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Robinson TW, Stikes R, Sorrell J, Gater A, Booth AT, Gardner A, Greenwell C, Businger S, Low R, Petrie R. Treatment for Neonatal Abstinence Syndrome using Nonpharmacological Interventions. Am J Perinatol 2024. [PMID: 38729163 DOI: 10.1055/s-0044-1786744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Management of neonatal abstinence syndrome includes nonpharmacological interventions, but their effectiveness may not be verified before implemented. The objective of this study is to evaluate the effectiveness of a type of bassinet in the treatment of infants with neonatal abstinence syndrome. STUDY DESIGN This is a retrospective observational cohort study. Study setting involved a 24-bed open-bay Level III neonatal intensive care unit located in a metropolitan academic trauma facility. Participant inclusion criteria involved prenatally opioid-exposed infants ≥ 35 weeks with confirmed maternal opioid urine toxicology, required pharmacological treatment for withdrawal symptoms, and were admitted to the neonatal intensive care unit. Three subsets of study participants were analyzed over three different time periods: Group 1 were infants admitted during 2019 without nonpharmacological intervention, Group 2 who were admitted from September 2021 to February 2022 and received nonpharmacological interventions, and Group 3 included those admitted from February 2022 to March 2023 who received the same interventions as Group 2 but were managed in bassinets being used in other local facilities for neonatal abstinence syndrome. RESULTS Group 3 had significant increases in length of stay compared with Group 1 (p = 0.006) and Group 2 (p = 0.013). Group 3 had a significantly greater length of treatment than Group 1 (p = 0.041) and a significantly higher total mg/kg morphine exposure than Group 1 (p = 0.006). CONCLUSION Addition of the bassinet for nonpharmacological management of infants with neonatal abstinence syndrome appeared to prolong length of stay, length of treatment, and increase total mg/kg morphine exposure. As a retrospective nonrandomized study, weakness of low certainty of causality is of concern but findings strongly warrant further research before devices such as the bassinet used in this study are adopted for routine neonatal abstinence syndrome care. KEY POINTS · Special bassinets are promoted to enhance sleep and decrease agitation.. · Such bassinets may assist infants undergoing drug withdrawal.. · Study of the bassinet failed to show benefit to this population..
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Affiliation(s)
- Tonya W Robinson
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - Reetta Stikes
- Center for Women and Infants, University of Louisville Hospital, Louisville, Kentucky
| | - Jaki Sorrell
- Center for Women and Infants, University of Louisville Hospital, Louisville, Kentucky
| | - Amanda Gater
- Center for Women and Infants, University of Louisville Hospital, Louisville, Kentucky
| | - Adam T Booth
- Center for Women and Infants, University of Louisville Hospital, Louisville, Kentucky
| | - Amanda Gardner
- Center for Women and Infants, University of Louisville Hospital, Louisville, Kentucky
| | - Colleen Greenwell
- Center for Women and Infants, University of Louisville Hospital, Louisville, Kentucky
| | - Shannon Businger
- Center for Women and Infants, University of Louisville Hospital, Louisville, Kentucky
| | - Ryan Low
- Center for Women and Infants, University of Louisville Hospital, Louisville, Kentucky
| | - Rachael Petrie
- Center for Women and Infants, University of Louisville Hospital, Louisville, Kentucky
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Ririe DG, Eisenach JC, Martin TJ. A Painful Beginning: Early Life Surgery Produces Long-Term Behavioral Disruption in the Rat. Front Behav Neurosci 2021; 15:630889. [PMID: 34025368 PMCID: PMC8131510 DOI: 10.3389/fnbeh.2021.630889] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
Early life surgery produces peripheral nociceptive activation, inflammation, and stress. Early life nociceptive input and inflammation have been shown to produce long-term processing changes that are not restricted to the dermatome of injury. Additionally stress has shown long-term effects on anxiety, depression, learning, and maladaptive behaviors including substance abuse disorder and we hypothesized that early life surgery would have long-term effects on theses complex behaviors in later life. In this study surgery in the rat hindpaw was performed to determine if there are long-term effects on anxiety, depression, audiovisual attention, and opioid reward behaviors. Male animals received paw incision surgery and anesthesia or anesthesia alone (sham) at postnatal day 6. At 10 weeks after surgery, open field center zone entries were decreased, a measure of anxiety (n = 20) (P = 0.03) (effect size, Cohen's d = 0.80). No difference was found in the tail suspension test as a measure of depression. At 16-20 weeks, attentional performance in an operant task was similar between groups at baseline and decreased with audiovisual distraction in both groups (P < 0.001) (effect size, η2 = 0.25), but distraction revealed a persistent impairment in performance in the surgery group (n = 8) (P = 0.04) (effect size, η2 = 0.13). Opioid reward was measured using heroin self-administration at 16-24 weeks. Heroin intake increased over time in both groups during 24-h free access (P < 0.001), but was greater in the surgery group (P = 0.045), with a significant interaction between time and treatment (P < 0.001) (effect size, Cohen f 2 = 0.36). These results demonstrate long-term disruptions in complex behaviors from surgical incision under anesthesia. Future studies to explore sex differences in early life surgery and the attendant peripheral neuronal input, stress, and inflammation will be valuable to understand emerging learning deficits, anxiety, attentional dysfunction, and opioid reward and their mechanisms. This will be valuable to develop optimal approaches to mitigate the long-term effects of surgery in early life.
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Affiliation(s)
- Douglas G Ririe
- Pain Mechanisms Lab, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - James C Eisenach
- Pain Mechanisms Lab, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
| | - Thomas J Martin
- Pain Mechanisms Lab, Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC, United States
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Neonatal morphine exposure and maternal deprivation alter nociceptive response and central biomarkers' levels throughout the life of rats. Neurosci Lett 2020; 738:135350. [PMID: 32889004 DOI: 10.1016/j.neulet.2020.135350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/26/2020] [Accepted: 08/31/2020] [Indexed: 11/20/2022]
Abstract
In the present study, we investigated the effect of repeated neonatal morphine exposure and/or maternal deprivation(MD) on the nociceptive response and central biomarkers' BDNF, IL-1β, and IL-4 levels at postnatal days 16(PND16), 30(PND30), and 60(PND60). At birth, the litters were standardized to contain 8 pups/dam (n = 58). From PND1 to PND10, the pups of the deprived groups were separated daily from their mothers for 3 h and divided into 5 groups: control(C), saline(S), morphine(M), deprived-saline(DS), and deprived-morphine(DM). The pups received subcutaneous injections of saline/morphine (5 μg) in the mid-scapular area between PND8 and PND14. Nociceptive responses were assessed by hot plate(HP) and tail-flick(TFL) tests and biomarker levels by ELISA. Thermal hyperalgesia(HP) was found in all assessments for the M, DS, and DM groups, and a decrease in nociceptive threshold(TFL) was found in the DS group at PND16; M and DM groups at PND30; and M, DS, and DM groups at PND60. There were interactions between treatment/deprivation/timepoint in all central biomarkers' levels. The current study indicates that neonatal exposure to morphine and MD, which occurs in the pediatric ICU, can alter the nociceptive and neuroinflammatory responses.
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Passariello A, Montaldo P, Palma M, Cirillo M, Di Guida C, Esposito S, Caruso M, Pugliese M, Giliberti P. Neonatal painful stimuli: skin conductance algesimeter index to measure efficacy 24% of sucrose oral solution. J Matern Fetal Neonatal Med 2019; 33:3596-3601. [PMID: 30786793 DOI: 10.1080/14767058.2019.1580690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pain management is one of the main challenges in addressing the improved care of hospitalized newborns. The administration of oral sucrose with and without non-nutritive suction has been proposed as a nonpharmacological intervention to relieve procedural pain in newborns. The effects have not yet been well characterized. The aim of this study is to investigate, using skin conductance algesimeter (SCA) pain monitor index, the effects of 24% sucrose solution on pain perception during capillary and arterial blood sampling. It is a prospective, randomized controlled study: sucrose versus placebo. Sucrose was given orally to infants who were submitted to arterial or capillary sampling. The SCA was measured during, and for 3 min before and after the intervention. Fifty-six infants were enrolled: 31 in the sucrose group and 25 in the placebo group. SCA showed that the measurement of peaks per second of pain during and 3 min after the procedures was lower in the sucrose group than the placebo group and that this difference was statistically significant (p < .05). In conclusion, 24% sucrose administered orally is effective in reducing pain during and after capillary and arterial sampling in newborns and can be used for the prevention and treatment of pain in the Neonatal Intensive Care Unit.Brief rationaleTo treat neonatal pain, a tiered approach with nonpharmacological and pharmacological method can be used.Among nonpharmacological therapies, sucrose administration is safe and effective in reducing single episodes of minor procedural pain. This study aimed to investigate, the effects of 24% sucrose solution on pain perception during capillary and arterial blood withdrawn by using an objective method: skin conductance algesimeter (SCA) pain monitor index.This randomized controlled trial in which term and/or preterm neonates (postnatal age maximum of 28 days corrected for postmenstrual age) received sucrose for procedural pain. Oral sucrose was administered directly by a disposable plastic vial. SCA was measured by means of a specific device.We demonstrated, using SCA pain monitor index, the efficacy of 24% sucrose solution on pain perception during capillary and arterial blood withdrawn. The results of this study provide an objective evidence of sucrose efficacy for the prevention and treatment of neonatal painful procedures.
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Affiliation(s)
- Annalisa Passariello
- Department of Translational Medical Science, Pediatric Section of University "Federico II", Naples, Italy.,Santobono-Pausilipon Hospital of Naples, Naples, Italy
| | - Paolo Montaldo
- Neonatal Intensive Care Unit, University of Campania "Luigi Vanvitelli", Naples, Italy.,Centre for Perinatal Neuroscience, Imperial College London, London, UK
| | - Marta Palma
- Department of Translational Medical Science, Pediatric Section of University "Federico II", Naples, Italy
| | - Marilù Cirillo
- Neonatal Intensive Care Unit, Dei Colli Hospital, Naples, Italy
| | - Carmela Di Guida
- Department of Translational Medical Science, Pediatric Section of University "Federico II", Naples, Italy
| | - Simona Esposito
- Department of Translational Medical Science, Pediatric Section of University "Federico II", Naples, Italy
| | - Marco Caruso
- Department of Translational Medical Science, Pediatric Section of University "Federico II", Naples, Italy
| | - Manuela Pugliese
- Department of Translational Medical Science, Pediatric Section of University "Federico II", Naples, Italy
| | - Paolo Giliberti
- Neonatal Intensive Care Unit, Dei Colli Hospital, Naples, Italy
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A Systematic Review of Behavioral and Environmental Interventions for Procedural Pain Management in Preterm Infants. J Pediatr Nurs 2019; 44:22-30. [PMID: 30683278 DOI: 10.1016/j.pedn.2018.10.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 10/07/2018] [Accepted: 10/08/2018] [Indexed: 11/23/2022]
Abstract
PROBLEM Current research suggests behavioral and environmental interventions to prevent neonatal pain prior to an invasive procedure are rarely administered and seldom documented. The aim of this study was to systematically review findings from published randomized controlled trials that tested the effects of behavioral and environmental procedural pain management interventions on behavioral pain response in preterm infants. ELIGIBILITY CRITERIA Randomized controlled trials examining the effects of behavioral and environmental pain management interventions on behavioral pain response in preterm infants were identified. Articles accepted for inclusion met the following criteria: English language, original, peer refereed, randomized controlled clinical trials published within the past 5 years, study sample: preterm infants, setting: neonatal intensive care units, study intervention behavioral and environmental, outcome pain measurement score from valid and reliable pain scale. SAMPLE Fourteen randomized controlled trials from a literature search of PubMed and Medline databases were included in this review. RESULTS Across all age groups, facilitated tucking, oral sucrose, and kangaroo care decreased behavioral and physiologic pain response alone and in combination with other behavioral and environmental interventions. CONCLUSION Among preterm infants, facilitated tucking, oral sucrose, and kangaroo care significantly mitigates biobehavioral pain response associated with acutely painful procedures. IMPLICATIONS Evidence suggests that behavioral and environmental interventions can decrease biobehavioral pain response associated with acutely painful procedures in preterm infants. This review highlights the need for rigorous studies to help healthcare providers to build a tailored pain treatment plan for preterm infants.
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Singh AP, Lakshminrusimha S, Thompson ME. Regional analgesia in neonates undergoing thoracoabdominal surgeries: A pilot study. J Neonatal Perinatal Med 2018; 12:73-79. [PMID: 30320598 DOI: 10.3233/npm-1827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The primary aim of this pilot study was to assess feasibility and to evaluate if peri-operative pain management with regional analgesia resulted in decreased use of narcotic medication and earlier return to preoperative respiratory/nutritional status. STUDY DESIGN Cases were defined as infants who received regional analgesia as part of their perioperative anesthetic management. Controls were matched for surgical procedures without regional analgesia. RESULTS Fifteen cases were identified and matched with 17 controls. Infants undergoing inguinal hernia repair returned to baseline earlier and were not intubated. There was no difference in time to extubation in other thoracoabdominal surgeries. There was no difference in cumulative narcotic analgesia administered between the two groups. CONCLUSION Postoperative regional analgesia is feasible in neonates. Inguinal hernia repair with regional anesthesia was performed without intubation and returned to preoperative status earlier. No differences were observed with other surgeries. Further prospective, randomized, multicenter studies are needed.
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Affiliation(s)
- Ajay Pratap Singh
- Department of Pediatrics, Texas Tech University at El Paso, El Paso, TX, USA
| | | | - Mark E Thompson
- University at Buffalo, Oishei Children's Hospital, Buffalo, NY, USA
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Knutsen HK, Alexander J, Barregård L, Bignami M, Brüschweiler B, Ceccatelli S, Cottrill B, Dinovi M, Edler L, Grasl-Kraupp B, Hogstrand C, Hoogenboom LR, Nebbia CS, Oswald IP, Petersen A, Rose M, Roudot AC, Schwerdtle T, Vollmer G, Wallace H, Benford D, Calò G, Dahan A, Dusemund B, Mulder P, Németh-Zámboriné É, Arcella D, Baert K, Cascio C, Levorato S, Schutte M, Vleminckx C. Update of the Scientific Opinion on opium alkaloids in poppy seeds. EFSA J 2018; 16:e05243. [PMID: 32625895 PMCID: PMC7009406 DOI: 10.2903/j.efsa.2018.5243] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Poppy seeds are obtained from the opium poppy (Papaver somniferum L.). They are used as food and to produce edible oil. The opium poppy plant contains narcotic alkaloids such as morphine and codeine. Poppy seeds do not contain the opium alkaloids, but can become contaminated with alkaloids as a result of pest damage and during harvesting. The European Commission asked EFSA to provide an update of the Scientific Opinion on opium alkaloids in poppy seeds. The assessment is based on data on morphine, codeine, thebaine, oripavine, noscapine and papaverine in poppy seed samples. The CONTAM Panel confirms the acute reference dose (ARfD) of 10 μg morphine/kg body weight (bw) and concluded that the concentration of codeine in the poppy seed samples should be taken into account by converting codeine to morphine equivalents, using a factor of 0.2. The ARfD is therefore a group ARfD for morphine and codeine, expressed in morphine equivalents. Mean and high levels of dietary exposure to morphine equivalents from poppy seeds considered to have high levels of opium alkaloids (i.e. poppy seeds from varieties primarily grown for pharmaceutical use) exceed the ARfD in most age groups. For poppy seeds considered to have relatively low concentrations of opium alkaloids (i.e. primarily varieties for food use), some exceedance of the ARfD is also seen at high levels of dietary exposure in most surveys. For noscapine and papaverine, the available data do not allow making a hazard characterisation. However, comparison of the dietary exposure to the recommended therapeutical doses does not suggest a health concern for these alkaloids. For thebaine and oripavine, no risk characterisation was done due to insufficient data. However, for thebaine, limited evidence indicates a higher acute lethality than for morphine and the estimated exposure could present a health risk.
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Dias FDSB, Gasparino RC, Carmona EV, Marba STM. Validation of the Échelle Douleur Inconfort Nouveau-Né for Brazilian culture. Rev Esc Enferm USP 2018; 51:e03285. [PMID: 29412227 DOI: 10.1590/s1980-220x2017008603285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 08/29/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the reliability and validity of the Brazilian version of the Échelle Douleur Inconfort Nouveau-Né, which measures prolonged pain in neonates. METHOD A methodological study carried out with 96 neonates. The Brazilian versions of the Échelle Douleur Inconfort Nouveau-Né and the Children's and Infants' Postoperative Pain Scale were used for data collection. For reliability, equivalence measured by intraobserver agreement and homogeneity were considered. To evaluate the validity, the convergent construct approach was considered correlating the Brazilian versions of the Échelle Douleur Inconfort Nouveau-Né and the Children's and Infants' Postoperative Pain Scale. RESULTS In assessing reliability, the coefficient of agreement between observers varied between 0.64 and 0.85 for the items that make up the instrument, and 0.96 for the total score. Cronbach's alpha was 0.82. Regarding the convergent validity evaluation, Spearman correlation coefficient between the values found for both scales was 0.79 (p< 0.0001). CONCLUSION The Brazilian version of the Échelle Douleur Inconfort Nouveau-Né is a reliable and valid instrument for assessing prolonged pain in neonates.
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Haward MF, Janvier A, Lorenz JM, Fischhoff B. Counseling parents at risk of delivery of an extremely premature infant: Differing strategies. AJOB Empir Bioeth 2017; 8:243-252. [PMID: 29048264 DOI: 10.1080/23294515.2017.1394399] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND It is not known how neonatologists address the affective and cognitive loads on parents deciding whether to resuscitate infants born extremely preterm. This study explores expert neonatologists' views on these decision-making processes and their own roles in counseling parents. METHODS Semistructured interviews asked internationally recognized experts to share their perspectives on perinatal consultations. Their responses were subjected to thematic analysis. RESULTS Eighteen of 22 invited experts participated. Approximately equal numbers reported employing a physician-driven approach, a parent-driven approach, and a combined approach during these consultations. Those who followed a physician-driven approach typically focused on conveying standard information about adverse outcomes. Those who followed a parent-driven approach typically focused on addressing parents' information requests, guiding their decision making, and providing affective support. Nearly all experts, in each group, endorsed addressing the child's quality of life, in terms of functionality, when discussing long-term outcomes. Although many believed that families adjusted to life with a disabled child, few discussed the topic during prenatal consultations. Most, in each group, reported trying to alleviate future "decisional regret" for parents whose premature infants subsequently became disabled. None spoke to parents about possible decisional regret after deciding to forgo resuscitation. CONCLUSIONS Expert neonatologists are deeply concerned that parents understand the decision facing them. However, they differ on what information they offer and how they balance parents' need for cognitive and affective support. They expressed more concern about parents' decisional regret should their child survive resuscitation, but have severe disability, than about decisional regret after foregoing resuscitation.
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Affiliation(s)
- Marlyse F Haward
- a Children's Hospital at Montefiore, Albert Einstein College of Medicine
| | - Annie Janvier
- b Department of Pediatrics and Clinical Ethics , Université de Montréal, Division of Neonatology, Hôpital Sainte-Justine, Bureau de L'éthique Clinique, Université de Montréal, and Centre de Recherche, Hôpital Sainte-Justine
| | - John M Lorenz
- c Department of Pediatrics , Columbia University College of Physicians and Surgeons, and Morgan Stanley Children's Hospital of New York
| | - Baruch Fischhoff
- d Department of Engineering and Public Policy and Institute for Politics and Strategy , Carnegie Mellon University
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Abstract
AIM Sensorial saturation (SS) is an analgesic approach to babies' pain that includes three types of stimulations: oral sugar, massage and caregivers' voice. The aim of this review is to assess its efficacy. METHODS We performed an analysis of scientific literature from 2001 to 2017, retrieving those clinical trials where SS had been compared with other analgesic treatments during procedural pain in babies. RESULTS We retrieved 14 studies. Pain sources were heel-prick in nine, eye examination and intramuscular shots in two each, and endotracheal aspiration in one. SS was the most effective treatment in all cases, except in endotracheal suctioning. No drawbacks were reported in any study using SS. CONCLUSION SS is a safe and effective approach to neonatal pain due to heel-prick, more effective than oral sucrose or glucose in both term and preterm babies; it seems also effective in other types of acute procedural pain like eye examination or intramuscular injections, but more studies are needed to confirm these preliminary data. More studies are also needed to test SS efficacy for other procedures, and for older infants.
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Affiliation(s)
- Chiara Locatelli
- a Neonatology Unit , St. Orsola-Malpighi Polyclinic , Bologna , Italy
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Acupuncture in the neonatal intensive care unit-using ancient medicine to help today's babies: a review. J Perinatol 2017; 37:749-756. [PMID: 27977013 DOI: 10.1038/jp.2016.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/21/2016] [Accepted: 11/01/2016] [Indexed: 11/08/2022]
Abstract
Acupuncture has been used for thousands of years in Eastern medicine for a variety of conditions and illnesses, including pain. Neonatal intensive care, on the other hand, is a relatively new branch of medicine that has emerged as the pivotal influence in increasing survival of critically ill newborn infants only within the last 50 years. Unfortunately, pain is an inevitable part of treatment in a neonatal intensive care unit (NICU). The control and prevention of pain remains a major issue for clinicians despite recognition and understanding of the myriad of short- and long-term problems that are associated with both pain and its treatment within the NICU environment. In this review, we examine the potential role of acupuncture to decrease and treat pain in babies requiring neonatal intensive care and discuss future therapeutic and research implications for the use of this ancient therapy within the modern environment of the NICU.
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Bellieni CV, Tei M, Cornacchione S, Di Lucia S, Nardi V, Verrotti A, Buonocore G. Pain perception in NICU: a pilot questionnaire. J Matern Fetal Neonatal Med 2017; 31:1921-1923. [PMID: 28514889 DOI: 10.1080/14767058.2017.1332038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
PURPOSE Neonatal pain management has made a great step forward over the last several years. Despite the drafting of International guidelines, an under-treatment of neonatal pain is still reported. MATERIALS AND METHODS Medical and paramedical personnel working in five Italian NICUs were asked to complete a questionnaire about pain management. The questionnaire was comprised of three sections: (i) brief explanation of the purpose; (ii) demographic information, including age, profession, religious beliefs, and hospital level; (iii) questionnaire about pain management and prevention. RESULTS One-hundred and forty caregivers participated in this study. Non-pharmacological analgesia during heel prick or venipuncture was used by 64% and 60% of them, respectively; topical analgesia was performed in 13% of venipunctures; no analgesia was used in 30% of cases for both heel prick and venipuncture. In the case of lumbar puncture, 35% of participants used topical analgesia, 15% non-pharmacological approach, 10% opioids, and 6% intravenous paracetamol. While 65% of participants gave a score of 4 out of 5 about the importance of pain treatment, 39% of them reported that in their department no pain scales were used. CONCLUSIONS Pain treatment in these NICUs is still far to be optimal. This nonetheless reflects a worldwide trend, which requires more attention on pain prevention, assessment, and treatment.
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Affiliation(s)
- C V Bellieni
- a Department of Paediatrics, Obstetrics and Reproductive Medicine , University of Siena , Siena , Italy
| | - M Tei
- a Department of Paediatrics, Obstetrics and Reproductive Medicine , University of Siena , Siena , Italy
| | - S Cornacchione
- a Department of Paediatrics, Obstetrics and Reproductive Medicine , University of Siena , Siena , Italy
| | - S Di Lucia
- a Department of Paediatrics, Obstetrics and Reproductive Medicine , University of Siena , Siena , Italy
| | - V Nardi
- b Department of Paediatrics , University of L'Aquila , L'Aquila , Italy
| | - A Verrotti
- b Department of Paediatrics , University of L'Aquila , L'Aquila , Italy
| | - G Buonocore
- a Department of Paediatrics, Obstetrics and Reproductive Medicine , University of Siena , Siena , Italy
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Abstract
PURPOSE OF REVIEW This review describes advances in rising and continuing ethical issues in research in patients in pain. Although some of the issues focus directly on pain research, such as research in neonatal pain management, others focus on widespread ethical issues that are relevant to pain research, such as scientific misconduct, deception, placebo use and genomics. RECENT FINDINGS Scientific misconduct is more widespread than realized and requires greater awareness of the markers of misconduct like irreproducibility. More education about what qualifies as misconduct, such as consent violations, plagiarism and inappropriate patient recruitment along with data falsification needs to be implemented. Wayward researchers may attend a rehabilitation conference to improve their practices. Studies in neonatal pain management do not require comparing an intervention with the inadequate analgesia of a placebo; comparing with a standard approach is sufficient. Deception of research patients may be acceptable under narrow circumstances. The legitimacy of using broad informed consent for biobanking and genomic studies are being challenged as changes to the Common Rule are being considered. SUMMARY Increasing complexity and the desire to further medical knowledge complicates research methods and informed consent. The ethical issues surrounding these and offshoot areas will continue to develop.
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Morphine exposure during early life alters thermal and mechanical thresholds in rats. Int J Dev Neurosci 2016; 60:78-85. [DOI: 10.1016/j.ijdevneu.2016.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Revised: 12/04/2016] [Accepted: 12/29/2016] [Indexed: 12/20/2022] Open
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Abstract
Care of infants supported with mechanical ventilation is complex, time intensive, and requires constant vigilance by an expertly prepared health care team. Current evidence must guide nursing practice regarding ventilated neonates. This article highlights the importance of common language to establish a shared mental model and enhance clear communication among the interprofessional team. Knowledge regarding the underpinnings of an open lung strategy and the interplay between the pathophysiology and individual infant's response to a specific ventilator strategy is most likely to result in a positive clinical outcome.
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Rozisky JR, Scarabelot VL, Oliveira CD, Macedo ICD, Deitos A, Laste G, Caumo W, Torres ILS. Melatonin as a potential counter-effect of hyperalgesia induced by neonatal morphine exposure. Neurosci Lett 2016; 633:77-81. [PMID: 27546822 DOI: 10.1016/j.neulet.2016.08.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Revised: 08/11/2016] [Accepted: 08/15/2016] [Indexed: 01/29/2023]
Abstract
Morphine administration in the neonatal period can induce long-term effects in pain circuitry leading to hyperalgesia induced by the opioid in adult life. This study explored a new pharmacological approach for reversing this effect of morphine. We focused on melatonin owing its well-known antinociceptive and anti-inflammatory effects, and its ability to interact with the opioid system. We used the formalin test to assess the medium and long-term effects of melatonin administration on hyperalgesia induced by morphine in early life. Newborn rats were divided into two groups: the control group, which received saline, and the morphine group, which received morphine (5μg subcutaneously [s.c.]) in the mid-scapular area, once daily for 7days, from P8 (postnatal day 8) until P14. At postnatal days 30 (P30) and 60 (P60), both groups were divided in two subgroups, which received melatonin or melatonin vehicle 30min before the formalin test. The nociceptive responses were assessed by analyzing the total time spent biting, flicking, and licking the formalin-injected hind paw; these responses were recorded during the first 5min (neurogenic/acute phase) and from 15 to 30min (inflammatory/tonic phase). Initially, animals in the morphine/vehicle group showed increased nociceptive behavior in phase II (inflammatory) of the formalin test at P30, and in the neurogenic and inflammatory phases at P60. These increased nociceptive responses were fully reversed by melatonin administration at either age. These findings show that melatonin administration is a potential means for countering hyperalgesia induced by neonatal morphine exposure in young and adult rats.
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Affiliation(s)
- Joanna Ripoll Rozisky
- Pain Pharmacology and Neuromodulation Laboratory, Preclinical Research, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil; Animal Experimentation Unit, Graduate Research Group, Hospital de Clínicas de Porto Alegre, RS, 90035-003, Brazil
| | - Vanessa Leal Scarabelot
- Pain Pharmacology and Neuromodulation Laboratory, Preclinical Research, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Postgraduate Program in Biological Sciences: Physiology, Institute of Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Animal Experimentation Unit, Graduate Research Group, Hospital de Clínicas de Porto Alegre, RS, 90035-003, Brazil
| | - Carla de Oliveira
- Pain Pharmacology and Neuromodulation Laboratory, Preclinical Research, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil; Animal Experimentation Unit, Graduate Research Group, Hospital de Clínicas de Porto Alegre, RS, 90035-003, Brazil
| | - Isabel Cristina de Macedo
- Pain Pharmacology and Neuromodulation Laboratory, Preclinical Research, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Postgraduate Program in Biological Sciences: Physiology, Institute of Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Animal Experimentation Unit, Graduate Research Group, Hospital de Clínicas de Porto Alegre, RS, 90035-003, Brazil
| | - Alícia Deitos
- Pain Pharmacology and Neuromodulation Laboratory, Preclinical Research, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil; Animal Experimentation Unit, Graduate Research Group, Hospital de Clínicas de Porto Alegre, RS, 90035-003, Brazil
| | - Gabriela Laste
- Pain Pharmacology and Neuromodulation Laboratory, Preclinical Research, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil; Animal Experimentation Unit, Graduate Research Group, Hospital de Clínicas de Porto Alegre, RS, 90035-003, Brazil
| | - Wolnei Caumo
- Pain Pharmacology and Neuromodulation Laboratory, Preclinical Research, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil
| | - Iraci L S Torres
- Pain Pharmacology and Neuromodulation Laboratory, Preclinical Research, Department of Pharmacology, Institute of Basic Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil; Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-003, Brazil; Postgraduate Program in Biological Sciences: Physiology, Institute of Health Sciences, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90050-170, Brazil.
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