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Packheiser J, Hartmann H, Fredriksen K, Gazzola V, Keysers C, Michon F. A systematic review and multivariate meta-analysis of the physical and mental health benefits of touch interventions. Nat Hum Behav 2024; 8:1088-1107. [PMID: 38589702 PMCID: PMC11199149 DOI: 10.1038/s41562-024-01841-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 01/29/2024] [Indexed: 04/10/2024]
Abstract
Receiving touch is of critical importance, as many studies have shown that touch promotes mental and physical well-being. We conducted a pre-registered (PROSPERO: CRD42022304281) systematic review and multilevel meta-analysis encompassing 137 studies in the meta-analysis and 75 additional studies in the systematic review (n = 12,966 individuals, search via Google Scholar, PubMed and Web of Science until 1 October 2022) to identify critical factors moderating touch intervention efficacy. Included studies always featured a touch versus no touch control intervention with diverse health outcomes as dependent variables. Risk of bias was assessed via small study, randomization, sequencing, performance and attrition bias. Touch interventions were especially effective in regulating cortisol levels (Hedges' g = 0.78, 95% confidence interval (CI) 0.24 to 1.31) and increasing weight (0.65, 95% CI 0.37 to 0.94) in newborns as well as in reducing pain (0.69, 95% CI 0.48 to 0.89), feelings of depression (0.59, 95% CI 0.40 to 0.78) and state (0.64, 95% CI 0.44 to 0.84) or trait anxiety (0.59, 95% CI 0.40 to 0.77) for adults. Comparing touch interventions involving objects or robots resulted in similar physical (0.56, 95% CI 0.24 to 0.88 versus 0.51, 95% CI 0.38 to 0.64) but lower mental health benefits (0.34, 95% CI 0.19 to 0.49 versus 0.58, 95% CI 0.43 to 0.73). Adult clinical cohorts profited more strongly in mental health domains compared with healthy individuals (0.63, 95% CI 0.46 to 0.80 versus 0.37, 95% CI 0.20 to 0.55). We found no difference in health benefits in adults when comparing touch applied by a familiar person or a health care professional (0.51, 95% CI 0.29 to 0.73 versus 0.50, 95% CI 0.38 to 0.61), but parental touch was more beneficial in newborns (0.69, 95% CI 0.50 to 0.88 versus 0.39, 95% CI 0.18 to 0.61). Small but significant small study bias and the impossibility to blind experimental conditions need to be considered. Leveraging factors that influence touch intervention efficacy will help maximize the benefits of future interventions and focus research in this field.
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Affiliation(s)
- Julian Packheiser
- Social Neuroscience, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany.
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands.
| | - Helena Hartmann
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands
- Center for Translational and Behavioral Neuroscience, University Hospital Essen, Essen, Germany
- Clinical Neurosciences, Department for Neurology, University Hospital Essen, Essen, Germany
| | - Kelly Fredriksen
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands
| | - Valeria Gazzola
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands
| | - Christian Keysers
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands
| | - Frédéric Michon
- Social Brain Lab, Netherlands Institute for Neuroscience, Royal Netherlands Academy of Art and Sciences, Amsterdam, the Netherlands
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Weng Y, Zhang J, Chen Z. Effect of non-pharmacological interventions on pain in preterm infants in the neonatal intensive care unit: a network meta-analysis of randomized controlled trials. BMC Pediatr 2024; 24:9. [PMID: 38172771 PMCID: PMC10765718 DOI: 10.1186/s12887-023-04488-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 12/14/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE To evaluate the effectiveness of different non-pharmacological interventions for pain management in preterm infants and provide high-quality clinical evidence. METHODS Randomized controlled trials (RCTs) of various non-pharmacological interventions for pain management in preterm infants were searched from PubMed, Web of Science, Embase, and the Cochrane Library from 2000 to the present (updated March 2023). The primary outcome was pain score reported as standardized mean difference (SMD). The secondary outcomes were oxygen saturation and heart rate reported as the same form. RESULTS Thirty five RCTs of 2134 preterm infants were included in the meta-analysis, involving 6 interventions: olfactory stimulation, combined oral sucrose and non-nutritive sucking (OS + NNS), facilitated tucking, auditory intervention, tactile relief, and mixed intervention. Based on moderate-quality evidence, OS + NNS (OR: 3.92, 95% CI: 1.72, 6.15, SUCRA score: 0.73), facilitated tucking (OR: 2.51, 95% CI: 1.15, 3.90, SUCRA score: 0.29), auditory intervention (OR: 2.48, 95% CI: 0.91, 4.10, SUCRA score: 0.27), olfactory stimulation (OR: 1.80, 95% CI: 0.51, 3.14, SUCRA score: 0.25), and mixed intervention (OR: 2.26, 95% CI: 0.10, 4.38, SUCRA score: 0.14) were all superior to the control group for pain relief. For oxygen saturation, facilitated tucking (OR: 1.94, 95% CI: 0.66, 3.35, SUCRA score: 0.64) and auditory intervention (OR: 1.04, 95% CI: 0.22, 2.04, SUCRA score: 0.36) were superior to the control. For heart rate, none of the comparisons between the various interventions were statistically significant. CONCLUSION This study showed that there are notable variations in the effectiveness of different non-pharmacological interventions in terms of pain scores and oxygen saturation. However, there was no evidence of any improvement in heart rate.
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Affiliation(s)
- Yuwei Weng
- Medical School of Nantong University, Nantong, 226001, China
| | - Jie Zhang
- Medical School of Nantong University, Nantong, 226001, China
| | - Zhifang Chen
- Obstetrical Department, Affiliated Maternity and Child Health Care Hospital of Nantong University, Nantong, 226001, China.
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Zubi ZBH, Abdullah AFB, Helmi MABM, Hasan TH, Ramli N, Ali AAABM, Mohamed MAS. Indications, Measurements, and Complications of Ten Essential Neonatal Procedures. Int J Pediatr 2023; 2023:3241607. [PMID: 37705709 PMCID: PMC10497369 DOI: 10.1155/2023/3241607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/11/2023] [Accepted: 07/21/2023] [Indexed: 09/15/2023] Open
Abstract
About 10% of newborns require some degree of assistance to begin their breathing, and 1% necessitates extensive resuscitation. Sick neonates are exposed to a number of invasive life-saving procedures as part of their management, either for investigation or for treatment. In order to support the neonates with the maximum possible benefits and reduce iatrogenic morbidity, health-care providers performing these procedures must be familiar with their indications, measurements, and potential complications. Hence, the aim of this review is to summarise ten of the main neonatal intensive care procedures with highlighting of their indications, measurements, and complications. They include the umbilical venous and arterial catheterizations and the intraosseous line which represent the principal postnatal emergency vascular accesses; the peripherally inserted central catheter for long-term venous access; the endotracheal tube and laryngeal mask airway for airway control and ventilation; chest tube for drainage of air and fluid from the thorax; and the nasogastric/orogastric tube for enteral feeding. Furthermore, lumber puncture and heel stick were included in this review as very important and frequently performed diagnostic procedures in the neonatal intensive care unit.
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Affiliation(s)
- Zainab Bubakr Hamad Zubi
- Department of Paediatrics, Sultan Ahmad Shah Medical Centre, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Ahmad Fadzil Bin Abdullah
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Muhd Alwi Bin Muhd Helmi
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Taufiq Hidayat Hasan
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Noraida Ramli
- Department of Paediatrics, School of Medical Sciences, University Sains Malaysia, 16150 Kubang Kerian, Kelantan, Malaysia
| | | | - Mossad Abdelhak Shaban Mohamed
- Department of Paediatrics, Kulliyyah of Medicine, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
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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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Us MC, Saran MG, Cebeci B, Akkuş E, Şeker E, Aybar ŞSŞ. A Randomized Comparative Effectiveness Study of Reflexology, Sucrose, and Other Treatments for Needle Procedures in Newborns. Pediatr Neurol 2023; 140:78-85. [PMID: 36608413 DOI: 10.1016/j.pediatrneurol.2022.11.019] [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] [Received: 03/07/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately 10 to 14 painful procedures per day are performed in infants during the hospital stay. We aimed to determine the effect of reflexology applied to the sole during painful procedures on pain perception in newborns compared with other nonpharmacologic methods. METHODS Our study was planned as a randomized controlled trial in term infants being followed up in the neonatal intensive care unit and maternity ward. To reduce pain during collection of venous blood or heel lance reflexology on the soles of the foot, 24% sucrose solution, kangaroo care, and classical music listening were applied to the infants. The Neonatal Infant Pain Scale (NIPS) was used to assess newborns during acute pain. RESULTS A total of 300 patients were enrolled in the study. Higher pain scores and crying times were observed during heel blood collection. All analgesic methods significantly reduced NIPS scores during heel blood collection. Sucrose was the most effective method, followed by reflexology. The best method that significantly shortened the crying time was again sucrose solution followed by reflexology, kangaroo care, and classical music, during heel blood collection. However, none of the nonpharmacologic methods was effective during venous blood collection. CONCLUSIONS Although sucrose was the most effective method, reflexology has significant positive effects, especially on average heartbeat, reducing pain, and shortening crying times during heel blood sampling. Reflexology might be considered among the nonpharmacologic methods to be applied before routine interventions, but still, there is a need for further studies to investigate the efficiency.
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Affiliation(s)
- Mahmut Caner Us
- Division of Social Pediatrics, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey; Department of Pediatrics, Haseki Training and Research Hospital, Istanbul, Turkey.
| | - Mine Güneş Saran
- Maternity Ward, Esenler Maternity and Child Health Hospital Istanbul, Istanbul, Turkey
| | - Burcu Cebeci
- Department of Neonatology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Erkan Akkuş
- Department of Pediatrics, Esenler Maternity and Child Health Hospital Istanbul, Istanbul, Turkey
| | - Esma Şeker
- Neonatal Intensive Care Unit, Esenler Maternity, and Child Health Hospital Istanbul, Turkey
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The effect of swaddling method applied to preterm infants during the aspiration procedure on pain. J Pediatr Nurs 2023; 70:61-67. [PMID: 36801626 DOI: 10.1016/j.pedn.2022.05.025] [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: 12/26/2021] [Revised: 05/10/2022] [Accepted: 05/27/2022] [Indexed: 02/19/2023]
Abstract
PURPOSE The study was carried out to determine the effect of the swaddling method on pain in preterm infants (between 27 and 36 weeks) hospitalized in the Neonatal Intensive Care Unit during the aspiration procedure. Preterm infants were recruited by convenience sampling from level III neonatal intensive care units in a city in Turkey. METHOD The study was conducted in a randomized controlled trial manner. The study consisted of preterm infants (n = 70) receiving care or treatment at a neonatal intensive care unit. While swaddling was applied to the infants in the experimental group before the aspiration process. The pain was assessed before, during, and after the nasal aspiration using the Premature Infant Pain Profile. RESULTS No significant difference was found in terms of pre-procedural pain scores whereas a statistically significant difference was detected in terms of pain scores during and after the procedure between the groups. CONCLUSION It was determined in the study that the swaddling method reduced the pain of the preterm infants during the aspiration procedure. IMPLICATIONS FOR PRACTICE This study emphasized that swaddling had pain-reducing during the aspiration procedure in the neonatal intensive care unit in preterm infants. It is recommended that future studies be conducted using different invasive procedures in preterm infants born earlier.
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Küçüktepe A, Canbulat Şahiner N. The effect of regional massage performed before blood collection on pain and vital signs in newborns. J Paediatr Child Health 2023; 59:660-666. [PMID: 36755524 DOI: 10.1111/jpc.16368] [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: 06/01/2022] [Revised: 09/12/2022] [Accepted: 01/25/2023] [Indexed: 02/10/2023]
Abstract
AIM This randomised-controlled trial aims to examine the effect of regional massage performed before blood collection on pain and vital signs in term newborns. METHODS The study sample consisted of a total of 96 term newborns, 49 in the experimental group and 47 in the control group, in the neonatal intensive care unit (NICU). Before the blood collection process, those in the experimental group received two (2) minutes of massage on their blood collection region, and their pain levels and vital signs were observed. Data were collected using a newborn information form, an intervention follow-up form, and the Neonatal Infant Pain Scale (NIPS). Statistical analyses of the collected data included descriptive statistics, Chi-squared test, independent-samples t test, paired-samples t test and Cohen's kappa statistic. A value of P < 0.05 was considered statistically significant. RESULTS While 51% (n = 49) of the newborns were included in the experimental group, 38.5% (n = 37) were born at the 38th gestational week. Their mean post-natal age was 4.82 ± 4.04 days. The newborns in the experimental and control groups had similar demographic characteristics and blood collection experiences, and there was no statistically significant difference between them (P > 0.05). The mean crying time in the control group (56.9 ± 25.4 s) was significantly longer than that in the experimental group (30.6 ± 29.3 s) (P < 0.05). The newborns in the experimental group had shorter crying times, lower pain levels and heart rate, and higher oxygen saturation than those in the control group. CONCLUSION The regional massage intervention reduced pain in term newborns. Therefore, neonatal nurses can be trained to use massage as an alternative infant care practice.
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Affiliation(s)
- Ayşe Küçüktepe
- Neonatal Intensive Care Unit, Karaman Training and Research Hospital, Karaman, Turkey
| | - Nejla Canbulat Şahiner
- Nursing Department, Karamanoglu Mehmetbey University Health Science Faculty, Karaman, Turkey
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Yildizdas HY, Erdem B, Karahan DY, Ozlu F, Sertdemir Y. Effect of whole body massage on pain scores of neonates during venous puncture and comparison with oral dextrose and Kangaroo care, a randomized controlled evaluator-blind clinical study. J Perinatol 2022; 43:590-594. [PMID: 36450853 DOI: 10.1038/s41372-022-01570-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/10/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Newborns in NICUs experience many painful procedures. The aim of the study was to evaluate the effect of whole body massage therapy on pain scores during venipuncture and to compare with oral 10% dextrose and Kangaroo care. STUDY DESIGN Newborns with gestational age ≥34 weeks were randomly enrolled to one of three groups: dextrose, massage and Kangaroo care and a blinded investigator scored the pain using NIPS before and during the procedure. RESULTS There were 25, 26 and 23 newborns in dextrose, massage and Kangaroo care groups, respectively. Pain scores were similar before and during venipuncture in groups (p > 0.05). 36.5% of newborns (27/74) had severe pain scores. Number of newborns with no pain (score 0-2), moderate pain (score 3-4) and severe pain (score 5-7) were similar in each group. CONCLUSION Massage, Kangaroo and oral 10% dextrose had similar effects on pain scores during venipuncture.
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Affiliation(s)
- Hacer Yapicioglu Yildizdas
- Department of Pediatrics, Division of Neonatology, Çukurova University, Faculty of Medicine, Adana, Turkey
| | - Buket Erdem
- Department of Pediatrics, Newborn Intensive Care Unit, Çukurova University, Faculty of Medicine, Adana, Turkey
| | - Duygu Yildiz Karahan
- Department of Pediatrics, Newborn Intensive Care Unit, Çukurova University, Faculty of Medicine, Adana, Turkey
| | - Ferda Ozlu
- Department of Pediatrics, Division of Neonatology, Çukurova University, Faculty of Medicine, Adana, Turkey.
| | - Yaşar Sertdemir
- Department of Biostatistics, Çukurova University, Faculty of Medicine, Adana, Turkey
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Nist MD, Robinson A, Harrison TM, Pickler RH. An integrative review of clinician-administered comforting touch interventions and acute stress responses of preterm infants. J Pediatr Nurs 2022; 67:e113-e122. [PMID: 36137912 DOI: 10.1016/j.pedn.2022.08.020] [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: 07/19/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022]
Abstract
PROBLEM Preterm infants experience numerous stressors in the neonatal intensive care unit. Non-pharmacological interventions, including maternal comforting touch, reduce stress responses of preterm infants; however, the effects of clinician-administered comforting touch are unclear. The purpose of this integrative review was to synthesize findings from clinical trials to determine the effect of clinician-administered comforting touch on preterm infants' acute stress responses. ELIGIBILITY CRITERIA Eligible clinical trials were published in English between 2001 and October 2021 and reported effects of clinician-administered comforting touch on acute stress responses in preterm infants. SAMPLE Thirty clinical trials were included. RESULTS Researchers tested the effect of comforting static touch, massage, massage with kinesthetic stimulation, sensorial saturation, and Yakson. There was significant heterogeneity in study design, comparison condition, and context of intervention delivery. Results varied; some studies demonstrated efficacy of comforting touch in reducing acute stress responses and others showed no effect. Generally, comforting touch provided during stressful procedures was associated with lower stress responses compared to standard care and was an effective adjunct to other stress management strategies. However, comforting touch alone was insufficient for managing pain, especially during skin-breaking procedures. CONCLUSIONS While comforting touch may be a useful part of stress management plans for preterm infants, additional research is needed to determine when comforting touch is appropriate and effective. IMPLICATIONS Comforting touch is beneficial to preterm infants and should be provided for stress management. For highly intrusive or painful procedures, comforting touch can be provided as part of a comprehensive stress management plan.
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Affiliation(s)
- Marliese Dion Nist
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Audrey Robinson
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Tondi M Harrison
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH 43210, USA.
| | - Rita H Pickler
- The Ohio State University College of Nursing, 1585 Neil Avenue, Columbus, OH 43210, USA.
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Liu J, Fang S, Wang Y, Gao L, Xin T, Liu Y. The effectiveness of massage interventions on procedural pain in neonates: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30939. [PMID: 36254036 PMCID: PMC9575769 DOI: 10.1097/md.0000000000030939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The painful procedures experienced by neonates during hospitalization have short-term or long-term effects on neonates. While the limitations of previous interventions make it imperative to explore effective interventions that are readily available. This systematic review and meta-analysis was conducted to evaluate the safety and effectiveness of massage for pain management in neonates. METHODS This systematic review was registered in PROSPER. PubMed, Embase, Cochrane Library, and the Clinical Trials Registry were searched to December 2021. Two reviewers independently carried out study selection, data extraction, bias risk assessment. Continuous data were analyzed by mean differences (MD). Dichotomous data were reported using relative risk. If at least two studies reported identical results by the same pain assessment tool, a meta-analysis was conducted using random effect model and inverse variance. RESULTS Total 11 included studies involving 755 neonates investigated the effects of massage on neonatal pain response compared to standard care. The meta-analysis showed that massage could effectively improve pain response in neonates compared to standard care no matter whether neonatal infant pain scale (NIPS) or premature infant pain profile (PIPP) was used as an assessment tool. Besides, massage was also effective for crying duration, blood oxygen saturation both during and after the procedure, but non-effective for the variation of respiratory rate after the procedure, and heart rate both during and after the procedure. CONCLUSIONS Massage may have a positive effect on pain relief of neonate, and rigorous trials are needed in the future to determine the most effective massage method.
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Affiliation(s)
- Jiang Liu
- School of Nursing, Weifang Medical University, Weifang, China
| | - Shirong Fang
- Weifang People’s Hospital, Weifang Medical University, Weifang, China
| | - Yuxia Wang
- Weifang Maternal and Child Health Hospital, Weifang, China
| | - Lunan Gao
- School of Nursing, Weifang Medical University, Weifang, China
| | - Tingting Xin
- School of Nursing, Weifang Medical University, Weifang, China
| | - Yuxiu Liu
- School of Nursing, Weifang Medical University, Weifang, China
- *Correspondence: Yuxiu Liu, School of Nursing, Weifang Medical University, No. 7166 Baotong Western Street, Weifang, China (e-mail: )
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11
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Cobo MM, Moultrie F, Hauck AGV, Crankshaw D, Monk V, Hartley C, Evans Fry R, Robinson S, van der Vaart M, Baxter L, Adams E, Poorun R, Bhatt A, Slater R. Multicentre, randomised controlled trial to investigate the effects of parental touch on relieving acute procedural pain in neonates (Petal). BMJ Open 2022; 12:e061841. [PMID: 36250332 PMCID: PMC9301810 DOI: 10.1136/bmjopen-2022-061841] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Newborn infants routinely undergo minor painful procedures as part of postnatal care, with infants born sick or premature requiring a greater number of procedures. As pain in early life can have long-term neurodevelopmental consequences and lead to parental anxiety and future avoidance of interventions, effective pain management is essential. Non-pharmacological comfort measures such as breastfeeding, swaddling and sweet solutions are inconsistently implemented and are not always practical or effective in reducing the transmission of noxious input to the brain. Stroking of the skin can activate C-tactile fibres and reduce pain, and therefore could provide a simple and safe parent-led intervention for the management of pain. The trial aim is to determine whether parental touch prior to a painful clinical procedure provides effective pain relief in neonates. METHODS AND ANALYSIS This is a multicentre randomised controlled trial. A total of 112 neonates born at 35 weeks' gestation or more requiring a blood test in the first week of life will be recruited and randomised to receive parental stroking either preprocedure or postprocedure. We will record brain activity (EEG), cardiac and respiratory dynamics, oxygen saturation and facial expression to provide proxy pain outcome measures. The primary outcome will be the reduction of noxious-evoked brain activity in response to a heel lance. Secondary outcomes will be a reduction in clinical pain scores (Premature Infant Pain Profile-Revised), postprocedural tachycardia and parental anxiety. ETHICS AND DISSEMINATION The study has been approved by the London-South East Research Ethics Committee (ref: 21/LO/0523). The results will be widely disseminated through peer-reviewed publications, international conferences and via our partner neonatal charities Bliss and Supporting the Sick Newborn And their Parents (SSNAP). If the parental tactile intervention is effective, recommendations will be submitted via the National Health Service clinical guideline adoption process. STUDY STATUS Commenced September 2021. TRIAL REGISTRATION NUMBER NCT04901611; 14 135 962.
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Affiliation(s)
- Maria M Cobo
- Department of Paediatrics, University of Oxford, Oxford, UK
- Colegio de Ciencias Biologicas y Ambientales, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Fiona Moultrie
- Department of Paediatrics, University of Oxford, Oxford, UK
| | | | | | - Vaneesha Monk
- Department of Paediatrics, University of Oxford, Oxford, UK
| | | | - Ria Evans Fry
- Department of Paediatrics, University of Oxford, Oxford, UK
| | | | | | - Luke Baxter
- Department of Paediatrics, University of Oxford, Oxford, UK
| | - Eleri Adams
- Newborn Care Unit, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Ravi Poorun
- Children's Services, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- College of Medicine & Health, University of Exeter, Exeter, UK
| | - Aomesh Bhatt
- Department of Paediatrics, University of Oxford, Oxford, UK
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12
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Mrljak R, Arnsteg Danielsson A, Hedov G, Garmy P. Effects of Infant Massage: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6378. [PMID: 35681968 PMCID: PMC9179989 DOI: 10.3390/ijerph19116378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 05/20/2022] [Accepted: 05/21/2022] [Indexed: 01/27/2023]
Abstract
Infant massage is performed in various international contexts. There is a need for an updated literature review on this topic. The purpose of the current review was to investigate the effects of infant massage. A systematic literature review was conducted to investigate the effects of infant massage on the following outcomes: pain relief, jaundice, and weight gain. The inclusion criteria were infants from 0-12 months. The literature search was performed until January 2022, using the CINAHL, PubMed, and PsycINFO databases, and included studies published from 2017-2021, returning 16 RCT/CCT studies with a total of 1416 participating infants. A review template was used by two independent reviewers to assess the risk of bias in the included studies. The results were synthesized and presented in the form of tables and narratives. In five of seven studies (n = 422 resp. n = 717) investigating pain relief, infant massage was found to alleviate pain. In all six studies (n = 455) investigating effects on infant massage and jaundice, beneficial effects were found on bilirubin levels. In all four studies (n = 244) investigating weight gain, increased weight gain was found among participants who received infant massage. The present literature review provides an indication of the current state of knowledge about infant massage and identifies its positive effects; however, the results must be interpreted with caution. Infant massage may be effective at relieving pain, improving jaundice, and increasing weight gain. Although statistically significant differences were not found between all experimental and control groups, no adverse effects of infant massage were observed. By placing the aforementioned effects in the context of child health care, infant massage may prove beneficial on these outcomes. Given the dearth of research on infant massage in the context of child health care, further research is warranted.
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Affiliation(s)
- Rebecca Mrljak
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (R.M.); (A.A.D.); (G.H.)
| | - Ann Arnsteg Danielsson
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (R.M.); (A.A.D.); (G.H.)
| | - Gerth Hedov
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (R.M.); (A.A.D.); (G.H.)
| | - Pernilla Garmy
- Faculty of Health Sciences, Kristianstad University, SE-291 88 Kristianstad, Sweden; (R.M.); (A.A.D.); (G.H.)
- Faculty of Medicine, Lund University, SE-221 85 Lund, Sweden
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13
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The Effect of Vibration on Pain During Heel Lance Procedures in Newborns: A Randomized Controlled Trial. Adv Neonatal Care 2022; 22:E43-E47. [PMID: 34334677 DOI: 10.1097/anc.0000000000000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/SIGNIFICANCE The pain-reducing effect of applying vibration, which is used as a nonpharmacological method in pain management, is explained by the gate control theory developed by Melzack and Wall. Studies that are based on this theory have shown similar results to those of Melzack and Wall, indicating that pain-transmitting nerves are suppressed by vibrations, leading to higher pain thresholds. PURPOSE The study aimed to evaluate the effect of applying vibration to manage pain during heel lance procedures in newborns. METHODS This is a randomized, controlled experimental study. The study sample included 56 newborns determined using power analysis (vibration group = 28; control group = 28). For those in the vibration group, a vibrating device was used for approximately 30 seconds before the heel lance procedure and then continued throughout the procedure. No interventions were provided to the newborns in the control group. Pain in the newborns was evaluated by the nurse who performed the heel lance procedures, before the procedures and 15 to 20 seconds and 5 minutes after procedures, and by 2 specialists who viewed the video footage and conducted the Neonatal Infant Pain Scale examination. RESULTS The pain scores were significantly lower at 15 to 20 seconds and 5 minutes after the heel lance procedures in the group that received vibrations than in the control group (P < .05). IMPLICATIONS FOR PRACTICE The application of vibration, which is effective, nonpharmacological, and noninvasive, could help nurses manage pain in newborns as a nonpharmacological method. IMPLICATIONS FOR RESEARCH The number of studies that examine the effect that vibration has on pain associated with heel lance procedures in newborns is very limited, and it is recommended that further studies be conducted with larger sample sizes.
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14
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Rana D, Garde K, Elabiad MT, Pourcyrous M. Whole body massage for newborns: A report on non-invasive methodology for neonatal opioid withdrawal syndrome. J Neonatal Perinatal Med 2022; 15:559-565. [PMID: 35599503 DOI: 10.3233/npm-220989] [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] [Indexed: 06/15/2023]
Abstract
BACKGROUND Infants with in-utero exposure to opioids are at risk Neonatal Opioid Withdrawal Syndrome (NOWS) and non-pharmacological methods of care, like swaddling, quiet ambient environment are routinely recommended but are not systematically studied. We hypothesized that opioid exposed infants can tolerate whole body massage while hospitalized. METHODS This is a prospective observational study (August 2017 to January 2019) and infants of mothers having a history of opioids use (OUD) were included. Infants received whole body massage for 30 minutes from birth till discharge home. Infants heart rate (HR), respiratory rate (RR), systolic (sBP) and diastolic blood pressure (dBP) were recorded prior to and at the end of massage session. RESULTS The pilot study enrolled 30 infants. The mean birth weight and gestational age were 38±1 weeks and 2868±523 grams, respectively. All massage sessions were well tolerated. There was marked decrease in HR, systolic and diastolic BP and RR, (p < 0.01) in all study infants post massage, more profound among infants with NOWS (p < 0.01) than without NOWS. CONCLUSIONS Whole body massage is very well tolerated by infants with in-utero opioid exposure. Infants with NOWS had marked decrease in their HR and BP from their baseline after massage.
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Affiliation(s)
- D Rana
- Departments of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - K Garde
- Department of Rehabilitation, Regional One Health, Memphis, TN, USA
| | - M T Elabiad
- Departments of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
| | - M Pourcyrous
- Departments of Pediatrics, University of Tennessee Health Science Center, Memphis, TN, USA
- Obstetrics & Gynecology, University of Tennessee Health Science Center, Memphis, TN, USA
- Physiology, University of Tennessee Health Science Center, Memphis, TN, USA
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15
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Costa TMDS, Oliveira EDS, Silva BVSD, Melo EBBD, Carvalho FOD, Duarte FHDS, Dantas RAN, Dantas DV. Massage for pain relief in newborns submitted to puncture: systematic review. Rev Gaucha Enferm 2022; 43:e20220029. [DOI: 10.1590/1983-1447.2022.20220029.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 05/16/2022] [Indexed: 11/30/2022] Open
Abstract
ABSTRACT Objective To analyze in the scientific literature the effects of massage on pain relief in newborns submitted to puncture. Method Systematic review with meta-analysis performed in October 2020, using PubMed, Web of Science, CINAHL, Scopus, Cochrane and Gale databases. Studies without time frame were included, which used massage as the main technique for relieving neonatal pain during puncture. Data were extracted using standardized forms and the synthesis of results occurred in a descriptive way. Results From the 12 studies included, massage was effective in pain relief in 83.3% of the studies. The comparative meta-analysis of massage versus routine care that assessed duration of crying obtained a statistically significant result (p = 0.0002; 95% CI -85.51 to -27.09). Conclusion Massage contributes to neonatal pain relief by reducing pain score and reducing crying time in newborns submitted to puncture.
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16
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Costa TMDS, Oliveira EDS, Silva BVSD, Melo EBBD, Carvalho FOD, Duarte FHDS, Dantas RAN, Dantas DV. Massagem para alívio da dor em recém-nascidos submetidos a punção: revisão sistemática. Rev Gaucha Enferm 2022. [DOI: 10.1590/1983-1447.2022.20220029.pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
RESUMO Objetivo Analisar na literatura científica os efeitos da massagem no alívio da dor em recém-nascidos submetidos a punção. Método Revisão sistemática com meta-análise realizada em outubro de 2020, utilizando as bases PubMed, Web of Science, CINAHL, Scopus, Cochrane e Gale. Incluíram-se estudos sem delimitação de recorte temporal, que utilizaram massagem como principal técnica para o alívio da dor neonatal durante a punção. Os dados foram extraídos através de formulários padronizados e a síntese dos resultados ocorreram de forma descritiva. Resultados Dos 12 estudos incluídos, a massagem foi eficaz no alívio da dor em 83,3% dos estudos. A meta-análise comparativa da massagem versus cuidados de rotina que avaliou duração do choro obteve resultado estatisticamente significativo (p = 0,0002; IC 95% -85,51 a -27,09). Conclusão A massagem contribui para o alívio da dor neonatal através da redução do escore de dor e redução do tempo de choro em recém-nascidos submetidos a punção.
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17
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Abdel Mageed AS, Olama KA, Abdel Rahman SA, El-Gazzar HE. The effect of sensory stimulation on apnea of prematurity. J Taibah Univ Med Sci 2021; 17:311-319. [PMID: 35592810 PMCID: PMC9073875 DOI: 10.1016/j.jtumed.2021.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/22/2021] [Accepted: 10/25/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives The study aims to assess the effect of sensory stimulation on apnoea among premature newborns. Methods Thirty preterm newborns that were diagnosed with apnoea of prematurity, had a gestational age between 32 and 34 weeks, had low birth weight, and were appropriate for gestational age from 1200 to 2000 g were included in this prospective randomized study. Subjects were divided into two equivalent groups: a control group that received the standard care including nasal oxygen (one litre per minute) and caffeine citrate, and a study group that received the same care plus sensory stimulation (tactile, proprioceptive, and kinaesthetic). Participants’ heart rate, oxygen saturation, and apnoea frequency were measured by the neonatal intensive care unit team using a pulse-oximeter. The sensory stimulation sessions were 10 min, 3 times per day, totalling 30 min over a 7 day period. Results There was a significant decrease in heart rate within both groups after receiving treatment from before treatment (p < 0.05), with no significant differences between the two groups. Furthermore, there was no significant difference in oxygen saturation within the groups after treatment compared with the levels before treatment, with no significant differences between the two groups (p > 0.05). Before treatment, there was a non-significant difference in the apnoea rate between both groups (p = 0.464), whereas there was a significant decrease in the apnoea rate of the study group after treatment compared with the control group (p = 0.031). Conclusion Sensory stimulation applied with standard respiratory care can decrease the frequency of apnoea of prematurity.
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18
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Fitri SYR, Nasution SK, Nurhidayah I, Maryam NNA. Massage therapy as a non-pharmacological analgesia for procedural pain in neonates: A scoping review. Complement Ther Med 2021; 59:102735. [PMID: 33974990 DOI: 10.1016/j.ctim.2021.102735] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 04/11/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Neonates who undergo painful medical procedures should be given analgesics to reduce future adverse risks. The evidence for massage therapy (MT) as an analgesic method still varies, both in its terminology and implementation. Only a few studies on this topic have been conducted using a standardised trial approach. This review can thus become the basis for better future research. OBJECTIVE This review aims to identify literature on MT practices as a method to manage or control pain in neonates undergoing painful procedures. METHODS The methodology for this review followed the JBI scoping review methodology guidelines. Searches were performed in several databases: MEDLINE (PubMed), CINAHL (EBSCO), Scopus (Elsevier) and EMBASE. Data collected were then extracted by two independent reviewers, synthesised and presented in the form of tables and narratives. RESULTS Fifteen studies involving a total of 1,058 neonates in nine countries were identified in the search as meeting the criteria set for this review. One study was a comparative study, five were quasi-experiment studies and nine were randomised control trials (RCT). CONCLUSION The implementation of massage as a non-pharmacological analgesic method for neonates undergoing painful procedures varied among the reviewed studies. Differences were identified in terms of the body part massaged, the duration and intensity of the massage, the level of pressure and the combination of massage with other methods. All studies presented positive results for reducing pain intensity in neonates undergoing procedural pain. Therefore, it is crucial that the method used for giving massage should be practical, accurate and safe.
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Affiliation(s)
| | | | - Ikeu Nurhidayah
- Faculty of Nursing, Universitas Padjadjaran Bandung, Indonesia
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19
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Yavaş S, Bülbül T, Topçu Gavas H. The effect on pain level and comfort of foot massages given by mothers to newborns before heel lancing: Double-blind randomized controlled study. Jpn J Nurs Sci 2021; 18:e12421. [PMID: 33880884 DOI: 10.1111/jjns.12421] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/19/2021] [Accepted: 03/11/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In addition to pharmacological methods, non-pharmacological methods can also be used for reducing pain and increasing comfort during invasive procedures in newborn babies. This study was conducted to determine the effect on pain level and comfort of foot massages given by mothers to newborns before heel lancing. METHODS This is a double-blind randomized controlled experimental study. The sample consisted of 128 newborns including 64 in the intervention group and 64 in the control group. The Newborn Infant Pain Scale (NIPS) and Newborn Comfort Behavior Scale (NCBS) were used to collect the data, along with questionnaires for information on the newborn and mother. The researcher explained to each mother in theory how to do a foot massage at least 2 h before the heel lancing procedure. Mothers then drew random assignments to either an intervention group that would give a foot massage for 3 min with baby oil, or a control group that simply waited 3 min, immediately prior to the lancing. RESULTS It was determined that the foot massage performed by the mother reduced the pain level of babies, increased their comfort levels, and decreased their distress levels. CONCLUSION Nurses play an active role in defining and evaluating the newborn's responses to pain. It is thought that this study will guide nurses working in the clinic in reducing the acute pain that develops with invasive interventions performed on newborns and in preventing the negative effects of pain on the newborn.
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Affiliation(s)
| | - Tülay Bülbül
- Faculty of Health Sciences, Department of Obstetrics and Gynecology Nursing, Erciyes University, Kayseri, Turkey
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20
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Bernstein K, Karkhaneh M, Zorzela L, Jou H, Vohra S. Massage therapy for paediatric procedural pain: A rapid review. Paediatr Child Health 2019; 26:e57-e66. [PMID: 33542780 DOI: 10.1093/pch/pxz133] [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: 01/25/2019] [Accepted: 09/13/2019] [Indexed: 11/14/2022] Open
Abstract
Background Pain is a common paediatric problem, and procedural pain, in particular, can be difficult to manage. Complementary therapies are often sought for pain management, including massage therapy (MT). We assessed the evidence for use of MT for acute procedural pain management in children. Methods We searched five main databases for (i) primary studies in English, (ii) included children 0 to 18 years of age, (iii) compared MT for procedural pain management to standard care alone or placebo, and (iv) measured pain as the primary or secondary outcome. The data were extracted by one author and verified by a second author. Randomized controlled trials were evaluated using the Cochrane Risk of Bias tool. Results Eleven paediatric trials of procedural pain in neonatal, burn, and oncology populations, a total of 771 participants, were identified. Eight reported statistically significant reductions in pain after MT compared to standard care. Pain was measured using validated pain scales, or physiologic indicators. The studies were heterogeneous in population, techniques, and outcome measures used. No adverse events associated with MT were identified. Conclusion MT may be an effective nonpharmacologic adjunct for management of procedural pain in children.
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Affiliation(s)
- Kylie Bernstein
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - Mohammad Karkhaneh
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - Liliane Zorzela
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - Hsing Jou
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
| | - Sunita Vohra
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta
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21
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Koç Özkan T, Şimşek Küçükkelepçe D, Aydin Özkan S. The effects of acupressure and foot massage on pain during heel lancing in neonates: A randomized controlled trial. Complement Ther Med 2019; 46:103-108. [DOI: 10.1016/j.ctim.2019.08.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 10/26/2022] Open
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Abstract
Measuring brain activity in infants provides an objective surrogate approach with which to infer pain perception following noxious events. Here we discuss different approaches which can be used to measure noxious-evoked brain activity, and discuss how these measures can be used to assess the analgesic efficacy of pharmacological and non-pharmacological interventions. We review factors that can modulate noxious-evoked brain activity, which may impact infant pain experience, including gestational age, sex, prior pain, stress, and illness.
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Affiliation(s)
- Deniz Gursul
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, United Kingdom
| | - Caroline Hartley
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, United Kingdom
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, John Radcliffe Hospital, Headington, Oxford, OX3 9DU, United Kingdom.
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Green G, Hartley C, Hoskin A, Duff E, Shriver A, Wilkinson D, Adams E, Rogers R, Moultrie F, Slater R. Behavioural discrimination of noxious stimuli in infants is dependent on brain maturation. Pain 2019; 160:493-500. [PMID: 30422872 PMCID: PMC6343955 DOI: 10.1097/j.pain.0000000000001425] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 11/26/2022]
Abstract
Changes in facial expression are an essential form of social communication and in nonverbal infants are often used to alert care providers to pain-related distress. However, studies of early human brain development suggest that premature infants aged less than 34 weeks' gestation do not display discriminative brain activity patterns to equally salient noxious and innocuous events. Here we examine the development of facial expression in 105 infants, aged between 28 and 42 weeks' gestation. We show that the presence of facial expression change after noxious and innocuous stimulation is age-dependent and that discriminative facial expressions emerge from approximately 33 weeks' gestation. In a subset of 49 infants, we also recorded EEG brain activity and demonstrated that the temporal emergence of facial discrimination mirrors the developmental profile of the brain's ability to generate discriminative responses. Furthermore, within individual infants, the ability to display discriminative facial expressions is significantly related to brain response maturity. These data demonstrate that the emergence of behavioural discrimination in early human life corresponds to our brain's ability to discriminate noxious and innocuous events and raises fundamental questions as to how best to interpret infant behaviours when measuring and treating pain in premature infants.
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Affiliation(s)
- Gabrielle Green
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Caroline Hartley
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Amy Hoskin
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Eugene Duff
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Adam Shriver
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
| | - Dominic Wilkinson
- The Oxford Uehiro Centre for Practical Ethics, University of Oxford, Oxford, United Kingdom
| | - Eleri Adams
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Richard Rogers
- Nuffield Department of Anaesthesia, John Radcliffe Hospital, Oxford, United Kingdom
| | - Fiona Moultrie
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Rebeccah Slater
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
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A Review of Non-Pharmacological Treatments for Pain Management in Newborn Infants. CHILDREN-BASEL 2018; 5:children5100130. [PMID: 30241352 PMCID: PMC6210323 DOI: 10.3390/children5100130] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/05/2018] [Accepted: 09/17/2018] [Indexed: 11/17/2022]
Abstract
Pain is a major problem in sick newborn infants, especially for those needing intensive care. Pharmacological pain relief is the most commonly used, but might be ineffective and has side effects, including long-term neurodevelopmental sequelae. The effectiveness and safety of alternative analgesic methods are ambiguous. The objective was to review the effectiveness and safety of non-pharmacological methods of pain relief in newborn infants and to identify those that are the most effective. PubMed and Google Scholar were searched using the terms: “infant”, “premature”, “pain”, “acupuncture”, “skin-to-skin contact”, “sucrose”, “massage”, “musical therapy” and ‘breastfeeding’. We included 24 studies assessing different methods of non-pharmacological analgesic techniques. Most resulted in some degree of analgesia but many were ineffective and some were even detrimental. Sucrose, for example, was often ineffective but was more effective than music therapy, massage, breast milk (for extremely premature infants) or non-invasive electrical stimulation acupuncture. There were also conflicting results for acupuncture, skin-to-skin care and musical therapy. Most non-pharmacological methods of analgesia provide a modicum of relief for preterm infants, but none are completely effective and there is no clearly superior method. Study is also required to assess potential long-term consequences of any of these methods.
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Kahraman A, Başbakkal Z, Yalaz M, Sözmen EY. The effect of nesting positions on pain, stress and comfort during heel lance in premature infants. Pediatr Neonatol 2018; 59:352-359. [PMID: 29248383 DOI: 10.1016/j.pedneo.2017.11.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 08/21/2017] [Accepted: 11/10/2017] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Nesting positions are commonly used in procedural analgesic administration in premature neonates. The effectiveness of nesting positions is questioned. The aim of the this study was to assess the pain, stress, comfort and salivary cortisol and melatonin values in nesting positions during the heel lance procedure in premature infants at the NICU. METHODS Experimental research; repeated measurement design. The sample comprised 33 premature neonates with gestational age of 31-35 weeks who had been hospitalized in the NICU. Nesting positions were given using linen or towels. The procedure of heel lance was recorded on camera. The camera recordings were evaluated according to the NIPS and the COMFORTneo scale. Saliva samples were obtained five minutes prior to and 30 min after the heel lance procedure. Salivary Cortisol and Melatonin were measured using the Salimetrics Cortisol Elisa Kit and the Salimetrics Melatonin Elisa Kit. RESULTS The crying time, the mean NIPS score, the COMFORTneo score, the COMFORTneo NRS-pain scores and the COMFORTneo NRS-distress scores for premature neonates who were in the prone position during the procedure were significantly lower than the scores in the supine position (p < 0.000). Furthermore, the level of salivary cortisol five minutes prior to and 30 min after the heel lance procedure had significantly decreased in the prone position; however, there were insignificant differences in the mean levels of salivary melatonin between the positions. CONCLUSIONS Nesting in the prone position has a pain reducing effect, enhancing comfort and reducing stress in premature infants.
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Affiliation(s)
- Ayşe Kahraman
- Ege University Faculty of Nursing, Bornova, İzmir, Turkey.
| | | | - Mehmet Yalaz
- Ege University Faculty of Medicine, Department of Pediatrics, Division of Neonatology, Bornova, İzmir, Turkey.
| | - Eser Y Sözmen
- Ege University Faculty of Medicine, Department of Medical Biochemistry, Bornova, İzmir, Turkey.
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Factors Influencing Neonatal Pain Management from the Perspectives of Nurses and Physicians in a Neonatal Intensive Care Unit: A Qualitative Study. IRANIAN JOURNAL OF PEDIATRICS 2017. [DOI: 10.5812/ijp.10015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Field T. Preterm newborn pain research review. Infant Behav Dev 2017; 49:141-150. [DOI: 10.1016/j.infbeh.2017.09.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 11/16/2022]
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Garg BD, Kabra NS, Balasubramanian H. Role of massage therapy on reduction of neonatal hyperbilirubinemia in term and preterm neonates: a review of clinical trials. J Matern Fetal Neonatal Med 2017; 32:301-309. [PMID: 28870134 DOI: 10.1080/14767058.2017.1376316] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Neonatal hyperbilirubinemia (NNH) is one of the leading causes of admissions in nursery throughout the world. It affects approximately 2.4-15% of neonates during the first 2 weeks of life. AIMS To evaluate the role of massage therapy for reduction of NNH in both term and preterm neonates. METHOD The literature search was done for various randomized control trials (RCTs) by searching the Cochrane Library, PubMed, and EMBASE. RESULTS This review included total of 10 RCTs (two in preterm neonates and eight in term neonates) that fulfilled inclusion criteria. In most of the trials, Field massage was given. Six out of eight trials reported reduction in bilirubin levels in term neonates. However, only one trial (out of two) reported significant reduction in bilirubin levels in preterm neonates. Both trials in preterm neonates and most of the trials in term neonates (five trials) reported increased stool frequencies. CONCLUSION Role of massage therapy in the management of NNH is supported by the current evidence. However, due to limitations of the trials, current evidences are not sufficient to use massage therapy for the management of NNH in routine practice.
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YU LC, TSE MMY, LAI CKY. Effect of gentle manual pressure on neonatal pain during heel prick: a randomised crossover trial. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjom.2017.25.5.309] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Lisa Chit YU
- Senior Clinical Associate, School of Nursing, Tung Wah College
| | - Mimi Mun Yee TSE
- Assistant Professor, School of Nursing, The Hong Kong Polytechnic University
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Niemi AK. Review of Randomized Controlled Trials of Massage in Preterm Infants. CHILDREN-BASEL 2017; 4:children4040021. [PMID: 28368368 PMCID: PMC5406680 DOI: 10.3390/children4040021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 03/14/2017] [Accepted: 03/27/2017] [Indexed: 01/06/2023]
Abstract
Preterm birth affects about 10% of infants born in the United States. Massage therapy is being used in some neonatal intensive care units for its potential beneficial effects on preterm infants. This article reviews published randomized controlled trials on the effects of massage in preterm infants. Most studies evaluating the effect of massage in weight gain in premature infants suggest a positive effect on weight gain. Increase in vagal tone has been reported in infants who receive massage and has been suggested as a possible mechanism for improved weight gain. More studies are needed on the underlying mechanisms of the effects of massage therapy on weight gain in preterm infants. While some trials suggest improvements in developmental scores, decreased stress behavior, positive effects on immune system, improved pain tolerance and earlier discharge from the hospital, the number of such studies is small and further evidence is needed. Further studies, including randomized controlled trials, are needed on the effects of massage in preterm infants.
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Affiliation(s)
- Anna-Kaisa Niemi
- Department of Pediatrics, Division of Neonatal & Developmental Medicine, Stanford University, Palo Alto, CA 94304, USA.
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The effects of massage therapy in hospitalized preterm neonates: A systematic review. Int J Nurs Stud 2017; 69:119-136. [PMID: 28235686 DOI: 10.1016/j.ijnurstu.2017.02.009] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to perform a systematic review to identify, evaluate and summarise studies on the administration of therapeutic massage to preterm neonates during their stay in the NICU, and to assess their methodological quality. DESIGN systematic review following PRISMA statements guidelines. DATA SOURCES A comprehensive search was performed including relevant articles between January 2004 and December 2013, using the following electronic databases: Medline, PEDro, Web of Science and Scopus. REVIEW METHODS Two reviewers conducted a review of the selected articles: one evaluated the methodological quality of the studies and performed data extraction and the other performed a cross-check. Divergences of opinion were resolved by discussion with a third reviewer. The studies reviewed implemented a wide variety of interventions and evaluation methods, and therefore it was not possible to perform a meta-analysis. The following data were extracted from each article: year of publication, study design, participants and main measurements of outcomes obtained through the intervention. A non-quantitative synthesis of the extracted data was performed. Level of evidence was graded using the Jadad Scale. RESULTS A total of 23 articles met the inclusion criteria and were thus included in the review; these presented a methodological quality ranging from 1 to 5 points (with a mean of 3 points). Most studies reported that the administration of various forms of therapeutic massage exerted a beneficial effect on factors related to the growth of preterm infants. The causes indicated by the researchers for these anthropometric benefits included increased vagal activity, increased gastric activity and increased serum insulin levels. Other demonstrated benefits of massage therapy when administered to hospitalised preterm infants included better neurodevelopment, a positive effect on brain development, a reduced risk of neonatal sepsis, a reduction in length of hospital stay and reduced neonatal stress. CONCLUSIONS Although based on a qualitative analysis of heterogeneous data, the present review suggests that a clear benefit is obtained from the administration of massage therapy in hospitalised preterm infants, a finding which should encourage the more generalised use of massotherapy in NICU clinical practice.
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Chik YM, Ip WY, Choi KC. The Effect of Upper Limb Massage on Infants’ Venipuncture Pain. Pain Manag Nurs 2017; 18:50-57. [DOI: 10.1016/j.pmn.2016.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 07/07/2016] [Accepted: 10/04/2016] [Indexed: 11/25/2022]
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Abstract
PURPOSE To review and analyze studies evaluating the effects of massage on term and preterm infants. DESIGN A systematic review of literature. RESULTS Benefits of massage for term infants are: improved weight gain, growth, and sleep and decreased hyperbilirubinemia. Benefits for preterm infants are: improved weight gain, decreased response to pain, and increased interactions with parents. However, the few studies use different interventions related to timing and number of massages, and the outcomes vary among studies. There is not enough evidence to support the use of massage for term and preterm infants, but massage may be considered on a case-by-case basis.
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PREMM: preterm early massage by the mother: protocol of a randomised controlled trial of massage therapy in very preterm infants. BMC Pediatr 2016; 16:146. [PMID: 27568006 PMCID: PMC5002318 DOI: 10.1186/s12887-016-0678-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 08/16/2016] [Indexed: 12/13/2022] Open
Abstract
Background Preterm infants follow an altered neurodevelopmental trajectory compared to their term born peers as a result of the influence of early birth, and the altered environment. Infant massage in the preterm infant has shown positive effects on weight gain and reduced length of hospital stay. There is however, limited current evidence of improved neurodevelopment or improved attachment, maternal mood or anxiety. The aim of this study is to investigate the effects of infant massage performed by the mother in very preterm (VPT) infants. Effects on the infant will be assessed at the electrophysiological, neuroradiological and clinical levels. Effects on maternal mood, anxiety and mother-infant attachment will also be measured. Methods/Design A randomised controlled trial to investigate the effect of massage therapy in VPT infants. Sixty VPT infants, born at 28 to 32 weeks and 6 days gestational age, who are stable, off supplemental oxygen therapy and have normal cranial ultrasounds will be recruited and randomised to an intervention (infant massage) group or a control (standard care) group. Ten healthy term born infants will be recruited as a reference comparison group. The intervention group will receive standardised massage therapy administered by the mother from recruitment, until term equivalent age (TEA). The control group will receive care as usual (CAU). Infants and their mothers will be assessed at baseline, TEA, 12 months and 24 months corrected age (CA), with a battery of clinical, neuroimaging and electrophysiological measures, as well as structured questionnaires, psychoanalytic observations and neurodevelopmental assessments. Discussion Optimising preterm infant neurodevelopment is a key aim of neonatal research, which could substantially improve long-term outcomes and reduce the socio-economic impact of VPT birth. This study has the potential to give insights into the mother-baby relationship and any positive effects of infant massage on neurodevelopment. An early intervention such as massage that is relatively easy to administer and could alter the trajectory of preterm infant brain development, holds potential to improve neurodevelopmental outcomes in this vulnerable population. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12612000335897. Date registered: 22/3/2012.
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Epidemiology and neonatal pain management of heelsticks in intensive care units: EPIPPAIN 2, a prospective observational study. Int J Nurs Stud 2016; 59:79-88. [DOI: 10.1016/j.ijnurstu.2016.03.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 02/29/2016] [Accepted: 03/22/2016] [Indexed: 11/18/2022]
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Mooney-Leber SM, Brummelte S. Neonatal pain and reduced maternal care: Early-life stressors interacting to impact brain and behavioral development. Neuroscience 2016; 342:21-36. [PMID: 27167085 DOI: 10.1016/j.neuroscience.2016.05.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 03/22/2016] [Accepted: 05/02/2016] [Indexed: 12/21/2022]
Abstract
Advances in neonatal intensive care units (NICUs) have drastically increased the survival chances of preterm infants. However, preterm infants are still exposed to a wide range of stressors during their stay in the NICU, which include painful procedures and reduced maternal contact. The activation of the hypothalamic-pituitary-adrenal (HPA) axis, in response to these stressors during this critical period of brain development, has been associated with many acute and long-term adverse biobehavioral outcomes. Recent research has shown that Kangaroo care, a non-pharmacological analgesic based on increased skin-to-skin contact between the neonate and the mother, negates the adverse outcomes associated with neonatal pain and reduced maternal care, however the biological mechanism remains widely unknown. This review summarizes findings from both human and rodent literature investigating neonatal pain and reduced maternal care independently, primarily focusing on the role of the HPA axis and biobehavioral outcomes. The physiological and positive outcomes of Kangaroo care will also be discussed in terms of how dampening of the HPA axis response to neonatal pain and increased maternal care may account for positive outcomes associated with Kangaroo care.
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Affiliation(s)
- Sean M Mooney-Leber
- Department of Psychology, Wayne State University, Detroit, MI, United States
| | - Susanne Brummelte
- Department of Psychology, Wayne State University, Detroit, MI, United States.
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Karaca Ciftci E, Kardas Ozdemir F, Aydın D. Effect of flick application on pain level and duration of crying during infant vaccination. Ital J Pediatr 2016; 42:8. [PMID: 26796524 PMCID: PMC4722612 DOI: 10.1186/s13052-016-0218-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 01/18/2016] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The aim of the research is to determine the effect of flick application to reduce pain on pain level and duration of crying during vaccination. METHOD This research was carried out on one-month-old babies in a family health center between March and June 2015. The babies coming for the second dose of Hepatitis B vaccine were divided into experiment and control groups. The babies in experiment group were flicked just before they were vaccinated. On the other hand, the babies in control group were vaccinated in usual way, with no other application. The pain level of babies in both groups was determined using "Neonatal Infant Pain Scale". In addition, babies' duration of crying was recorded. RESULTS In the study, it was detected that there was not a significant difference between pain score averages of babies in experiment and control groups (p > 0.05) before the application, however a significant difference in pain score average was detected during the application (p < 0.01) and after the application (p < 0.001). Babies' duration of crying was compared and it was determined that babies in experiment group cried for shorter period, but no relevance was found (p > 0.05). CONCLUSIONS Flick application at vaccination area could be used to reduce pain during vaccination at babies.
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Affiliation(s)
- Esra Karaca Ciftci
- Department of Child Health Nursing, Faculty of Health Sciences, Zirve University, 27260, Gaziantep, Turkey.
| | - Funda Kardas Ozdemir
- Department of Nursing, Kars School of Health, Kafkas University, 36000,, Kars, Turkey.
| | - Diler Aydın
- Department of Nursing, Faculty of Health Science, Bandirma Onyedi Eylul University, 10200,, Bandırma, Balıkesir, Turkey.
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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: 85] [Impact Index Per Article: 9.4] [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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Gnazzo A, Guerriero V, Di Folco S, Zavattini GC, de Campora G. Skin to skin interactions. Does the infant massage improve the couple functioning? Front Psychol 2015; 6:1468. [PMID: 26441813 PMCID: PMC4585314 DOI: 10.3389/fpsyg.2015.01468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 09/14/2015] [Indexed: 11/30/2022] Open
Abstract
Transition to parenthood is a critical stage of life due to several changes the couple has to handle. A large body of studies described how transition to parenthood can be linked to the onset of depressive symptoms, as well as the perception of a low social support, and an increased stress, representing a risk for the early mother-baby relationship. Infant massage (IM) emerged as a helpful tool to improve maternal skills in interacting with the baby, and leading toward a decreasing of post-partum symptoms. However, a growing body of literature highlights that men also may experience post-partum diseases, representing an additional risk for the development of the baby. To date, no study observed the impact of the IM on both partners. The aim of the current qualitative research is to observe the impact of the IM on a single couple of parents at childbirth. Pre (Time 1) and post-intervention (Time 3) procedure has been established to observe the changes occurring over the time in the couple. In particular, each member of the couple filled out the EPDS, the BDI-II, the MSPSS, and the PSI-SF both at Time 1 and at Time 3. The treatment (Time 2) was represented by the IM training, and lasted 4 weeks. Findings revealed a decrease in depressive symptoms in both partners, as well as an improvement of their perception of stress related to parental role. No changes has been detected with respect to the perception of social support. The IM seems to be a helpful approach to prevent the establishment of pathological conditions in new parents. Although no direct measures on the child were used, the current qualitative data seem to suggest that the IM may represent a valuable tool to prevent the onset of early negative outcomes of the baby. Further investigations and empirical data are needed to improve the knowledge in this field.
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Affiliation(s)
- Antonio Gnazzo
- Department of Dynamic and Clinical Psychology, Sapienza University of RomeRome, Italy
| | - Viviana Guerriero
- Department of Dynamic and Clinical Psychology, Sapienza University of RomeRome, Italy
| | - Simona Di Folco
- Department of Pedagogy, Psychology, Philosophy, University of CagliariCagliari, Italy
| | - Giulio C. Zavattini
- Department of Dynamic and Clinical Psychology, Sapienza University of RomeRome, Italy
| | - Gaia de Campora
- Department of Pedagogy, Psychology, Philosophy, University of CagliariCagliari, Italy
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Hathaway EE, Luberto CM, Bogenschutz LH, Geiss S, Wasson RS, Cotton S. Integrative Care Therapies and Physiological and Pain-related Outcomes in Hospitalized Infants. Glob Adv Health Med 2015; 4:32-7. [PMID: 26331102 PMCID: PMC4533649 DOI: 10.7453/gahmj.2015.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Background: Pain management is a frequent problem in the neonatal intensive care unit (NICU). Few studies examining effects of integrative care therapies on pain-related outcomes in neonates have included physiological outcomes or investigated the use of such therapies in a practice-based setting. Objective: The purpose of this practice-based retrospective study was to examine the associations between integrative care therapies, particularly massage and healing touch, and pain-related outcomes among hospitalized infants. Methods: We conducted a retrospective review of a clinical database from a level III NICU regularly delivering integrative care therapies. Paired-samples t-tests were used to examine associations between integrative care therapies and 4 pre-post outcome measures: therapist-rated pain and presentation (ranging from asleep to agitated) and neonates' heart rate and oxygen saturation. Results: Of 186 patients (Mage=68 days), 58% were male and 67% were Caucasian. Sixty-two percent received both massage and healing touch; the remainder received a single therapy. From pre-post therapy, statistically significant changes were observed in infants' heart rate (Mpre=156 vs Mpost=140 per minute; P<.001), oxygen saturation (Mpre=95.0% vs.Mpost=97.4%; P<.001), and therapist-reported pain (Mpre=2.8 vs Mpost=0.2; P<.001) and presentation (Mpre=3.2 vs. Mpost=1.0; P<.001). Conclusion: Observed improvements in pain-related outcomes suggest that massage and healing touch may be useful integrative therapies to consider as pain management options in the NICU.
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Affiliation(s)
- Elizabeth E Hathaway
- Department of Family and Community Medicine, Division of Integrative Medicine, University of Cincinnati College of Medicine, Ohio, United States (Ms Hathaway)
| | - Christina M Luberto
- Department of Family and Community Medicine, Division of Integrative Medicine, University of Cincinnati College of Medicine, Ohio, United States (Ms Luberto)
| | - Lois H Bogenschutz
- Division of Child Life and Integrative Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States (Ms Bogenschutz)
| | - Sue Geiss
- Division of Child Life and Integrative Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States (Ms Geiss)
| | - Rachel S Wasson
- Department of Family and Community Medicine, Division of Integrative Medicine, University of Cincinnati College of Medicine, Ohio, United States (Ms Wasson)
| | - Sian Cotton
- Division of Child Life and Integrative Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, United States (Dr Cotton)
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Koç T, Gözen D. The Effect of Foot Reflexology on Acute Pain in Infants: A Randomized Controlled Trial. Worldviews Evid Based Nurs 2015. [DOI: 10.1111/wvn.12099] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- Tuba Koç
- Istanbul University; Florence Nightingale Faculty of Nursing, Pediatric Nursing Department; Istanbul Turkey
| | - Duygu Gözen
- Istanbul University, Florence Nightingale Faculty of Nursing; Pediatric Nursing Department; Istanbul Turkey
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Santos J, Pearce SE, Stroustrup A. Impact of hospital-based environmental exposures on neurodevelopmental outcomes of preterm infants. Curr Opin Pediatr 2015; 27:254-60. [PMID: 25635585 PMCID: PMC4410011 DOI: 10.1097/mop.0000000000000190] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Over 300,000 infants are hospitalized in a neonatal intensive care unit (NICU) in the United States annually during a developmental period critical to later neurobehavioral function. Environmental exposures during the fetal period and infancy have been shown to impact long-term neurobehavioral outcomes. This review summarizes evidence linking NICU-based environmental exposures to neurodevelopmental outcomes of children born preterm. RECENT FINDINGS Preterm infants experience multiple exposures important to neurodevelopment during the NICU hospitalization. The physical layout of the NICU, management of light and sound, social interactions with parents and NICU staff, and chemical exposures via medical equipment are important to long-term neurobehavioral outcomes in this highly vulnerable population. SUMMARY Existing research documents NICU-based exposure to neurotoxic chemicals, aberrant light, excess sound, and restricted social interaction. In total, this creates an environment of co-existing excesses (chemicals, light, sound) and deprivation (touch, speech). The full impact of these co-exposures on the long-term neurodevelopment of preterm infants has not been adequately elucidated. Research into the importance of the NICU from an environmental health perspective is in its infancy, but could provide understanding about critical modifiable factors impacting the neurobehavioral health of hundreds of thousands of children each year.
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Affiliation(s)
| | - Sarah E. Pearce
- Icahn School of Medicine at Mount Sinai
- Division of Newborn Medicine, Department of Pediatrics
| | - Annemarie Stroustrup
- Icahn School of Medicine at Mount Sinai
- Division of Newborn Medicine, Department of Pediatrics
- Department of Preventive Medicine
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Abstract
As a standard of care for preterm/term newborns effective pain management may improve their clinical and neurodevelopmental outcomes. Neonatal pain is assessed using context-specific, validated, and objective pain methods, despite the limitations of currently available tools. Therapeutic approaches reducing invasive procedures and using pharmacologic, behavioral, or environmental measures are used to manage neonatal pain. Nonpharmacologic approaches like kangaroo care, facilitated tucking, non-nutritive sucking, sucrose, and others can be used for procedural pain or adjunctive therapy. Local/topical anesthetics, opioids, NSAIDs/acetaminophen and other sedative/anesthetic agents can be incorporated into NICU protocols for managing moderate/severe pain or distress in all newborns.
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Abstract
Pain control in newborns is poorly understood and often neglected in neonatal practice in many settings in our environment. Managing pain among newborns can be quite challenging and the effectiveness of various interventions used to ameliorate pain in this category of patients are either unknown or poorly understood by many a people engaged in the care of newborns in one way or the other. A search for published works on neonatal analgesia was performed using Google and PubMed. The Cochrane Database of Systematic Reviews was also searched. The areas of focus were definition, pathophysiology and management of pain in neonates. Relevant information was extracted and processed. Contrary to what is widely believed in many quarters, howbeit erroneously, there is compelling evidence that newborns do indeed feel pain. Supportive care, comprising of use of sucrose, glucose, breastfeeding, kangaroo mother care are worthwhile measures in ameliorating pain in the newborn. Novel therapies (such as sensorial saturation and swaddling) have been evaluated and proven useful. The use of sedation did not show any beneficial results.
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Affiliation(s)
- Herbert A Obu
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu 01129, Nigeria
| | - Josephat M Chinawa
- Department of Paediatrics, University of Nigeria Teaching Hospital, Enugu 01129, Nigeria
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45
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A Randomized-controlled Trial of Parent-led Tactile Stimulation to Reduce Pain During Infant Immunization Injections. Clin J Pain 2014; 30:259-65. [DOI: 10.1097/ajp.0b013e318296079e] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Abstract
PURPOSE The aim of this study was to determine whether massage therapy can be used as an adjunct intervention to induce sleep in infants born preterm. METHODS Thirty infants born at a minimum of 28 weeks gestational age, who were at the time of the study between 32 and 48 weeks adjusted gestational age, were randomly assigned to receive massage therapy on 1 day and not receive massage on an alternate day. The Motionlogger Micro Sleep Watch Actigraph recorded lower extremity activity on the morning of each day. RESULTS No significant difference was found between groups for sleep efficiency (P = .13) during the time period evaluated. Groups differed significantly during the time period after the massage ended with more infants sleeping on the nonmassage day (χ = 4.9802, P = .026). CONCLUSIONS Massage is well tolerated in infants born preterm and infants do not fall asleep faster after massage than without massage.
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47
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The efficacy of massage on short and long term outcomes in preterm infants. Infant Behav Dev 2013; 36:662-9. [DOI: 10.1016/j.infbeh.2013.06.009] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/09/2013] [Accepted: 06/28/2013] [Indexed: 11/22/2022]
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48
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Evaluating venous pool technique for blood sampling in neonatal ICU. MCN Am J Matern Child Nurs 2013; 38:345-51. [PMID: 24145488 DOI: 10.1097/nmc.0b013e3182a1cdcf] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate venous pool technique (VPT) for obtaining neonatal blood samples as compared with the needlestick technique. METHOD AND SAMPLE An experimental design was used with subjects enrolled in two phases: an equivalence phase (N = 10) and a comparison phase (N = 64). In the equivalence phase, subjects weighing 1,500 g or more had two needlesticks. In the comparison phase, subjects weighing 800 g or more were randomized to receive blood drawn by either needlestick method or VPT. RESULTS Comparative results suggest that infant and maternal demographic factors, sampling attempts, and sampling failures were similar. However, for the outcome of hematoma development, the standard technique was significantly worse (t = 2.25 ; p = .029). Results suggest that the VPT method is safe and accurate for use in critically ill neonates. CLINICAL IMPLICATIONS This study demonstrated that the VPT process is easily learned and may provide advantages over standard blood sampling methods. Nurses can use this information to evaluate this VPT technique in their institutions.
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49
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Abstract
Regardless of age, health care professionals have a professional and ethical obligation to provide safe and effective analgesia to patients undergoing painful procedures. Historically, newborns, particularly premature and sick infants, have been undertreated for pain. Intubation of the trachea and mechanical ventilation are ubiquitous painful procedures in the neonatal intensive care unit that are poorly assessed and treated. The authors review the use of sedation and analgesia to facilitate endotracheal tube placement and mechanical ventilation. Controversies regarding possible adverse neurodevelopmental outcomes after sedative and anesthetic exposure and in the failure to treat pain is also discussed.
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50
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Karlson CW, Hamilton NA, Rapoff MA. Massage on experimental pain in healthy females: A randomized controlled trial. J Health Psychol 2013; 19:427-40. [DOI: 10.1177/1359105312471572] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This randomized controlled study evaluated the effect of massage on affect, relaxation, and experimental pain induced by electrical stimulation. Participants were 96 healthy women ( M age = 20.13 ± 5.93 years; 84.4% White) randomly assigned to a 15-minute no-treatment control, guided imagery, massage or massage plus guided imagery condition. Multilevel piecewise modeling revealed no group differences in pain intensity, threshold, or tolerance. The two massage conditions generally reported decreased pain unpleasantness, lower unpleasant affect, maintenance of pleasant affect, and increased relaxation compared to the no-treatment condition. The results suggest that massage may alter immediate affective qualities in the context of pain.
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