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Brévaut-Malaty V, Resseguier N, Garbi A, Tosello B, Thomachot L, Vialet R, Gire C. Long Term Neurodevelopmental Outcomes after Sevoflurane Neonatal Exposure of Extremely Preterm Children: A Cross-Sectional Observationnal Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040548. [PMID: 35455592 PMCID: PMC9028040 DOI: 10.3390/children9040548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
Abstract
Sevoflurane, a volatile anesthetic, is used when extremely preterm neonates (EPT) undergo painful procedures. Currently, no existing studies analyze sevoflurane’s long-term effects during the EPT’s immediate neonatal period. Our primary objective was to compare the EPT’s neurocognitive development regardless of any sevoflurane exposure prior to 45 weeks corrected gestational age (GA). We analyzed those live discharges, less than 28 weeks GA, who were either exposed, unexposed, and/or multiply exposed to sevoflurane before 45 weeks GA. All data were obtained from a cross-sectional multicenter study (GPQoL study, NCT01675726). Children, both exposed and non-exposed to sevoflurane, were sampled using a propensity-guided approach. Neurological examinations (Touwen), cognitive and executive functions (WISC IV, NEPSY, Rey figure), and assessments when the children were between 7 and 10 years old, were correlated to their neonatal sevoflurane exposure. There were 139 children in the study. The mean gestational age was 26.2 weeks (±0.8) GA and the mean birth weight was 898 g (±173). The mean age of their evaluation was 8.47 years old (±0.70). Exposure to sevoflurane to the mean corrected age 27.10 (3.37) weeks GA had a significant correlation with cerebral palsy (adjusted odds ratio (aOR): 6.70 (CI 95%: 1.84–32.11)) and other major disorders (cerebral palsy and/or severe cognitive retardation) (aOR: 2.81 [95% CI: 1.13–7.35]). Our results demonstrate the possibility of long-term effects on EPT infants who had a sevoflurane exposure before 45 weeks corrected GA. However, these results will require further confirmation by randomized controlled trials.
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Affiliation(s)
- Véronique Brévaut-Malaty
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
| | - Noémie Resseguier
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France;
| | - Aurélie Garbi
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
| | - Barthélémy Tosello
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
- CNRS, EFS, ADES, Aix Marseille University, 13915 Marseille, France
- Correspondence: ; Tel.: +33-(0)-491964822
| | - Laurent Thomachot
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
| | - Renaud Vialet
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
| | - Catherine Gire
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France;
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Tesoro S, Marchesini V, Fratini G, Engelhardt T, De Robertis E. Drugs for anesthesia and analgesia in the preterm infant. Minerva Anestesiol 2020; 86:742-755. [DOI: 10.23736/s0375-9393.20.14073-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Guo W, Liu X, Zhou X, Wu T, Sun J. Efficacy and safety of combined nonpharmacological interventions for repeated procedural pain in preterm neonates: A systematic review of randomized controlled trials. Int J Nurs Stud 2020; 102:103471. [DOI: 10.1016/j.ijnurstu.2019.103471] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 10/28/2019] [Accepted: 10/30/2019] [Indexed: 10/25/2022]
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Zhang B, Wang J, Li M, Qi F. Minimum Alveolar Concentration of Sevoflurane with Cisatracurium for Endotracheal Intubation in Neonates. Med Sci Monit 2019; 25:7982-7988. [PMID: 31647785 PMCID: PMC6824189 DOI: 10.12659/msm.917472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Sevoflurane inhalation induction is widely used in pediatric anesthesia, but the minimum alveolar concentration for endotracheal intubation (MACEI) when combined with neuromuscular blockade in neonates has been largely unexplored. This study assessed the MACEI of sevoflurane combined with cisatracurium in neonates. Material/Methods Anesthesia induction was commenced by inhaling 4% sevoflurane with 2 l/min of 100% oxygen via mask. Neonates were administered cisatracurium 0.2 mg/kg followed by adjustment of inspired sevoflurane to target end-tidal concentration based on intubation condition of the preceding subject. When the steady-state end-tidal sevoflurane concentration target was maintained for at least 15 min, endotracheal intubation by direct laryngoscope was performed. The intubation condition was considered failed if either heart rate (HR) after intubation increased by 20% or mean arterial blood pressure (MAP) by 30% or more than that before intubation. Otherwise, the intubation condition was regarded as successful. Dixon’s up-and-down method was used with 0.2% as the step size to determine the target end-tidal sevoflurane concentration. Results The MACEI of sevoflurane combined with cisatracurium in neonates was 2.76±0.24%. Using probit analysis, the 50% effective end-tidal sevoflurane concentration (ED50) for successful condition of endotracheal intubation was 2.61% (95%CI 2.07–2.88%) and the 95% effective end-tidal sevoflurane concentration (ED95) was 3.28% (95%CI 2.95–7.19%). Hypotension and bradycardia occurred in 2 neonates during induction. Conclusions Sevoflurane combined with cisatracurium is feasible and effective for intubation in neonates, and the MACEI of sevoflurane in this subpopulation is 2.76±0.24%. However, cardiovascular adverse effects should be taken into consideration.
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Affiliation(s)
- Bin Zhang
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Junxia Wang
- Department of Pediatrics, Qianfoshan Hospital of Shangdong Province, Jinan, Shandong, China (mainland)
| | - Mingzhuo Li
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China (mainland)
| | - Feng Qi
- Department of Anesthesiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
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Rozé JC, Ancel PY, Lepage P, Martin-Marchand L, Al Nabhani Z, Delannoy J, Picaud JC, Lapillonne A, Aires J, Durox M, Darmaun D, Neu J, Butel MJ. Nutritional strategies and gut microbiota composition as risk factors for necrotizing enterocolitis in very-preterm infants. Am J Clin Nutr 2017; 106:821-830. [PMID: 28659297 PMCID: PMC5573022 DOI: 10.3945/ajcn.117.152967] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 06/05/2017] [Indexed: 12/22/2022] Open
Abstract
Background: The pathophysiology of necrotizing enterocolitis (NEC) remains poorly understood.Objective: We assessed the relation between feeding strategies, intestinal microbiota composition, and the development of NEC.Design: We performed a prospective nationwide population-based study, EPIPAGE 2 (Etude Epidémiologique sur les Petits Ages Gestationnels), including preterm infants born at <32 wk of gestation in France in 2011. From individual characteristics observed during the first week of life, we calculated a propensity score for the risk of NEC (Bell's stage 2 or 3) after day 7 of life. We analyzed the relation between neonatal intensive care unit (NICU) strategies concerning the rate of progression of enteral feeding, the direct-breastfeeding policy, and the onset of NEC using general linear mixed models to account for clustering by the NICU. An ancillary propensity-matched case-control study, EPIFLORE (Etude Epidémiologique de la flore), in 20 of the 64 NICUs, analyzed the intestinal microbiota by culture and 16S ribosomal RNA gene sequencing.Results: Among the 3161 enrolled preterm infants, 106 (3.4%; 95% CI: 2.8%, 4.0%) developed NEC. Individual characteristics were significantly associated with NEC. Slower and intermediate rates of progression of enteral feeding strategies were associated with a higher risk of NEC, with an adjusted OR of 2.3 (95% CI: 1.2, 4.5; P = 0.01) and 2.0 (95% CI: 1.1, 3.5; P = 0.02), respectively. Less favorable and intermediate direct-breastfeeding policies were associated with higher NEC risk as well, with an adjusted OR of 2.5 (95% CI: 1.1, 5.8; P = 0.03) and 2.3 (95% CI: 1.1, 4.8; P = 0.02), respectively. Microbiota analysis performed in 16 cases and 78 controls showed an association between Clostridium neonatale and Staphylococcus aureus with NEC (P = 0.001 and P = 0.002).Conclusions: A slow rate of progression of enteral feeding and a less favorable direct-breastfeeding policy are associated with an increased risk of developing NEC. For a given level of risk assessed by propensity score, colonization by C. neonatale and/or S. aureus is significantly associated with NEC. This trial (EPIFLORE study) was registered at clinicaltrials.gov as NCT01127698.
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Affiliation(s)
- Jean-Christophe Rozé
- Department of Neonatal Medicine, .,Epidémiologie Clinique, Clinical Investigation Center - Clinical Epidemiology (CIC004), and.,INRA, UMR 1280 Physiology of Nutritional Adaptations, Nantes University Hospital, Nantes, France
| | - Pierre-Yves Ancel
- INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, Paris, France,Risks in Pregnancy Department, Paris Descartes University, Paris, France,Clinical investigation center CIC P1419, Cochin Hotel-Dieu Hospital, AP-HP, Paris, France
| | - Patricia Lepage
- Micalis Institute, INRA, AgroParisTech, University Paris-Saclay, Paris, France
| | - Laetitia Martin-Marchand
- INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, Paris, France
| | - Ziad Al Nabhani
- Micalis Institute, INRA, AgroParisTech, University Paris-Saclay, Paris, France
| | - Johanne Delannoy
- Risks in Pregnancy Department, Paris Descartes University, Paris, France,EA 4065 Intestinal Ecosystem, Probiotics, Antibiotics, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - Jean-Charles Picaud
- Department of Neonatal Medicine, Croix Rousse Hospital, Lyon Hospitals, Lyon, France
| | - Alexandre Lapillonne
- Department of Neonatal Medicine, AP-HP, Necker Enfants Malades Hospital, Paris, France
| | - Julio Aires
- Risks in Pregnancy Department, Paris Descartes University, Paris, France,EA 4065 Intestinal Ecosystem, Probiotics, Antibiotics, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - Mélanie Durox
- INSERM, U1153, Obstetrical, Perinatal and Pediatric Epidemiology Team, Epidemiology and Statistics Sorbonne Paris Cité Research Center, Paris Descartes University, Paris, France
| | - Dominique Darmaun
- INRA, UMR 1280 Physiology of Nutritional Adaptations, Nantes University Hospital, Nantes, France
| | - Josef Neu
- Department of Pediatrics, University of Florida, Gainesville, FL
| | - Marie-José Butel
- Risks in Pregnancy Department, Paris Descartes University, Paris, France,EA 4065 Intestinal Ecosystem, Probiotics, Antibiotics, Faculty of Pharmacy, Paris Descartes University, Paris, France
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Gomes HSDO, Gomes HDS, Sado-Filho J, Costa LR, Costa PS. Does sevoflurane add to outpatient procedural sedation in children? A randomised clinical trial. BMC Pediatr 2017; 17:86. [PMID: 28340572 PMCID: PMC5366115 DOI: 10.1186/s12887-017-0838-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/08/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is little evidence concerning the effect of sevoflurane in outpatient procedural sedation, especially in children. We hypothesised that the addition of sevoflurane to a sedation regimen improves children's behaviour with minimal adverse events. METHODS This is a randomised, triple-blind clinical trial conducted on an outpatient basis. Participants were 27 healthy children aged 4 to 6 years, who previously refused dental treatment with non-pharmacologic methods. All participants received oral midazolam (0.5 mg/kg, maximum 20 mg) and oral ketamine (3 mg/kg, maximum 50 mg) and, in addition: Group MK - 100% oxygen; Group MKS - inhalational sevoflurane at a sedative dose (final expired concentration between 0.3 and 0.4%). Dental appointments were video recorded for assessment of the children's sleep patterns, crying, movements, and overall behaviour during the procedure with the Houpt scale. Intra- and post-operative adverse events were systematically reported. Data were analysed by bivariate analyses in the IBM SPSS v. 19, at a significance level of 5%. RESULTS MK (n = 13) and MKS (n = 14) did not differ regarding the Houpt scores (P > 0.05), but 53.8% of children in the MK group showed hysterical and continuous crying at the time of the local anaesthesia injection, compared to 7.1% of children in the MKS group (P = 0.01; phi = 0.5). There was a trend toward less crying and movement over time during the dental appointment in the MKS group (P = 0.48). Minor adverse events were observed in 10 MK children and 4 MKS children (P = 0.01). CONCLUSIONS The addition of sevoflurane to oral midazolam-ketamine improved the children's crying behaviour during local anaesthetic administration, and did not increase the occurrence of adverse events. TRIAL REGISTRATION Clinical Trials NCT02284204 . Registered 5 October 2014.
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Affiliation(s)
| | | | - Joji Sado-Filho
- University Hospital, Universidade Federal de Goiás, Goiânia, Brazil
| | | | - Paulo Sucasas Costa
- Department of Paediatrics, Universidade Federal de Goiás, Faculdade de Medicina, Rua 235 com Primeira Avenida, sem número, Setor Universitário, Goiânia, CEP 74605-020, Brazil.
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Takashima M, Ray-Barruel G, Ullman A, Keogh S, Rickard CM. Randomized controlled trials in central vascular access devices: A scoping review. PLoS One 2017; 12:e0174164. [PMID: 28323880 PMCID: PMC5360326 DOI: 10.1371/journal.pone.0174164] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 03/03/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Randomized controlled trials evaluate the effectiveness of interventions for central venous access devices, however, high complication rates remain. Scoping reviews map the available evidence and demonstrate evidence deficiencies to focus ongoing research priorities. METHOD A scoping review (January 2006-December 2015) of randomized controlled trials evaluating the effectiveness of interventions to improve central venous access device outcomes; including peripherally inserted central catheters, non-tunneled, tunneled and totally implanted venous access catheters. MeSH terms were used to undertake a systematic search with data extracted by two independent researchers, using a standardized data extraction form. RESULTS In total, 178 trials were included (78 non-tunneled [44%]; 40 peripherally inserted central catheters [22%]; 20 totally implanted [11%]; 12 tunneled [6%]; 6 non-specified [3%]; and 22 combined device trials [12%]). There were 119 trials (68%) involving adult participants only, with 18 (9%) pediatric and 20 (11%) neonatal trials. Insertion-related themes existed in 38% of trials (67 RCTs), 35 RCTs (20%) related to post-insertion patency, with fewer trials on infection prevention (15 RCTs, 8%), education (14RCTs, 8%), and dressing and securement (12 RCTs, 7%). There were 46 different study outcomes reported, with the most common being infection outcomes (161 outcomes; 37%), with divergent definitions used for catheter-related bloodstream and other infections. CONCLUSION More high quality randomized trials across central venous access device management are necessary, especially in dressing and securement and patency. These can be encouraged by having more studies with multidisciplinary team involvement and consumer engagement. Additionally, there were extensive gaps within population sub-groups, particularly in tunneled devices, and in pediatrics and neonates. Finally, outcome definitions need to be unified for results to be meaningful and comparable across studies.
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Affiliation(s)
- Mari Takashima
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Gillian Ray-Barruel
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Amanda Ullman
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Samantha Keogh
- School of Nursing & Institute of Health and Biomedical Innovation (IHBI), Queensland University of Technology, Brisbane, Australia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR) group, Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
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Liu S, Zhang X, Liu F, Paule MG, Callicott R, Newport GD, Ali SF, Patterson TA, Apana SM, Berridge MS, Maisha MP, Hanig JP, Slikker W, Wang C. The Utility of a Nonhuman Primate Model for Assessing Anesthetic-Induced Developmental Neurotoxicity. ACTA ACUST UNITED AC 2017. [DOI: 10.4303/jdar/236011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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She YJ, Wang HZ, Huang JX, Tan YH, Wang ZX, Tian H, Song XR. Effect of a bolus dose of fentanyl on the ED₅₀ and ED₉₅ of sevoflurane in neonates. Med Sci Monit 2014; 20:2658-65. [PMID: 25503557 PMCID: PMC4271805 DOI: 10.12659/msm.891276] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background The minimum alveolar concentration (MAC) of sevoflurane in neonates is 3.3%, but this value has not been verified in Chinese neonates and the effect of different doses of fentanyl on MAC in neonates has not been investigated. This study was designed to determine the ED50 and ED95 values of sevoflurane in Chinese neonates with and without fentanyl. Material/Methods Ninety-three neonates were randomly assigned to receive sevoflurane alone (control group, n=30), 1 μg/kg sevoflurane (group fent1, n=29), or 2 μg/kg fentanyl (group fent2, n=32). Following inhalational induction and tracheal intubation, the end-tidal concentration of sevoflurane was adjusted to achieve the designated concentration, which was determined using the modified Dixon’s up-and-down method starting with 3.0% in each group, with a 0.25% step size. Success was defined as no motor response within 60 s of skin incision. Results The MAC (standard deviation) values of sevoflurane were 2.91% (0.27) in the control group, 2.53% (0.31) in the fent1 group, and 2.34% (0.33) in the fent2 group according to Dixon’s up-and-down method. Logistic probit regression analysis revealed that the ED50 and ED95 (95% CI) of sevoflurane in neonates were 2.82% (2.66–2.98) and 3.39% (2.89–3.89), respectively, in the control group; 2.44% (2.19–2.68) and 3.30% (2.51–4.09), respectively, in the fent1 group; and 2.21% (1.97–2.45) and 3.11% (2.35–3.88), respectively, in the fent2 group. Conclusions The MAC value of sevoflurane in Chinese neonates was lower than previously reported and was reduced by the addition of fentanyl.
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Affiliation(s)
- Ying-Jun She
- Department of Anesthesiology, Guangzhou Women and Children Medical Center, Guangzhou Medical University affiliated Women and Children Medical Center, Guangzhou, China (mainland)
| | - Huai-Zhen Wang
- Department of Anesthesiology, Guangzhou Women and Children Medical Center, Guangzhou Medical University affiliated Women and Children Medical Center, Guangzhou, China (mainland)
| | - Jun-Xiang Huang
- Department of Anesthesiology, Guangzhou Women and Children Medical Center, Guangzhou Medical University affiliated Women and Children Medical Center, Guangzhou, China (mainland)
| | - Yong-Hong Tan
- Department of Anesthesiology, Guangzhou Women and Children Medical Center, Guangzhou Medical University affiliated Women and Children Medical Center, Guangzhou, China (mainland)
| | - Zi-Xing Wang
- Department of Anesthesiology, Guangzhou Women and Children Medical Center, Guangzhou Medical University affiliated Women and Children Medical Center, Guangzhou, China (mainland)
| | - Hang Tian
- Department of Anesthesiology, Guangzhou Women and Children Medical Center, Guangzhou Medical University affiliated Women and Children Medical Center, Guangzhou, China (mainland)
| | - Xing-Rong Song
- Department of Anesthesiology, Guangzhou Women and Children Medical Center, Guangzhou Medical University affiliated Women and Children Medical Center, Guangzhou, China (mainland)
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A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manag 2014; 18:153-61. [PMID: 23748256 DOI: 10.1155/2013/956549] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Sucrose has been demonstrated to provide analgesia for minor painful procedures in infants. However, results of trials investigating other sweet solutions for neonatal pain relief have not yet been synthesized. OBJECTIVE To establish the efficacy of nonsucrose sweet-tasting solutions for pain relief during painful procedures in neonates. METHOD The present article is a systematic review and meta-analyses of the literature. Standard methods of the Cochrane Neonatal Collaborative Review Group were used. Literature searches were reviewed for randomized controlled trials investigating the use of sweet solutions, except sucrose, for procedural pain management in neonates. Outcomes assessed included validated pain measures and behavioural and physiological indicators. RESULTS Thirty-eight studies (3785 neonates) were included, 35 of which investigated glucose. Heel lancing was performed in 21⁄38 studies and venipuncture in 11⁄38 studies. A 3.6-point reduction in Premature Infant Pain Profile scores during heel lances was observed in studies comparing 20% to 30% glucose with no intervention (two studies, 124 neonates; mean difference -3.6 [95% CI -4.6 to -2.6]; P<0.001; I2=54%). A significant reduction in the incidence of cry after venipuncture for infants receiving 25% to 30% glucose versus water or no intervention was observed (three studies, 130 infants; risk difference -0.18 [95% CI -0.31 to -0.05]; P=0.008, number needed to treat = 6 [95% CI 3 to 20]; I2=63%). CONCLUSIONS The present systematic review and meta-analyses demonstrate that glucose reduces pain scores and crying during single heel lances and venipunctures. Results indicate that 20% to 30% glucose solutions have analgesic effects and can be recommended as an alternative to sucrose for procedural pain reduction in healthy term and preterm neonates.
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Costa P, Bueno M, Oliva CL, Elci de Castro T, Ponce de Camargo P, Kimura AF. [Analgesia and sedation during placement of peripherally inserted central catheters in neonates]. Rev Esc Enferm USP 2013; 47:801-7. [PMID: 24310675 DOI: 10.1590/s0080-623420130000400005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 03/09/2013] [Indexed: 11/22/2022] Open
Abstract
This study aimed to characterize the analgesia and sedation strategies in neonates having a peripherally inserted central catheter (PICC) placed, and to relate it to the number of venipunctures, duration of procedure and catheter tip position. This was a cross-sectional study with prospective data collection, conducted in a neonatal intensive care unit of a private hospital in the city of São Paulo, during the period from August 31, 2010 to July 1, 2011, which evaluated 254 PICC insertions. The adoption of analgesic or sedative strategies occurred in 88 (34.6%) catheter placements and was not related to the number of venipunctures, duration of procedure or catheter tip position. Intravenous administration of midazolam, in 47 (18.5%), and fentanyl, in 19 (7.3%), catheter insertions were the most frequent strategies. Wider adoption of analgesic strategies is recommended before, during and after the procedure.
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Affiliation(s)
- Priscila Costa
- Laboratório de Ensino, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, Escola de Enfermagem, Universidade de São Paulo, São PauloSP, Brasil,
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Bellieni CV, Rocchi R, Buonocore G. The Ethics of Pain Clinical Trials on Persons Lacking Judgment Ability: Much to Improve. PAIN MEDICINE 2012; 13:427-33. [DOI: 10.1111/j.1526-4637.2011.01325.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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