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MacNeil M, Hundert A, Campbell-Yeo M. Soothing and Distress Behaviors of Infants, Parents, and Clinicians During Childhood Vaccinations. Pain Manag Nurs 2024:S1524-9042(24)00163-2. [PMID: 38991909 DOI: 10.1016/j.pmn.2024.05.002] [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: 06/06/2023] [Revised: 04/18/2024] [Accepted: 05/07/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES The purpose of this study was to describe the behaviors of infants who were born preterm, their parents, and clinicians during 2-, 6-, 12-, and 18-month vaccinations. METHODS Vaccination sessions were video recorded for 3-5 minutes. The proportion of 5-second intervals in which distress and soothing behavior by infants, parents, and clinicians was coded using the Measure of Adult and Infant Soothing and Distress. Coding consisted of three phases: baseline/anticipatory (60 seconds prior to first needle), procedure (first needle to removal of final needle), and recovery (up to 180 seconds after removal of final needle). RESULTS A total of 64 infants were included. Distress behavior by infants during the baseline phase ranged from 13% (12-month vaccinations) to 29% (2-month). There was limited anticipatory soothing behavior from parents (10% [12-month] to 50% [2-month]) and clinicians (6% [12-month] to 17% [2-month]). Distress behavior in infants during the procedure ranged from 43% (18-month) to 96% (2-month). There was limited soothing behavior during the procedure from parents (10% [12-month] to 81% [12-month]) and clinicians (13% [12-month] to 71% [2-month]). Few infants received additional pain-reducing interventions, including skin-to-skin contact, 24% oral sucrose, and topical anesthetic. DISCUSSION Despite infant distress, there was limited anticipatory behavior from parents and clinicians. Two-month-old infants displayed the most distress across all time points yet received the least amount of treatment and proximal parent and clinician behavior. Additional implementation efforts are required to increase awareness and practice uptake among parents and clinicians to ensure infants receive equitable and effective pain management.
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Affiliation(s)
- Morgan MacNeil
- School of Nursing, Dalhousie University, Halifax, NS, Canada; Faculty of Health, Dalhousie University, Halifax, NS, Canada; MOM-LINC Lab, IWK Health, Halifax, NS, Canada
| | | | - Marsha Campbell-Yeo
- School of Nursing, Dalhousie University, Halifax, NS, Canada; Faculty of Health, Dalhousie University, Halifax, NS, Canada; MOM-LINC Lab, IWK Health, Halifax, NS, Canada; Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada.
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Barr GA, Opendak M, Perry RE, Sarro E, Sullivan RM. Infant pain vs. pain with parental suppression: Immediate and enduring impact on brain, pain and affect. PLoS One 2023; 18:e0290871. [PMID: 37972112 PMCID: PMC10653509 DOI: 10.1371/journal.pone.0290871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 08/18/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND In the short term, parental presence while a human infant is in pain buffers the immediate pain responses, although emerging evidence suggests repeated social buffering of pain may have untoward long-term effects. METHODS/FINDING To explore the short- and long-term impacts of social buffering of pain, we first measured the infant rat pup's [postnatal day (PN) 8, or 12] response to mild tail shock with the mother present compared to shock alone or no shock. Shock with the mother reduced pain-related behavioral activation and USVs of pups at both ages and reduced Fos expression in the periaqueductal gray, hypothalamic paraventricular nucleus, and the amygdala at PN12 only. At PN12, shock with the mother compared to shock alone differentially regulated expression of several hundred genes related to G-protein-coupled receptors (GPCRs) and neural development, whereas PN8 pups showed a less robust and less coherent expression pattern. In a second set of experiments, pups were exposed to daily repeated Shock-mother pairings (or controls) at PN5-9 or PN10-14 (during and after pain sensitive period, respectively) and long-term outcome assessed in adults. Shock+mother pairing at PN5-9 reduced adult carrageenan-induced thermal hyperalgesia and reduced Fos expression, but PN10-14 pairings had minimal impact. The effect of infant treatment on adult affective behavior showed a complex treatment by age dependent effect. Adult social behavior was decreased following Shock+mother pairings at both PN5-9 and PN10-14, whereas shock alone had no effect. Adult fear responses to a predator odor were decreased only by PN10-14 treatment and the infant Shock alone and Shock+mother did not differ. CONCLUSIONS/SIGNIFICANCE Overall, integrating these results into our understanding of long-term programming by repeated infant pain experiences, the data suggest that pain experienced within a social context impacts infant neurobehavioral responses and initiates an altered developmental trajectory of pain and affect processing that diverges from experiencing pain alone.
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Affiliation(s)
- Gordon A. Barr
- Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States of America
- Perelman School of Medicine at the University of Pennsylvania, Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Maya Opendak
- Child Study Center, Center for Early Childhood Health & Development, Child & Adolescent Psychiatry, New York University School of Medicine, New York, New York, United States of America
- Emotional Brain Institute, Nathan Kline Institute, Orangeburg, New York, United States of America
| | - Rosemarie E. Perry
- Child Study Center, Center for Early Childhood Health & Development, Child & Adolescent Psychiatry, New York University School of Medicine, New York, New York, United States of America
- Emotional Brain Institute, Nathan Kline Institute, Orangeburg, New York, United States of America
| | - Emma Sarro
- Child Study Center, Center for Early Childhood Health & Development, Child & Adolescent Psychiatry, New York University School of Medicine, New York, New York, United States of America
- Emotional Brain Institute, Nathan Kline Institute, Orangeburg, New York, United States of America
| | - Regina M. Sullivan
- Child Study Center, Center for Early Childhood Health & Development, Child & Adolescent Psychiatry, New York University School of Medicine, New York, New York, United States of America
- Emotional Brain Institute, Nathan Kline Institute, Orangeburg, New York, United States of America
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Campbell-Yeo M, Benoit B, Newman A, Johnston C, Bardouille T, Stevens B, Jiang A. The influence of skin-to-skin contact on Cortical Activity during Painful procedures in preterm infants in the neonatal intensive care unit (iCAP mini): study protocol for a randomized control trial. Trials 2022; 23:512. [PMID: 35725632 PMCID: PMC9208173 DOI: 10.1186/s13063-022-06424-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 05/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background
Strong evidence suggests that maternal-infant skin-to-skin contact (SSC) is effective in reducing behavioural responses to pain. Given the multi-sensory benefits of SSC, it is highly likely that SSC provided during pain in early life may reduce pain-induced brain activity. The aim of this study is to examine the effect of SSC compared to 24% sucrose on pain-induced activity in the preterm infant brain during a medically required heel lance. Secondary objectives include determining (a) differences between behavioural pain response and noxious-related brain activity during heel lance and (b) rate of adverse events across groups. Methods We will randomly assign 126 babies (32 to 36 completed weeks gestational age) admitted to the neonatal intensive care unit, and their mothers within the first seven days of age to receive (i) SSC plus sterile water and (ii) 24% oral sucrose. Each baby will receive a medically indicated heel lance, following a no treatment baseline period. The primary outcome is noxious-related brain activity measured using an electroencephalogram (EEG) pain-specific event-related potential. Secondary outcomes include pain intensity measured using a bio-behavioural infant pain assessment tool (Premature Infant Pain Profile-Revised) and rate of adverse events. Discussion This will be the first clinical trial to compare the effect of SSC and 24% sucrose on pain-induced brain activity in the preterm infant brain during a clinical noxious stimulus, measured using EEG. Given the negative neurodevelopmental outcomes associated with unmanaged pain, it is imperative that preterm babies receive the most effective pain-reducing treatments to improve their health outcomes. Our findings will have important implications in informing optimal pain assessment and management in preterm infants. Trial registration ClinicalTrials.gov NCT03745963. Registered on November 19, 2018.
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Affiliation(s)
- Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University and IWK Health, Halifax, NS, Canada.
| | - Britney Benoit
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada
| | - Aaron Newman
- Faculty of Science, Department of Psychology & Neuroscience, Dalhousie University, Halifax, NS, Canada
| | | | - Tim Bardouille
- Department of Physics & Atmospheric Science, Dalhousie University, Halifax, NS, Canada
| | - Bonnie Stevens
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto and Child Health Evaluative Sciences Program, Research Institute, The Hospital for Sick Children (SickKids), Toronto, ON, Canada
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Evaluation of the Premature Infant Pain Profile-Revised (PIPP-R) e-Learning Module: Immediate and Sustained Competency. Adv Neonatal Care 2022; 22:246-252. [PMID: 34334673 DOI: 10.1097/anc.0000000000000922] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Electronic health (e-health) learning is a potential avenue to educate health professionals about accurately using infant pain assessment tools, although little is known about the impact of e-health interventions on clinical competence. PURPOSE To evaluate whether an e-health learning module for teaching the accurate use of the Premature Infant Pain Profile-Revised (PIPP-R) pain assessment tool results in immediate and sustained competency to assess infant pain. METHODS Neonatal intensive care unit (NICU) nurses who participated in a larger study across 2 tertiary NICUs in Canada examining the implementation and clinical utility of the PIPP-R e-learning module completed 2 follow-up evaluations at 1 week and 3 months. Participants were asked to view a video recording of an infant undergoing a painful procedure and to assess the infant's pain intensity response using the PIPP-R measure. Immediate and sustained competency was assessed via interrater consensus of participant-reported PIPP-R scores compared with those of an experienced trained coder. RESULTS Of the 25 eligible nurses, 22 completed 1-week and 3-month follow-up evaluations. At the 1-week follow-up, 84% of nurses scored the video accurately compared with 50% at 3 months. Behavioral pain indicators were more likely to be scored incorrectly than physiological indicators. IMPLICATIONS FOR PRACTICE Follow-up training after completion of the initial e-learning module training may improve competency related to the clinical use of the PIPP-R tool to assess infant pain over time. IMPLICATIONS FOR RESEARCH Additional study regarding the need and timing of e-health training to optimize sustained competency in infant pain assessment is warranted.
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Eissler AB, Zwakhalen S, Stoffel L, Hahn S. Systematic Review of the Effectiveness of Involving Parents During Painful Interventions for Their Preterm Infants. J Obstet Gynecol Neonatal Nurs 2022; 51:6-15. [PMID: 34627734 DOI: 10.1016/j.jogn.2021.08.100] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2021] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To systematically review the literature related to the effectiveness of parents' active involvement during painful interventions for their preterm infants. DATA SOURCES We performed a systematic search of PubMed, EMBASE/Ovid, CINAHL, Livivio, and PsycInfo using the keywords "preterm infants," "pain," and "parents." STUDY SELECTION Articles were eligible for inclusion if they were published between 2000 and 2021 and reported randomized controlled trials (RCTs) in which preterm infants underwent painful interventions, and parents were present and actively involved in pain-reducing measures. DATA EXTRACTION We used the Consolidated Standards of Reporting Trials (CONSORT) checklist for RCTs for data extraction. We assessed methodologic quality using critical appraisal for RCTs according to the Joanna Briggs Institute. DATA SYNTHESIS In total, 22 articles met the inclusion criteria. These articles reported 19 studies focused on kangaroo/skin-to-skin care, one focused on breastfeeding, and two focused on facilitated tucking. The methods used to evaluate pain in the infant varied substantially. Overall, kangaroo/skin-to-skin care and facilitated tucking resulted in clinically and statistically significant decreases in pain. For breastfeeding, effectiveness was linked to a more mature sucking pattern of the preterm infant. CONCLUSION The current evidence suggests that involving parents in pain-reducing measures during painful interventions for their preterm infants is beneficial. However, more research is needed for the different methods of involving parents in pain-reducing measures.
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Zou Y, Li Y, Jiang M, Liu X. Effect of early skin-to-skin contact after vaginal delivery on pain during perineal wound suturing: A randomized controlled trial. J Obstet Gynaecol Res 2021; 48:729-738. [PMID: 34962008 DOI: 10.1111/jog.15120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/18/2021] [Accepted: 11/26/2021] [Indexed: 11/28/2022]
Abstract
AIM To evaluate whether early skin-to-skin contact at the end of the second stage of labor could relieve perineal wound suture pain. METHODS From March 2020 to November 2020, a total of 241 parturients with full-term single fetuses delivered through the vagina and who underwent episiotomy suture (n = 120) or perineal laceration repair (n = 121) in our hospital were included in the study. Parturients were categorized according to whether they received episiotomy suture or perineal laceration repair. They were randomized into an early skin contact group and a traditional neonatal care group. The primary outcome was pain, which was quantified by the Numerical Rating Scale, Visual Analog Scale, Verbal Rating Scale, Faces Pain Scale-Revised. The secondary outcomes were healing of the perineal wound, the maternal cooperation rate and operation time. The confounding factors of severe pain were analyzed. RESULTS Early skin-to-skin contact alleviated the pain of perineal laceration repair and episiotomy suture, shortened the operation time of episiotomy suture and improved the cooperation rate of parturients receiving suture. It had no effect on perineal wound healing, operation time, or the cooperation rate of perineal laceration repair. In addition to the operation and early skin contact, the occurrence of high-grade pain was also associated with prepregnancy body mass index, group B streptococcus (GBS) positive, and academic degree. CONCLUSION Early skin-to-skin contact at the end of the second stage of labor can alleviate pain and improve the delivery experience of vaginal delivery.
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Affiliation(s)
- Yun Zou
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Yue Li
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Mei Jiang
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Xiaowei Liu
- Department of Obstetrics, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital, Beijing, China
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Cañadas DC, Perales AB, Casado Belmonte MDP, Martínez RG, Carreño TP. Kangaroo mother care and skin-to-skin care in preterm infants in the neonatal intensive care unit: A bibliometric analysis. Arch Pediatr 2021; 29:90-99. [PMID: 34955302 DOI: 10.1016/j.arcped.2021.11.007] [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: 05/31/2021] [Revised: 09/20/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The desire to understand and the growing interest in research on the effects of kangaroo mother care in preterm infants in the neonatal intensive care unit have led to a significant increase in the number of manuscripts published in this field over the past decade. It is therefore necessary to regularly review the state of knowledge on this phenomenon in order to identify progress and constraints, to stimulate reflection, and to encourage progress in future research. PURPOSE The aim of this study was to determine the current state of scientific production in relation to kangaroo mother care in preterm infants in the neonatal intensive care unit through bibliometric analysis. DATA SOURCES This study presents a review of 212 published papers from the Scopus database (1990-2019). DATA EXTRACTION Two processing software applications were used: VOSviewer and SciMAT. In addition, through a keyword analysis, this study established the hot spot research trends to be developed in future work. The study adhered to the PRISMA-ScR guidelines for quality improvement studies as part of the EQUATOR network. RESULTS Our results show that research in this field is going through a time of high productivity and we could sort this growing body of work into different periods, highlighting the most important topics.The analysis shows that most research in this field is focused on five motor topics. These are: prematurity, male, psychology, intensive care neonatal, and major clinical study. The analysis also allowed us to identify four basic and cross-disciplinary topics that need to be developed and that emerge as future research directions: preterm infants, child-parent relations, child development, and skin-to-skin contact. IMPLICATIONS FOR PRACTICE AND RESEARCH The main contribution of this work is the creation of a knowledge map on the research in this field. This article provides information on how we can shape the future to provide optimal care for these infants and their parents.
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Affiliation(s)
- Delia Cristóbal Cañadas
- Torrecárdenas University Hospital, Paediatric Intensive Care Unit, C/ Hermandad de Donantes de Sangre s/n 04009, Almería, Spain.
| | | | | | | | - Tesifón Parrón Carreño
- Department of Nursing, University of Almería, Physiotherapy and Medicine, Almería, Spain; Andalusian Council of Health at Almería Province, Almería, Spain
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Hundert A, Woolcott C, Dorling J, Benoit B, Campbell-Yeo M. Classification of Individual Pain Response Trajectories Following Medically Indicated Heel Lances in Preterm Infants During Their NICU Admission. Clin J Pain 2021; 38:151-158. [PMID: 34928871 DOI: 10.1097/ajp.0000000000001011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 11/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Infants born preterm are exposed to repeated painful procedures during neonatal intensive care unit admission. Particularly in preterm infants, trajectories of pain response are not well understood. The aim of this study was to classify pain response trajectories over 2 minute following medically indicated heel lances in preterm infants. MATERIALS AND METHODS This study used existing clinical trial data (NCT01561547) that evaluated the efficacy of kangaroo care and sucrose for infant pain control. Pain was measured using the Premature Infant Pain Profile at 30, 60, 90, and 120 seconds following a heel lance. Group-based trajectory modeling was used to classify pain response in this 2 minute period. RESULTS A total of 236 infants with median gestational age of 33 weeks contributed 610 procedures. A model with 5 trajectory classes best fit the data. Three trajectories were stable over time at different levels of intensity from low-mild to low-moderate pain. One trajectory reflected a linear reduction from high-moderate to low-moderate pain. The final trajectory showed variable moderate-high pain. At all times points, 3 classes were at least 1-point different from the overall sample mean pain score. Only 21 (9%) infants maintained the same class for all 3 procedures. DISCUSSION In this sample of preterm infants receiving pain relief, most pain trajectories reflected mild to low-moderate pain that was stable over 2 minute after heel lance initiation. Trajectories were not consistent over multiple procedures within infants, and an overall mean pain score for the sample may misrepresent subgroups of pain response.
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Affiliation(s)
- Amos Hundert
- Centre for Pediatric Pain Research, IWK Health Centre
- Department of Community Health and Epidemiology
| | - Christy Woolcott
- Perinatal Epidemiology Research Unit, Department of Pediatrics, Obstetrics and Gynaecology
| | - Jon Dorling
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics
| | - Britney Benoit
- Nova Scotia Health, Halifax
- Rankin School of Nursing, St. Francis Xavier University, Antigonish, Nova Scotia, Canada
| | - Marsha Campbell-Yeo
- Centre for Pediatric Pain Research, IWK Health Centre
- School of Nursing, Dalhousie University
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Lee LA, Moss SJ, Martin DA, Rosgen BK, Wollny K, Gilfoyle E, Fiest KM. Comfort-holding in critically ill children: a scoping review. Can J Anaesth 2021; 68:1695-1704. [PMID: 34405358 PMCID: PMC8370455 DOI: 10.1007/s12630-021-02090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/07/2022] Open
Abstract
Purpose To understand and summarize the breadth of knowledge on comfort-holding in pediatric intensive care units (PICUs). Sources This scoping review was conducted using PRISMA methodology. A literature search was conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane CENTRAL Register of Controlled Trials. Search strategies were developed with a medical librarian and revised through a peer review of electronic search strategies. All databases were searched from inception to 14 April 2020. Only full-text articles available in English were included. All identified articles were reviewed independently and in duplicate using predetermined criteria. All study designs were eligible if they reported on comfort-holding in a PICU. Data were extracted independently and in duplicate. Principal findings Of 13,326 studies identified, 13 were included. Comfort-holding was studied in the context of end-of-life care, developmental care, mobilization, and as a unique intervention. Comfort-holding is common during end-of-life care with 77.8% of children held, but rare during acute management (51% of children < three years, < 5% of children ≥ three years). Commonly reported outcomes included child outcomes (e.g., physiologic measurements), safety outcomes (e.g., accidental line removal), parent outcomes (e.g., psychological symptoms), and frequency of holding. Conclusion There is a paucity of literature on comfort-holding in PICUs. This scoping review identifies significant gaps in the literature, including assessment of child-based outcomes of comfort-holding or safety assessment of comfort-holding, and highlights core outcomes to consider in future evaluations of this intervention including child-based outcomes, parent-based outcomes, and safety of the intervention. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-021-02090-3.
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Affiliation(s)
- Laurie A Lee
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Faculty of Nursing, University of Calgary, Calgary, AB, Canada. .,Pediatric Intensive Care Unit, Alberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive, Calgary, AB, T3B 6A8, Canada.
| | - Stephana J Moss
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Dori-Ann Martin
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada.,Pediatric Intensive Care Unit, Alberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive, Calgary, AB, T3B 6A8, Canada
| | - Brianna K Rosgen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Krista Wollny
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Elaine Gilfoyle
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Skin-to-Skin Care by Mother vs. Father for Preterm Neonatal Pain: A Randomized Control Trial (ENVIRON Trial). Int J Pediatr 2021; 2021:8886887. [PMID: 33488739 PMCID: PMC7803418 DOI: 10.1155/2021/8886887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To compare skin-to-skin care (SSC) given by mother and father for preterm neonatal pain control by premature infant pain profile (PIPP) score. Methods 64 stable preterm (28-36 weeks gestational age) neonates born at a level-3 neonatal intensive care unit were included in the trial. Random allocation with the help of a computer-generated sequence was done. In group A, SSC was given by the mother 15 minutes before the first heel-stick, and subsequently, SSC was given by the father before the second heel-stick. In group B, the sequence of SSC provider was reversed. Blinded PIPP score assessment at 0, 1, and 5 minutes of heel-stick were done by two independent assessors using video recording. Results The mean (SD) birth weight was 1665.18 (339.35) grams, and mean (SD) gestational age was 34.28 (2.24) weeks. The PIPP score at 0, 1, and 5 minutes had no statistical or clinically significant differences between both groups (PIPP score mean (SD) at 0 minute = 3.20 (1.11) vs. 3.01 (1.29), p value = 0.38; 1 minute = 8.59 (4.27) vs. 8.26 (4.08), p value = 0.66; 5 minutes = 3.79 (1.40) vs. 3.93 (1.99), p value = 0.65 in SSC by mother and father group, respectively). Furthermore, there was no statistical difference between the groups for any components of the PIPP score (all p values > 0.05). The PIPP score at 5 minutes almost attained the 0-minute level in both the groups. Conclusion Father is as effective as the mother for providing skin-to-skin care for preterm neonatal pain control. This trial is registered with CTRI/2018/01/016783.
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Friedrichsdorf SJ, Goubert L. [Pediatric pain treatment and prevention for hospitalized children]. Schmerz 2020; 35:195-210. [PMID: 33337532 DOI: 10.1007/s00482-020-00519-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. OBJECTIVES To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses. METHODS This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable "Factsheet Pain in Children: Management" and reviews best evidence and practice. RESULTS Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind-body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation. CONCLUSION Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
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Affiliation(s)
- Stefan J Friedrichsdorf
- Center of Pain Medicine, Palliative Care and Integrative Medicine, University of California at San Francisco (UCSF), Benioff Children's Hospitals in Oakland and San Francisco, Kalifornien, USA.
- Department of Pain Medicine, Palliative Care and Integrative Medicine, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN, USA.
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA.
| | - Liesbet Goubert
- Department of Experimental-Clinical and Health Psychology, Ghent University, Gent, Belgien
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Sustained efficacy of kangaroo care for repeated painful procedures over neonatal intensive care unit hospitalization: a single-blind randomized controlled trial. Pain 2020; 160:2580-2588. [PMID: 31356452 DOI: 10.1097/j.pain.0000000000001646] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Preterm neonates hospitalized in the neonatal intensive care unit undergo frequent painful procedures daily, often without pain treatment, with associated long-term adverse effects. Maternal-infant skin-to-skin contact, or kangaroo care (KC), and sweet-tasting solutions such as sucrose are effective strategies to reduce pain during a single procedure; however, evidence of sustained efficacy over repeated procedures is limited. We aimed to determine the relative sustained efficacy of maternal KC, administered alone or in combination with 24% sucrose, to reduce behavioral pain intensity associated with routine neonatal procedures, compared with 24% sucrose alone. Stable preterm infants (n = 242) were randomized to receive KC and water, KC and 24% sucrose, or 24% sucrose before all routine painful procedures throughout their neonatal intensive care unit stay. Pain intensity, determined using the Premature Infant Pain Profile, was measured during 3 medically indicated heel lances distributed across hospitalization. Maternal and neonatal baseline characteristics, Premature Infant Pain Profile scores at 30, 60, or 90 seconds after heel lance, the distribution of infants with pain scores suggesting mild, moderate, or severe pain, Neurobehavioral Assessment of the Preterm Infant scores, and incidence of adverse outcomes were not statistically significantly different between groups. Maternal KC, as a pain-relieving intervention, remained efficacious over time and repeated painful procedures without evidence of any harm or neurological impact. It seemed to be equally effective as 24% oral sucrose, and the combination of maternal KC and sucrose did not seem to provide additional benefit, challenging the existing recommendation of using sucrose as the primary standard of care.
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Nimbalkar S, Shukla VV, Chauhan V, Phatak A, Patel D, Chapla A, Nimbalkar A. Blinded randomized crossover trial: Skin-to-skin care vs. sucrose for preterm neonatal pain. J Perinatol 2020; 40:896-901. [PMID: 32152488 DOI: 10.1038/s41372-020-0638-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 02/14/2020] [Accepted: 02/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare skin-to-skin care (SSC) and oral sucrose for preterm neonatal pain control. METHODS Preterm neonates (28-36 weeks gestation) requiring heel-stick were eligible. In group-A, SSC was given 15-min before first heel-stick, and sucrose was given 2-min before second heel-stick. In group-B, the sequence was reversed. Blinded premature infant pain profile (PIPP) score assessment was done at 0, 1, and 5-min of heel-stick by two assessors. RESULTS A hundred neonates were enrolled. The inter-rater agreement for the PIPP score was good. The behavior state component was significantly lower in the sucrose group at all assessment points. The mean (SD) difference between 1-min and 0 min was similar [SSC 3.58(3.16) vs. sucrose 4.09(3.82), p = 0.24] between groups. The PIPP score attained baseline values at 5-min in both groups. CONCLUSION Albeit sucrose indicated instantaneous action, SSC and sucrose have comparable clinical efficacy for preterm neonatal pain control. Multisensory stimulation with SSC may result in a higher behavioral state component of the PIPP score.
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Affiliation(s)
| | - Vivek V Shukla
- Pramukhswami Medical College, Anand, Gujarat, India. .,University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | - Ajay Phatak
- Pramukhswami Medical College, Anand, Gujarat, India
| | - Dipen Patel
- Pramukhswami Medical College, Anand, Gujarat, India
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Sezici E, Yigit D. The Effect of Skin-to-Skin Contact on Maternal Anxiety, Heart Rate, and Oxygen Saturation during the Vaccination of One-Month-Old Infants. Compr Child Adolesc Nurs 2020; 43:410-420. [PMID: 32073934 DOI: 10.1080/24694193.2020.1721614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study aimed to reduce maternal anxiety scores and heart rates, increase oxygen saturation linked to vaccination processes with Skin-to skin contact (SSC). The study is a prospective, multicenter, paired, randomized, controlled trial. This experimental study was conducted with a pretest-posttest control group. The study was carried out with 128 mothers of infants. A Sociodemographic Questionnaire, the State Anxiety Inventory and a pulse oximeter were used in the data collection. In the study, SSC began to be given to the infants in the intervention group five minutes before vaccination and the infant was left in SSC for an uninterrupted 15 minutes following the vaccination. The maternal anxiety scores were noted before and after the vaccination process. The mothers' heart rates and oxygen saturation were monitored a total of three times. The anxiety scores of the intervention group decreased while oxygen saturation increased after the vaccination as compared to the control group. The heart rate decreased in the intervention group but increased in the control group. The study revealed that SSC reduced scores of maternal anxiety and heart rates and increased oxygen saturation during the vaccination process.
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Affiliation(s)
- Emel Sezici
- Department of Pediatric Nursing, Faculty of Health Sciences, Kutahya Health Sciences University , Kutahya, Turkey
| | - Deniz Yigit
- Department of Pediatric Nursing, School of Health Sciences, Eskisehir Osmangazi University , Eskisehir, Turkey
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Comparing the Analgesic Effects of 4 Nonpharmacologic Interventions on Term Newborns Undergoing Heel Lance: A Randomized Controlled Trial. J Perinat Neonatal Nurs 2020; 34:338-345. [PMID: 32804876 DOI: 10.1097/jpn.0000000000000495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This randomized trial compared the analgesic effect of 4 nonpharmacologic interventions (breastfeeding, oral sucrose, nonnutritive sucking, and skin-to-skin contact) on term newborns between 24 and 48 hours of age who underwent a heel lance. The Neonatal Pain, Agitation, and Sedation Scale was used to evaluate pain. The newborns (N = 226) were assigned to one of 4 intervention groups (n = 176) or a control group without pain intervention (n = 50). The results indicate that all intervention groups showed decreased pain levels when compared with the control group (P < .01). The oral sucrose group experienced a superior analgesic effect when compared with the skin-to-skin contact group (P < .01), but no difference was observed when compared with the breastfeeding group (P > .05) or the nonnutritive sucking group (P > .05). All intervention groups showed a shortened crying time (P < .01) and reduced procedural duration (P < .01) compared with the control group. All of these interventions are clinically applicable and acceptable when caring for a newborn during a minor painful procedure.
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Pediatric pain treatment and prevention for hospitalized children. Pain Rep 2019; 5:e804. [PMID: 32072099 PMCID: PMC7004501 DOI: 10.1097/pr9.0000000000000804] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 10/23/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022] Open
Abstract
Introduction: Prevention and treatment of pain in pediatric patients compared with adults is often not only inadequate but also less often implemented the younger the children are. Children 0 to 17 years are a vulnerable population. Objectives: To address the prevention and treatment of acute and chronic pain in children, including pain caused by needles, with recommended analgesic starting doses. Methods: This Clinical Update elaborates on the 2019 IASP Global Year Against Pain in the Vulnerable “Factsheet Pain in Children: Management” and reviews best evidence and practice. Results: Multimodal analgesia may include pharmacology (eg, basic analgesics, opioids, and adjuvant analgesia), regional anesthesia, rehabilitation, psychological approaches, spirituality, and integrative modalities, which act synergistically for more effective acute pediatric pain control with fewer side effects than any single analgesic or modality. For chronic pain, an interdisciplinary rehabilitative approach, including physical therapy, psychological treatment, integrative mind–body techniques, and normalizing life, has been shown most effective. For elective needle procedures, such as blood draws, intravenous access, injections, or vaccination, overwhelming evidence now mandates that a bundle of 4 modalities to eliminate or decrease pain should be offered to every child every time: (1) topical anesthesia, eg, lidocaine 4% cream, (2) comfort positioning, eg, skin-to-skin contact for infants, not restraining children, (3) sucrose or breastfeeding for infants, and (4) age-appropriate distraction. A deferral process (Plan B) may include nitrous gas analgesia and sedation. Conclusion: Failure to implement evidence-based pain prevention and treatment for children in medical facilities is now considered inadmissible and poor standard of care.
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McNair C, Campbell-Yeo M, Johnston C, Taddio A. Nonpharmacologic Management of Pain During Common Needle Puncture Procedures in Infants: Current Research Evidence and Practical Considerations: An Update. Clin Perinatol 2019; 46:709-730. [PMID: 31653304 DOI: 10.1016/j.clp.2019.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. Numerous nonpharmacologic interventions are available that may be used for these painful procedures, including swaddling/containment, pacifier/non-nutritive sucking, rocking/holding, breastfeeding and breastmilk, skin-to-skin care, sweet tasting solutions, music therapy, sensorial saturation, and parental presence. Adoption these interventions into routine clinical practice is feasible and should be a standard of care in quality health care for infants. This review summarizes the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions.
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Affiliation(s)
- Carol McNair
- Nursing and Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada
| | - Marsha Campbell-Yeo
- Department of Pediatrics, IWK Health Centre, School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Celeste Johnston
- Ingram School of Nursing, McGill University, Montreal, Canada; IWK Health Centre, 5850/5980 University Avenue, Halifax B3K 6R8, Canada
| | - Anna Taddio
- Clinical, Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Child Health Evaluative Sciences, The Hospital for Sick Children, 144 College Street, Toronto, Ontario M5S 3M2, Canada.
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Memories of Infant Pain in the Neonatal Intensive Care Unit Influence Posttraumatic Stress Symptoms in Mothers of Infants Born Preterm. Clin J Pain 2019; 34:936-943. [PMID: 29698249 DOI: 10.1097/ajp.0000000000000620] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES The birth of a preterm infant and witnessing ones' infant in pain is remembered by parents as being one of the most stressful aspects of the neonatal intensive care unit (NICU). Elevated posttraumatic stress symptoms (PTSS) are highly prevalent among mothers of preterm infants, however, little is known about mothers' memories of invasive procedures in the NICU and how these memories may contribute to the development of PTSS. We examined the relationships between number of invasive procedures, mothers' memories of these procedures, and their PTSS at discharge from the NICU. MATERIALS AND METHODS Participants included 36 mothers of infants born below 37 weeks gestational age recruited from a tertiary-level NICU. Medical chart review was performed between birth and discharge from the NICU. At discharge, a research nurse conducted a structured memory interview with the mothers to assess their memories of their infants' invasive procedures. Mothers also completed a self-report measure of PTSS (Posttraumatic Stress Disorder Checklist for the DSM-5). RESULTS Mothers of infants exposed to greater numbers of invasive procedures had more elevated PTSS at discharge (R=0.37). Moreover, mothers who recalled having greater anxiety about their infant's invasive procedures had greater symptoms of reexperiencing (R=0.34) and avoidance (R=0.28) at discharge from the NICU. DISCUSSION Greater neonatal exposure to invasive procedures and mothers' recall of these procedures were related to mothers' posttraumatic stress symptomatology at discharge. Invasive procedures in the NICU represent an important target area for neonatal intervention to reduce maternal distress and improve outcomes.
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Assessment and Management of Procedural Pain During the Entire Neonatal Intensive Care Unit Hospitalization. Pain Manag Nurs 2019; 20:503-511. [DOI: 10.1016/j.pmn.2018.11.061] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 10/11/2018] [Accepted: 11/28/2018] [Indexed: 02/06/2023]
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Ryan M, Lacaze-Masmonteil T, Mohammad K. Neuroprotection from acute brain injury in preterm infants. Paediatr Child Health 2019; 24:276-290. [PMID: 31239818 PMCID: PMC6587421 DOI: 10.1093/pch/pxz056] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Infants born at ≤32+6 weeks gestation are at higher risk for intracranial ischemic and hemorrhagic injuries, which often occur in the first 72 hours postbirth. Antenatal strategies to reduce the incidence of acute brain injuries include administering maternal corticosteroids and prompt antibiotic treatment for chorioamnionitis. Perinatal strategies include delivery within a tertiary centre, delayed cord clamping, and preventing hypothermia. Postnatal strategies include empiric treatment with antibiotics when chorioamnionitis is suspected, the cautious use of inotropes, the avoidance of blood PCO2 fluctuation, and neutral head positioning. Clinicians should be aware of the policies and procedures that, especially when combined, can provide neuroprotection for preterm infants.
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Affiliation(s)
- Michelle Ryan
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
| | | | - Khorshid Mohammad
- Canadian Paediatric Society, Fetus and Newborn Committee, Ottawa, Ontario
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Ryan M, Lacaze-Masmonteil T, Mohammad K. La neuroprotection contre les lésions cérébrales aiguës chez les nouveau-nés prématurés. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Michelle Ryan
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
| | | | - Khorshid Mohammad
- Société canadienne de pédiatrie, comité d’étude du fœtus et du nouveau-né, Ottawa (Ontario)
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Pandita A, Panghal A, Gupta G, Verma A, Pillai A, Singh A, Naranje K. Is kangaroo mother care effective in alleviating vaccination associated pain in early infantile period? A RCT. Early Hum Dev 2018; 127:69-73. [PMID: 30321774 DOI: 10.1016/j.earlhumdev.2018.10.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 08/15/2018] [Accepted: 10/04/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Childhood vaccination is a common procedure and a part of routine medical care during infancy. Although vaccination is the cornerstone for prevention of many infectious diseases, it is associated with significant pain, which is often ignored. Non pharmacological interventions such as breast feeding and kangaroo mother care (KMC) have been used to decrease this procedural pain. However there is paucity of published data on effective use of KMC in term neonates and infants beyond the neonatal age. METHOD This randomized controlled trial included 61 infants ≤14 weeks of postnatal age, and compared KMC to swaddling during vaccination. Neonatal infant pain scale (NIPS) was used to assess the pain associated with vaccination. RESULTS NIPS scores at 1 min and 5 min after vaccination and duration of cry were significantly less in the KMC group. CONCLUSION KMC is effective in reducing vaccination associated pain in young infants.
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Affiliation(s)
| | | | - Girish Gupta
- Department of Neonatology, SGPGI, Lucknow, India
| | - Anup Verma
- Department of Biostatistics and Health Informatics, Sanjay Gandhi Postgratuate Institute of Medical Sciences, Lucknow, India
| | - Anish Pillai
- Division of Neonatology, BC Women's and Children's Hospital, Vancouver, Canada
| | - Anita Singh
- Department of Neonatology, SGPGI, Lucknow, India
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Shukla V, Chapla A, Uperiya J, Nimbalkar A, Phatak A, Nimbalkar S. Sucrose vs. skin to skin care for preterm neonatal pain control-a randomized control trial. J Perinatol 2018; 38:1365-1369. [PMID: 30087456 DOI: 10.1038/s41372-018-0193-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 05/26/2018] [Accepted: 06/19/2018] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare the efficacy of SSC with oral Sucrose for pain management in preterm neonates. METHODOLOGY Parallel-group, assessor-blinded randomized control trial conducted from February-June 2017 at a level 3B-NICU. Hundred preterm neonates (29-0/7 to 36-6/7 weeks gestational age) requiring heel-stick were randomly assigned (1:1), to SSC (50, Group-A) and Sucrose (50, Group-B). In Group-A, SSC was provided at least 10 min before the procedure. In Group-B, 0.2 ml of oral Sucrose was provided 2 min before the procedure. Blinded assessment of Premature Infant Pain Profile (PIPP) score was done 30 s post-procedure using recorded videos. RESULTS Baseline variables were [Mean(SD)] gestational age [32.79(2.34) weeks], age [14.04(11.10) days] and birth weight [1.62(0.35) kilograms]. PIPP score was less in group- A vs. B but could not achieve statistical significance [Mean(SD): 7.74(2.43) vs. 8.1(2.82), p = 0.50 CI of the difference: (-1.40,0.68)]. CONCLUSIONS SSC and Sucrose have comparable efficacy in managing pain in premature neonates.
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Affiliation(s)
- Vivek Shukla
- SUNY, Downstate Medical Center, Brooklyn, NY, USA.
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Johnston C, Campbell‐Yeo M, Disher T, Benoit B, Fernandes A, Streiner D, Inglis D, Zee R. Skin-to-skin care for procedural pain in neonates. Cochrane Database Syst Rev 2017; 2:CD008435. [PMID: 28205208 PMCID: PMC6464258 DOI: 10.1002/14651858.cd008435.pub3] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Skin-to-skin care (SSC), often referred to as 'kangaroo care' (KC) due to its similarity with marsupial behaviour of ventral maternal-infant contact, is one non-pharmacological intervention for pain control in infants. OBJECTIVES The primary objectives were to determine the effect of SSC alone on pain from medical or nursing procedures in neonates compared to no intervention, sucrose or other analgesics, or additions to simple SSC such as rocking; and to determine the effects of the amount of SSC (duration in minutes), method of administration (e.g. who provided the SSC) of SSC in reducing pain from medical or nursing procedures in neonatesThe secondary objectives were to determine the safety of SSC care for relieving procedural pain in infants; and to compare the SSC effect in different postmenstrual age subgroups of infants. SEARCH METHODS For this update, we used the standard search strategy of the Cochrane Neonatal Review group to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 1); MEDLINE via PubMed (1966 to 25 February 2016); Embase (1980 to 25 February 2016); and CINAHL (1982 to 25 February 2016). We also searched clinical trials' databases, conference proceedings, and the reference lists of retrieved articles for randomized controlled trials and quasi-randomized trials. SELECTION CRITERIA Studies with randomisation or quasi-randomisation, double- or single-blinded, involving term infants (≥ 37 completed weeks' postmenstrual age (PMA) to a maximum of 44 weeks' PMA and preterm infants (< 37 completed weeks PMA) receiving SSC for painful procedures conducted by healthcare professionals. DATA COLLECTION AND ANALYSIS The main outcome measures were physiological or behavioural pain indicators and composite pain scores. A mean difference (MD) with 95% confidence interval (CI) using a fixed-effect model was reported for continuous outcome measures. We included variations on type of tissue-damaging procedure, provider of care, and duration of SSC. MAIN RESULTS Twenty-five studies (n = 2001 infants) were included. Nineteen studies (n = 1065) used heel lance as the painful procedure, one study combined venepuncture and heel stick (n = 50), three used intramuscular injection (n = 776), one used 'vaccination' (n = 60), and one used tape removal (n = 50). The studies were generally strong and had low or uncertain risk of bias. Blinding of the intervention was not possible, making them subject to high risk, depending on the method of scoring outcomes.Seventeen studies (n = 810) compared SSC to a no-treatment control. Although 15 studies measured heart rate during painful procedures, data from only five studies (n = 161) could be combined for a mean difference (MD) of -10.78 beats per minute (95% CI -13.63 to -7.93) favouring SSC. Meta-analysis of four studies (n = 120) showed no difference in heart rate following the painful procedure (MD 0.08, 95% CI -4.39 to 4.55). Two studies (n = 38) reported heart rate variability with no significant differences. Two studies (n = 101) in a meta-analysis on oxygen saturation at 30 and 60 seconds following the painful procedure did not show a difference. Duration of crying meta-analysis was performed on four studies (n = 133): two (n = 33) investigated response to heel lance (MD = -34.16, 95% CI -42.86 to -25.45), and two (n = 100) following IM injection (MD = -8.83, 95% CI -14.63 to -3.02), favouring SSC. Five studies, one consisting of two substudies (n = 267), used the Premature Infant Pain Profile (PIPP) as a primary outcome, which favoured SCC at 30 seconds (MD -3.21, 95% CI -3.94 to -2.47), at 60 seconds (3 studies; n = 156) (MD -1.64, 95% CI -2.86 to -0.43), and at 90 seconds (n = 156) (MD -1.28, 95% CI -2.53 to -0.04); but at 120 seconds there was no difference (n = 156) (MD 0.07, 95% CI -1.11 to 1.25). No studies on return of heart rate to baseline level, cortisol levels, and facial actions could be combined for meta-analysis findings.Eight studies compared SSC to another intervention with or without a no-treatment control. Two cross-over studies (n = 80) compared mother versus other provider (father, another female) on PIPP scores at 30, 60, 90, and 120 seconds with no significant difference. When SSC was compared to other interventions, there were not enough similar studies to pool results in an analysis. One study compared SSC (n = 640) with and without dextrose and found that the combination was most effective and that SSC alone was more effective than dextrose alone. Similarly, in another study SSC was more effective than oral glucose for heart rate (n = 95). SSC either in combination with breastfeeding or alone was favoured over a no-treatment control, but not different to breastfeeding. One study compared SSC alone and in combination with both sucrose and breastfeeding on heart rate (HR), NIPS scores, and crying time (n = 127). The combinations were more effective than SSC alone for NIPS and crying. Expressed breast milk was compared to SSC in one study (n = 50) and found both equally effective on PIPP scores. There were not enough participants with similar outcomes and painful procedures to compare age groups or duration of SSC. No adverse events were reported in any of the studies. AUTHORS' CONCLUSIONS SSC appears to be effective as measured by composite pain indicators with both physiological and behavioural indicators and, independently, using heart rate and crying time; and safe for a single painful procedure. Purely behavioural indicators tended to favour SSC but with facial actions there is greater possibility of observers not being blinded. Physiological indicators were mixed although the common measure of heart rate favoured SSC. Two studies compared mother-providers to others, with non-significant results. There was more heterogeneity in the studies with behavioural or composite outcomes. There is a need for replication studies that use similar, clearly defined outcomes. Studies examining optimal duration of SSC, gestational age groups, repeated use, and long-term effects of SSC are needed. Of interest would be to study synergistic effects of SSC with other interventions.
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Affiliation(s)
| | - Marsha Campbell‐Yeo
- IWK Health CentreNeonatal Intensive Care Unit5850/5980 University AvenuePO Box 9700HalifaxNSCanadaB3K 6R8
| | | | | | - Ananda Fernandes
- Coimbra College of NursingDepartment of Child HealthAv. BissayaBarretoAp. 55CoimbraPortugal3001‐901
| | - David Streiner
- McMaster UniversityDepartment of Psychiatry and Behavioural Neurociences100 West 5th StreetRoom B‐366HamiltonONCanadaL8N 3K7
| | - Darlene Inglis
- IWK Health CentreNeonatal Intensive Care Unit5850/5980 University AvenuePO Box 9700HalifaxNSCanadaB3K 6R8
| | - Rebekah Zee
- IWK Health CentreNeonatal Intensive Care Unit5850/5980 University AvenuePO Box 9700HalifaxNSCanadaB3K 6R8
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Disher T, Benoit B, Johnston C, Campbell-Yeo M. Skin-to-skin contact for procedural pain in neonates: acceptability of novel systematic review synthesis methods and GRADEing of the evidence. J Adv Nurs 2016; 73:504-519. [DOI: 10.1111/jan.13182] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Timothy Disher
- Faculty of Health Professions; School of Nursing; Dalhousie University; Halifax Nova Scotia Canada
- IWK Health Centre; Halifax Nova Scotia Canada
| | - Britney Benoit
- Faculty of Health Professions; School of Nursing; Dalhousie University; Halifax Nova Scotia Canada
- IWK Health Centre; Halifax Nova Scotia Canada
| | | | - Marsha Campbell-Yeo
- Faculty of Health Professions; School of Nursing and Department of Psychology & Neuroscience; Dalhousie University; Halifax Nova Scotia Canada
- IWK Health Centre; Department of Pediatrics; Halifax Nova Scotia Canada
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Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 2016; 7:CD001069. [PMID: 27420164 PMCID: PMC6457867 DOI: 10.1002/14651858.cd001069.pub5] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Administration of oral sucrose with and without non-nutritive sucking is the most frequently studied non-pharmacological intervention for procedural pain relief in neonates. OBJECTIVES To determine the efficacy, effect of dose, method of administration and safety of sucrose for relieving procedural pain in neonates as assessed by validated composite pain scores, physiological pain indicators (heart rate, respiratory rate, saturation of peripheral oxygen in the blood, transcutaneous oxygen and carbon dioxide (gas exchange measured across the skin - TcpO2, TcpCO2), near infrared spectroscopy (NIRS), electroencephalogram (EEG), or behavioural pain indicators (cry duration, proportion of time crying, proportion of time facial actions (e.g. grimace) are present), or a combination of these and long-term neurodevelopmental outcomes. SEARCH METHODS We used the standard methods of the Cochrane Neonatal. We performed electronic and manual literature searches in February 2016 for published randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, Issue 1, 2016), MEDLINE (1950 to 2016), EMBASE (1980 to 2016), and CINAHL (1982 to 2016). We did not impose language restrictions. SELECTION CRITERIA RCTs in which term or preterm neonates (postnatal age maximum of 28 days after reaching 40 weeks' postmenstrual age), or both, received sucrose for procedural pain. Control interventions included no treatment, water, glucose, breast milk, breastfeeding, local anaesthetic, pacifier, positioning/containing or acupuncture. DATA COLLECTION AND ANALYSIS Our main outcome measures were composite pain scores (including a combination of behavioural, physiological and contextual indicators). Secondary outcomes included separate physiological and behavioural pain indicators. We reported a mean difference (MD) or weighted MD (WMD) with 95% confidence intervals (CI) using the fixed-effect model for continuous outcome measures. For categorical data we used risk ratio (RR) and risk difference. We assessed heterogeneity by the I(2) test. We assessed the risk of bias of included trials using the Cochrane 'Risk of bias' tool, and assessed the quality of the evidence using the GRADE system. MAIN RESULTS Seventy-four studies enrolling 7049 infants were included. Results from only a few studies could be combined in meta-analyses and for most analyses the GRADE assessments indicated low- or moderate-quality evidence. There was high-quality evidence for the beneficial effect of sucrose (24%) with non-nutritive sucking (pacifier dipped in sucrose) or 0.5 mL of sucrose orally in preterm and term infants: Premature Infant Pain Profile (PIPP) 30 s after heel lance WMD -1.70 (95% CI -2.13 to -1.26; I(2) = 0% (no heterogeneity); 3 studies, n = 278); PIPP 60 s after heel lance WMD -2.14 (95% CI -3.34 to -0.94; I(2) = 0% (no heterogeneity; 2 studies, n = 164). There was high-quality evidence for the use of 2 mL 24% sucrose prior to venipuncture: PIPP during venipuncture WMD -2.79 (95% CI -3.76 to -1.83; I(2) = 0% (no heterogeneity; 2 groups in 1 study, n = 213); and intramuscular injections: PIPP during intramuscular injection WMD -1.05 (95% CI -1.98 to -0.12; I(2) = 0% (2 groups in 1 study, n = 232). Evidence from studies that could not be included in RevMan-analyses supported these findings. Reported adverse effects were minor and similar in the sucrose and control groups. Sucrose is not effective in reducing pain from circumcision. The effectiveness of sucrose for reducing pain/stress from other interventions such as arterial puncture, subcutaneous injection, insertion of nasogastric or orogastric tubes, bladder catherization, eye examinations and echocardiography examinations are inconclusive. Most trials indicated some benefit of sucrose use but that the evidence for other painful procedures is of lower quality as it is based on few studies of small sample sizes. The effects of sucrose on long-term neurodevelopmental outcomes are unknown. AUTHORS' CONCLUSIONS Sucrose is effective for reducing procedural pain from single events such as heel lance, venipuncture and intramuscular injection in both preterm and term infants. No serious side effects or harms have been documented with this intervention. We could not identify an optimal dose due to inconsistency in effective sucrose dosage among studies. Further investigation of repeated administration of sucrose in neonates is needed. There is some moderate-quality evidence that sucrose in combination with other non-pharmacological interventions such as non-nutritive sucking is more effective than sucrose alone, but more research of this and sucrose in combination with pharmacological interventions is needed. Sucrose use in extremely preterm, unstable, ventilated (or a combination of these) neonates needs to be addressed. Additional research is needed to determine the minimally effective dose of sucrose during a single painful procedure and the effect of repeated sucrose administration on immediate (pain intensity) and long-term (neurodevelopmental) outcomes.
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Affiliation(s)
- Bonnie Stevens
- The Hospital for Sick ChildrenNursing Research555 University AvenueTorontoONCanadaM5G 1X8
- The Hospital for Sick ChildrenResearch InstituteTorontoONCanada
- University of TorontoLawrence S Bloomberg Faculty of Nursing Faculties of Medicine and DentistryTorontoONCanada
- University of TorontoCentre for the Study of PainTorontoONCanada
| | - Janet Yamada
- Ryerson UniversityDaphne Cockwell School of NursingTorontoONCanada
| | - Arne Ohlsson
- University of TorontoDepartments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and Evaluation600 University AvenueTorontoONCanadaM5G 1X5
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Kuhn P. Skin-to-skin care, cortical activation and pain behaviour in preterm infants. Acta Paediatr 2016; 105:339-40. [PMID: 26946233 DOI: 10.1111/apa.13328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/11/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Pierre Kuhn
- Médecine et Réanimation du Nouveau-né, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, France. .,Institut de Neurosciences Cellulaires et Intégratives, CNRS/UdS, Strasbourg, France.
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Bellieni CV, Johnston CC. Analgesia, nil or placebo to babies, in trials that test new analgesic treatments for procedural pain. Acta Paediatr 2016; 105:129-36. [PMID: 26387784 DOI: 10.1111/apa.13210] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 08/11/2015] [Accepted: 09/04/2015] [Indexed: 11/29/2022]
Abstract
UNLABELLED This review assessed how often neonates in control groups experienced unnecessary pain during clinical trials involving procedural pain. We retrieved 45 studies in the 30 months up to June 2015 and found that in 29 (64%) the control babies received either placebos or no treatment. Placebos were used in 15/25 (60%) studies involving heel pricks and in 6/8 (75%) involving venepuncture. CONCLUSION Despite international guidelines, neonates included in control groups during painful procedures do not receive analgesia in the majority of cases. Several historical reasons can explain this, but in the light of present knowledge, this should not continue. Ethical committees are thereof invited since now to not permit clinical trials that do not explicitly rule out pain during treatments and journals are invited to not publish them.
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Affiliation(s)
| | - C Celeste Johnston
- McGill University; Montreal QC Canada
- IWK Health Centre; Halifax NS Canada
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Boundy EO, Dastjerdi R, Spiegelman D, Fawzi WW, Missmer SA, Lieberman E, Kajeepeta S, Wall S, Chan GJ. Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis. Pediatrics 2016; 137:peds.2015-2238. [PMID: 26702029 PMCID: PMC4702019 DOI: 10.1542/peds.2015-2238] [Citation(s) in RCA: 312] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2015] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Kangaroo mother care (KMC) is an intervention aimed at improving outcomes among preterm and low birth weight newborns. OBJECTIVE Conduct a systematic review and meta-analysis estimating the association between KMC and neonatal outcomes. DATA SOURCES PubMed, Embase, Web of Science, Scopus, African Index Medicus (AIM), Latin American and Caribbean Health Sciences Information System (LILACS), Index Medicus for the Eastern Mediterranean Region (IMEMR), Index Medicus for the South-East Asian Region (IMSEAR), and Western Pacific Region Index Medicus (WPRIM). STUDY SELECTION We included randomized trials and observational studies through April 2014 examining the relationship between KMC and neonatal outcomes among infants of any birth weight or gestational age. Studies with <10 participants, lack of a comparison group without KMC, and those not reporting a quantitative association were excluded. DATA EXTRACTION Two reviewers extracted data on study design, risk of bias, KMC intervention, neonatal outcomes, relative risk (RR) or mean difference measures. RESULTS 1035 studies were screened; 124 met inclusion criteria. Among LBW newborns, KMC compared to conventional care was associated with 36% lower mortality(RR 0.64; 95% [CI] 0.46, 0.89). KMC decreased risk of neonatal sepsis (RR 0.53, 95% CI 0.34, 0.83), hypothermia (RR 0.22; 95% CI 0.12, 0.41), hypoglycemia (RR 0.12; 95% CI 0.05, 0.32), and hospital readmission (RR 0.42; 95% CI 0.23, 0.76) and increased exclusive breastfeeding (RR 1.50; 95% CI 1.26, 1.78). Newborns receiving KMC had lower mean respiratory rate and pain measures, and higher oxygen saturation, temperature, and head circumference growth. LIMITATIONS Lack of data on KMC limited the ability to assess dose-response. CONCLUSIONS Interventions to scale up KMC implementation are warranted.
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Affiliation(s)
| | | | - Donna Spiegelman
- Departments of Epidemiology,,Biostatistics, and,Departments of Global Health and Population, and
| | - Wafaie W. Fawzi
- Departments of Epidemiology,,Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts;,Departments of Global Health and Population, and
| | - Stacey A. Missmer
- Departments of Epidemiology,,Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ellice Lieberman
- Departments of Epidemiology,,Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts;,Department of Pediatric Newborn Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - Grace J. Chan
- Departments of Global Health and Population, and,Save the Children, Washington, DC; and,Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts
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Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: A randomized controlled trial. Midwifery 2015; 31:365-72. [DOI: 10.1016/j.midw.2014.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 10/25/2014] [Accepted: 11/01/2014] [Indexed: 11/17/2022]
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