Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants

Comparison of different methods for reducing pain during a heel lance in newborns: a randomized trial

BACKGROUND

This study aimed to compare three different methods [breastfeeding, skin-to-skin contact (SSC), swaddling + holding] to reduce the pain felt by term newborns during a heel lance (HL).

METHODS

This was a randomized three-group experimental study. The study sample included 90 newborns, 30 in each group. The data were collected using a pulse oximeter, a voice recorder, an Information Form, the Neonatal Infant Pain Scale (NIPS). The newborns' pain level, heart rate, and oxygen saturation were measured at three different times.

RESULTS

No difference was found between the groups' mean NIPS scores before the HL procedure (p > 0.05). The mean NIPS scores 10 s after the procedure started and after the HL procedure were the lowest in the breastfeeding group, followed by the SSC and swaddling + holding groups (p < 0.05). There was no difference between the groups' mean heart rates before the procedure; however, there was a significant difference 10 s after the procedure started and after the procedure (p < 0.05).

CONCLUSION

Breastfeeding is the most effective method to reduce pain during and after HL procedures in term newborns, followed by SSC and swaddling + holding.

TRIAL REGISTRATION

This study was retrospectively registered at ClinicalTrials.gov with the registration number NCT05797532 (date: 04.04.2023).

Caregivers' role regarding managing postoperative pain of hospitalised children (0-3 years)

Background

Acute postoperative pain is a common surgical symptom affecting 40% - 80% of patients. Postoperative pain produces much distress in children. Effective postoperative pain management is a human right. Various stakeholders, including caregivers, are involved in the management of children's postoperative pain. However, the role of the caregiver is accentuated during the child's discharge, with limited studies focusing on the role during hospitalisation.

Aim

This study aimed to describe how caregivers manage their children's (0-3 years) postoperative pain during hospitalisation and explore caregivers' expectations about how their hospitalised children's postoperative pain is managed.

Setting

The study setting was a regional hospital in Ghana.

Methods

The research employed a descriptive qualitative methodology. Purposive sampling was used to recruit caregivers. Data were collected using individual in-depth interviews. The transcripts were thematically analysed using Clarke and Braun's framework.

Results

The researchers identified four themes: caregiver's experiences of caring for children with postoperative pain, caregivers' assessment of children's postoperative pain, caregivers' assistance with management and expectations of the caregivers concerning the management of postoperative pain in their hospitalised children (0-3 years).

Conclusion

Caregivers in this study acknowledged the fact that the postoperative pain experienced by their children had a noteworthy emotional effect on them.

Contribution

Nurses must adequately educate caregivers on managing postoperative pain in hospitalised children (0-3 years). Again, the nurses must be with the child and the caregiver, as this enhances collaboration and adequate postoperative pain management in these children.

Factors Associated with Mother's Own Milk Feeding and Direct Breastfeeding at Discharge in Preterm Infants with Feeding Difficulties: Clinical and Research Implications

Background: Prematurity presents numerous barriers to mother's own milk (MOM) feeding and direct breastfeeding (DBF). Aim: This study aimed to determine factors associated with MOM feeding and DBF at discharge from the neonatal intensive care unit (NICU) in preterm-born infants presenting with feeding difficulties. Methods: A retrospective study of data from 237 preterm-born infants referred for evaluation of feeding difficulties and discharged home on full oral feeds was examined. Maternal and infant characteristics and oral feeding milestones were examined for their association with MOM intake and DBF at discharge using bivariate and multivariate regression analyses. Results: MOM feeding at discharge occurred in 35.4% (n = 84) infants. The odds of any MOM feeding at discharge were higher with higher maternal age, absence of maternal substance use, and fewer days between full per oral (PO) and discharge (all, p < 0.05). Among the 84 MOM-fed infants, 4.76% (n = 4) were exclusively breastfed, whereas 39.3% (n = 33) were partially DBF at discharge. The DBF infants had higher birthweight, no incidence of being small for gestational age, lower incidence of respiratory support at birth and intraventricular hemorrhage, lower postmenstrual age (PMA) at full PO, shorter duration from first PO to full PO, and lower PMA at discharge (all, p < 0.05). Conclusion: We found reduced use of MOM and DBF among preterm-born infants with feeding difficulties at NICU discharge. Clinical management and research advocacy must focus on targeted interventions in this setting by recognizing significant modifiable factors applicable to prepregnancy, pregnancy, NICU, and postdischarge care.

The Effect of Breastfeeding on the Newborn's Comfort and Pain Levels During Heel Blood Collection

This research was planned to determine the effect of breastfeeding on newborns' behavioral pain and comfort scores during heel blood collection. A pretest/posttest experimental-control group design was used. The research was conducted between August 2021 and June 2022. A total of 50 newborns, including 25 in each of the experimental and control groups, were included in the study. An Infant Descriptive Information Form, the COMFORTneo Behaviour Scale, the NIPS-Neonatal Infant Pain Scale, and the LATCH Breastfeeding Diagnosis and Assessment Tool were used in the study. The comfort behaviors and pain scores of infants in the experimental and control groups were evaluated during the heel blood collection process. The comparison of the comfort behaviors (comfort, pain, and distress), differences between pretest-posttest scores on the NIPPS pain score, and crying duration of the newborns in the experimental and control groups indicated a significant difference (p 0.05). The intra-group differences between the mean pretest and posttest scores of both the intervention and control groups were found to be statistically significant (p 0.05). Breastfeeding is an important nursing intervention for reducing procedural pain in newborns. The breastfeeding method reduces pain and distress and increases comfort for newborns during the heel blood collection process.

Neonatal Intensive Care Nurses' Knowledge of Neonatal Pain Assessment in Private and Public Hospitals in Jeddah, Saudi Arabia: A Cross-Sectional Study

BACKGROUND

Neonatal Intensive Care Unit (NICU) nurses with adequate neonatal pain assessment knowledge are crucial in effective neonatal pain management. There is limited research that assessed the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment.

OBJECTIVE

To assess the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment.

DESIGN AND METHODS

 A cross-sectional design using an online survey was conducted to capture information regarding neonatal pain assessment knowledge from 125 NICU nurses in Saudi Arabia. Knowledge of pain assessment was assessed using a modified version of the knowledge, attitudes, and practice scale. Knowledge scores were classified as high, average, and low.

RESULTS

Participants' knowledge regarding neonatal pain assessment was inadequate (Mean = 63/100). The majority of the participants had a low to average level of knowledge (n= 97, 78%).

CONCLUSION

A significant proportion of NICU nurses had inadequate knowledge regarding neonatal pain assessment, which can be improved. Educational interventions are needed to boost these nurses' knowledge regarding neonatal pain assessment.

Parents' experiences with interprofessional collaboration in neonatal pain management: A descriptive qualitative study

AIM

To describe parents' experiences with interprofessional collaboration (IPC) in neonatal pain management.

BACKGROUND

Neonatal care should be based on IPC, and non-pharmacological pain-relieving methods are recommended to be used primarily that enables parental participation. However, there is a lack of knowledge about pain management on IPC from the parent's viewpoint.

DESIGN

A descriptive qualitative study.

METHOD

The research involved a purposive sample of parents (n = 16) whose infant had been treated at a neonatal intensive care unit in Finland. Interviews were conducted with participants from all over Finland who were recruited through the national association for premature infants. Parents discussed their experiences during semi-structured interviews which were guided by the subareas of IPC, partnership, cooperation and coordination. The data were analysed using deductive-inductive content analysis. The reporting of results followed COREQ guidelines.

RESULTS

Based on the parent's experiences the partnership involved themes of understanding the neonatal pain management context, being able to influence the pain management, and feeling valued. Cooperation included themes of identifying different roles and equality. Coordination was described through the sharing of knowledge, skills and expertise, as well as feeling supported by professionals.

CONCLUSION

Parental involvement on IPC should be developed through interventions that involve training around pain assessment and non-pharmacological pain-relief methods.

RELEVANCE FOR CLINICAL PRACTICE

Professionals involved in neonatal care should act in a goal-oriented and unified manner to promote a culture of care that allows for active parental participation.

NO PATIENT OR PUBLIC CONTRIBUTION

The research has been carried out in accordance with good scientific practice. Only the research team has been involved in the design, conduct, analysis and drafting of the manuscript.

The Effect of Breastfeeding on Food Allergies in Newborns and Infants

Breastfeeding is the preferred method of infant feeding and its establishment is one of the primary goals for the infant. Allergic diseases are common in childhood, with increased morbidity. Food allergies are also associated with a strong negative impact on health-related quality of life and is a major public health problem. In addition, maternal exclusion of common allergens during pregnancy and/or lactation suggests that supplementation with regular cow's milk formula during the first week of life should be avoided. Breast milk contains many active immune factors, such as cytokines, inflammatory mediators, signaling molecules and soluble receptors, which may also reduce the risk of allergic disease. The prophylactic effects of breastfeeding have been the subject of many studies, some with weak evidence. In this narrative review, we aim to provide an up-to-date account of the effects of prophylactic breastfeeding on food allergy and other common allergies in infants and children up to 5 years of age. Colostrum in particular has been shown to be prophylactic against food allergy. The American Academy of Pediatrics cautions that the relationship between duration of breastfeeding and incidence of food allergy in early childhood is unclear. The protective role of breastfeeding has a positive effect on allergy prevention, which is opposed by the early introduction of solid foods, but larger studies are needed to confirm the evidence. There is evidence that breastfeeding is effective in providing partial protection to infants.