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Onuagu V, Gardner F, Soni A, Doheny KK. Autonomic measures identify stress, pain, and instability associated with retinopathy of prematurity ophthalmologic examinations. FRONTIERS IN PAIN RESEARCH 2022; 3:1032513. [PMID: 36483945 PMCID: PMC9722726 DOI: 10.3389/fpain.2022.1032513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/07/2022] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Retinopathy of prematurity (ROP) ophthalmologic examinations cause stress and pain. Infants' stress and pain can be measured non-invasively using skin conductance (SC) and high frequency heart rate variability (HF-HRV), reflecting sympathetic-mediated sweating and parasympathetic activity, respectively. OBJECTIVES To test the utility of SC to detect sympathetic activation during ROP examination, and the contribution of HF-HRV to predict stability post-examination. METHODS In this prospective, single center study, we measured SC continuously pre-, during, and post-examination, and HRV at 24 h pre-ROP examination. Clinical data included stability [apneas, bradycardias, and desaturations (A/B/Ds)], and interventions post-examination. RESULTS SC increased 56% above baseline during ROP examination (p = 0.001) and remained elevated post-examination (p = 0.02). Post-hoc analysis showed higher illness acuity, represented by need for respiratory support, was associated with lower HF-HRV at 24 h pre-ROP examination (p = 0.001). Linear regression indicated lower HF-HRV at 24 h pre-examination contributed to the need for higher intervention (i.e., stimulation to breathe, oxygen support) particularly among infants with higher illness acuity [F(1, 15) = 5.05, p = 0.04; β = -1.33, p = 0.04]. CONCLUSION ROP examination induced a 2-fold increase in sympathetic activation which remained above baseline in recovery. Also, we propose that the low parasympathetic tone associated with autonomic imbalance contributes to instability and need for higher intervention to assure stabilization with A/B/D events. Our findings provide insight into the underestimation of adverse events associated with ROP examination and identification of infants who may be more vulnerable to potential sequelae following ROP examinations.
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Affiliation(s)
- Vivian Onuagu
- Department of Neonatology, Mountain View Hospital Las Vegas, Las Vegas, NV, United States
| | - Fumiyuki Gardner
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
| | - Ajay Soni
- Department of Ophthalmology, Penn State College of Medicine, Hershey, PA, United States
| | - Kim K Doheny
- Department of Pediatrics, Penn State College of Medicine, Hershey, PA, United States
- Department of Neural and Behavioral Sciences, Penn State College of Medicine, Hershey, PA, United States
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Walas W, Halaba ZP, Szczapa T, Latka-Grot J, Maroszyńska I, Malinowska E, Rutkowska M, Kubiaczyk A, Wrońska M, Skrzypek M, De Jonckheere J, Jean-Noel M, Piotrowski A. Procedural Pain Assessment in Infants Without Analgosedation: Comparison of Newborn Infant Parasympathetic Evaluation and Skin Conductance Activity - A Pilot Study. Front Pediatr 2021; 9:746504. [PMID: 35087770 PMCID: PMC8787338 DOI: 10.3389/fped.2021.746504] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/30/2021] [Indexed: 01/24/2023] Open
Abstract
Objective: New technologies to measure pain responses, such as heart rate variability and skin conductance hold promise in the development of tools that can be reliable and quantifiable of detecting pain. The main objective of this study was to assess the capability of two monitors i.e., Newborn Infant Parasympathetic Evaluation (NIPE) and Skin Conductance Algesimeter for detecting procedural pain in non-anesthetized infants. Materials and Methods: Thirty-three non-anesthetized infants were enrolled to the study. To detect pain caused by heel stick, NIPE, and Skin Conductance monitors and behavioral pain scales were used. Three minutes before and just after heel stick, pain was evaluated by behavioral scales, and simultaneously over the whole period by NIPE and SCA. Results: A statistically significant decrease of NIPE Index and an increase of SCA values were found after the HS procedure. There were no statistically significant differences between the decrease in NIPEi values and the increase in PPS values between subgroups based on pain assessment by behavioral-scale scores. Conclusion: Both NIPE and SCA can be useful for detection of procedural pain and may constitue an additional valuable tool for better handling of pain among patients treated in NICUs. More studies on larger groups of patients are needed.
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Affiliation(s)
- Wojciech Walas
- Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Zenon P Halaba
- Department of Pediatrics, Institute of Medical Sciences, University of Opole, Opole, Poland
| | - Tomasz Szczapa
- Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Department of Neonatology, Poznań University of Medical Sciences, Poznań, Poland
| | - Julita Latka-Grot
- Neonatal Department, Children's Memorial Health Institute, Warszawa, Poland
| | - Iwona Maroszyńska
- Department of Intensive Care and Congenital Malformations of Newborns and Infants, Polish Mother's Memorial Hospital Research Institute, Łódz, Poland
| | - Ewelina Malinowska
- Department of Intensive Care and Congenital Malformations of Newborns and Infants, Polish Mother's Memorial Hospital Research Institute, Łódz, Poland
| | | | - Agata Kubiaczyk
- Neonatal Biophysical Monitoring and Cardiopulmonary Therapies Research Unit, Department of Neonatology, Poznań University of Medical Sciences, Poznań, Poland
| | - Monika Wrońska
- Department of Anaesthesiology and Intensive Care, Children's Memorial Health Institute, Warszawa, Poland
| | - Michał Skrzypek
- Department of Biostatistics, School of Public Health, Medical University of Silesia, Bytom, Poland
| | | | | | - Andrzej Piotrowski
- Department of Anaesthesiology and Intensive Care, Children's Memorial Health Institute, Warszawa, Poland
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Buekers J, Theunis J, De Boever P, Vaes AW, Koopman M, Janssen EV, Wouters EF, Spruit MA, Aerts JM. Wearable Finger Pulse Oximetry for Continuous Oxygen Saturation Measurements During Daily Home Routines of Patients With Chronic Obstructive Pulmonary Disease (COPD) Over One Week: Observational Study. JMIR Mhealth Uhealth 2019; 7:e12866. [PMID: 31199331 PMCID: PMC6594211 DOI: 10.2196/12866] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 04/16/2019] [Accepted: 04/27/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) patients can suffer from low blood oxygen concentrations. Peripheral blood oxygen saturation (SpO2), as assessed by pulse oximetry, is commonly measured during the day using a spot check, or continuously during one or two nights to estimate nocturnal desaturation. Sampling at this frequency may overlook natural fluctuations in SpO2. OBJECTIVE This study used wearable finger pulse oximeters to continuously measure SpO2 during daily home routines of COPD patients and assess natural SpO2 fluctuations. METHODS A total of 20 COPD patients wore a WristOx2 pulse oximeter for 1 week to collect continuous SpO2 measurements. A SenseWear Armband simultaneously collected actigraphy measurements to provide contextual information. SpO2 time series were preprocessed and data quality was assessed afterward. Mean SpO2, SpO2 SD, and cumulative time spent with SpO2 below 90% (CT90) were calculated for every (1) day, (2) day in rest, and (3) night to assess SpO2 fluctuations. RESULTS A high percentage of valid SpO2 data (daytime: 93.27%; nocturnal: 99.31%) could be obtained during a 7-day monitoring period, except during moderate-to-vigorous physical activity (MVPA) (67.86%). Mean nocturnal SpO2 (89.9%, SD 3.4) was lower than mean daytime SpO2 in rest (92.1%, SD 2.9; P<.001). On average, SpO2 in rest ranged over 10.8% (SD 4.4) within one day. Highly varying CT90 values between different nights led to 50% (10/20) of the included patients changing categories between desaturator and nondesaturator over the course of 1 week. CONCLUSIONS Continuous SpO2 measurements with wearable finger pulse oximeters identified significant SpO2 fluctuations between and within multiple days and nights of patients with COPD. Continuous SpO2 measurements during daily home routines of patients with COPD generally had high amounts of valid data, except for motion artifacts during MVPA. The identified fluctuations can have implications for telemonitoring applications that are based on daily SpO2 spot checks. CT90 values can vary greatly from night to night in patients with a nocturnal mean SpO2 around 90%, indicating that these patients cannot be consistently categorized as desaturators or nondesaturators. We recommend using wearable sensors for continuous SpO2 measurements over longer time periods to determine the clinical relevance of the identified SpO2 fluctuations.
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Affiliation(s)
- Joren Buekers
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
- Measure, Model & Manage Bioresponses, Department of Biosystems, KU Leuven, Leuven, Belgium
| | - Jan Theunis
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Patrick De Boever
- Health Unit, Flemish Institute for Technological Research (VITO), Mol, Belgium
- Centre for Environmental Sciences, Hasselt University, Diepenbeek, Belgium
| | - Anouk W Vaes
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO), Horn, Netherlands
| | - Maud Koopman
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO), Horn, Netherlands
| | - Eefje Vm Janssen
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO), Horn, Netherlands
| | - Emiel Fm Wouters
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO), Horn, Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Martijn A Spruit
- Department of Research and Education, Centre of Expertise for Chronic Organ Failure (CIRO), Horn, Netherlands
- Department of Respiratory Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
- Rehabilitation Research Center (REVAL), Biomedical Research Institute (BIOMED), Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
- School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jean-Marie Aerts
- Measure, Model & Manage Bioresponses, Department of Biosystems, KU Leuven, Leuven, Belgium
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Subramaniam SD, Doss B, Chanderasekar LD, Madhavan A, Rosary AM. Scope of physiological and behavioural pain assessment techniques in children - a review. Healthc Technol Lett 2018; 5:124-129. [PMID: 30155264 PMCID: PMC6103781 DOI: 10.1049/htl.2017.0108] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/10/2018] [Indexed: 12/26/2022] Open
Abstract
Pain is an unpleasant subjective experience. At present, clinicians are using self-report or pain scales to recognise and monitor pain in children. However, these techniques are not efficient to observe the pain in children having cognitive disorder and also require highly skilled observers to measure pain. Using these techniques it is also difficult to choose the analgesic drug dosages to the patients after surgery. Thus, this conceptual work explains the demand for automatic coding techniques to evaluate pain and also it documents some evidence of techniques that act as an alternative approach for objectively determining pain in children. In this review, some good indicators of pain in children are explained in detail; they are facial expressions from an RGB image, thermal image and also feature from well proven physiological signals such as electrocardiogram, skin conductance, body temperature, surgical pleth index, pupillary reflex dilation, analgesia nociception index, photoplethysmography, perfusion index etc.
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Affiliation(s)
| | - Brindha Doss
- Department of Biomedical Engineering, PSG College of Technology, Coimbatore 641004, India
| | | | - Aswini Madhavan
- Department of Biomedical Engineering, PSG College of Technology, Coimbatore 641004, India
| | - Antony Merlin Rosary
- Department of Electronics & Communication Engineering, PSG College of Technology, Coimbatore, 641004, India
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Hur H, Park H. Newborn Pain and Skin Reaction according to the Method of Removing the Eyepatch Used for Phototherapy. CHILD HEALTH NURSING RESEARCH 2018. [DOI: 10.4094/chnr.2018.24.1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Anand KJS. Defining pain in newborns: need for a uniform taxonomy? Acta Paediatr 2017; 106:1438-1444. [PMID: 28556311 PMCID: PMC5601230 DOI: 10.1111/apa.13936] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 05/15/2017] [Accepted: 05/24/2017] [Indexed: 12/18/2022]
Abstract
A framework for defining pain terms such as acute, persistent, prolonged or chronic pain to newborns was derived from the scientific literature on neonatal pain assessments, previous attempts to define chronic pain and the clinical and neurophysiological features of neonatal pain. This novel framework incorporates the temporal features, localising characteristics, and secondary effects of the pain experienced, as well as the behavioural and physiological response patterns of newborns. CONCLUSION Although not evidence-based, this framework provides an initial starting point for defining commonly used neonatal pain terms. It will require future revision/refinement based on the accumulating evidence for non-acute pain.
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Bhogal AS, Mani AR. Pattern Analysis of Oxygen Saturation Variability in Healthy Individuals: Entropy of Pulse Oximetry Signals Carries Information about Mean Oxygen Saturation. Front Physiol 2017; 8:555. [PMID: 28824451 PMCID: PMC5539125 DOI: 10.3389/fphys.2017.00555] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 07/17/2017] [Indexed: 11/13/2022] Open
Abstract
Pulse oximetry is routinely used for monitoring patients' oxygen saturation levels with little regard to the variability of this physiological variable. There are few published studies on oxygen saturation variability (OSV), with none describing the variability and its pattern in a healthy adult population. The aim of this study was to characterize the pattern of OSV using several parameters; the regularity (sample entropy analysis), the self-similarity [detrended fluctuation analysis (DFA)] and the complexity [multiscale entropy (MSE) analysis]. Secondly, to determine if there were any changes that occur with age. The study population consisted of 36 individuals. The “young” population consisted of 20 individuals [Mean (±1 SD) age = 21.0 (±1.36 years)] and the “old” population consisted of 16 individuals [Mean (±1 SD) age = 50.0 (±10.4 years)]. Through DFA analysis, OSV was shown to exhibit fractal-like patterns. The sample entropy revealed the variability to be more regular than heart rate variability and respiratory rate variability. There was also a significant inverse correlation between mean oxygen saturation and sample entropy in healthy individuals. Additionally, the MSE analysis described a complex fluctuation pattern, which was reduced with age (p < 0.05). These findings suggest partial “uncoupling” of the cardio-respiratory control system that occurs with aging. Overall, this study has characterized OSV using pre-existing tools. We have showed that entropy analysis of pulse oximetry signals carries information about body oxygenation. This may have the potential to be used in clinical practice to detect differences in diseased patient subsets.
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Affiliation(s)
- Amar S Bhogal
- UCL Division of Medicine, University College LondonLondon, United Kingdom
| | - Ali R Mani
- UCL Division of Medicine, University College LondonLondon, United Kingdom
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YAO DAN, DENG XINGQIANG, WANG MINGGUANG. Management of musculoskeletal dysfunction in infants. Exp Ther Med 2016; 11:2079-2082. [PMID: 27284288 PMCID: PMC4888006 DOI: 10.3892/etm.2016.3226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 04/04/2016] [Indexed: 12/31/2022] Open
Abstract
Excessive crying (or infant colic) is a common pain syndrome of infancy without any specific known aetiology or effective management. Many cases result in long-term poor sleep, behavioral problems and parental stress. The biomechanical aspects of this condition lack adequate investigation despite its strong link with assisted and/or difficult births. The present review focused on the current trends in the management of this mal-musculoskeletal health of infants associated with the condition of excessive crying. In addition, the risk factors associated with therapeutic procedures used to manage the above conditions were also discussed.
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Affiliation(s)
- DAN YAO
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - XINGQIANG DENG
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - MINGGUANG WANG
- Department of Neurology, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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Development of Cardiovascular Indices of Acute Pain Responding in Infants: A Systematic Review. Pain Res Manag 2016; 2016:8458696. [PMID: 27445630 PMCID: PMC4904608 DOI: 10.1155/2016/8458696] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 08/20/2015] [Indexed: 11/21/2022]
Abstract
Background. Cardiovascular indices of pain are pervasive in the hospital setting. However, no prospective research has examined the development of cardiac responses to acutely painful procedures in the first year of life. Objectives. Our main goal was to synthesize existing evidence regarding the development of cardiovascular responses to acutely painful medical procedures over the first year of life in preterm and term born infants. Methods. A systematic search retrieved 6994 articles to review against inclusion criteria. A total of 41 studies were included in the review. Results. In response to acutely painful procedures, most infants had an increase in mean heart rate (HR) that varied in magnitude both across and within gestational and postnatal ages. Research in the area of HR variability has been inconsistent, limiting conclusions. Conclusions. Longitudinal research is needed to further understand the inherent variability of cardiovascular pain responses across and within gestational and postnatal ages and the causes for the variability.
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