Affiliation(s)
- Maria Pureza Laudiano-Dray
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Rebecca Pillai Riddell
- Department of Psychology, Faculty of Health, The O.U.C.H. Lab, York University, Toronto, ON, Canada
- Psychiatry Research, Hospital for Sick Children, Toronto, ON, Canada
| | - Laura Jones
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Rajeshwari Iyer
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Kimberley Whitehead
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Maria Fitzgerald
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Judith Meek
- Neonatal Unit, Elizabeth Garrett Anderson Obstetric Wing, University College London Hospitals, London, United Kingdom
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17
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Gomes Neto M, da Silva Lopes IA, Araujo ACCLM, Oliveira LS, Saquetto MB. The effect of facilitated tucking position during painful procedure in pain management of preterm infants in neonatal intensive care unit: a systematic review and meta-analysis. Eur J Pediatr 2020; 179:699-709. [PMID: 32222816 DOI: 10.1007/s00431-020-03640-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/13/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022]
Abstract
We performed a systematic review and meta-analysis to investigate the effects of facilitated tucking position during painful procedure in pain management of preterm infants. We searched MEDLINE, PEDro, SciELO and the Cochrane Library (until June 2019) for randomized controlled trials. An α value ≤ 0.05 was considered significant. Heterogeneity among studies was examined with Cochran's Q and I2 statistic, in which values greater than 40% were considered indicative of high heterogeneity and random-effects model was chosen. Analyses were performed with Review Manager 5.3. Fifteen studies met the eligibility criteria, including 664 preterm infants. The meta-analyses showed a significant reduction in pain of - 1.02 (95% CI - 1.7 to - 0.4, N = 216) during endotraqueal suctioning for participants in the facilitated tucking position group (FTPG) compared with routine care group. The meta-analyses showed a non-significant difference in pain - 0.3 (95% CI - 2.05 to - 1.4, N = 88) during heel stick for participants in the FTPG compared with oral glucose group. The meta-analyses showed a non-significant difference in pain for participants in the FTPG compared with oral opioid group 0.2 (95% CI - 1.4 to 1.8, N = 140).Conclusion: Facilitated tucking position may improve the pain during painful procedures.What is Known:• Exposure of premature babies to painful procedures is associated with changes in brain development, regardless of other factors.• Facilitated tucking reduces the expression of pain in premature infants.What is New:• Facilitated tucking position was efficient in pain management of preterm infants when compared to routine care.• Facilitated tucking compared to opioid or oral glucose did not achieve a significant reduction in pain intensity.
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Affiliation(s)
- Mansueto Gomes Neto
- Physiotherapy Department, Physiotherapy Course, Federal University of Bahia, Salvador, Bahia, Brazil.,Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil.,Graduate Program in Medicine and Health, Faculty of Medicine of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | | | - Lucas Silva Oliveira
- Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Micheli Bernardone Saquetto
- Physiotherapy Department, Physiotherapy Course, Federal University of Bahia, Salvador, Bahia, Brazil. .,Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil. .,Graduate Program in Medicine and Health, Faculty of Medicine of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil. .,Departamento de Fisioterapia, Curso de Fisioterapia, Instituto de Ciências da Saúde, Universidade Federal da Bahia-UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela, Salvador, BA, CEP 40110-100, Brazil.
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18
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McNair C, Campbell-Yeo M, Johnston C, Taddio A. Nonpharmacologic Management of Pain During Common Needle Puncture Procedures in Infants: Current Research Evidence and Practical Considerations: An Update. Clin Perinatol 2019; 46:709-730. [PMID: 31653304 DOI: 10.1016/j.clp.2019.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. Numerous nonpharmacologic interventions are available that may be used for these painful procedures, including swaddling/containment, pacifier/non-nutritive sucking, rocking/holding, breastfeeding and breastmilk, skin-to-skin care, sweet tasting solutions, music therapy, sensorial saturation, and parental presence. Adoption these interventions into routine clinical practice is feasible and should be a standard of care in quality health care for infants. This review summarizes the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions.
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Affiliation(s)
- Carol McNair
- Nursing and Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada
| | - Marsha Campbell-Yeo
- Department of Pediatrics, IWK Health Centre, School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Celeste Johnston
- Ingram School of Nursing, McGill University, Montreal, Canada; IWK Health Centre, 5850/5980 University Avenue, Halifax B3K 6R8, Canada
| | - Anna Taddio
- Clinical, Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Child Health Evaluative Sciences, The Hospital for Sick Children, 144 College Street, Toronto, Ontario M5S 3M2, Canada.
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19
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Ullsten A, Eriksson M, Axelin A. O Parent, Where Art Thou? PAEDIATRIC AND NEONATAL PAIN 2019; 1:53-55. [PMID: 35548375 PMCID: PMC8975190 DOI: 10.1002/pne2.12010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Alexandra Ullsten
- Department of Musicology Örebro University Örebro Sweden
- Centre for Clinical Research Karlstad Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health Örebro University Örebro Sweden
| | - Anna Axelin
- Department of Nursing Science University of Turku Turku Finland
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20
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Gautheyrou L, Durand S, Jourdes E, De Jonckheere J, Combes C, Cambonie G. Facilitated tucking during early neonatologist-performed echocardiography in very preterm neonates. Acta Paediatr 2018; 107:2079-2085. [PMID: 30144169 DOI: 10.1111/apa.14555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/04/2018] [Accepted: 08/22/2018] [Indexed: 11/27/2022]
Abstract
AIM To assess the effect of facilitated tucking (FT), a nonpharmacologic nursing intervention, on echocardiographic parameters and infant comfort collected prospectively during neonatologist-performed echocardiography. METHODS Echocardiography was performed twice, in standard conditions and with FT; the order was randomised by computer. Echocardiography provided data on pulmonary artery flow and pressure, right and left ventricular function, and persistent ductus arteriosus. Comfort was assessed by a behavioural scale of pain, variations in heart rate (HR) and SpO2 , and a newborn infant parasympathetic evaluation index based on the high-frequency variability in HR. RESULTS Fifty newborns, with mean gestational age of 28 [26.6-29.0] weeks and mean birthweight of 950 [780-1190] g, were studied at a postnatal age of 13 [9-27] hours. FT was associated with longer acceleration time/right ventricular ejection time in the main pulmonary artery (p = 0.006), reduced averaged HR variations (p = 0.03) and lower pain scores (p < 0.001). The other haemodynamic parameters and the parasympathetic index were not influenced by FT. CONCLUSION Echocardiography performed soon after birth in very premature neonates may generate mild discomfort. FT during echocardiography is associated with lower pulmonary artery pressures and improves infant's comfort during this examination.
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Affiliation(s)
- Laurène Gautheyrou
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Sabine Durand
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Emilie Jourdes
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Julien De Jonckheere
- EA 4489, Perinatal Growth and Environment; Lille University; Montpellier Cedex 5 France
- CIC-IT 1403; Lille University Hospital; Lille France
| | - Clémentine Combes
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Gilles Cambonie
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
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Perroteau A, Nanquette MC, Rousseau A, Renolleau S, Bérard L, Mitanchez D, Leblanc J. Efficacy of facilitated tucking combined with non-nutritive sucking on very preterm infants' pain during the heel-stick procedure: A randomized controlled trial. Int J Nurs Stud 2018; 86:29-35. [PMID: 29960105 DOI: 10.1016/j.ijnurstu.2018.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 06/11/2018] [Accepted: 06/12/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Reducing acute pain in premature infants during neonatal care improves their neurophysiological development. The use of pharmacological and non-pharmacological analgesia, such as sucrose, is limited per day, particularly for very preterm infants. Thus, the usual practice of non-nutritive sucking is often used alone. Facilitated tucking could be an additional strategy to non-nutritive sucking for reducing pain. To the best of our knowledge, no randomized trial has compared the combination of facilitated tucking and non-nutritive sucking to non-nutritive sucking alone. OBJECTIVES To compare the efficacy of facilitated tucking in combination with non-nutritive sucking (intervention group) to non-nutritive sucking alone (control group) in reducing pain during the heel-stick procedure in very preterm infants. DESIGN Prospective, randomized controlled trial. SETTINGS Level III and II neonatal care units, including the neurosensory care management program. METHODS Very preterm infants (gestational age between 28 and 32 weeks) were randomly assigned by a computer programme to the intervention or control group during a heel-stick procedure within the first 48 h of life. In both groups, infants were placed in an asymmetric position on a cushion; noise and light were limited following routine care. A heel-stick was performed first in the care sequence. In the intervention group, facilitated tucking was performed by a nurse or nursing assistant. The procedure was video recorded from 15 s (T-15 s) before the procedure until three minutes (T + 3 min) after the end of the procedure. Pain was blindly assessed by two independent specialist nurses. The primary outcome was the pain score evaluated 15 s before the procedure and 30 s immediately after by the premature infant pain profile (PIPP) scale. The secondary outcome was the pain score evaluated between T-15 s and T + 3 min by the DAN scale (a French acronym for the acute pain of a newborn). RESULTS Sixty infants were included (30 in each group). The PIPP pain scores did not differ between the intervention group (median: 8.0; interquartile range (IQR): 6.0-12.0) and the control group (median: 9.5; IQR: 7.0-13.0, p = 0.32). Pain assessed by the DAN scale at T + 3 min was lower in the intervention group than in the control group (median: 0.3; IQR: 0.0-1.0 and 2.0; IQR: 0.5-3.0, respectively, p = 0.001). CONCLUSIONS The combined use of facilitated tucking and non-nutritive sucking did not significantly alleviate pain during the heel-stick procedure. However, the addition of facilitated tucking facilitated faster pain recovery following the heel-stick procedure.
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Affiliation(s)
- Anne Perroteau
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Armand Trousseau, Department of Perinatology, F75012, Paris, France.
| | - Marie-Christine Nanquette
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Armand Trousseau, Department of Perinatology, F75012, Paris, France.
| | - Alexandra Rousseau
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien (HUEP), Clinical Research Unit of East of Paris (URC-Est), F75012, Paris, France.
| | - Sylvain Renolleau
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Necker Enfants Malades, Department of Resuscitative Medicine and Surgical, F75015, Paris, France.
| | - Laurence Bérard
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien (HUEP), Clinical Research Platform of East of Paris (URC-Est/CRC-Est), F75012, Paris, France.
| | - Delphine Mitanchez
- Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Armand Trousseau, Department of Perinatology, F75012, Paris, France.
| | - Judith Leblanc
- Assistance Publique - Hôpitaux de Paris (AP-HP), Groupe Hospitalier des Hôpitaux Universitaires Est Parisien (HUEP), Clinical Research Center of East of Paris (CRC-Est), F75012, Paris, France.
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Peng HF, Yin T, Yang L, Wang C, Chang YC, Jeng MJ, Liaw JJ. Non-nutritive sucking, oral breast milk, and facilitated tucking relieve preterm infant pain during heel-stick procedures: A prospective, randomized controlled trial. Int J Nurs Stud 2018; 77:162-170. [DOI: 10.1016/j.ijnurstu.2017.10.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 10/02/2017] [Accepted: 10/03/2017] [Indexed: 10/18/2022]
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Rodrigues L, Nesargi SV, Fernandes M, Shashidhar A, Rao SPN, Bhat S. Analgesic Efficacy of Oral Dextrose and Breast Milk during Nasopharyngeal Suctioning of Preterm Infants on CPAP: A Blinded Randomized Controlled Trial. J Trop Pediatr 2017; 63:483-488. [PMID: 28369634 DOI: 10.1093/tropej/fmx017] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Continuous positive airway pressure (CPAP) requires nasopharyngeal suctioning for airway patency, which is painful. Other procedures have used breast milk and 25% dextrose as analgesics. We aimed to compare their analgesic efficacy during nasopharyngeal suctioning in preterm neonates on CPAP. In this blinded randomized controlled trial, babies received 25% dextrose or breast milk orally. Pain before, during and after was assessed using the Premature Infant Pain Profile (PIPP) score. Analysis was done for 40 babies. The mean PIPP score in the 25% dextrose group during the procedure was 11.25 ± 2.73 and 13.2 ± 2.55 (p = 0.02) with the intervention and without. In the breast milk group the PIPP score during the procedure was 11.35 ± 3.05 and 13.45 ± 3.27 (p = 0.04); this difference persisted even after the procedure. There was no significant difference between the interventions. Both interventions significantly reduce pain. The analgesic effect of breast milk was sustained.
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Affiliation(s)
- Luvena Rodrigues
- Department of Paediatrics, Goa Medical College and Hospital, Bambolim, Goa 403202, India
| | - Saudamini V Nesargi
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Maneka Fernandes
- Department of Paediatrics, Goa Medical College and Hospital, Bambolim, Goa 403202, India
| | - A Shashidhar
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Suman P N Rao
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
| | - Swarnarekha Bhat
- Department of Neonatology, St. John's Medical College Hospital, Bangalore, Karnataka, India
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A Pilot Study of Responses to Suctioning Among Neonates on Bubble Nasal Continuous Positive Airway Pressure. Adv Neonatal Care 2017; 17:E3-E11. [PMID: 29210760 DOI: 10.1097/anc.0000000000000442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Maintenance of a patent airway while the neonate is on nasal continuous positive airway pressure (nasal CPAP) requires vigilant monitoring and oral/nasopharyngeal suctioning. Currently, no evidence-based guidelines for safe suctioning in neonates while on bubble nasal CPAP have been published. PURPOSE (1) To characterize the clinical and behavioral responses of neonates on bubble nasal CPAP in a level III neonatal intensive care unit following routine oral and nasopharyngeal suctioning. METHODS This pilot study has a 1-sample within-subject repeated-measures design in which neonates (N = 16) served as their own control. Data on a neonate's physiological and behavior measures (heart rate, respiratory rate, oxygen saturation [SaO2], and Premature Infant Pain Profile [PIPP] score) were collected before, during, and after the completion of suctioning sequence. FINDING/RESULTS A total of 16 neonates with a mean gestational age of 29.76 weeks and an average day of life of 3.4 were enrolled. The infant's heart rates did not differ significantly (P = .51) across the suctioning sequence. There were no statistical significant changes in the average respiratory rate across the suctioning sequences (P = .79). SaO2 demonstrated a drop between baseline and after each suctioning (P < .001). The PIPP score demonstrated a precipitous increase throughout the procedure (P < .001). On average, it took 9.5 seconds (SD = 4.9) to complete the suctioning sequences. IMPLICATIONS FOR PRACTICE Our results suggest that the guideline tested is safe and tolerated by infants. IMPLICATIONS FOR RESEARCH This guideline should be tested in a larger sample and with neonates on other nasal CPAP systems.
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Johnston C, Campbell‐Yeo M, Disher T, Benoit B, Fernandes A, Streiner D, Inglis D, Zee R. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev 2017; 2:CD008435. [PMID: 28205208 PMCID: PMC6464258 DOI: 10.1002/14651858.cd008435.pub3] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Skin-to-skin care (SSC), often referred to as 'kangaroo care' (KC) due to its similarity with marsupial behaviour of ventral maternal-infant contact, is one non-pharmacological intervention for pain control in infants. OBJECTIVES The primary objectives were to determine the effect of SSC alone on pain from medical or nursing procedures in neonates compared to no intervention, sucrose or other analgesics, or additions to simple SSC such as rocking; and to determine the effects of the amount of SSC (duration in minutes), method of administration (e.g. who provided the SSC) of SSC in reducing pain from medical or nursing procedures in neonatesThe secondary objectives were to determine the safety of SSC care for relieving procedural pain in infants; and to compare the SSC effect in different postmenstrual age subgroups of infants. SEARCH METHODS For this update, we used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1); MEDLINE via PubMed (1966 to 25 February 2016); Embase (1980 to 25 February 2016); and CINAHL (1982 to 25 February 2016). We also searched clinical trials' databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA Studies with randomisation or quasi-randomisation, double- or single-blinded, involving term infants (≥ 37 completed weeks' postmenstrual age (PMA) to a maximum of 44 weeks' PMA and preterm infants (< 37 completed weeks PMA) receiving SSC for painful procedures conducted by healthcare professionals. DATA COLLECTION AND ANALYSIS The main outcome measures were physiological or behavioural pain indicators and composite pain scores. A mean difference (MD) with 95% confidence interval (CI) using a fixed-effect model was reported for continuous outcome measures. We included variations on type of tissue-damaging procedure, provider of care, and duration of SSC. MAIN RESULTS Twenty-five studies (n = 2001 infants) were included. Nineteen studies (n = 1065) used heel lance as the painful procedure, one study combined venepuncture and heel stick (n = 50), three used intramuscular injection (n = 776), one used 'vaccination' (n = 60), and one used tape removal (n = 50). The studies were generally strong and had low or uncertain risk of bias. Blinding of the intervention was not possible, making them subject to high risk, depending on the method of scoring outcomes.Seventeen studies (n = 810) compared SSC to a no-treatment control. Although 15 studies measured heart rate during painful procedures, data from only five studies (n = 161) could be combined for a mean difference (MD) of -10.78 beats per minute (95% CI -13.63 to -7.93) favouring SSC. Meta-analysis of four studies (n = 120) showed no difference in heart rate following the painful procedure (MD 0.08, 95% CI -4.39 to 4.55). Two studies (n = 38) reported heart rate variability with no significant differences. Two studies (n = 101) in a meta-analysis on oxygen saturation at 30 and 60 seconds following the painful procedure did not show a difference. Duration of crying meta-analysis was performed on four studies (n = 133): two (n = 33) investigated response to heel lance (MD = -34.16, 95% CI -42.86 to -25.45), and two (n = 100) following IM injection (MD = -8.83, 95% CI -14.63 to -3.02), favouring SSC. Five studies, one consisting of two substudies (n = 267), used the Premature Infant Pain Profile (PIPP) as a primary outcome, which favoured SCC at 30 seconds (MD -3.21, 95% CI -3.94 to -2.47), at 60 seconds (3 studies; n = 156) (MD -1.64, 95% CI -2.86 to -0.43), and at 90 seconds (n = 156) (MD -1.28, 95% CI -2.53 to -0.04); but at 120 seconds there was no difference (n = 156) (MD 0.07, 95% CI -1.11 to 1.25). No studies on return of heart rate to baseline level, cortisol levels, and facial actions could be combined for meta-analysis findings.Eight studies compared SSC to another intervention with or without a no-treatment control. Two cross-over studies (n = 80) compared mother versus other provider (father, another female) on PIPP scores at 30, 60, 90, and 120 seconds with no significant difference. When SSC was compared to other interventions, there were not enough similar studies to pool results in an analysis. One study compared SSC (n = 640) with and without dextrose and found that the combination was most effective and that SSC alone was more effective than dextrose alone. Similarly, in another study SSC was more effective than oral glucose for heart rate (n = 95). SSC either in combination with breastfeeding or alone was favoured over a no-treatment control, but not different to breastfeeding. One study compared SSC alone and in combination with both sucrose and breastfeeding on heart rate (HR), NIPS scores, and crying time (n = 127). The combinations were more effective than SSC alone for NIPS and crying. Expressed breast milk was compared to SSC in one study (n = 50) and found both equally effective on PIPP scores. There were not enough participants with similar outcomes and painful procedures to compare age groups or duration of SSC. No adverse events were reported in any of the studies. AUTHORS' CONCLUSIONS SSC appears to be effective as measured by composite pain indicators with both physiological and behavioural indicators and, independently, using heart rate and crying time; and safe for a single painful procedure. Purely behavioural indicators tended to favour SSC but with facial actions there is greater possibility of observers not being blinded. Physiological indicators were mixed although the common measure of heart rate favoured SSC. Two studies compared mother-providers to others, with non-significant results. There was more heterogeneity in the studies with behavioural or composite outcomes. There is a need for replication studies that use similar, clearly defined outcomes. Studies examining optimal duration of SSC, gestational age groups, repeated use, and long-term effects of SSC are needed. Of interest would be to study synergistic effects of SSC with other interventions.
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Affiliation(s)
| | - Marsha Campbell‐Yeo
- IWK Health CentreNeonatal Intensive Care Unit5850/5980 University AvenuePO Box 9700HalifaxNSCanadaB3K 6R8
| | | | | | - Ananda Fernandes
- Coimbra College of NursingDepartment of Child HealthAv. BissayaBarretoAp. 55CoimbraPortugal3001‐901
| | - David Streiner
- McMaster UniversityDepartment of Psychiatry and Behavioural Neurociences100 West 5th StreetRoom B‐366HamiltonONCanadaL8N 3K7
| | - Darlene Inglis
- IWK Health CentreNeonatal Intensive Care Unit5850/5980 University AvenuePO Box 9700HalifaxNSCanadaB3K 6R8
| | - Rebekah Zee
- IWK Health CentreNeonatal Intensive Care Unit5850/5980 University AvenuePO Box 9700HalifaxNSCanadaB3K 6R8
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PEARL-Pain in Early Life: A New Network for Research and Education. J Perinat Neonatal Nurs 2017; 31:91-95. [PMID: 28437297 DOI: 10.1097/jpn.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Montirosso R, Tronick E, Borgatti R. Promoting Neuroprotective Care in Neonatal Intensive Care Units and Preterm Infant Development: Insights From the Neonatal Adequate Care for Quality of Life Study. CHILD DEVELOPMENT PERSPECTIVES 2016. [DOI: 10.1111/cdep.12208] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Reece-Stremtan S, Gray L. ABM Clinical Protocol #23: Nonpharmacological Management of Procedure-Related Pain in the Breastfeeding Infant, Revised 2016. Breastfeed Med 2016; 11:425-429. [PMID: 27623411 DOI: 10.1089/bfm.2016.29025.srs] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. These guidelines are not intended to be all-inclusive, but to provide a basic framework for physician education regarding breastfeeding.
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Affiliation(s)
- Sarah Reece-Stremtan
- 1 Division of Anesthesiology, Pain, and Perioperative Medicine, Children's National Health System , Washington, District of Columbia
| | - Larry Gray
- 2 Department of Pediatrics, University of Chicago , Chicago, Illinois
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Gao H, Gao H, Xu G, Li M, Du S, Li F, Zhang H, Wang D. Efficacy and safety of repeated oral sucrose for repeated procedural pain in neonates: A systematic review. Int J Nurs Stud 2016; 62:118-25. [DOI: 10.1016/j.ijnurstu.2016.07.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 07/15/2016] [Accepted: 07/15/2016] [Indexed: 11/28/2022]
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Ho LP, Ho SSM, Leung DYP, So WKW, Chan CWH. A feasibility and efficacy randomised controlled trial of swaddling for controlling procedural pain in preterm infants. J Clin Nurs 2016; 25:472-82. [PMID: 26818372 DOI: 10.1111/jocn.13075] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 01/29/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to investigate the feasibility and efficacy of swaddling to control procedural pain among preterm infants. BACKGROUND Swaddling has been recommended for controlling neonatal pain. However, the feasibility for use is uncertain and insufficient evidence is available among preterm infants. DESIGN A two-arm randomised controlled trial with repeated measures. METHOD The study was conducted in a 21-bed neonatal intensive care unit of a regional hospital in Hong Kong. Preterm infants who required heelstick procedure were eligible. Fifty-four preterm infants between 30-37 gestational weeks were randomly assigned to swaddling (n = 27) and control (standard care, n = 27) groups. Pain assessment was performed pre, during, immediate, two, four, six and eight minutes after heelstick procedure using the Premature Infant Pain Profile. RESULTS The mean Premature Infant Pain Profile scores were significantly reduced in the intervention group compared to the control group during, immediate, two, four, and six minutes after the heelstick procedure. The mean changes of heart rate and oxygen saturation in the intervention group were significantly lower than that of the control group at all measured time points. Notably, the swaddled infants quickly resumed to the baseline level at two minutes whereas the control group reached the stable state at an extended period of six minutes. CONCLUSION The findings show that swaddling is feasible and efficacious in controlling pain for heelstick procedure among preterm infants. No adverse effects were observed. RELEVANCE TO CLINICAL PRACTICE This article presents the feasibility and efficacy of swaddling as a non-pharmacological and non-invasive intervention to relieve pain during the heelstick procedures among preterm infants. Swaddling can contribute to control minor procedural pain in neonates as one of the simple, safe, cost effective, humanistic and natural analgesia alternatives.
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Affiliation(s)
- Lai Ping Ho
- Neonatal Unit, Prince of Wales Hospital, Hong Kong SAR, China
| | - Simone S M Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Doris Y P Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
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Factors Influencing Parental Participation in Neonatal Pain Alleviation. J Pediatr Nurs 2016; 31:519-27. [PMID: 27339733 DOI: 10.1016/j.pedn.2016.05.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Revised: 05/15/2016] [Accepted: 05/26/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE Neonates are likely to experience numerous painful procedures in neonatal intensive care units (NICUs). Parents have expressed a wish to be more involved in their infants' pain alleviation. The purpose of this study was to describe parents' perceptions concerning the factors that influence parental participation in pain alleviation in an NICU. DESIGN AND METHODS The qualitative study was conducted in level II and III NICUs (7 units) of Finland's four university hospitals. Data were collected through open-ended questionnaires and analyzed using inductive content analysis. RESULTS Factors that promoted parental participation consisted of five main categories: parental counseling by staff, parents' awareness of their own role, parents' motivation to participate in pain relief, family-friendly facilities and good communication. Factors hindering parental participation consisted of eight categories, including restrictive environment, lack of knowledge, everyday life requirements, underestimation of parents, the nature of the medical procedures, procedure- and pain-related emotions, deteriorated health status of the child and mother and (8) uncertainty of parenting. CONCLUSIONS This study revealed a number of factors that are important to take into account when improving parental involvement in neonatal pain alleviation. Especially, parental participation can be promoted by providing sufficient counseling based on the parents' needs and creating facilities that support parents' participation. PRACTICE IMPLICATION Parents should be engaged as partners in caregiving and decision making, and they should be given space to assume the role of parents during their child's hospitalization.
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Lima AGCF, Santos VS, Nunes MS, Barreto JAA, Ribeiro CJN, Carvalho J, Ribeiro MCO. Glucose solution is more effective in relieving pain in neonates than non-nutritive sucking: A randomized clinical trial. Eur J Pain 2016; 21:159-165. [PMID: 27460979 DOI: 10.1002/ejp.912] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2016] [Indexed: 11/12/2022]
Abstract
BACKGROUND Few studies have compared the analgesic effect of 25% glucose and non-nutritive sucking. We compared the analgesic effect of 25% glucose and non-nutritive sucking in newborns undergoing hepatitis B vaccination. Our hypothesis is that 25% glucose is more effective in relieving pain than non-nutritive sucking. METHODS A randomized clinical trial with 78 healthy newborns was performed. Neonates were assigned randomly to receive 25% glucose (G25) and non-nutritive sucking (NNS). Pain was assessed using the Neonatal Infant Pain Scale (NIPS) before and during the immunization procedure. In addition, we evaluated various physiological parameters and crying time. RESULTS Neonates who received 25% glucose registered lower NIPS scores than those from the NNS group [mean (SD), 3.3 (2.1) vs. 5.6 (1.6), p < 0.001]. The crying time was shorter among newborns in the G25 group than in the NNS and control groups. CONCLUSION The use of 25% glucose before the vaccination procedure was more effective in relieving acute pain, with newborns in the G25 group registering scores two times lower on the NIPS scale. The clinical practice of administering 25% glucose is therefore a suggested nondrug measure for pain relief during painful procedures. SIGNIFICANCE Neonates who received 25% glucose registered lower NIPS scores than those from the NNS group; the crying time was shorter among newborns in the G25 group than in the NNS and control groups; the use of 25% glucose before the vaccination procedure was more effective in relieving acute pain.
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Affiliation(s)
- A G C F Lima
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
| | - V S Santos
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
| | - M S Nunes
- Department of Nursing, Federal University of Sergipe, Lagarto, Brazil
| | - J A A Barreto
- Department of Nursing, Federal University of Sergipe, Lagarto, Brazil
| | - C J N Ribeiro
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil
| | - J Carvalho
- Department of Nursing, Federal University of Sergipe, Aracaju, Brazil
| | - M C O Ribeiro
- Postgraduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Brazil.,Department of Nursing, Federal University of Sergipe, Aracaju, Brazil
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Warren I, Hicks B, Kleberg A, Eliahoo J, Anand KJS, Hickson M. The validity and reliability of the EValuation of INtervention Scale: preliminary report. Acta Paediatr 2016; 105:618-22. [PMID: 26896153 DOI: 10.1111/apa.13370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Revised: 01/15/2016] [Accepted: 02/15/2016] [Indexed: 11/26/2022]
Abstract
AIM Pain management is a priority for infants receiving neonatal care as they undergo many necessary painful and stressful interventions, which are associated with negative short- or long-term consequences. This study aims to validate the content, and test the reliability, of the EValuation of INtervention Scale (EVIN), which is designed to evaluate the use of widely recommended nonpharmacological strategies to reduce neonatal pain and stress during procedures. METHODS The content of the EVIN was validated with multidisciplinary participation (N = 80), and consistency was established via observations on preterm infants (N = 12, at 31-34 weeks' gestation) during interventions in a neonatal unit. A revised scale was tested for inter-rater reliability with observations of invasive (blood sampling, N = 16) and noninvasive (nappy change, N = 18) interventions. The intraclass correlation coefficient (ICC) was used to determine inter-rater reliability. SPSS (PASW Statistics) version 18 was used for analysis. RESULTS Very good intraclass correlation coefficients (>0.8) for both invasive (0.962) and noninvasive procedures (0.970) were achieved. CONCLUSION These results indicate that the EVIN is suitable for the evaluation of nonpharmacological support during painful or stressful interventions.
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Affiliation(s)
- Inga Warren
- Therapy Services; Imperial Neonatal Service; Imperial College Healthcare NHS Trust; London UK
| | - Beverley Hicks
- Therapy Services; Imperial Neonatal Service; Imperial College Healthcare NHS Trust; London UK
| | - Agneta Kleberg
- Astrid Lindgren Children Hospital; Karolinska University Hospital; Stockholm Sweden
| | - Joseph Eliahoo
- Statistical Advisory Service; Imperial College; London UK
| | | | - Mary Hickson
- Therapy Services; Imperial College Healthcare NHS Trust; London UK
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Abstract
The prevention of pain in neonates should be the goal of all pediatricians and health care professionals who work with neonates, not only because it is ethical but also because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor, yet painful procedures. Therefore, every health care facility caring for neonates should implement (1) a pain-prevention program that includes strategies for minimizing the number of painful procedures performed and (2) a pain assessment and management plan that includes routine assessment of pain, pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and measures for minimizing pain associated with surgery and other major procedures.
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Pillai Riddell RR, Racine NM, Gennis HG, Turcotte K, Uman LS, Horton RE, Ahola Kohut S, Hillgrove Stuart J, Stevens B, Lisi DM. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev 2015; 2015:CD006275. [PMID: 26630545 PMCID: PMC6483553 DOI: 10.1002/14651858.cd006275.pub3] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Infant acute pain and distress is commonplace. Infancy is a period of exponential development. Unrelieved pain and distress can have implications across the lifespan. This is an update of a previously published review in the Cochrane Database of Systematic Reviews, Issue 10 2011 entitled 'Non-pharmacological management of infant and young child procedural pain'. OBJECTIVES To assess the efficacy of non-pharmacological interventions for infant and child (up to three years) acute pain, excluding kangaroo care, and music. Analyses were run separately for infant age (preterm, neonate, older) and pain response (pain reactivity, immediate pain regulation). SEARCH METHODS For this update, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library (Issue 2 of 12, 2015), MEDLINE-Ovid platform (March 2015), EMBASE-OVID platform (April 2011 to March 2015), PsycINFO-OVID platform (April 2011 to February 2015), and CINAHL-EBSCO platform (April 2011 to March 2015). We also searched reference lists and contacted researchers via electronic list-serves. New studies were incorporated into the review. We refined search strategies with a Cochrane-affiliated librarian. For this update, nine articles from the original 2011 review pertaining to Kangaroo Care were excluded, but 21 additional studies were added. SELECTION CRITERIA Participants included infants from birth to three years. Only randomised controlled trials (RCTs) or RCT cross-overs that had a no-treatment control comparison were eligible for inclusion in the analyses. However, when the additive effects of a non-pharmacological intervention could be assessed, these studies were also included. We examined studies that met all inclusion criteria except for study design (e.g. had an active control) to qualitatively contextualize results. There were 63 included articles in the current update. DATA COLLECTION AND ANALYSIS Study quality ratings and risk of bias were based on the Cochrane Risk of Bias Tool and GRADE approach. We analysed the standardized mean difference (SMD) using the generic inverse variance method. MAIN RESULTS Sixty-three studies, with 4905 participants, were analysed. The most commonly studied acute procedures were heel-sticks (32 studies) and needles (17 studies). The largest SMD for treatment improvement over control conditions on pain reactivity were: non-nutritive sucking-related interventions (neonate: SMD -1.20, 95% CI -2.01 to -0.38) and swaddling/facilitated tucking (preterm: SMD -0.89; 95% CI -1.37 to -0.40). For immediate pain regulation, the largest SMDs were: non-nutritive sucking-related interventions (preterm: SMD -0.43; 95% CI -0.63 to -0.23; neonate: SMD -0.90; 95% CI -1.54 to -0.25; older infant: SMD -1.34; 95% CI -2.14 to -0.54), swaddling/facilitated tucking (preterm: SMD -0.71; 95% CI -1.00 to -0.43), and rocking/holding (neonate: SMD -0.75; 95% CI -1.20 to -0.30). Fifty two of our 63 trials did not report adverse events. The presence of significant heterogeneity limited our confidence in the findings for certain analyses, as did the preponderance of very low quality evidence. AUTHORS' CONCLUSIONS There is evidence that different non-pharmacological interventions can be used with preterms, neonates, and older infants to significantly manage pain behaviors associated with acutely painful procedures. The most established evidence was for non-nutritive sucking, swaddling/facilitated tucking, and rocking/holding. All analyses reflected that more research is needed to bolster our confidence in the direction of the findings. There are significant gaps in the existing literature on non-pharmacological management of acute pain in infancy.
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Affiliation(s)
- Rebecca R Pillai Riddell
- York UniversityDepartment of Psychology4700 Keele StreetOUCH Laboratory, 2004/6 Sherman Health Sciences BuildingTorontoONCanadaM3J 1P3
| | - Nicole M Racine
- York UniversityDepartment of Psychology4700 Keele StreetOUCH Laboratory, 2004/6 Sherman Health Sciences BuildingTorontoONCanadaM3J 1P3
| | - Hannah G Gennis
- York UniversityDepartment of Psychology4700 Keele StreetOUCH Laboratory, 2004/6 Sherman Health Sciences BuildingTorontoONCanadaM3J 1P3
| | - Kara Turcotte
- University of British Columbia OkanaganDepartment of PsychologyKelownaBCCanada
| | | | - Rachel E Horton
- The Child and Adolescent Psychology CentrePrivate PracticeAuroraONCanada
| | | | - Jessica Hillgrove Stuart
- York UniversityDepartment of Psychology4700 Keele StreetOUCH Laboratory, 2004/6 Sherman Health Sciences BuildingTorontoONCanadaM3J 1P3
| | - Bonnie Stevens
- The Hospital for Sick ChildrenNursing Research555 University AvenueTorontoONCanadaM5G 1X8
| | - Diana M Lisi
- University of British Columbia OkanaganDepartment of PsychologyKelownaBCCanada
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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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Neonatal Intensive Care Nurses' Perceptions of Parental Participation in Infant Pain Management: A Comparative Focus Group Study. J Perinat Neonatal Nurs 2015; 29:363-74. [PMID: 26505851 DOI: 10.1097/jpn.0000000000000136] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This comparative focus group study explored nurses' experiences and perceptions regarding parental participation in infant pain management in the neonatal intensive care unit (NICU). A total of 87 nurses from 7 NICUs in Finland, Sweden, and the United States participated in focus-group interviews (n = 25). Data were analyzed using deductive and inductive thematic analysis. Nurses' experiences and perceptions varied considerably, from nurses being in control, to nurses sharing some control with parents, to nurse-parent collaboration in infant pain management. When nurses controlled pain management, parents were absent or passive. In these cases, the nurses believed this led to better pain control for infants and protected parents from emotional distress caused by infant pain. When nurses shared control with parents, they provided information and opportunities for participation. They believed parent participation was beneficial, even if it caused nurses or parents anxiety. When nurses collaborated with parents, they negotiated the optimal pain management approach for an individual infant. The collaborative approach was most evident for the nurses in the Swedish NICUs and somewhat evident in the NICUs in Finland and the United States. Further research is needed to address some nurses' perceptions and concerns and to facilitate greater consistency in the application of evidence-based best practices.
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Abbasoğlu A, Cabıoğlu MT, Tuğcu AU, İnce DA, Tekindal MA, Ecevit A, Tarcan A. Acupressure at BL60 and K3 Points Before Heel Lancing in Preterm Infants. Explore (NY) 2015; 11:363-6. [DOI: 10.1016/j.explore.2015.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Indexed: 12/11/2022]
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Vezyroglou K, Mehler K, Kribs A, Becker I, Langhammer K, Roth B, Hünseler C. Oral glucose in preterm neonates during oropharyngeal suctioning: a randomized controlled cross-over trial. Eur J Pediatr 2015; 174:867-74. [PMID: 25520214 DOI: 10.1007/s00431-014-2472-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Revised: 11/29/2014] [Accepted: 12/04/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED To investigate whether orally applied glucose reduces pain response during oropharyngeal suctioning in preterm infants with a birth weight >1500 g, we conducted a randomized, double-blind, placebo-controlled cross-over trial on 32 preterm infants undergoing oropharyngeal suctioning while on nasal continuous positive airway pressure (CPAP). The Premature Infant Pain Profile (PIPP) score was assessed and compared in a cross-over design to investigate whether there was a significant difference in the patients' pain response. The mean PIPP score during oropharyngeal suctioning after placebo was 8.6 (KI 7.8-9.4). After glucose administration, the mean PIPP score was 8.0 (KI 7.1-8.9). Comparison of the treatment effects reached no statistic significance (p = 0.23). During the oral study drug administration during nasal CPAP, we observed 47 adverse events, but none necessitated therapeutic intervention and none was classified as serious. CONCLUSION In our study, late preterm infants in the first days of life did not benefit significantly from analgesia with glucose during oropharyngeal suctioning. The oral administration of glucose under nasal CPAP led to no serious adverse events.
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Affiliation(s)
- Katharina Vezyroglou
- Department of Neonatology and Pediatric Intensive Care Medicine, Children's Hospital, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany,
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Gao H, Xu G, Gao H, Dong R, Fu H, Wang D, Zhang H, Zhang H. Effect of repeated Kangaroo Mother Care on repeated procedural pain in preterm infants: A randomized controlled trial. Int J Nurs Stud 2015; 52:1157-65. [PMID: 25912524 DOI: 10.1016/j.ijnurstu.2015.04.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/29/2015] [Accepted: 04/03/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preterm infants' repeated exposure to painful procedures may lead to negative consequences. Thus, non-pharmacological pain management is essential due to medication side effects. Kangaroo Mother Care, which aims at offering human care to neonates, has been established for the treatment of a single painful procedure, but the effectiveness of Kangaroo Mother Care across repeated painful procedures is unknown. OBJECTIVE To test the effectiveness of repeated Kangaroo Mother Care on repeated heel-stick pain in preterm neonates. DESIGN Randomized controlled trial. SETTING Level III Neonatal Intensive Care Unit at a large teaching hospital in northeast China. METHOD Preterm infants (gestational age less than 37 weeks) (n=80) were recruited and randomly assigned using a random table format to either an incubator group (n=40) or Kangaroo Mother Care group (n=40). Pain assessments were carried out during four routine heel stick procedures. For the first heel stick, preterm infants in each group received no intervention (routinely stayed in incubator). During the next three heel sticks, the infants in Kangaroo Mother Care group received heel sticks during Kangaroo Mother Care, while infants in the incubator group received heel sticks in incubator. The procedure of each heel stick included 3 phases: baseline, blood collection and recovery. Crying, grimacing and heart rate in response to pain were evaluated at each phase across four heel sticks by three trained independent observers who were blinded to the purpose of the study. Data were analyzed by analysis of variance (ANOVA), with repeated measures at different evaluation phases of heel stick. RESULTS 75 preterm infants completed the protocol. Between-group comparison revealed that preterm infants' heart rate was significantly lower, and the duration of crying and facial grimacing were both significantly shorter in the Kangaroo Mother Care group (n=38) than the incubator group (n=37) from the blood collection phase to recovery phase during repeated heel sticks. No significant within-group difference was found in heart rate between the baseline phase and recovery phase through repeated heel sticks for Kangaroo Mother Care group. In contrast, the incubator group experienced significant within group differences in heart rate between baseline and recovery through repeated heel sticks. CONCLUSION The effect of repeated Kangaroo Mother Care analgesia remains stable in preterm infants over repeated painful procedures. Given the many invasive procedures that are part of clinical care in preterm infants and most mothers preferred to provide comfort for their infants during painful procedures, Kangaroo Mother Care may be a safe analgesic alternative in preterm infants in whom it is feasible.
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Affiliation(s)
- Haixia Gao
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.
| | - Honglian Gao
- Binzhou Medical University Hospital, Binzhou, China
| | - Rongzhi Dong
- Binzhou Medical University Hospital, Binzhou, China
| | - Hongjie Fu
- Binzhou Medical University Hospital, Binzhou, China
| | - Danwen Wang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Heng Zhang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hua Zhang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
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Finlayson K, Dixon A, Smith C, Dykes F, Flacking R. Mothers’ perceptions of family centred care in neonatal intensive care units. SEXUAL & REPRODUCTIVE HEALTHCARE 2014; 5:119-24. [DOI: 10.1016/j.srhc.2014.06.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 05/19/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
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Badiee Z, Nassiri Z, Armanian A. Cobedding of twin premature infants: calming effects on pain responses. Pediatr Neonatol 2014; 55:262-8. [PMID: 24694748 DOI: 10.1016/j.pedneo.2013.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 11/14/2013] [Accepted: 11/26/2013] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The purpose of this trial was to determine whether cobedding of preterm twins has analgesic effects during heel lancing or not. METHODS One hundred premature twins (50 sets) born between 26 weeks' and 34 weeks' gestation undergoing heel blood sampling were randomly assigned into two groups: the cobedding group (receiving care in the same incubator) and the standard care group (receiving care in separate incubators). Pain was assessed using the premature infant pain profile score. Duration of crying was measured after heel blood sampling, and salivary cortisol was measured prior to and after heel blood sampling. RESULTS Infants in the standard care group cried for a longer time during heel lancing than those in the cobedding group (42.6 ± 19.8 seconds vs. 36.4 ± 21.7 seconds, p = 0.03). The mean premature infant pain profile score after heel lancing was significantly higher in the standard care group (9.8 ± 2.6 vs. 8.06 ± 2.8, p = 0.002). The mean salivary cortisol after heel lancing was also significantly higher in the standard care group (24.3 ± 7.4 nmol/L vs. 20.8 ± 7.4 nmol/L, p = 0.02). No significant adverse effects were seen with cobedding. CONCLUSION Cobedding is a comforting measure for twin premature infants during heel lancing, which can be performed without any significant adverse effects.
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Affiliation(s)
- Zohreh Badiee
- Department of Pediatrics, School of Medicine, and Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Zohreh Nassiri
- Department of Pediatrics, School of Medicine, and Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Amirmohammad Armanian
- Department of Pediatrics, School of Medicine, and Child Growth and Development Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manag 2014; 18:153-61. [PMID: 23748256 DOI: 10.1155/2013/956549] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sucrose has been demonstrated to provide analgesia for minor painful procedures in infants. However, results of trials investigating other sweet solutions for neonatal pain relief have not yet been synthesized. OBJECTIVE To establish the efficacy of nonsucrose sweet-tasting solutions for pain relief during painful procedures in neonates. METHOD The present article is a systematic review and meta-analyses of the literature. Standard methods of the Cochrane Neonatal Collaborative Review Group were used. Literature searches were reviewed for randomized controlled trials investigating the use of sweet solutions, except sucrose, for procedural pain management in neonates. Outcomes assessed included validated pain measures and behavioural and physiological indicators. RESULTS Thirty-eight studies (3785 neonates) were included, 35 of which investigated glucose. Heel lancing was performed in 21⁄38 studies and venipuncture in 11⁄38 studies. A 3.6-point reduction in Premature Infant Pain Profile scores during heel lances was observed in studies comparing 20% to 30% glucose with no intervention (two studies, 124 neonates; mean difference -3.6 [95% CI -4.6 to -2.6]; P<0.001; I2=54%). A significant reduction in the incidence of cry after venipuncture for infants receiving 25% to 30% glucose versus water or no intervention was observed (three studies, 130 infants; risk difference -0.18 [95% CI -0.31 to -0.05]; P=0.008, number needed to treat = 6 [95% CI 3 to 20]; I2=63%). CONCLUSIONS The present systematic review and meta-analyses demonstrate that glucose reduces pain scores and crying during single heel lances and venipunctures. Results indicate that 20% to 30% glucose solutions have analgesic effects and can be recommended as an alternative to sucrose for procedural pain reduction in healthy term and preterm neonates.
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Johnston C, Campbell-Yeo M, Fernandes A, Inglis D, Streiner D, Zee R. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev 2014:CD008435. [PMID: 24459000 DOI: 10.1002/14651858.cd008435.pub2] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Skin-to-skin care (SSC), otherwise known as Kangaroo Care (KC) due to its similarity with marsupial behaviour of ventral maternal-infant contact, is one non-pharmacological intervention for pain control in infants. OBJECTIVES The primary objectives were to determine the effect of SSC alone on pain from medical or nursing procedures in neonates undergoing painful procedures compared to no intervention, sucrose or other analgesics, or additions to simple SSC such as rocking; and the effects of the amount of SSC (duration in minutes) and the method of administration (who provided the SSC, positioning of caregiver and neonate pair).The secondary objectives were to determine the incidence of untoward effects of SSC and to compare the SSC effect in different postmenstrual age subgroups of infants. SEARCH METHODS The standard methods of the Cochrane Neonatal Collaborative Review Group were used. Databases searched in August 2011: Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library); Evidence-Based Medicine Reviews; MEDLINE (1950 onwards); PubMed (1975 onwards); EMBASE (1974 onwards); CINAHL (1982 onwards); Web of Science (1980 onwards); LILACS database (1982 onwards); SCIELO database (1982 onwards); PsycInfo (1980 onwards); AMED (1985 onwards); Dissertation-Abstracts International (1980 onwards). Searches were conducted throughout September 2012. SELECTION CRITERIA Studies with randomisation or quasi-randomisation, double or single-blinded, involving term infants (> 37 completed weeks postmenstrual age (PMA)) to a maximum of 44 weeks PMA and preterm infants (< 37 completed weeks PMA) receiving SSC for painful procedures conducted by doctors, nurses, or other healthcare professionals. DATA COLLECTION AND ANALYSIS The main outcome measures were physiological or behavioural pain indicators and composite pain scores. A weighted mean difference (WMD) with 95% confidence interval (CI) using a fixed-effect model was reported for continuous outcome measures. We included variations on type of tissue-damaging procedure, provider of care, and duration of SSC. MAIN RESULTS Nineteen studies (n = 1594 infants) were included. Fifteen studies (n = 744) used heel lance as the painful procedure, one study combined venepuncture and heel stick (n = 50), two used intramuscular injection, and one used 'vaccination' (n = 80). The studies that were included were generally strong and free from bias.Eleven studies (n = 1363) compared SSC alone to a no-treatment control. Although 11 studies measured heart rate during painful procedures, data from only four studies (n = 121) could be combined to give a mean difference (MD) of 0.35 beats per minute (95% CI -6.01 to 6.71). Three other studies that were not included in meta-analyses also reported no difference in heart rate after the painful procedure. Two studies reported heart rate variability outcomes and found no significant differences. Five studies used the Premature Infant Pain Profile (PIPP) as a primary outcome, which favoured SCC at 30 seconds (n = 268) (MD -3.21, 95% CI -3.94 to -2.48), 60 seconds (n = 164) (MD -1.85, 95% CI -3.03 to -0.68), and 90 seconds (n = 163) (MD -1.34, 95% CI -2.56 to -0.13), but at 120 seconds (n = 157) there was no difference. No studies provided findings on return of heart rate to baseline level, oxygen saturation, cortisol levels, duration of crying, and facial actions that could be combined for analysis.Eight studies compared SSC to another intervention with or without a no-treatment control. Two cross-over studies (n = 80) compared mother versus other provider on PIPP scores at 30, 60, 90, and 120 seconds with no significant difference. When SSC was compared to other interventions, there were not enough similar studies to pool results in an analysis. One study compared SSC with and without dextrose and found that the combination was most effective and that SSC alone was more effective than dextrose alone. Similarly, in another study SSC was more effective than oral glucose for heart rate but not oxygen saturation. SSC either in combination with breastfeeding or alone was favoured over a no-treatment control, but was not different to breastfeeding. There were not enough participants with similar outcomes and painful procedures to compare age groups or duration of SSC. No adverse events were reported in any of the studies. AUTHORS' CONCLUSIONS SSC appears to be effective, as measured by composite pain indicators and including both physiological and behavioural indicators, and safe for a single painful procedure such as a heel lance. Purely behavioural indicators tended to favour SSC but there remains questionable bias regarding behavioural indicators. Physiological indicators were typically not different between conditions. Only two studies compared mother providers to others, with non-significant results. There was more heterogeneity in the studies with behavioural or composite outcomes. There is a need for replication studies that use similar, clearly defined outcomes. New studies examining optimal duration of SSC, gestational age groups, repeated use, and long-term effects of SSC are needed.
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Affiliation(s)
- Celeste Johnston
- Ingram School of Nursing, McGill University, Quebec, Canada, H3A 2T5
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Yamamoto RT, Foulds-Mathes W, Kanarek RB. Antinociceptive actions of peripheral glucose administration. Pharmacol Biochem Behav 2013; 117:34-9. [PMID: 24333388 DOI: 10.1016/j.pbb.2013.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 11/22/2013] [Accepted: 12/02/2013] [Indexed: 11/29/2022]
Abstract
The effects of intraperitoneal (ip) D-glucose administration on antinociception were studied in male Long-Evans rats. Rats were assessed for antinociception using the hot-water tail-withdrawal procedure (54±0.2 °C) to determine if peripheral administration of D-glucose (300, 560, or 720 mg/kg) would enhance morphine-mediated antinociception (MMA) (1.0, 3.0, 4.2, 5.6, and 10.0mg/kg cumulative-dosing regime) and if D-glucose (560, 720, or 1000 mg/kg) alone could produce antinociceptive activity that was naloxone (0.32 mg/kg) reversible. Additionally, the actions of D-glucose on MMA were compared with a stereoisomer, L-glucose, which is not metabolized. The results of these studies demonstrate that peripheral administration of D-glucose significantly enhances MMA and that D-glucose alone produces antinociceptive actions that are potentially mediated by the endogenous opioid system. Furthermore, L-glucose failed to have an effect on MMA suggesting that the alterations in antinociception seen with D-glucose are not due to stressors such as osmolality or injection. The current studies provide evidence that D-glucose alteration of antinociception is not simply a response to taste or gustation.
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Affiliation(s)
- Rinah T Yamamoto
- Department of Psychology, Tufts University, Medford, MA 02155,USA.
| | | | - Robin B Kanarek
- Department of Psychology, Tufts University, Medford, MA 02155,USA
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Campbell-Yeo M, Johnston C, Benoit B, Latimer M, Vincer M, Walker CD, Streiner D, Inglis D, Caddell K. Trial of repeated analgesia with Kangaroo Mother Care (TRAKC Trial). BMC Pediatr 2013; 13:182. [PMID: 24284002 PMCID: PMC3828622 DOI: 10.1186/1471-2431-13-182] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 10/09/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin-to-skin contact (SSC) between mother and infant, commonly referred to as Kangaroo Mother Care (KMC), is recommended as an intervention for procedural pain. Evidence demonstrates its consistent efficacy in reducing pain for a single painful procedure. The purpose of this study is to examine the sustained efficacy of KMC, provided during all routine painful procedures for the duration of Neonatal Intensive Care Unit (NICU) hospitalization, in diminishing behavioral pain response in preterm neonates. The efficacy of KMC alone will be compared to standard care of 24% oral sucrose, as well as the combination of KMC and 24% oral sucrose. METHODS/DESIGN Infants admitted to the NICU who are less than 36 6/7 weeks gestational age (according to early ultrasound), that are stable enough to be held in KMC, will be considered eligible (N = 258). Using a single-blinded randomized parallel group design, participants will be assigned to one of three possible interventions: 1) KMC, 2) combined KMC and sucrose, and 3) sucrose alone, when they undergo any routine painful procedure (heel lance, venipuncture, intravenous, oro/nasogastric insertion). The primary outcome is infant's pain intensity, which will be assessed using the Premature Infant Pain Profile (PIPP). The secondary outcome will be maturity of neurobehavioral functioning, as measured by the Neurobehavioral Assessment of the Preterm Infant (NAPI). Gestational age, cumulative exposure to KMC provided during non-pain contexts, and maternal cortisol levels will be considered in the analysis. Clinical feasibility will be accounted for from nurse and maternal questionnaires. DISCUSSION This will be the first study to examine the repeated use of KMC for managing procedural pain in preterm neonates. It is also the first to compare KMC to sucrose, or the interventions in combination, across time. Based on the theoretical framework of the brain opioid theory of attachment, it is expected that KMC will be a preferred standard of care. However, current pain management guidelines are based on minimal data on repeated use of either intervention. Therefore, regardless of the outcomes of this study, results will have important implications for guidelines and practices related to management of procedural pain in preterm infants. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01561547.
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Gerull R, Cignacco E, Stoffel L, Sellam G, Nelle M. Physiological parameters after nonpharmacological analgesia in preterm infants: a randomized trial. Acta Paediatr 2013; 102:e368-73. [PMID: 23651076 DOI: 10.1111/apa.12288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 04/28/2013] [Accepted: 05/02/2013] [Indexed: 11/30/2022]
Abstract
AIM To compare the influence of three different nonpharmacological interventions on cortical activation, heart rate and peripheral oxygen saturation (SaO2 ) after heelstick in preterm infants. METHODS Twenty five preterm infants between 24 0/7 and 32 0/7 weeks of gestational age were randomized to either oral sucrose (S), facilitated tucking (FT) or a combination of the two interventions (SFT) prior to five heelsticks each within the first 14 days of life. SaO2 , heart rate and oxygenation of the somatosensory cortex, measured by near infrared spectroscopy (NIRS), were analysed. RESULTS Hundred and twenty five heelsticks were performed. The heart rate increased significantly after heelstick in all three intervention groups (p < 0.004 in all groups). The increase was higher in the FT group compared with the other groups (S: p = 0.007; SFT: p = 0.004). There was no difference among the two groups receiving sucrose (S and SFT; p = 0.87). SaO2 did not change significantly after heelstick in all intervention groups. Near infrared spectroscopy measurements did not show a significant change in the curve but patients in the FT group showed a trend towards higher average oxygenation of the contralateral somatosensory cortex. CONCLUSION Oral sucrose seems to be more effective in reducing reaction to pain than FT. Application of both interventions did not show an additive effect.
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Affiliation(s)
- Roland Gerull
- Department of Pediatrics; Division of Neonatology; Inselspital and University of Berne; Berne Switzerland
| | - Eva Cignacco
- Medical Faculty; Institute of Nursing Science; University of Basel; Basel Switzerland
| | - Liliane Stoffel
- Department of Pediatrics; Division of Neonatology; Inselspital and University of Berne; Berne Switzerland
| | - Gila Sellam
- Medical Faculty; Institute of Nursing Science; University of Basel; Basel Switzerland
| | - Mathias Nelle
- Department of Pediatrics; Division of Neonatology; Inselspital and University of Berne; Berne Switzerland
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Abstract
This article presents the elements of the Intervention section of the Infant Care Path for Physical Therapy in the Neonatal Intensive Care Unit (NICU). The types of physical therapy interventions presented in this path are evidence-based and the suggested timing of these interventions is primarily based on practice knowledge from expert therapists, with supporting evidence cited. Physical therapy intervention in the NICU is infant-driven and focuses on providing family-centered care. In this context, interventions to facilitate a calm behavioral state and motor organization in the infant, address positioning and handling of the infant, and provide movement therapy are presented.
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Affiliation(s)
- Eilish Byrne
- Neonatal Intensive Care Unit, Lucile Packard Children's Hospital, Stanford University, Palo Alto, CA 94304, USA.
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Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ahola Kohut S, Hillgrove Stuart J, Stevens B, Gerwitz-Stern A. Cochrane Review: Non-pharmacological management of infant and young child procedural pain. ACTA ACUST UNITED AC 2012. [DOI: 10.1002/ebch.1883] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Abstract
The use of oral sucrose has been the most extensively studied pain intervention in newborn care to date. More than 150 published studies relating to sweet-taste-induced calming and analgesia in human infants have been identified, of which 100 (65%) include sucrose. With only a few exceptions, sucrose, glucose, or other sweet solutions reduced pain responses during commonly performed painful procedures in diverse populations of infants up to 12 months of age. Sucrose has been widely recommended for routine use during painful procedures in newborn and young infants, yet these recommendations have not been translated into consistent use in clinical practice. One reason may be related to important knowledge and research gaps concerning analgesic effects of sucrose. Notably, the mechanism of sweet-taste-induced analgesia is still not precisely understood, which has implications for using research evidence in practice. The aim of this article is to review what is known about the mechanisms of sucrose-induced analgesia; highlight existing evidence, knowledge gaps, and current controversies; and provide directions for future research and practice.
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Affiliation(s)
- Denise Harrison
- Centre for Practice Changing Research, Children’s Hospital of Eastern Ontario, Ottawa, Canada.
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