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Sensorial saturation improves infants' procedure-related pain behaviour in the cardiac intensive care unit: A quasi-experimental study. Aust Crit Care 2023; 36:232-238. [PMID: 35183430 DOI: 10.1016/j.aucc.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 01/10/2022] [Accepted: 01/15/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Painful procedures are unavoidable when providing critical care to infants in intensive care units. These adverse experiences during infancy can lead to later hyperalgesia and poor neurodevelopmental outcomes. Thus, appropriate interventions are required to relieve infant pain during these procedures. OBJECTIVES This study evaluated the effectiveness of sensorial saturation in reducing pain for infants during jugular central venous catheter removal procedures in intensive care units. METHODS This study involved a quasi-experimental, repeated-measures design. Data were collected from participants sequentially recruited from April to June 2019 (control period) and July to September 2019 (experimental period). Participants included 78 infants younger than 1 year with congenital heart disease. The control group (n = 38) received a general nursing intervention using swaddling, a common child-care practice that consists of wrapping infants to restrict movements, whereas the experimental group (n = 40) received sensorial saturation using oral sugar, body massage, and verbal interaction. Infants' physiological reactions to procedural pain were measured by changes in heart rate, oxygen saturation, and respiratory rate. Infants' procedural pain and behavioural indicators were measured using the Modified Behavioural Pain Scale. Data were analysed using descriptive statistics, independent t-tests, χ2 tests, and repeated-measures analysis of variance. RESULTS Compared with the control group, the experimental group had lower heart rates (F = 53.15, p < .001), respiratory rates (F = 15.19, p < .001), and behavioural pain scores (F = 45.21, p < .001), both during and after the procedure. CONCLUSIONS Sensorial saturation can be used as a nursing intervention in infants. Given the many invasive procedures that are part of infant clinical care, sensorial saturation may be a safe analgesic alternative. The findings of this study could lead to the development of evidence-based clinical practice guidelines for the nonpharmacological management of acute pain in infants.
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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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Ren X, Li L, Lin S, Zhong C, Wang B. Effects of white noise on procedural pain-related cortical response and pain score in neonates: A randomized controlled trial. Int J Nurs Sci 2022; 9:269-277. [PMID: 35891905 PMCID: PMC9305016 DOI: 10.1016/j.ijnss.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 06/04/2022] [Accepted: 06/09/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives To evaluate the effects of white noise on pain-related cortical response, pain score, and behavioral and physiological parameters in neonates with procedural pain. Methods A double-blind, randomized controlled trial was conducted. Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB (experimental group) or 0 dB (control group) 2 min before radial artery blood sampling and continued until 5 min after needle withdrawal. Pain-related cortical response was measured by regional cerebral oxygen saturation (rScO2) monitored with near-infrared spectroscopy, and facial expressions and physiological parameters were recorded by two video cameras. Two assessors scored the Premature Infant Pain Profile-Revised (PIPP-R) independently when viewing the videos. Primary outcomes were pain score and rScO2 during arterial puncture and 5 min after needle withdrawal. Secondary outcomes were pulse oximetric oxygen saturation (SpO2) and heart rate (HR) during arterial puncture, and duration of painful expressions. The study was registered at the Chinese Clinical Trial Registry (ChiCTR2200055571). Results Sixty neonates (experimental group, n = 29; control group, n = 31) were included in the final analysis. The maximum PIPP-R score in the experimental and control groups was 12.00 (9.50, 13.00), 12.50 (10.50, 13.75), respectively (median difference −0.5, 95% CI −2.0 to 0.5), and minimum rScO2 was (61.22 ± 3.07)%, (61.32 ± 2.79)%, respectively (mean difference −0.325, 95% CI −1.382 to 0.732), without significant differences. During arterial puncture, the mean rScO2, HR, and SpO2 did not differ between groups. After needle withdrawal, the trends for rScO2, PIPP-R score, and facial expression returning to baseline were different between the two groups without statistical significance. Conclusion The white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score, behavioral and physiological parameters in neonates with procedural pain.
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Affiliation(s)
- Xuyan Ren
- Clinical Nursing Education & Research Section, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- School of Nursing, Southern Medical University, Guangzhou, China
| | - Li Li
- Clinical Nursing Education & Research Section, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Corresponding author.
| | - Siya Lin
- Clinical Nursing Education & Research Section, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Chunxia Zhong
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Bin Wang
- Department of Pediatrics, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Assessing Neonatal Pain with NIPS and COMFORT-B: Evaluation of NICU’s Staff Competences. Pain Res Manag 2022; 2022:8545372. [PMID: 35340544 PMCID: PMC8942671 DOI: 10.1155/2022/8545372] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/25/2022] [Accepted: 01/28/2022] [Indexed: 11/18/2022]
Abstract
Background Pain is considered “the 5th vital sign” that should be regularly assessed in the neonatal intensive care setting. Although over 40 pain assessment tools have been developed for neonates, their implementation in everyday practice is challenging. Epidemiological studies demonstrate that pain is still underassessed and undertreated in European NICUs. Purpose To evaluate the interrater and intrarater reliability of the NIPS and COMFORT-B scales among the tertiary NICU's staff members 4 years after their implementation in local pain guidelines with no prior dedicated training. Methods Physicians and nurses were invited to evaluate 5 video recordings of infants hospitalized in the intensive care settings, using the NIPS and COMFORT-B scales. The assessment took part twice at a 3-month interval. Interrater reliability was calculated for both scales using Kendall's W coefficient of concordance and Krippendorff's alpha coefficient. Cohen's kappa was used to assess intrarater reliability. Results 17 physicians and 19 nurses took part in the study. Interrater agreement for the COMFORT-B scale was above 0.8 for Kendall's W coefficient (p < .01) and above 0.667 for Krippendorff's alpha coefficient. Kendall's W coefficient for the NIPS scores ranged between 0.7 and 0.8 (p < .01). Krippendorff's alpha was above 0.667. Intrarater agreement for both the COMFORT-B and NIPS scales was 0.693 and 0.724, respectively. Conclusions Overall, the agreement between our staff members was moderately good for both scales. This is not enough to avoid inadequate pain assessment. More training is needed to improve NICU's staff competences in using pain scales.
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Bošković S, Ličen S. Identification of Neonatal Infant Pain Assessment Tools as a Possibility of Their Application in Clinical Practice in Croatia: An Integrative Literature Review. Pain Manag Nurs 2021; 22:674-680. [PMID: 33582010 DOI: 10.1016/j.pmn.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 12/09/2020] [Accepted: 01/09/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This article presents an integrative review of the literature with the aim of identifying instruments already in existence for measuring neonatal infant pain with a view to exploring possibilities of applying them in clinical practice in Croatia. DESIGN An integrative review. DATA SOURCES The databases searched included MEDLINE, Cinahl Cochrane Library, and Science Direct. The search was limited to available full-text articles in English published between 1990 and 2020. The studies were selected according to the PRISMA strategy and evaluated based on the methodologic framework proposed by Whittemore and Knafl. REVIEW/ANALYSIS METHODS The research identified 13 scales for assessing pain in neonatal infants, including 5 one-dimensional and 8 multidimensional scales that assess acute and prolonged pain in preterm and full-term infants. RESULTS Overall, the articles in this review confirm that pain is a multidimensional phenomenon and that professionals should consider other specific characteristics of the neonatal infant population while measuring pain. CONCLUSIONS Our review showed that various tools exist assessing pain in neonatal infants that could be used in clinical practice in Croatia. However, it is difficult to determine the most appropriate instrument at this stage, as the choice depends on various factors that still need to be considered. The decision on which pain scale to use or which is more appropriate should be based on further psychometric tests, its accuracy, and ease of use.
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Affiliation(s)
- Sandra Bošković
- Department of Health Care, University of Rijeka, Rijeka, Croatia
| | - Sabina Ličen
- Department of Nursing, University of Primorska, Izola, Slovenia.
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Affiliation(s)
- Carlo V Bellieni
- Pediatric Intensive Care Unit, University Hospital, Siena, Italy
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Avila‐Alvarez A, Pertega‐Diaz S, Vazquez Gomez L, Sucasas Alonso A, Romero Rey H, Eiriz Barbeito D, Cabana Vazquez M. Pain assessment during eye examination for retinopathy of prematurity screening: Skin conductance versus PIPP-R. Acta Paediatr 2020; 109:935-942. [PMID: 31630433 DOI: 10.1111/apa.15066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022]
Abstract
AIM To assess changes in skin conductance during retinopathy of prematurity screening and to study the correlation between the skin conductance and a validated pain scale. METHODS Prospective observational study. Fifty-three eye examinations were performed in 32 preterm infant candidates for retinopathy of prematurity screening. Outcome measures were changes in Premature Infant Pain Profile-Revised (PIPP-R) scale and number of skin conductance fluctuations. RESULTS There was a significant increase from baseline in the number of skin conductance fluctuations and PIPP-R during the procedure. The maximum value of number of skin conductance fluctuations was 0.64 ± 0.44 peaks/sec, and the maximum value of PIPP-R was 10.8 ± 3.3. A correlation between the skin conductance and PIPP-R was not found at any time during the eye examination. Repeated measures correlation analyses showed only a moderate positive correlation between PIPP-R and number of skin conductance fluctuation values. CONCLUSION There were significant changes in both PIPP-R and number of skin conductance fluctuations during retinopathy of prematurity screening, reaffirming that this procedure is painful and stressful. The number of skin conductance fluctuations and PIPP-R are not significantly correlated, which likely reflects that these parameters evaluate different but complementary aspects of neonatal pain responses.
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Affiliation(s)
- Alejandro Avila‐Alvarez
- Department of Neonatology Complexo Hospitalario Universitario de A Coruña A Coruña Spain
- A Coruña Biomedical Research Institute (INIBIC) A Coruña Spain
| | - Sonia Pertega‐Diaz
- A Coruña Biomedical Research Institute (INIBIC) A Coruña Spain
- Research Support Unit Complexo Hospitalario Universitario A Coruña A Coruña Spain
| | - Lorena Vazquez Gomez
- Department of Neonatology Complexo Hospitalario Universitario de A Coruña A Coruña Spain
| | - Andrea Sucasas Alonso
- Department of Neonatology Complexo Hospitalario Universitario de A Coruña A Coruña Spain
| | - Henar Romero Rey
- Department of Neonatology Complexo Hospitalario Universitario de A Coruña A Coruña Spain
| | - Dolores Eiriz Barbeito
- Department of Neonatology Complexo Hospitalario Universitario de A Coruña A Coruña Spain
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Abstract
Hospitalized newborn infants experience pain that can have negative short- and long-term consequences and thus should be prevented and treated. National and international guidelines state that adequate pain management requires valid pain assessment. Nociceptive signals cause a cascade of physical and behavioral reactions that alone or in combination can be observed and used to assess the presence and intensity of pain. Units that are caring for newborn infants must adopt sufficient pain assessment tools to cover the gestational ages and pain types that occurs in their setting. Pain assessment should be performed on a regular basis and any detection of pain should be acted on. Future research should focus on developing and validating pain assessment tools for specific situations.
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Affiliation(s)
- Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 85, Örebro, Sweden.
| | - Marsha Campbell-Yeo
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, S-701 85, Örebro, Sweden; School of Nursing, Faculty of Health, Departments of Pediatrics, Psychology & Neuroscience, Dalhousie University, 5850/5890 University Ave, Halifax, NS, B3K 6R8, Canada; Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada.
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Bellieni CV, Buonocore G. What we do in neonatal analgesia overshadows how we do it. Acta Paediatr 2018; 107:388-390. [PMID: 29059490 DOI: 10.1111/apa.14125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/24/2017] [Accepted: 10/17/2017] [Indexed: 11/27/2022]
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Collados-Gómez L, Camacho-Vicente V, González-Villalba M, Sanz-Prades G, Bellón-Vaquerizo B. Percepción del personal de enfermería sobre el manejo del dolor en neonatos. ENFERMERIA INTENSIVA 2018; 29:41-47. [DOI: 10.1016/j.enfi.2017.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/14/2017] [Accepted: 08/07/2017] [Indexed: 12/27/2022]
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Anand KJS, Eriksson M, Boyle EM, Avila-Alvarez A, Andersen RD, Sarafidis K, Polkki T, Matos C, Lago P, Papadouri T, Attard-Montalto S, Ilmoja ML, Simons S, Tameliene R, van Overmeire B, Berger A, Dobrzanska A, Schroth M, Bergqvist L, Courtois E, Rousseau J, Carbajal R. Assessment of continuous pain in newborns admitted to NICUs in 18 European countries. Acta Paediatr 2017; 106:1248-1259. [PMID: 28257153 DOI: 10.1111/apa.13810] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 02/06/2017] [Accepted: 02/21/2017] [Indexed: 12/25/2022]
Abstract
AIM Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown. METHODS A prospective cohort study in 243 neonatal intensive care units (NICUs) from 18 European countries recorded the frequency of pain assessments, use of mechanical ventilation, sedation, analgesia or neuromuscular blockade for each neonate for up to 28 days after NICU admission. RESULTS Only 2113 of 6648 (31.8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46.0%), noninvasive ventilation (NiV, 35.0%) and no ventilation (NoV, 20.1%) groups (p < 0.001). Daily assessments for continuous pain occurred in only 10.4% of all neonates (TrV: 14.0%, NiV: 10.7%, NoV: 7.6%; p < 0.001). More frequent assessments of continuous pain occurred in NICUs with pain guidelines, nursing champions and surgical admissions (all p < 0.01), and for newborns <32 weeks gestational age, those requiring ventilation, or opioids, sedatives-hypnotics, general anaesthetics (O-SH-GA) (all p < 0.001), or surgery (p = 0.028). Use of O-SH-GA drugs increased the odds for pain assessment in the TrV (OR:1.60, p < 0.001) and NiV groups (OR:1.40, p < 0.001). CONCLUSION Assessments of continuous pain occurred in less than one-third of NICU admissions and daily in only 10% of neonates. NICU clinical practices should consider including routine assessments of continuous pain in newborns.
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Affiliation(s)
- Kanwaljeet J. S. Anand
- Departments of Pediatrics, Anesthesiology, Perioperative & Pain Medicine; Stanford University School of Medicine; Stanford CA USA
| | - Mats Eriksson
- School of Health Sciences; Faculty of Medicine and Health; Örebro University; Örebro Sweden
| | - Elaine M. Boyle
- Department of Health Sciences; University of Leicester; Leicester UK
| | | | | | - Kosmas Sarafidis
- 1st Department of Neonatology; ‘Hippokrateion’ General Hospital; Aristotle University of Thessaloniki; Thessalokiki Greece
| | - Tarja Polkki
- Children and Women Department; Oulu University Hospital; Oulu Finland
| | | | - Paola Lago
- Department of Woman's and Child's Health; University of Padua; Padua Italy
| | - Thalia Papadouri
- Department of Paediatrics; Arch. Makarios III Hospital; Nicosia Cyprus
| | | | - Mari-Liis Ilmoja
- Department of Paediatrics; Tallinn Children's Hospital; Tallinn Estonia
| | - Sinno Simons
- Department of Pediatrics; Erasmus MC-Sophia Kinderziekenhuis; Rotterdam The Netherlands
| | - Rasa Tameliene
- Department of Neonatology; Kaunas Perinatal Center; Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Bart van Overmeire
- Cliniques Universitaires de Bruxelles; Erasme Hospital; Bruxelles Belgium
| | - Angelika Berger
- Department of Pediatrics and Adolescent Medicine; Medical University Vienna; Vienna Austria
| | - Anna Dobrzanska
- Department of Neonatology; Children's Memorial Health Institute Warsaw; Warszawa Poland
| | - Michael Schroth
- Department of Paediatrics; Cnopf'sche Kinderklinik; Nürnberg Children's Hospital; Nürenberg Germany
| | - Lena Bergqvist
- Department of Clinical Science, Intervention and Technology; Karolinska Institutet; Solna Sweden
| | - Emilie Courtois
- Urgences Pédiatriques; Hôpital Armand Trousseau; INSERM U1153; Université Pierre et Marie Curie Paris VI; Paris VI Paris France
| | - Jessica Rousseau
- Urgences Pédiatriques; Hôpital Armand Trousseau; INSERM U1153; Université Pierre et Marie Curie Paris VI; Paris VI Paris France
| | - Ricardo Carbajal
- Urgences Pédiatriques; Hôpital Armand Trousseau; INSERM U1153; Université Pierre et Marie Curie Paris VI; Paris VI Paris France
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