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Feng J, Lin R, Zhang Y, Ning S, Du N, Li J, Cui Y, Huang G, Wang H, Chen X, Liu T, Chen W, Ma L, Li J. Postoperative EEG abnormalities in relation to neurodevelopmental outcomes after pediatric cardiac surgery. Pediatr Res 2024:10.1038/s41390-024-03401-2. [PMID: 38992156 DOI: 10.1038/s41390-024-03401-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND We had reported that postoperative EEG background including sleep-wake cycle (SWC) and discharge (seizures, spikes/sharp waves) abnormalities were significantly correlated with adverse early outcomes in children after cardiac surgery. We aimed to analyze the relations between these EEG abnormalities and neurodevelopmental outcomes at about 2 years after cardiac surgery. METHODS We enrolled 121 patients undergoing cardiac surgery at 3.3 months (0.03 ~ 28 months). EEG abnormalities described above during the first postoperative 48 h were evaluated. Griffiths Mental Development Scales-Chinese was used to evaluate the quotients of overall development and 5 subscales of the child's locomotor, language, personal-social, eye-hand coordination and performance skills at 16 ~ 31 months of age. RESULTS EEG background abnormalities occurred in 59/121 (48.8%) patients and 33 (55.9%) unrecovered to normal by 48 h. Abnormal SWC occurred in 15 (12.4%) patients and 7 (5.8%) unrecovered to normal by 48 h. EEG seizures occurred in 11 (9.1%) patients with frontal lobe seizures in 4. Spikes/sharp waves occurred in 100 (82.6%). EEG background abnormalities, number of spikes/sharp waves and frontal lobe seizures were significantly associated with neurodevelopmental impairment at about 1 ~ 2 year after surgery (Ps ≤ 0.05). CONCLUSIONS Most parameters of EEG abnormalities were significantly associated with neurodevelopmental impairment after cardiac surgery. IMPACT Neurodevelopmental impairment in children with congenital heart disease remain poorly understood. Previous studies had reported that either EEG seizures or background abnormalities were associated with worse neurodevelopmental outcomes. Our present study showed that all the EEG background and discharge abnormalities including EEG background, seizures and spikes/sharp waves in the early postoperative period were significantly associated with neurodevelopmental impairment at about 1 ~ 2 years after cardiac surgery. Comprehensive evaluation of early postoperative EEG may provide further insights about postoperative brain injury, its relation with neurodevelopmental impairment, and guide to improve clinical management.
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Affiliation(s)
- Jinqing Feng
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China
- Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Rouyi Lin
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China
- Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yani Zhang
- Department of Neurology, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Shuyao Ning
- Department of Electroneurophysiology, Guangzlhou Medical University, Guangzhou, Guangdong Province, China
| | - Na Du
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Jianbin Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yanqin Cui
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Guodong Huang
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Huaizhen Wang
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Xinxin Chen
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Techang Liu
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Wenxiong Chen
- Department of Neurology, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Li Ma
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China
- Heart Center, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Jia Li
- Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Medical University, Guangzhou, Guangdong Province, China.
- Clinical Physiology Laboratory, Institute of Pediatrics, Guangzhou Medical University, Guangzhou, Guangdong Province, China.
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Cistone N, Pickler RH, Fortney CA, Nist MD. Effect of Routine Nurse Caregiving on the Stress Responses and Behavior State in Preterm Infants: A Systematic Review. Adv Neonatal Care 2024:00149525-990000000-00131. [PMID: 38968382 DOI: 10.1097/anc.0000000000001177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2024]
Abstract
BACKGROUND Although routine nurse caregiving is vital for the overall health of preterm infants, variations in approaches may exert distinct effects on preterm infants' stress responses and behavior state. PURPOSE The purpose of this systematic review was to examine routine nurse caregiving in the neonatal intensive care unit and its effect on stress responses and behavior state in preterm infants. DATA SOURCES A systematic search was conducted using PubMed, Embase, and CINAHL for studies published between 2013 and 2023. STUDY SELECTION Included studies enrolled preterm infants born <37 weeks gestational age and investigated nurse caregiving practices and effects on stress responses and/or behavior state. DATA EXTRACTION Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, data about study design, methods, findings, and limitations were extracted and summarized. Included studies were evaluated for bias using the National Health, Lung, and Blood Institute quality assessment tools. RESULTS All 13 studies included in the review received a fair quality rating. Nurse caregiving activities, including suctioning, diaper changes, bathing, and weighing, were associated with increases in heart and respiratory rates, blood pressure, energy expenditure, and motor responses, lower oxygen saturations, and fewer sleep states. IMPLICATIONS FOR PRACTICE AND RESEARCH Adapting nurse caregiving frequency and duration, aligning caregiving with infant state, and integrating developmental care strategies may reduce infant stress responses and support behavioral rest. Further research is needed to understand how caregiving activities affect stress responses and behavior state in preterm infants, aiding in identifying modifiable caregiving stressors to promote optimal development.
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Affiliation(s)
- Nicole Cistone
- Author Affiliations:The Ohio State University College of Nursing, Columbus, Ohio
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Pavlyshyn H, Sarapuk I, Kozak K. The relationship between neonatal stress in preterm infants and developmental outcomes at the corrected age of 24-30 months. Front Psychol 2024; 15:1415054. [PMID: 38840740 PMCID: PMC11150848 DOI: 10.3389/fpsyg.2024.1415054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 05/10/2024] [Indexed: 06/07/2024] Open
Abstract
Aim The aim of research was to study the relationship between the stress experienced by preterm infants in the neonatal intensive care unit (NICU) and developmental status in the follow up, and to establish factors, associated with their neurodevelopment. Methods The first stage of research involved measuring stress markers (cortisol, melatonin) in infants (n = 56) during their NICU stay; the second phase assessed the developmental status at the corrected age of 24-30 months. Results The total ASQ-3 score, communication, problem solving, and personal-social skills scores at the corrected age of 24-30 months were positively correlated with melatonin level determined in the neonatal period (r = 0.31, p = 0.026; r = 0.36, p = 0.009; r = 0.30, p = 0.033, and r = 0.32; p = 0.022 respectively). In the same time, ASQ-3 communication and personal-social scores were negatively correlated with cortisol level (r = -0.31, p = 0.043; r = -0.35, p = 0.022). The ROC-curve analysis revealed that a decrease of melatonin below 3.44 ng/mL and 3.71 ng/mL during the neonatal period could predict communication and problem-solving delay, respectively. An increase in cortisol above 0.64 mcg/dl is predictive in personal-social delay. Negative correlation was identified between the NICU and total hospital stay duration and ASQ-3 communication scores in the follow-up (r = -0.27; p = 0.049 and r = -0.41; p = 0.002, respectively). The duration of mechanical ventilation was negatively correlated with gross motor scores (r = -0.46; p = 0.043). Apgar score was positively correlated with ASQ-3 communication (r = 0.29; p = 0.032) and personal-social scores (r = 0.28; p = 0.034); maternal age-with ASQ-3 total (r = 0.29; p = 0.034), communication (r = 0.37; p = 0.006), and personal-social scores (r = 0.29; p = 0.041). Positive correlations were observed between gestational age and communication scores (r = 0.28; p = 0.033). Infants who suffered neonatal sepsis had significantly often delay of communication (p = 0.014) and gross motor skills (p = 0.016). Children who required mechanical ventilation were more likely to have communication delay (p = 0.034). Conclusion Developmental outcomes in preterm infants at the corrected age of 24-30 months were associated with neonatal stress. Correlations between the communication, problem-solving and personal-social development in the follow up and cortisol and melatonin levels determined in the neonatal period supported this evidence. Factors as low gestational age, duration of hospital and NICU stay, mechanical ventilation, and sepsis were associated with more frequent delays in communication, gross motor and problems-solving skills.
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Affiliation(s)
- Halyna Pavlyshyn
- Department of Pediatrics, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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Mekonen WM, Muhye AB, Gobeza MB. Nurses' knowledge and practice about neonatal pain management in public hospitals in West Oromia, Ethiopia, 2022: multi-centered cross-sectional study. BMC Nurs 2024; 23:292. [PMID: 38724983 PMCID: PMC11080202 DOI: 10.1186/s12912-024-01972-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND In low-and middle-income countries inadequate neonatal pain management persists as a significant public health issue despite the availability of guidelines. Newborns often experience pain from routine medical and surgical procedures, with limited nurses' knowledge and suboptimal practices posing common obstacles to effective neonatal pain management in hospital settings. Hence, this study aimed to evaluate nurses' knowledge and practices related to neonatal pain management and the factors influencing them in public hospitals in West Oromia, Ethiopia, in 2022. METHODS A multicenter cross-sectional study was conducted among 203 nurses working in public hospitals in West Oromia from 8th May-6th June 2022. Data was gathered using structured, self-administered questionnaire and sampled through simple random sampling. The collected data were coded and entered into a computer using Epi-Data version 4.6 Statistical Software. They were analyzed using the Statistical Package for Social Science (SPSS; IBM Corporation) version 26. Binary logistic regression was used to identify significant independent variables at p < 0.05. FINDINGS In this study, 127 (62.6%) exhibited adequate knowledge, while 33 (16.3%) nurses demonstrated good practice in neonatal pain management. Attending lectures or receiving training about neonatal pain management was found to be significantly associated with nurses' knowledge of neonatal pain management [AOR, 2.31, 95%CI; 1.29-4.27]. On the other, having adequate knowledge of neonatal pain management [AOR, 3.3, 95%CI; 1.14-9.32]; the presence of a pain management policy in place [AOR, 5.44, 95% CI; 1.92-15.37] and attending lectures on neonatal pain management [AOR, 2.55, 95% CI; 1.09-5.97] were found to be significantly associated to nurses' practices. CONCLUSION Given the substandard level of nurses' practice in neonatal pain management. It is suggested to enhance the nurses' knowledge and practice about neonatal pain management by providing refreshment courses, training sessions, or facilitating nurses' opportunity access to reading resources about neonatal pain management.
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Affiliation(s)
- Wandimu Muche Mekonen
- Department of Pediatrics & Neonatal Nursing, School of Nursing and Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Addis Bilal Muhye
- Department of Pediatrics & Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengistu Berhanu Gobeza
- Department of Pediatrics & Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Chen Y, Zhou L, Tan Y. The effect of maternal voice and non-nutritional sucking on repeated procedural pain of heel prick in neonates: a quasi-experimental study. BMC Pediatr 2024; 24:256. [PMID: 38627645 PMCID: PMC11020345 DOI: 10.1186/s12887-024-04738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Neonates in the neonatal intensive care unit undergo frequent painful procedures. It is essential to reduce pain using safe and feasible methods. PURPOSE To evaluate the effects of non-nutritional sucking, mother's voice, or non-nutritional sucking combined with mother's voice on repeated procedural pain in hospitalized neonates. METHODS A quasi-experimental study was conducted in which 141 neonates were selected in a hospital in Changsha, China. Newborns were divided into four groups: non-nutritional sucking (NNS) (n = 35), maternal voice (MV) (n = 35), NNS + MV (n = 34), and control (n = 37) groups. The Preterm Infant Pain Profile-Revised Scale (PIPP-R) was used to assess pain. RESULTS During the heel prick, the heart rate value and blood oxygen saturation were significantly different between the groups (P < 0.05). Both non-nutritional sucking and maternal voice significantly reduced PIPP-R pain scores of hospitalized newborns (P < 0.05). The pain-relief effect was more robust in the combined group than in other groups. CONCLUSIONS This study showed that both non-nutritional sucking and the mother's voice alleviated repeated procedural pain in neonates. Therefore, these interventions can be used as alternatives to reduce repeated procedural pain.
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Affiliation(s)
- Yushuang Chen
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Leshan Zhou
- Xiangya Nursing School, Yuelu District, Central South University, No 172, Tongzipo Road, Changsha City, 410013, China.
| | - Yanjuan Tan
- Xiangya Thrid Hospital, Central South University, Changsha, China
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Lakatos PP, Rodas NV, Matic T, Williams ME, Samora LL, Carson MC. Providing Continuity in Infant Mental Health Services for Medically Fragile Infants and Their Families. J Clin Psychol Med Settings 2024; 31:5-18. [PMID: 37000305 PMCID: PMC10924710 DOI: 10.1007/s10880-023-09957-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 04/01/2023]
Abstract
Having a baby who is prenatally or postnatally diagnosed with a medical condition places considerable stress on the parents, infants, and their developing relationship. Infant mental health (IMH) services offer an opportunity to address the challenges and support the parent-infant relationship. The present study outlined a continuum of care IMH program embedded within various medical settings of a large metropolitan children's hospital. Applications of IMH principles within the fetal care center, neonatal intensive care unit, high risk infant follow-up clinic, and the patient's home are described. Descriptive data about families served across settings and a case study are provided in order to illustrate the implementation of this unique IMH intervention model.
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Affiliation(s)
- Patricia P Lakatos
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA.
| | - Naomi V Rodas
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Tamara Matic
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Marian E Williams
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Laura L Samora
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
| | - Melissa C Carson
- Children's Hospital Los Angeles, University of Southern California University Center for Excellence in Developmental Disabilities, 4650 Sunset Blvd, MS#53, Los Angeles, CA, 90027, USA
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Hollund IMH, Aakvik KAD, Benum SD, Ingvaldsen SH, Lydersen S, Tikanmäki M, Hovi P, Räikkönen K, Kajantie E, Johnson S, Marlow N, Baumann N, Wolke D, Indredavik MS, Evensen KAI. Mental health, pain and tiredness in adults born very preterm or with very low birthweight. Acta Paediatr 2024; 113:72-80. [PMID: 37787099 DOI: 10.1111/apa.16982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/04/2023]
Abstract
AIM Adults born preterm have increased risk of mental health problems and other neurodevelopmental conditions. We aimed to investigate associations of mental health with pain and tiredness in adults born very preterm (VP; <32 weeks) or very low birthweight (VLBW; <1500 g) and at term, and whether these associations are influenced by physical activity. METHODS As part of an EU Horizon 2020 project, individual participant data from six prospective cohort studies were harmonised for 617 VP/VLBW and 1122 term-born participants. Mental health was assessed by the Achenbach System of Empirically Based Assessment Adult Self-Report. Pain and tiredness were harmonised based on specific items from self-reported questionnaires. Associations between mental health and pain or tiredness were explored by linear regression. RESULTS An increase in the mental health scales internalising, externalising and total problems was associated with increased pain and tiredness in the preterm and term group alike. Results were maintained when adjusting for physical activity. CONCLUSION The findings indicate that associations between mental health, pain and tiredness in adults are independent of gestation or birthweight. Future research should explore other potential mechanisms that may underlie the increased risk of mental health problems in the preterm population.
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Affiliation(s)
- Ingrid Marie Husby Hollund
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Kristina Anna Djupvik Aakvik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Silje Dahl Benum
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigrid Hegna Ingvaldsen
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Lydersen
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marjaana Tikanmäki
- Clinical Medicine Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
- Public Health Unit, Finnish Institute for Health and Welfare, Helsinki/Oulu, Finland
| | - Petteri Hovi
- Public Health Unit, Finnish Institute for Health and Welfare, Helsinki/Oulu, Finland
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Katri Räikkönen
- Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | - Eero Kajantie
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Clinical Medicine Research Unit, Oulu University Hospital and University of Oulu, Oulu, Finland
- Public Health Unit, Finnish Institute for Health and Welfare, Helsinki/Oulu, Finland
- Children's Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Samantha Johnson
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Neil Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, London, UK
| | - Nicole Baumann
- Department of Population Health Sciences, University of Leicester, Leicester, UK
- Turner Institute for Brain & Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Psychology, University of Warwick, Coventry, UK
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry, UK
- Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Marit S Indredavik
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kari Anne I Evensen
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
- Unit for Physiotherapy Services, Trondheim Municipality, Trondheim, Norway
- Children's Clinic, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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Guo DD, Huang HY, Liu HE, Liu K, Luo XJ. Orientin Reduces the Effects of Repeated Procedural Neonatal Pain in Adulthood: Network Pharmacology Analysis, Molecular Docking Analysis, and Experimental Validation. Pain Res Manag 2023; 2023:8893932. [PMID: 38047157 PMCID: PMC10691896 DOI: 10.1155/2023/8893932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/08/2023] [Accepted: 11/08/2023] [Indexed: 12/05/2023]
Abstract
Background Premature infants often undergo painful procedures and consequently experience repeated procedural neonatal pain. This can elicit hyperalgesia and cognitive impairment in adulthood. Treatments for neonatal pain are limited. Orientin is a flavonoid C-glycoside that has repeatedly been shown to have pharmacological effects in the past decades. The aim of this study was to systematically explore the effect of orientin on repeated procedural neonatal pain using network pharmacology, molecular docking analysis, and experimental validation. Methods Several compound-protein databases and disease-protein databases were employed to identify proteins that were both predicted targets of orientin and involved in neonatal pain. A protein-protein interaction (PPI) network was constructed, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed to explore the potential mechanism of action. Molecular docking analysis was employed to calculate the binding energy and visualize the interactions between orientin and potential target proteins. Finally, a mouse model of repeated procedural neonatal pain was established and orientin was administered for 6 days. The mechanical and thermal pain thresholds were assessed in neonates and adult mice. A Morris water maze was employed to investigate cognitive impairment in adult mice. Results A total of 286 proteins that were both predicted targets of orientin and involved in neonatal pain were identified. The hub proteins were SRC, HSP90AA1, MAPK1, RHOA, EGFR, AKT1, PTPN11, ESR1, RXRA, and HRAS. GO analysis indicated that the primary biological process (BP), molecular function (MF), and cellular component (CC) were protein phosphorylation, protein kinase activity, and vesicle lumen, respectively. KEGG analysis revealed that the mitogen-activated protein kinase (MAPK) signaling pathway may be the key to the mechanism of action. Molecular docking analysis showed the high binding affinities of orientin for MAPK1, MAPK8, and MAPK14. In mice, orientin inhibited the hyperalgesia in the pain threshold tests in neonates and adult mice and cognitive impairment in adult mice. Immunofluorescence showed that phosphorylated MAPK1 (p-ERK) protein levels in the hippocampus and spinal dorsal horn were downregulated by orientin. Conclusion The findings suggested that orientin alleviates neonatal pain, and the MAPK signaling pathway is involved.
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Affiliation(s)
- Dong-Dong Guo
- Department of Anesthesiology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Hai-Yan Huang
- Department of Cardiovascular, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
| | - Hai-E. Liu
- Department of Anesthesiology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Kun Liu
- Department of Anesthesiology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai 201102, China
| | - Xing-Jing Luo
- Department of Anesthesiology, National Children's Medical Center, Children's Hospital of Fudan University, Shanghai 201102, China
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Liao L, Wang YY, Cao Y, Tan M. A Bibliometric Analysis of Neonatal Pain Management Research From 2010 to 2022. Z Geburtshilfe Neonatol 2023; 227:336-346. [PMID: 37487521 DOI: 10.1055/a-2110-2157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND Research related to neonatal pain management has received increasing attention in recent years. Effective pain management contributes to the maintenance of the healthy physical and mental growth of the newborn. To better understand this research topic, we analyzed the current state of development in this field over the past thirteen years by bibliometric analysis and provide directions for future research. METHODS Original articles were collected from the Web of Science Core Collection (WoSCC) between January 1, 2010, to December 31, 2022, the title and abstract clearly stating 'neonatal pain management' or its alternative search keywords. CiteSpace, VOSviewer, and the WoS analysis tool were used to analyze and present the data. RESULTS A total of 967 articles met the inclusion criteria. Significant growth of the number of publications increased roughly fourfold from 2010 to 2022. Overall, the United States and Canada were the highest contributors to neonatal pain management research. Weak cooperation was observed in international research (developing and developed countries) and cross-institutional cooperation. Neonatal pain-related research was the most common focus. Pain education and interventions for parents and medical personnel have also received increasing attention recently. CONCLUSION The current study revealed that research in terms of publications on neonatal pain management has rapidly increased for more than the past ten years. Developed countries, especially the United States and Canada, were more concerned with this topic than developing countries. More international research and cross-institutional cooperation are required to promote the development of neonatal pain medicine in the future.
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Affiliation(s)
- Ling Liao
- Department of Nursing, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Ying Ying Wang
- Department of Emergency, Yijishan Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Ying Cao
- Department of Nursing, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Min Tan
- Department of Nursing, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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McLean MA, Nakajima L, Chau CMY, Weinberg J, Synnes AR, Miller SP, Grunau RE. Cortisol levels are related to neonatal pain exposure in children born very preterm at age 18 months in two independent cohorts. PAEDIATRIC & NEONATAL PAIN 2023; 5:86-95. [PMID: 37744280 PMCID: PMC10514780 DOI: 10.1002/pne2.12112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 03/24/2023] [Accepted: 05/14/2023] [Indexed: 09/26/2023]
Abstract
Exposure to pain-related stress from frequent invasive procedures in the neonatal intensive care unit (NICU) has been associated with altered physiological stress regulation, neurodevelopment, and behavior in children born very preterm (≤32 weeks gestation). Previously, in a cohort born 2003-2006 (Cohort 1), we found that, at 18 months corrected age (CA), children born extremely low gestational age (ELGA; 24-28 weeks) and very low gestational age (VLGA; 29-32 weeks), had higher pre-test cortisol levels and a different pattern of cortisol output across a developmental assessment involving cognitive challenge compared to children born full-term (FT; 39-41 weeks). Also, greater neonatal pain-related stress exposure among the preterm children was related to higher pre-test cortisol levels. Given the adverse long-term effects of neonatal pain in preterm infants and the ensuing rise in clinical concerns to appropriately manage pain in the NICU in recent years, we aimed to examine whether our findings from Cohort 1 would still be evident in an independent cohort (Cohort 2) born 2006-2011 and recruited from the same tertiary NICU in Vancouver, Canada. We also compared the cortisol patterns, clinical and socio-demographic factors, and their interrelationships between the two cohorts. In Cohort 2, our findings using multi-level modeling support and extend our earlier findings in Cohort 1, demonstrating that children born ELGA display higher pre-test cortisol levels than FT. As well, greater cortisol output across assessment was related to more anxiety/depressive behaviors in children born VLGA. Importantly, children born ELGA were exposed to less neonatal pain/stress, mechanical ventilation, and morphine in Cohort 2 than Cohort 1. In both cohorts, however, cortisol levels and patterns were related to neonatal pain/stress and clinical factors (days on mechanical ventilation, overall morphine exposure). Despite less exposure to pain/stress and adverse clinical factors in Cohort 2 compared to Cohort 1, cortisol levels and patterns across cognitive challenge in preterm children at 18-month CA were consistent across the two independent cohorts. These findings highlight that, despite improvements to neonatal care, children born extremely preterm continue to display altered HPA axis activity, which is associated with their poorer neurodevelopmental and behavioral outcomes.
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Affiliation(s)
- Mia A. McLean
- Department of PediatricsUniversity of British ColumbiaBritish ColumbiaVancouverCanada
- BC Children's Hospital Research InstituteBritish ColumbiaVancouverCanada
- School of Psychology and NeuroscienceAuckland University of TechnologyAucklandNew Zealand
| | - Lisa Nakajima
- Department of PediatricsUniversity of British ColumbiaBritish ColumbiaVancouverCanada
| | - Cecil M. Y. Chau
- Department of PediatricsUniversity of British ColumbiaBritish ColumbiaVancouverCanada
- BC Children's Hospital Research InstituteBritish ColumbiaVancouverCanada
| | - Joanne Weinberg
- BC Children's Hospital Research InstituteBritish ColumbiaVancouverCanada
- Department of Cellular and Physiological SciencesUniversity of British ColumbiaBritish ColumbiaVancouverCanada
| | - Anne R. Synnes
- Department of PediatricsUniversity of British ColumbiaBritish ColumbiaVancouverCanada
- BC Children's Hospital Research InstituteBritish ColumbiaVancouverCanada
| | - Steven P. Miller
- Department of PediatricsUniversity of British ColumbiaBritish ColumbiaVancouverCanada
- BC Children's Hospital Research InstituteBritish ColumbiaVancouverCanada
| | - Ruth E. Grunau
- Department of PediatricsUniversity of British ColumbiaBritish ColumbiaVancouverCanada
- BC Children's Hospital Research InstituteBritish ColumbiaVancouverCanada
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Čolić A, Vukojević N, Anić Jurica S. ASSESSMENT OF NEONATAL CARE STANDARD BY THE PREDICTIVE MODEL FOR RETINOPATHY OF PREMATURITY BASED ON WEIGHT GAIN. Acta Clin Croat 2023; 62:175-183. [PMID: 38304365 PMCID: PMC10829965 DOI: 10.20471/acc.2023.62.01.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 02/26/2023] [Indexed: 02/03/2024] Open
Abstract
Care of extremely premature infants is in constant need for evaluation and progress. WINROP, a predictive model based on weight gain, has been developed to reduce the number of stressful examinations for retinopathy for prematurity. Validation studies of WINROP emphasize the difference of applicability in neonatal units of various practice. The aim of the study was to assess the standard of neonatal care by WINROP. Data on extremely premature infants were collected from medical records and entered in WINROP. High- and low-risk WINROP distribution and retinopathy of prematurity outcomes were analyzed. Fifty-four infants, gestational age ≤28 weeks, were included in the study after exclusion of weight related comorbidities. High risk was noted in 74% (n=40) of infants with 24% (n=13) developing retinopathy of prematurity requiring treatment. In low alarm group, there were 3 cases with severe disease. In conclusion, WINROP is not just a provider of predictive information on the severity of retinopathy of prematurity. High-risk alarm indicates the need of adjustment of nutritional strategies. Infants without pathological growth morbidities who develop severe retinopathy of prematurity in low-risk group point to other risk factors for retinopathy of prematurity to be evaluated and changed in future practice.
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Affiliation(s)
- Ana Čolić
- Division of Neonatology, Department of Gynecology and Obstetrics, Zagreb University Hospital Center, Zagreb, Croatia
| | - Nenad Vukojević
- School of Medicine, University of Zagreb, Department of Ophthalmology, Zagreb University Hospital Center, Zagreb, Croatia
| | - Sonja Anić Jurica
- Division of Neonatology, Department of Gynecology and Obstetrics, Zagreb University Hospital Center, Zagreb, Croatia
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12
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The effect of swaddling method applied to preterm infants during the aspiration procedure on pain. J Pediatr Nurs 2023; 70:61-67. [PMID: 36801626 DOI: 10.1016/j.pedn.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/10/2022] [Accepted: 05/27/2022] [Indexed: 02/19/2023]
Abstract
PURPOSE The study was carried out to determine the effect of the swaddling method on pain in preterm infants (between 27 and 36 weeks) hospitalized in the Neonatal Intensive Care Unit during the aspiration procedure. Preterm infants were recruited by convenience sampling from level III neonatal intensive care units in a city in Turkey. METHOD The study was conducted in a randomized controlled trial manner. The study consisted of preterm infants (n = 70) receiving care or treatment at a neonatal intensive care unit. While swaddling was applied to the infants in the experimental group before the aspiration process. The pain was assessed before, during, and after the nasal aspiration using the Premature Infant Pain Profile. RESULTS No significant difference was found in terms of pre-procedural pain scores whereas a statistically significant difference was detected in terms of pain scores during and after the procedure between the groups. CONCLUSION It was determined in the study that the swaddling method reduced the pain of the preterm infants during the aspiration procedure. IMPLICATIONS FOR PRACTICE This study emphasized that swaddling had pain-reducing during the aspiration procedure in the neonatal intensive care unit in preterm infants. It is recommended that future studies be conducted using different invasive procedures in preterm infants born earlier.
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13
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Deniz AÖ, Açikgöz A. A Randomized Controlled Trial: The Effect of Acupressure and Foot Reflexology on Pain During Heel-Lancing in Neonates. Clin Nurs Res 2023; 32:306-312. [PMID: 34955035 DOI: 10.1177/10547738211061815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This randomized controlled study aimed to determine the effects of acupressure and foot reflexology on procedural pain during heel-lancing in newborns. This study was conducted with 105 neonates (35 foot reflexology group, 35 acupressure group, and 35 control group) who met the inclusion criteria and who were delivered by cesarean section between October 2017 and March 2018 at a state hospital in Turkey. A "Newborn Information Form" and a "Neonatal Pain, Agitation, and Sedation Scale" (N-PASS) were used to collect data. The study found a significant intergroup difference between pain scores of neonates during the procedures (p < .05). Advanced analyses found that the pain scores in the acupressure and foot reflexology groups were similar, whereas the pain scores in the control group were higher than in the other two groups. Acupressure and foot reflexology administered during heel lancing in newborns are effective methods for reducing pain.
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Pavlyshyn H, Sarapuk I. Skin-to-skin contact-An effective intervention on pain and stress reduction in preterm infants. Front Pediatr 2023; 11:1148946. [PMID: 37033163 PMCID: PMC10073438 DOI: 10.3389/fped.2023.1148946] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/07/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction The outcomes of pain and stress in preterm infants in the neonatal intensive care units (NICUs) compel the continued search for pain- and stress-reducing interventions. The objective of the study To investigate how skin-to-skin contact (SSC) influences chronic pain and stress in preterm infants in the NICU. Materials and methods The study included 140 preterm infants in the NICU with gestational age less than 34 weeks. The overall design was a baseline-response design. Urine and saliva were collected before (baseline) and after SSC to measure pain and stress markers by enzyme immunoassay method. The behavioral indicators of chronic pain were assessed using the EDIN (Échelle Douleur Inconfort Nouveau-Né-neonatal pain and discomfort). Results There was a significant decrease in the dopamine level in preterm infants after SSC in comparison with baseline values (85.99 [69.35; 112.20] pg/ml vs. 132.20 [104.80; 183.70] pg/ml), p < 0.001. The β-endorphin and serotonin levels increased after SSC (40.09 [26.81; 70.63] pg/ml vs. 29.87 [20.61; 46.94] pg/ml, p = 0.009 and 25.49 [20.45; 40.08] ng/ml vs. 22.30 [15.13; 31.65] ng/ml, p = 0.011, respectively). A significant decrease in cortisol levels in saliva and urine after SSC in comparison with baseline values (0.125 [0.079; 0.225] μg/dl vs. 0.371 [0.188; 1.002] μg/dl, p = 0.000 and 27.06 [14.59; 35.35] ng/ml vs. 35.25 [19.78; 61.94] ng/ml, p = 0.001, with a simultaneous increase of oxytocin level (57.00 [36.55; 88.49] pg/ml vs. 38.20 [28.78; 56.04] pg/ml, p = 0.009 were revealed. The total pain EDIN score in infants after SSC was below 6 points, significantly decreasing compared to the baseline (p < 0.05). Conclusion Preterm infants in the NICU experience stress and pain, which were confirmed by the EDIN pain scale and laboratory markers. The level of dopamine and cortisol as pain and stress hormones were reliably high, and normalized after regular SSC. Simultaneously, pain-relieving and anti-stress markers of oxytocin, β-endorphin and serotonin reliably increased in preterm infants in response to the SSC.
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Vulnerability of the Neonatal Connectome following Postnatal Stress. J Neurosci 2022; 42:8948-8959. [PMID: 36376077 PMCID: PMC9732827 DOI: 10.1523/jneurosci.0176-22.2022] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 06/29/2022] [Accepted: 07/07/2022] [Indexed: 11/16/2022] Open
Abstract
Stress following preterm birth can disrupt the emerging foundation of the neonatal brain. The current study examined how structural brain development is affected by a stressful early environment and whether changes in topological architecture at term-equivalent age could explain the increased vulnerability for behavioral symptoms during early childhood. Longitudinal changes in structural brain connectivity were quantified using diffusion-weighted imaging (DWI) and tractography in preterm born infants (gestational age <28 weeks), imaged at 30 and/or 40 weeks of gestation (N = 145, 43.5% female). A global index of postnatal stress was determined based on the number of invasive procedures during hospitalization (e.g., heel lance). Higher stress levels impaired structural connectivity growth in a subnetwork of 48 connections (p = 0.003), including the amygdala, insula, hippocampus, and posterior cingulate cortex. Findings were replicated in an independent validation sample (N = 123, 39.8% female, n = 91 with follow-up). Classifying infants into vulnerable and resilient based on having more or less internalizing symptoms at two to five years of age (n = 71) revealed lower connectivity in the hippocampus and amygdala for vulnerable relative to resilient infants (p < 0.001). Our findings suggest that higher stress exposure during hospital admission is associated with slower growth of structural connectivity. The preservation of global connectivity of the amygdala and hippocampus might reflect a stress-buffering or resilience-enhancing factor against a stressful early environment and early-childhood internalizing symptoms.SIGNIFICANCE STATEMENT The preterm brain is exposed to various external stimuli following birth. The effects of early chronic stress on neonatal brain networks and the remarkable degree of resilience are not well understood. The current study aims to provide an increased understanding of the impact of postnatal stress on third-trimester brain development and describe the topological architecture of a resilient brain. We observed a sparser neonatal brain network in infants exposed to higher postnatal stress. Limbic regulatory regions, including the hippocampus and amygdala, may play a key role as crucial convergence sites of protective factors. Understanding how stress-induced alterations in early brain development might lead to brain (re)organization may provide essential insights into resilient functioning.
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The effects of different procedures on pain levels in preterm and term infants in neonatal intensive care unit: a cross‐sectional survey of pain assessment in newborns. Ir J Med Sci 2022:10.1007/s11845-022-03183-8. [DOI: 10.1007/s11845-022-03183-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022]
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Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9101568. [PMID: 36291504 PMCID: PMC9600280 DOI: 10.3390/children9101568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 10/09/2022] [Accepted: 10/13/2022] [Indexed: 11/05/2022]
Abstract
Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain.
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18
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Rêgo DDSB, Silva CS, Mello LEAM, Leslie ATFS. Early life nociceptive stimulus and fentanyl exposure increase hippocampal neurogenesis and anxiety but do not affect spatial learning and memory. Front Neurosci 2022; 16:988096. [PMID: 36248634 PMCID: PMC9557065 DOI: 10.3389/fnins.2022.988096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/07/2022] [Indexed: 11/15/2022] Open
Abstract
This study aimed to determine whether preemptive fentanyl administration in neonatal rats reduces the impact of a nociceptive stimulus initiated during the first day of life (P1) on hippocampal neurogenesis, behavior, and learning. At P1, Wistar rat pups received either a subcutaneous injection of fentanyl (F) before intraplantar injection of complete Freund’s adjuvant (CFA) (CFA + F group), an isolated injection of CFA (CFA group), or subcutaneous injection of fentanyl without CFA injection (F). Control animals received saline injections using the same route and volume as the treatment groups. Hippocampal neurogenesis was evaluated by 5′ –bromo-2′-deoxyuridine (BrdU) staining on P10 and P39 to assess neuronal proliferation and survival, respectively. Anxiety behavior in adulthood was assessed using an open field test (OF) and an elevated plus maze test (EPM). Spatial memory was assessed on a Morris water maze test (MWM), where the animals were trained for seven days, beginning on P81, and the probe trial was performed to evaluate memory retention. Although the CFA + F group showed an increased number of proliferative cells on P10, this finding did not persist on P39. The CFA + F group spent more time in the closed arms in the EPM, revealing more anxious behavior, although the early noxious experience, both with and without fentanyl, did not alter neurogenesis in adolescence and learning in adulthood. This study highlights that the impact of pain in early life pain combined with fentanyl on hippocampal neurogenesis on P10 did not persist on P39. In addition, this combined intervention during the first week of life was associated with higher anxiety levels.
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Affiliation(s)
| | - Clivandir S. Silva
- Laboratório de Neurobiologia, Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Luiz Eugenio A. M. Mello
- Laboratório de Neurobiologia, Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Instituto D’Or de Pesquisa e Ensino, IDOr, São Paulo, Brazil
| | - Ana Teresa Figueiredo Stochero Leslie
- Laboratório de Neurobiologia, Departamento de Fisiologia, Universidade Federal de São Paulo, São Paulo, Brazil
- Departmento de Pediatria, Universidade Federal de São Paulo, São Paulo, Brazil
- *Correspondence: Ana Teresa Figueiredo Stochero Leslie,
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Thirunavukarasu AJ, Hassan R, Savant S, Hamilton DL. Analgesia for retinopathy of prematurity screening: A systematic review. Pain Pract 2022; 22:642-651. [PMID: 35703418 PMCID: PMC9543288 DOI: 10.1111/papr.13138] [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: 03/01/2022] [Revised: 05/04/2022] [Accepted: 05/31/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIMS Premature neonates require regular ophthalmological examination, generally indirect ophthalmoscopy, to screen for retinopathy of prematurity (ROP). Conventional analgesia is provided with topical anesthetic eyedrops and oral sugar solution, but neonates still experience significant pain. Here, the literature base was examined to evaluate the usefulness of other pharmacological analgesics. MATERIALS AND METHODS A systematic review was undertaken, adhering to a PROSPERO preregistered protocol in accordance with PRISMA guidelines (identifier CRD42022302459). Electronic databases were searched for primary research articles on pharmacological pain interventions used for ROP screening in neonates. The primary outcome measure was pain scores recorded using validated pain scoring tools, with and without pharmacological interventions in neonates during eye examination. For analysis, studies were separated into two categories: topical anesthesia and alternative pharmacological treatments. RESULTS Eleven studies met the inclusion criteria. Topical analgesia, oral paracetamol, and intranasal fentanyl were found to be effective in reducing the pain of eye examination. Oral morphine and inhaled nitrous oxide had no significant effect on premature infant pain profile (PIPP) scores during indirect ophthalmoscopy. DISCUSSION In addition to topical anesthesia, premedication with oral paracetamol is recommended during screening examination for ROP. The routine use of fentanyl is not recommended due to the risk of potential side effects. Non-pharmacological measures, such as sweet oral solutions and comfort techniques should also be employed. Further research is required to determine whether the use of nitrous oxide has a role, and to develop a safe and effective analgesic strategy to fully ameliorate the pain of ROP screening.
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Affiliation(s)
- Arun J. Thirunavukarasu
- School of Clinical MedicineUniversity of CambridgeCambridgeUK,Corpus Christi CollegeUniversity of CambridgeCambridgeUK
| | - Refaat Hassan
- School of Clinical MedicineUniversity of CambridgeCambridgeUK,Sidney Sussex CollegeUniversity of CambridgeCambridgeUK
| | - Shalom V. Savant
- School of Clinical MedicineUniversity of CambridgeCambridgeUK,St John's CollegeUniversity of CambridgeCambridgeUK
| | - Duncan L. Hamilton
- James Cook University HospitalMiddlesbroughUK,School of MedicineUniversity of SunderlandSunderlandUK
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Brévaut-Malaty V, Resseguier N, Garbi A, Tosello B, Thomachot L, Vialet R, Gire C. Long Term Neurodevelopmental Outcomes after Sevoflurane Neonatal Exposure of Extremely Preterm Children: A Cross-Sectional Observationnal Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9040548. [PMID: 35455592 PMCID: PMC9028040 DOI: 10.3390/children9040548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/02/2022] [Accepted: 04/08/2022] [Indexed: 11/19/2022]
Abstract
Sevoflurane, a volatile anesthetic, is used when extremely preterm neonates (EPT) undergo painful procedures. Currently, no existing studies analyze sevoflurane’s long-term effects during the EPT’s immediate neonatal period. Our primary objective was to compare the EPT’s neurocognitive development regardless of any sevoflurane exposure prior to 45 weeks corrected gestational age (GA). We analyzed those live discharges, less than 28 weeks GA, who were either exposed, unexposed, and/or multiply exposed to sevoflurane before 45 weeks GA. All data were obtained from a cross-sectional multicenter study (GPQoL study, NCT01675726). Children, both exposed and non-exposed to sevoflurane, were sampled using a propensity-guided approach. Neurological examinations (Touwen), cognitive and executive functions (WISC IV, NEPSY, Rey figure), and assessments when the children were between 7 and 10 years old, were correlated to their neonatal sevoflurane exposure. There were 139 children in the study. The mean gestational age was 26.2 weeks (±0.8) GA and the mean birth weight was 898 g (±173). The mean age of their evaluation was 8.47 years old (±0.70). Exposure to sevoflurane to the mean corrected age 27.10 (3.37) weeks GA had a significant correlation with cerebral palsy (adjusted odds ratio (aOR): 6.70 (CI 95%: 1.84–32.11)) and other major disorders (cerebral palsy and/or severe cognitive retardation) (aOR: 2.81 [95% CI: 1.13–7.35]). Our results demonstrate the possibility of long-term effects on EPT infants who had a sevoflurane exposure before 45 weeks corrected GA. However, these results will require further confirmation by randomized controlled trials.
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Affiliation(s)
- Véronique Brévaut-Malaty
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
| | - Noémie Resseguier
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France;
| | - Aurélie Garbi
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
| | - Barthélémy Tosello
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
- CNRS, EFS, ADES, Aix Marseille University, 13915 Marseille, France
- Correspondence: ; Tel.: +33-(0)-491964822
| | - Laurent Thomachot
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
| | - Renaud Vialet
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
| | - Catherine Gire
- Department of Neonatology, North Hospital, University Hospital of Marseille, Chemin des Bourrelys, CEDEX 20, 13915 Marseille, France; (V.B.-M.); (A.G.); (L.T.); (R.V.); (C.G.)
- CEReSS—Health Service Research and Quality of Life Center, Faculty of Medicine, Aix-Marseille University, 27 Boulevard Jean Moulin, 13005 Marseille, France;
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Dutriez-Casteloot I, Emmanuelli V, Wiart JF, Tavernier A, Besengez C, Storme L, Houfflin-Debarge V. Long-Lasting Analgesia With Transdermal Fentanyl: A New Approach in Rat Neonatal Research. Front Pharmacol 2022; 13:798011. [PMID: 35370716 PMCID: PMC8968727 DOI: 10.3389/fphar.2022.798011] [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: 10/19/2021] [Accepted: 02/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background: With advances in neonatal care, management of prolonged pain in newborns is a daily concern. In addition to ethical considerations, pain in early life would have long-term effects and consequences. However, its treatment remains inadequate. It was therefore important to develop an experimental model of long-lasting analgesia for neonatal research. Materials and Methods: Experiments were performed in six groups of rats with transdermal fentanyl 0, 3, 12, 50, 100, or 200 μg/kg/h from second postnatal day (P2) until weaning. Assessment of analgesia was carried out at P21, with behavioral scores (ranging from 0 to 3) using a 4% formalin test. Plasma levels of fentanyl were determined by UPLC/TQD at P22. Growth rate was investigated. Results: Fentanyl 100 and 200 μg/kg/h reduced scores of formalin-evoked behavioral pain. They increased time spent in pain score 0 (8 min 55 s and 6 min 34 s versus 23 s in controls) as in low pain scores 1 and 2, and decreased time in the most severe pain score 3 (19 min 56 s and 17 min 39 s versus 44 min 15 s). Fentanylemia increased in a dose-dependent manner from 50 μg/kg/h (2.36 ± 0.64 ng/ml) to 200 μg/kg/h (8.66 ± 1.80 ng/ml). Concerning growth, no difference was observed except weaker growth from P17 to P22 with 200 μg/kg/h. Clinically, we noticed no visible side effect from 3 to 100 μg/kg/h. Concomitantly, 200 μg/kg/h was responsible for ophthalmological side effects with appearance of corneal bilateral clouding in 90% pups. No difference was observed between male and female rats. Conclusion: Altogether, results indicate that transdermal fentanyl 100 μg/kg/h is an efficient therapeutic for long-lasting analgesia in lactating pups. This new model provides a useful tool for protection and welfare, and future opportunity for studying long-term health consequences of sustainable neonatal analgesia.
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Affiliation(s)
- Isabelle Dutriez-Casteloot
- ULR2694 METRICS-Perinatal Environment and Health, University of Lille, Lille, France.,Department of Biology, Faculty of Sciences and Technology, University of Lille, Lille, France
| | - Virginie Emmanuelli
- Department of Obstetrics, Jeanne de Flandre Hospital, University Hospital Center of Lille, Lille, France
| | - Jean-François Wiart
- Department of Toxicology, University Hospital Center of Lille, Lille, France
| | - Annabelle Tavernier
- Department of Biology, Faculty of Sciences and Technology, University of Lille, Lille, France
| | - Capucine Besengez
- ULR2694 METRICS-Perinatal Environment and Health, University of Lille, Lille, France
| | - Laurent Storme
- ULR2694 METRICS-Perinatal Environment and Health, University of Lille, Lille, France
| | - Véronique Houfflin-Debarge
- ULR2694 METRICS-Perinatal Environment and Health, University of Lille, Lille, France.,Department of Obstetrics, Jeanne de Flandre Hospital, University Hospital Center of Lille, Lille, France
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Bruschettini M, Olsson E, Persad E, Garratt A, Soll R. Clinical rating scales for assessing pain in newborn infants. Hippokratia 2022. [DOI: 10.1002/14651858.mr000064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics; Lund University, Skåne University Hospital; Lund Sweden
- Cochrane Sweden; Lund University, Skåne University Hospital; Lund Sweden
| | - Emma Olsson
- Department of Pediatrics, Faculty of Medicine and Health; Örebro University; Örebro Sweden
| | - Emma Persad
- Cochrane Austria, Department for Evidence-based Medicine and Evaluation; Danube University Krems; Krems Austria
| | - Andrew Garratt
- Division for Health Services; Norwegian Institute of Public Health; Oslo Norway
| | - Roger Soll
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics; Larner College of Medicine at the University of Vermont; Burlington Vermont USA
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23
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Firestein MR, Myers MM, Feder KJ, Ludwig RJ, Welch MG. Effects of Family Nurture Intervention in the NICU on Theory of Mind Abilities in Children Born Very Preterm: A Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9020284. [PMID: 35205004 PMCID: PMC8870221 DOI: 10.3390/children9020284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 01/21/2023]
Abstract
Preterm infants are at risk for socioemotional deficits, neurodevelopmental disorders, and potentially theory of mind (ToM) deficits. Preterm infants enrolled in a randomized controlled trial in the neonatal intensive care unit (NICU) received Standard Care (SC) or Family Nurture Intervention (FNI). Children (N = 72; median age 61.8 ± 2.6 months; FNI: 35 (55%), SC:2 9 (45%)) completed a ToM task, of whom 64 (54% male; born to White (43.8%), Black (18.7%), and Hispanic (25.0%) mothers) contributed to this analysis. FNI and SC infants born extremely preterm to very preterm differed significantly: 78% (14 of 18) of FNI children passed vs. 30% (3 of 10) SC children (p = 0.01, effect size = 1.06). This large effect size suggests that FNI in the NICU may ameliorate deficits in social-cognitive skills of extreme to very preterm infants by school age.
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Affiliation(s)
- Morgan R Firestein
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Michael M Myers
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | | | - Robert J Ludwig
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
| | - Martha G Welch
- Department of Psychiatry, Columbia University Irving Medical Center, New York, NY 10032, USA
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY 10032, USA
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van Dokkum NH, de Kroon MLA, Dijk PH, Kraft KE, Reijneveld SA, Bos AF. Course of Stress during the Neonatal Intensive Care Unit Stay in Preterm Infants. Neonatology 2022; 119:84-92. [PMID: 34883490 DOI: 10.1159/000520513] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 10/25/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Understanding the course of stress during the neonatal intensive care unit stay may provide targets for interventions. Our aim was to describe the course of stress in preterm infants during the first 28 days of life, the influence of gestational age, and associations with clinical characteristics. METHODS In a single centre prospective cohort study, we included infants with a gestational age <30 weeks and/or birth weight <1,000 g. We measured stress over the first 28 days using the Neonatal Infant Stressor Scale (NISS). We plotted daily NISS total and subcategory scores by gestational age. The subcategories were (1) nursing, (2) skin-breaking, (3) monitoring and imaging, and (4) medical morbidity-related scores. We assessed associations of cumulative NISS scores over the first 7, 14, and 28 days with clinical characteristics using regression analyses. RESULTS We included 45 infants, with a median gestational age of 27 weeks. The mean daily NISS score was 66.5 (SD 8.7), with highest scores in the first 7 days of life. Scores decreased the slowest for the lowest gestational ages, in particular for nursing scores, rather than skin-breaking, monitoring and imaging, and medical morbidity-related scores. Adjusted for gestational age, infants with lower Apgar scores, sepsis, intraventricular haemorrhages, and on mechanical ventilation had significantly higher cumulative NISS scores at 7, 14, and 28 days. CONCLUSION NISS scores varied greatly within infants and over time, with the highest mean scores in the first week after birth. The course of declining NISS scores in the first 28 days depended on gestational age at birth.
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Affiliation(s)
- Nienke H van Dokkum
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marlou L A de Kroon
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Peter H Dijk
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karianne E Kraft
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arend F Bos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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25
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Abdelmageed RI, Youssef AM, El-Farrash RA, Mohamed HM, Abdelaziz AW. Measurement of Cumulative Preterm Neonatal and Maternal Stressors During Neonatal Intensive Care Unit Admission. J Pediatr Psychol 2021; 47:595-605. [PMID: 34865092 DOI: 10.1093/jpepsy/jsab124] [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: 07/08/2021] [Revised: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES By nature, the neonatal intensive care unit (NICU) environment is stressful for both infants and mothers. This study aimed to explore and quantify the severity of early life stressors in premature infants admitted to the NICU and evaluate the effect of cumulative neonatal stressors on maternal mental health. METHODS This cross-sectional study included 100 preterm infants admitted to the NICU for at least 10 days. Daily experiences with painful/stressful procedures for 10 days were determined using the Neonatal Infant Stressor Scale. The included mothers were assessed for their psychological well-being 1 week after NICU admission using the Parental Stressor Scale: NICU and Edinburgh Postnatal Depression Scale. RESULTS During the first 10 days of NICU admission, preterm infants experienced an average of 350.76 ± 84.43 acute procedures and an average of 44.84 ± 11.12 cumulative hours of chronic events, with the highest scores recorded on first 3 days of admission. Although intravenous flushing for patency was the most frequent acute procedure, blood gas sampling was the most painful. Forty-five percent of the mothers showed significant depressive symptoms, with the maternal role alteration reported as the most stressful experience, especially for young and new mothers (p < .001). The cumulative stressors experienced by infants were significantly associated with elevated maternal perception of psychological maladjustment (p < .001). CONCLUSION This study confirmed that the NICU environment is stressful for both infants and mothers, with the total cumulative stressors experienced by preemies in the NICU having an negative impact on maternal mental health.
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Affiliation(s)
| | - Azza M Youssef
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Egypt
| | | | | | - Asmaa W Abdelaziz
- Pediatrics Department, Faculty of Medicine, Ain Shams University, Egypt
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26
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Shiff I, Bucsea O, Pillai Riddell R. Psychosocial and Neurobiological Vulnerabilities of the Hospitalized Preterm Infant and Relevant Non-pharmacological Pain Mitigation Strategies. Front Pediatr 2021; 9:568755. [PMID: 34760849 PMCID: PMC8573383 DOI: 10.3389/fped.2021.568755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/23/2021] [Indexed: 11/21/2022] Open
Abstract
Background: Preterm pain is common in the Neonatal Intensive Care Unit (NICU), with multiple invasive procedures occurring daily. Objective: To review the psychosocial and neurobiological vulnerabilities of preterm infants and to provide an updated overview of non-pharmacological strategies for acute procedural pain in hospitalized preterm infants. Methods: We utilized a narrative review methodology, which also included a synthesis of key pieces of published systematic reviews that are relevant to the current work. Results and Conclusions: Preterm infants are uniquely susceptible to the impact of painful procedures and prolonged separation from caregivers that are often inherent in a NICU stay. Non-pharmacological interventions can be efficacious for mitigating procedural pain for preterm infants. Interventions should continue to be evaluated with high quality randomized controlled trials, and should endeavor to take into account the neurobiological and psychosocial aspects of preterm vulnerability for pain prevention and management strategies.
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Affiliation(s)
- Ilana Shiff
- Department of Psychology, York University, Toronto, ON, Canada
| | - Oana Bucsea
- Department of Psychology, York University, Toronto, ON, Canada
| | - Rebecca Pillai Riddell
- Department of Psychology, York University, Toronto, ON, Canada
- Department of Psychiatry Research, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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27
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Metallinou D, Lazarou E, Lykeridou A. Pharmacological and Non-Pharmacological Brain-Focused Clinical Practices for Premature Neonates at High Risk of Neuronal Injury. MÆDICA 2021; 16:281-290. [PMID: 34621352 DOI: 10.26574/maedica.2020.16.2.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective:Disruption of smooth intrauterine brain development is a significant consequence of premature birth that may lead to adverse neurological outcomes. Although noteworthy progress has been made in the management of prematurity, the rates of neonatal morbidity and neurodevelopmental disorders remain high, underlining the need to find clinical practices that particularly protect the central nervous system. Aim:To identify recent articles regarding pharmacological and non-pharmacological brain-focused clinical practices (BFCP) for premature neonates at high risk of neuronal injury. Material and methods:We did an extensive search of PubMed and Google Scholar for relevant research published between 2000 and 2020. Results:Nineteen full-length original research papers fulfilled the inclusion criteria and were selected for the purpose of the present review. Non-pharmacological BFCP intend to improve the neonate's experience in the NICU environment and can be applied by a multidisciplinary team, while pharmacological ones are related to novel molecules that aim to quell apoptosis and inflammation or promote neurogenesis. Conclusion:In the future, a combination of pharmacological and non-pharmacological BFCP might be considered as the most promising protection and/or treatment provided in clinical practice to premature neonates at high risk of neuronal injury.
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Affiliation(s)
- Dimitra Metallinou
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Greece
| | | | - Aikaterini Lykeridou
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Greece
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28
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Schmitz-Koep B, Zimmermann J, Menegaux A, Nuttall R, Bäuml JG, Schneider SC, Daamen M, Boecker H, Zimmer C, Wolke D, Bartmann P, Hedderich DM, Sorg C. Decreased amygdala volume in adults after premature birth. Sci Rep 2021; 11:5403. [PMID: 33686187 PMCID: PMC7970879 DOI: 10.1038/s41598-021-84906-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/22/2021] [Indexed: 12/17/2022] Open
Abstract
Premature-born infants have impaired amygdala structure, presumably due to increased stress levels of premature birth mediated by the amygdala. However, accounting for lifelong plasticity of amygdala, it is unclear whether such structural changes persist into adulthood. To address this problem, we stated the following questions: first, are whole amygdala volumes reduced in premature-born adults? And second, as adult anxiety traits are often increased after prematurity and linked with amygdala structure, are alterations in amygdala associated with adults' anxiety traits after premature birth? We addressed these questions by automated amygdala segmentation of MRI volumes in 101 very premature-born adults (< 32 weeks of gestation and/or birth weight below 1500 g) and 108 full-term controls at 26 years of age of a prospectively and longitudinally collected cohort. We found significantly lower whole amygdala volumes in premature-born adults. While premature-born adults had significantly higher T score for avoidant personality reflecting increased social anxiety trait, this trait was not correlated with amygdala volume alterations. Results demonstrate reduced amygdala volumes in premature born adults. Data suggest lasting effects of prematurity on amygdala structure.
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Affiliation(s)
- Benita Schmitz-Koep
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany. .,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.
| | - Juliana Zimmermann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Aurore Menegaux
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Rachel Nuttall
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Josef G Bäuml
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Sebastian C Schneider
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Marcel Daamen
- Functional Neuroimaging Group, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany.,Department of Neonatology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Henning Boecker
- Functional Neuroimaging Group, Department of Diagnostic and Interventional Radiology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Dieter Wolke
- Department of Psychology, University of Warwick, University Road, Coventry, CV4 7AL, UK.,Warwick Medical School, University of Warwick, University Road, Coventry, CV4 7AL, UK
| | - Peter Bartmann
- Department of Neonatology, University Hospital Bonn, Venusberg-Campus 1, Bonn, Germany
| | - Dennis M Hedderich
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Christian Sorg
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Technical University of Munich, Klinikum Rechts Der Isar, Ismaninger Str. 22, 81675, Munich, Germany.,TUM-NIC Neuroimaging Center, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany.,Department of Psychiatry, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
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29
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Sorting pain out of salience: assessment of pain facial expressions in the human fetus. Pain Rep 2021; 6:e882. [PMID: 33537520 PMCID: PMC7850725 DOI: 10.1097/pr9.0000000000000882] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. Acute pain facial expressions can be detected/scored in human fetuses. We propose a seven-item scale to differentiate pain facial expressions from rest/acoustic stimuli ones. Introduction: The question of whether the human fetus experiences pain has received substantial attention in recent times. With the advent of high-definition 4-dimensional ultrasound (4D-US), it is possible to record fetal body and facial expressions. Objective: To determine whether human fetuses demonstrate discriminative acute behavioral responses to nociceptive input. Methods: This cross-sectional study included 5 fetuses with diaphragmatic hernia with indication of intrauterine surgery (fetoscopic endoluminal tracheal occlusion) and 8 healthy fetuses, who were scanned with 4D-US in 1 of 3 conditions: (1) acute pain group: Fetuses undergoing intrauterine surgery were assessed in the preoperative period during the anesthetic injection into the thigh; (2) control group at rest: Facial expressions at rest were recorded during scheduled ultrasound examinations; and (3) control group acoustic startle: Fetal facial expressions were recorded during acoustic stimulus (500–4000 Hz; 60–115 dB). Results: Raters blinded to the fetuses’ groups scored 65 pictures of fetal facial expressions based on the presence of 12 items (facial movements). Analyses of redundancy and usefulness excluded 5 items for being of low discrimination capacity (P>0.2). The final version of the pain assessment tool consisted of a total of 7 items: brow lowering/eyes squeezed shut/deepening of the nasolabial furrow/open lips/horizontal mouth stretch/vertical mouth stretch/neck deflection. Odd ratios for a facial expression to be detected in acute pain compared with control conditions ranged from 11 (neck deflection) to 1,400 (horizontal mouth stretch). Using the seven-item final tool, we showed that 5 is the cutoff value discriminating pain from nonpainful startle and rest. Conclusions: This study inaugurates the possibility to study pain responses during the intrauterine life, which may have implications for the postoperative management of pain after intrauterine surgical interventions
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30
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Knowledge and Practices in Neonatal Pain Management of Nurses Employed in Hospitals with Different Levels of Referral-Multicenter Study. Healthcare (Basel) 2021; 9:healthcare9010048. [PMID: 33466529 PMCID: PMC7824971 DOI: 10.3390/healthcare9010048] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/30/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
Background: One of the key elements of patient care is the relief and prevention of pain sensations. The importance of pain prevention and treatment has been emphasized by many international organizations. Despite the recommendations and guidelines based on evidence, contemporary research shows that the problem of pain among patients in neonatal intensive care units (NICUs) in various centers is still an important and neglected problem. Aim: The aim of this study was to assess the level of knowledge of the medical personnel and their perception of the issue of pain in neonatal patients. Methods: A quantitative descriptive study carried out in 2019. The study used a nurses’ perceptions of neonatal pain questionnaire. Results: A total of 43 Polish hospitals and 558 respondents participated in the project. 60.9% (n = 340) and 39.1% (n = 218) of respondents were employed in secondary and tertiary referral departments, respectively. Conclusion: Our analyses indicate that despite the availability of pain assessment tools for neonatal patients, only a few centers use standardized tools. The introduction of strategies to promote and extend the personnel’s awareness of neonatal pain monitoring scales is necessary.
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31
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Non-pharmaceutical intervention and pain management situation for neonatal analgesia. FRONTIERS OF NURSING 2021. [DOI: 10.2478/fon-2020-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Neonatal pain management is an important issue which should have great attention. More and more researches have proved that neonates can feel pain when undergoes painful procedures such as vaccination, heel stick, and so on, and it will result in short-term and long-term outcomes. So it is very important to manage neonatal pain. This article summarized some non-pharmaceutical interventions, including sucrose or glucose, non-nutritional sucking (NNS), breastfeeding, facilitated tucking (FT), kangaroo mother care (KMC), swaddling, heel warming, sensorial saturation (SS), and music therapy, which showed obvious effects for neonatal pain. In addition, this article summarized the progress of neonatal pain intervention in various countries and showed that many countries have not paid enough attention to this problem, while some countries have carried out promotion programs for neonatal pain management which give some clinical enlightenment to our country that we need to pay more attention to this problem.
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32
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Peng NH, Lee MC, Su WL, Lee CH, Chen CH, Chang YC, Huang CH. Knowledge, attitudes and practices of neonatal professionals regarding pain management. Eur J Pediatr 2021; 180:99-107. [PMID: 32556509 DOI: 10.1007/s00431-020-03718-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 06/01/2020] [Accepted: 06/06/2020] [Indexed: 10/24/2022]
Abstract
Pain management is an important issue which impacts the prognosis of neonates in neonatal intensive care units. Evidence has shown that professionals' knowledge and attitudes regarding pain management can impact the quality of their practice. The purpose of this study was to evaluate the knowledge, attitudes, and practices of neonatal professionals regarding neonatal pain management. A cross-sectional study was performed involving neonatal physicians and nurses, using a research questionnaire to investigate the knowledge and attitudes of professionals as well as to assess their practice of pain management. Research found an apparent discrepancy between the knowledge levels of neonatologists and nurses regarding pain assessment and management, with nurses displaying weaker professional knowledge and more negative attitudes toward pain management than did neonatologists. Additionally, research revealed a lack of knowledge and negative attitudes among participants regarding the provision of sufficient opioid analgesics to sick infants during invasive procedures and even for dying neonates. There is an urgent need for continuing education regarding neonatal pain management with the goal of empowering neonatal professionals; further research is needed into the question of how to translate education into more reliable practice.Conclusion: This research provides useful information regarding the knowledge, attitudes, and clinical practice of neonatal pain management among neonatologists and nurses and points out some differences in the knowledge levels of these two groups. What is Known: •Neonates can perceive and respond to pain stimuli by showing their biological signals similarly to children and adults. •Untreated or insufficient pain management for high-risk neonates has short-term. negative effects and may also induce long-term negative effects. What is New: •The level of knowledge, the attitudes, and the practices regarding neonatal pain in intensive care are different among neonatal professionals. •There is an urgent need to provide interdisciplinary continuing education to improve the knowledge of neonatal professionals and encourage them to more highly prioritize neonatal pain management.
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Affiliation(s)
- N-H Peng
- Putian University, Putian Nursing University, Putian, Fujian Province, P.R. China.
| | - M-C Lee
- Department of Medicine, School of Medicine, Tzu Chi University, Buddhist Tzu Chi General Hospital in Taichung, Hualien City, Taiwan, Republic of China
| | - W-L Su
- Taipei Veterans General Hospital, Taipei City, Taiwan, Republic of China
| | - C-H Lee
- Neonatology Department, Changhua Christian Hospital, Changhua City, Taiwan
| | - C-H Chen
- Center for Faculty Development, Taichung Veterans General Hospital, Taiwan, Republic of China
| | - Y-C Chang
- Department of Mathematics, Tamkang University, Tamsui City, Taiwan, Republic of China
| | - C-H Huang
- Neonatal Intensive Care Unit, Hsin Chu Mackay Memorial Hospital, Hsin Chu City, Taiwan, Republic of China
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Kassab M, Joseph R, Alhammad N, Mohammad KI. Oral Sucrose for Neonatal Pain: Perception of Jordanian Nurses. Neonatal Netw 2021; 40:25-30. [PMID: 33479008 DOI: 10.1891/0730-0832/11-t-663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neonatal pain management using sucrose has been an established practice in Western countries. However, in the developing world, the practice is still not widely accepted. Neonatal nurses' perceptions about the neonatal pain experience and efficacy of oral sucrose may influence that decision. PURPOSE To investigate Jordanian neonatal nurses' perceptions about the use of oral sucrose for neonatal pain. DESIGN AND SAMPLE A cross-sectional descriptive design was used to collect data from 191 neonatal nurses working in 3 different hospital settings in northern and middle central Jordan. MAIN OUTCOME VARIABLES Knowledge and perception of Jordanian nurses about neonatal pain and oral sucrose and their relationship to demographic variables. RESULTS More than half of nurses had knowledge deficit about pain management. Fifty-five percent of the nurses had a positive perception toward pain assessment tools, and the majority indicated positive opinion toward oral sucrose usage. Demographic factors can impact their perceptions.
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A global perspective on parental stress in the neonatal intensive care unit: a meta-analytic study. J Perinatol 2020; 40:1739-1752. [PMID: 32901116 DOI: 10.1038/s41372-020-00798-6] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/15/2020] [Accepted: 08/20/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The Parental Stressor Scale: Neonatal Intensive Care Unit (PSS:NICU) is a well-validated tool to assess different sources of stress in parents during the NICU hospitalization of their infant. The present meta-analytic study assessed the relative impact of different NICU-related sources of parental stress in a pool of studies conducted in a wide set of different countries. Also, differences in stress levels by parent gender and country, as well as the impact of infants' neonatal characteristics and clinical conditions were explored. METHODS Records were searched on PubMed, Scopus, and Web of Science (January 1993-December 2019). A purposive open search string was adopted: ["PSS:NICU"] OR ["PSS-NICU"] OR ["Parental Stressor Scale"]. A multiple random-effect meta-analysis was conducted on data from 53 studies extracted by independent coders. RESULTS Parental role alteration emerged as the greatest source of stress for both mothers and fathers. Mothers reported higher stress levels compared to fathers. A significant difference emerged only for the subscale related to sights and sounds physical stimuli. No significant effects of infants' neonatal characteristics (gestational age, birth weight) and clinical conditions (comorbidities) emerged. A marginal positive effect of NICU length of stay emerged on the global level of parents' stress. CONCLUSIONS The current meta-analysis underlines that parental stress related to NICU admission is a worldwide healthcare issue. Immediate and tailored support to parents after the birth of their at-risk infant should be prioritized to reduce parental stress and to promote mothers and fathers' emotional well-being and new-born neurodevelopmental outcomes.
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35
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Reducing discomfort of eye drops prior to retinal examination in the neonatal intensive care unit. J Perinatol 2020; 40:1857-1862. [PMID: 33060779 DOI: 10.1038/s41372-020-00852-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 09/07/2020] [Accepted: 09/26/2020] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate the effectiveness in reducing pain by giving oral sucrose and non-pharmacological comfort measures prior to topical administration of mydriatic eye drops on premature infants undergoing retinopathy of prematurity (ROP) screening eye exams in a neonatal intensive care unit (NICU). STUDY DESIGN A prospective quality improvement study was conducted in the NICU where infants were given oral sucrose prior to administration of mydriatic eye drops while a second person performed facilitated tucking and containment. Premature Infant Pain Profile (PIPP) scores were recorded during eye drop administration and compared to a group that did not receive any comfort measures. RESULT Sixty-eight infants were enrolled. Mean PIPP scores increased an average of 1.5 (SD = 1.5) during administration of mydriatic drops without comfort measures compared to 0.6 (SD = 0.8) when comfort measures were used. This difference was statistically significant (p < 0.001). CONCLUSIONS Oral sucrose and simple comfort measures can be effective in reducing pain associated with mydriatic eye drops.
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Balice-Bourgois C, Newman CJ, Simonetti GD, Zumstein-Shaha M. A complex interprofessional intervention to improve the management of painful procedures in neonates. PAEDIATRIC & NEONATAL PAIN 2020; 2:63-73. [PMID: 35547023 PMCID: PMC8975212 DOI: 10.1002/pne2.12012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/22/2019] [Accepted: 12/18/2019] [Indexed: 11/24/2022]
Abstract
During hospitalization, neonates are exposed to a stressful environment and a high number of painful procedures. If pain is not treated adequately, short‐ and long‐term complications may develop. Despite evidence about neonatal pain and available guidelines, procedural pain remains undertreated. This gap between research and practice is mostly due to limited implementation of evidence‐based knowledge and time constraints. This study describes in detail the development process of a complex interprofessional intervention to improve the management of procedural pain in neonates called NEODOL© (NEOnato DOLore). The framework of the Medical Research Council (MRC) for the development and evaluation of complex interventions was used as a methodological guide for the design of the NEODOL© intervention. The development of the intervention is based on several steps and multiple methods. To report this process, we used the Criteria for Reporting the Development of Complex Interventions in Healthcare (CReDECI 2). Additionally, we evaluated the content of the intervention using a Delphi method to obtain consensus from experts, stakeholders, and parents. The complex interprofessional intervention, NEODOL©, is developed and designed for three groups: healthcare professionals, parents, and neonates for a level IIb neonatal unit at a regional hospital in southern Switzerland. A total of 16 panelists participated in the Delphi process. At the end of the Delphi process, the panelists endorsed the NEODOL© intervention as important and feasible. Following the MRC guidelines, a multimethod process was used to develop a complex interprofessional intervention to improve the management of painful procedures in newborns. Complex interprofessional interventions need theoretical bases, careful development, and integration of stakeholders to provide a comprehensive approach. The NEODOL intervention consists of promising components and has the potential to improve the management of painful procedures and should facilitate the knowledge translation into practice.
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Affiliation(s)
- Colette Balice-Bourgois
- Ente Ospedaliero Cantonale Pediatric Institute of Southern Switzerland Bellinzona Switzerland.,Nursing Research Center Ente Ospedaliero Cantonale Bellinzona Switzerland.,Faculty of Biology and Medicine University Institute of Higher Education and Research in Healthcare University of Lausanne Lausanne Switzerland
| | - Christopher J Newman
- Paediatric Neurology and Neurorehabilitation Unit Lausanne University Hospital Lausanne Switzerland
| | - Giacomo D Simonetti
- Ente Ospedaliero Cantonale Pediatric Institute of Southern Switzerland Bellinzona Switzerland.,Faculty of Biomedical Sciences University of Southern Switzerland Lugano Switzerland
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Lavanga M, Smets L, Bollen B, Jansen K, Ortibus E, Huffel SV, Naulaers G, Caicedo A. A perinatal stress calculator for the neonatal intensive care unit: an unobtrusive approach. Physiol Meas 2020; 41:075012. [PMID: 32521528 DOI: 10.1088/1361-6579/ab9b66] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Early experience of pain and stress in the neonatal intensive care unit is known to have an effect on the neurodevelopment of the infant. However, an automated method to quantify the procedural pain or perinatal stress in premature patients does not exist. APPROACH In the current study, EEG and ECG data were collected for more than 3 hours from 136 patients in order to quantify stress exposure. Specifically, features extracted from the EEG and heart-rate variability in both quiet and non-quiet sleep segments were used to develop a subspace linear-discriminant analysis stress classifier. MAIN RESULTS The main novelty of the study lies in the absence of intrusive methods or pain elicitation protocols to develop the stress classifier. Three main findings can be reported. First, we developed different stress classifiers for the different age groups and stress intensities, obtaining an area under the curve in the range [0.78-0.93] for non-quiet sleep and [0.77-0.96] for quiet sleep. Second, a dysmature EEG was found in patients under stress. Third, an enhanced cortical connectivity and increased brain-heart communication was correlated with a higher stress load, while the autonomic activity did not seem to be associated to stress exposure. SIGNIFICANCE The results shed a light on the pain and stress processing in preterm neonates, suggesting that software tools to investigate dysmature EEG might be helpful to assess stress load in premature patients. These results could be the foundation to assess the impact of stress on infants' development and to tune preventive care.
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Affiliation(s)
- M Lavanga
- Department of Electrical Engineering (ESAT), STADIUS Center for Dynamical Systems, Signal Processing and Data Analytics, KU Leuven, Kasteelpark Arenberg 10, box 2446, 3001, Leuven, Belgium. Authors contributed equally to this work
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Popowicz H, Kwiecień-Jaguś K, Olszewska J, Mędrzycka-Dąbrowska WA. Pain Scales in Neonates Receiving Mechanical Ventilation in Neonatal Intensive Care Units - Systematic Review. J Pain Res 2020; 13:1883-1897. [PMID: 32801846 PMCID: PMC7399469 DOI: 10.2147/jpr.s248042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 06/24/2020] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Recently, interest in the problem of proper prevention and monitoring of pain, especially acute, has been increasing in relation to various age groups. Greater awareness of the problem prompts discussion about the purpose of analgesia in newborns treated with mechanical ventilation. AIM The purpose of the systematic review was to analyze current research on the use of pain scales in newborns treated with mechanical ventilation in the Neonatal Intensive Care Unit. METHODS Medline databases: PubMed, OVID, EBSCO, Web of Science and Cochrane Library were traced using the appropriate keywords. The search was limited to studies in English. The review took into account the years 2006-2019. Considering the criteria, 12 articles were included in further analysis, to which full access was obtained. RESULTS The analyzed scientific research showed differences in beliefs about the validity and credibility of the scales used. Researchers indicated that staff with practical experience in using scales in their daily practice was very skeptical of the results obtained on their basis. CONCLUSION Based on this review, no explicit evidence can be obtained to support the use of one proper scale in pain assessment. It can be inferred that the COMFORT and N-PASS scales are effective for pain assessment and for determining the need for analgesics in mechanically ventilated neonates. These scales may be equally effective in assessing chronic pain, especially in mechanically ventilated children. On the other hand, the PIPP and CRIES scales are most commonly recommended for assessing acute and postoperative pain.
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Affiliation(s)
- Hanna Popowicz
- Department of Obstetric and Gynaecological Nursing, Medical University of Gdansk, Gdansk, Poland
| | - Katarzyna Kwiecień-Jaguś
- Department of Anaesthesiology Nursing and Intensive Care, Medical University of Gdansk, Gdansk, Poland
| | - Jolanta Olszewska
- Department of Obstetric and Gynaecological Nursing, Medical University of Gdansk, Gdansk, Poland
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Chiorean A, Savoy C, Beattie K, El Helou S, Silmi M, Van Lieshout RJ. Childhood and adolescent mental health of NICU graduates: an observational study. Arch Dis Child 2020; 105:684-689. [PMID: 31974300 DOI: 10.1136/archdischild-2019-318284] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 01/07/2020] [Accepted: 01/12/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the mental health of children and adolescents admitted to neonatal intensive/special care units (NICUs) in infancy. METHODS This cross-sectional study used a provincially representative cohort from the 2014 Ontario Child Health Study. Parents provided data on psychiatric disorders using the MINI International Neuropsychiatric Interview for Children and Adolescents in 3141 children aged 4-11 years (NICU n=389; control n=2752) and in 2379 children aged 12-17 years (NICU n=298; control n=2081). Additionally, 2235 adolescents aged 12-17 years completed the interview themselves (NICU n=285; control n=1950). Odds of psychiatric disorder were compared in those admitted and controls. RESULTS Based on parent reports, NICU graduates aged 4-11 years had increased adjusted ORs (95% CI) of 1.78 (1.39 to 2.28) for any psychiatric disorder, with a marginal prevalence of 32.4% in NICU participants and 27.6% in controls. At this age, NICU graduates also had increased ORs of 1.74 (1.25 to 2.40) for psychiatric comorbidity, 1.48 (1.04 to 2.11) for oppositional defiant disorder, 1.61 (1.19 to 2.19) for attention-deficit hyperactivity disorder, 4.11 (2.33 to 7.25) for separation anxiety disorder and 2.13 (1.37 to 3.31) for specific phobia. At 12-17 years, 40.5% and 30.5% of NICU graduates and 30.6% and 17.9% of controls had any psychiatric disorder as reported by parents and self-report, respectively. Parents and adolescents, respectively, reported increased adjusted ORs (95% CI) of 1.63 (1.18 to 2.26) and 1.55 (1.13 to 2.11) for any disorder, 1.64 (1.06 to 2.54) and 1.74 (1.11 to 2.73) for psychiatric comorbidity, and 1.89 (1.22 to 2.93) and 3.17 (2.03 to 4.95) for oppositional defiant disorder. CONCLUSIONS NICU graduates are at increased risk for psychiatric disorders during childhood and adolescence.
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Affiliation(s)
- Andreea Chiorean
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Calan Savoy
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Beattie
- Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Salhab El Helou
- Division of Neonatology, Department of Pediatrics, McMaster University Children's Hospital, Hamilton, Ontario, Canada
| | - Maysoon Silmi
- Division of Neonatology, Department of Pediatrics, McMaster University Children's Hospital, Hamilton, Ontario, Canada
| | - Ryan J Van Lieshout
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
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Lavanga M, Bollen B, Jansen K, Ortibus E, Naulaers G, Van Huffel S, Caicedo A. A Bradycardia-Based Stress Calculator for the Neonatal Intensive Care Unit: A Multisystem Approach. Front Physiol 2020; 11:741. [PMID: 32670096 PMCID: PMC7332774 DOI: 10.3389/fphys.2020.00741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/08/2020] [Indexed: 12/11/2022] Open
Abstract
Early life stress in the neonatal intensive care unit (NICU) can predispose premature infants to adverse health outcomes and neurodevelopment delays. Hands-on-care and procedural pain might induce apneas, hypoxic events, and sleep-wake disturbances, which can ultimately impact maturation, but a data-driven method based on physiological fingerprints to quantify early-life stress does not exist. This study aims to provide an automatic stress detector by investigating the relationship between bradycardias, hypoxic events and perinatal stress in NICU patients. EEG, ECG, and SpO 2 were recorded from 136 patients for at least 3 h in three different monitoring groups. In these subjects, the stress burden was assessed using the Leuven Pain Scale. Different subspace linear discriminant analysis models were designed to detect the presence or the absence of stress based on information in each bradycardic spell. The classification shows an area under the curve in the range [0.80-0.96] and a kappa score in the range [0.41-0.80]. The results suggest that stress seems to increase SpO 2 desaturations and EEG regularity as well as the interaction between the cardiovascular and neurological system. It might be possible that stress load enhances the reaction to respiratory abnormalities, which could ultimately impact the neurological and behavioral development.
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Affiliation(s)
- Mario Lavanga
- Division STADIUS, Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
| | - Bieke Bollen
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Belgium
| | - Katrien Jansen
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Belgium
| | - Els Ortibus
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Belgium
| | - Gunnar Naulaers
- Department of Development and Regeneration, Faculty of Medicine, KU Leuven, Belgium
| | - Sabine Van Huffel
- Division STADIUS, Department of Electrical Engineering (ESAT), KU Leuven, Leuven, Belgium
| | - Alexander Caicedo
- Applied Mathematics and Computer Science, School of Engineering, Science and Technology, Universidad del Rosario, Bogotá, Colombia
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Ranjbar A, Bernstein C, Shariat M, Ranjbar H. Comparison of facilitated tucking and oral dextrose in reducing the pain of heel stick in preterm infants: a randomized clinical trial. BMC Pediatr 2020; 20:162. [PMID: 32290829 PMCID: PMC7155270 DOI: 10.1186/s12887-020-2020-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With the increase in hospitalization of premature infants in emergency departments and the painful procedure in these sectors, appropriate methods of pain relief are required. This study aimed to compare the effect of oral dextrose and facilitated tucking in the reduction of pain during heel sticks in premature infants and assess their effectiveness and feasibility for use in emergency settings. METHODS This study was a randomized controlled clinical trial with cross-over design. Sixty infants were recruited from a Neonatal Intensive Care Unit (NICU) at Valiasr hospital in Tehran, Iran from March 2015 to September 2016. They were randomly allocated into three groups (no pain relief method, oral dextrose and facilitated tucking). Six blood samples were collected by heel stick for each infant. Oral dextrose and facilitated tucking were compared with the routine method of blood sampling and pain was measured two times for each method. The pain scores was measured by the Premature Infant Pain Profile (PIPP). Repeated Measure ANOVA, ANOVA and Scheffe post-hoc test were used with SPSS 16. RESULTS The pain score's increase during heel stick was significantly lower after using oral dextrose (3.58 ± 0.34) and facilitated tucking (5.58 ± 0.53) in comparison to the routine method (8.91 ± 0.18) of blood sampling (P < 0.001, η2 = 0.971). Oral dextrose was more effective than facilitated tucking (P < 0.001, Cohen's d = 4.49). The emergency nurses rated oral dextrose as easier (t = 2.20, df = 118, p = 0.02, Cohen's d = 0.39) and more applicable method (t = 2.99, df = 118, p = 0.003, Cohen's d = 0.54) for the emergency department. CONCLUSIONS Facilitated tucking is an effective method of pain reduction which can be used in the absence of oral dextrose, in a situation in which it is contraindicated or in combination with oral dextrose. Based on the increase of infant's admission in emergency department future studies are needed to identify the best method of pain reduction for procedures in this setting. TRIAL REGISTRATION Current Controlled Trials IRCT201408029568N9, 2014-09-08.
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Affiliation(s)
| | - Colleen Bernstein
- Department of Psychology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Mamak Shariat
- Materno-Fetal, Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran.
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Perra O, Wass S, McNulty A, Sweet D, Papageorgiou K, Johnston M, Patterson A, Bilello D, Alderdice F. Training attention control of very preterm infants: protocol for a feasibility study of the Attention Control Training (ACT). Pilot Feasibility Stud 2020; 6:17. [PMID: 32055404 PMCID: PMC7008548 DOI: 10.1186/s40814-020-0556-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 01/27/2020] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Children born preterm may display cognitive, learning, and behaviour difficulties as they grow up. In particular, very premature birth (gestation age between 28 and less than 32 weeks) may put infants at increased risk of intellectual deficits and attention deficit disorder. Evidence suggests that the basis of these problems may lie in difficulties in the development of executive functions. One of the earliest executive functions to emerge around 1 year of age is the ability to control attention. An eye-tracking-based cognitive training programme to support this emerging ability, the Attention Control Training (ACT), has been developed and tested with typically developing infants. The aim of this study is to investigate the feasibility of using the ACT with healthy very preterm (VP) infants when they are 12 months of age (corrected age). The ACT has the potential to address the need for supporting emerging cognitive abilities of VP infants with an early intervention, which may capitalise on infants' neural plasticity. METHODS/DESIGN The feasibility study is designed to investigate whether it is possible to recruit and retain VP infants and their families in a randomised trial that compares attention and social attention of trained infants against those that are exposed to a control procedure. Feasibility issues include the referral/recruitment pathway, attendance, and engagement with testing and training sessions, completion of tasks, retention in the study, acceptability of outcome measures, quality of data collected (particularly, eye-tracking data). The results of the study will inform the development of a larger randomised trial. DISCUSSION Several lines of evidence emphasise the need to support emerging cognitive and learning abilities of preterm infants using early interventions. However, early interventions with preterm infants, and particularly very preterm ones, face difficulties in recruiting and retaining participants. These problems are also augmented by the health vulnerability of this population. This feasibility study will provide the basis for informing the implementation of an early cognitive intervention for very preterm infants. TRIAL REGISTRATION Registered Registration ID: NCT03896490. Retrospectively registered at Clinical Trials Protocol Registration and Results System (clinicaltrials.gov).
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Affiliation(s)
- Oliver Perra
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Sam Wass
- School of Psychology, University of East London, London, UK
| | - Alison McNulty
- TinyLife, The Premature Baby Charity for Northern Ireland, Belfast, UK
| | - David Sweet
- Health and Social Care Belfast Trust, Belfast, Northern Ireland, UK
| | - Kostas Papageorgiou
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Matthew Johnston
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, UK
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Aaron Patterson
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Delfina Bilello
- School of Nursing and Midwifery, Queen’s University Belfast, Medical Biology Building, 97 Lisburn Road, Belfast, BT9 7BL Northern Ireland, UK
- Centre for Evidence and Social Innovation, Queen’s University Belfast, Belfast, Northern Ireland, UK
- School of Psychology, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | - Fiona Alderdice
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Williams MD, Lascelles BDX. Early Neonatal Pain-A Review of Clinical and Experimental Implications on Painful Conditions Later in Life. Front Pediatr 2020; 8:30. [PMID: 32117835 PMCID: PMC7020755 DOI: 10.3389/fped.2020.00030] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 01/20/2020] [Indexed: 12/13/2022] Open
Abstract
Modern health care has brought our society innumerable benefits but has also introduced the experience of pain very early in life. For example, it is now routine care for newborns to receive various injections or have blood drawn within 24 h of life. For infants who are sick or premature, the pain experiences inherent in the required medical care are frequent and often severe, with neonates requiring intensive care admission encountering approximately fourteen painful procedures daily in the hospital. Given that much of the world has seen a steady increase in preterm births for the last several decades, an ever-growing number of babies experience multiple painful events before even leaving the hospital. These noxious events occur during a critical period of neurodevelopment when the nervous system is very vulnerable due to immaturity and neuroplasticity. Here, we provide a narrative review of the literature pertaining to the idea that early life pain has significant long-term effects on neurosensory, cognition, behavior, pain processing, and health outcomes that persist into childhood and even adulthood. We refer to clinical and pre-clinical studies investigating how early life pain impacts acute pain later in life, focusing on animal model correlates that have been used to better understand this relationship. Current knowledge around the proposed underlying mechanisms responsible for the long-lasting consequences of neonatal pain, its neurobiological and behavioral effects, and its influence on later pain states are discussed. We conclude by highlighting that another important consequence of early life pain may be the impact it has on later chronic pain states-an area of research that has received little attention.
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Affiliation(s)
- Morika D. Williams
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Translational Research in Pain Program, North Carolina State University, Raleigh, NC, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States
| | - B. Duncan X. Lascelles
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, NC, United States
- Translational Research in Pain Program, North Carolina State University, Raleigh, NC, United States
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC, United States
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
- Center for Translational Pain Medicine, Duke University, Durham, NC, United States
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Hsieh CT, Lee YJ, Lee JW, Lu S, Tucci MA, Dai X, Ojeda NB, Lee HJ, Fan LW, Tien LT. Interleukin-1 receptor antagonist ameliorates the pain hypersensitivity, spinal inflammation and oxidative stress induced by systemic lipopolysaccharide in neonatal rats. Neurochem Int 2020; 135:104686. [PMID: 31987865 DOI: 10.1016/j.neuint.2020.104686] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/05/2020] [Accepted: 01/13/2020] [Indexed: 02/07/2023]
Abstract
Perinatal inflammation-induced reduction in pain threshold may alter pain sensitivity to hyperalgesia or allodynia which may persist into adulthood. In this study, we investigated the anti-inflammatory protective effect of interleukin-1 receptor antagonist (IL-1ra), an anti-inflammatory cytokine, on systemic lipopolysaccharide (LPS)-induced spinal cord inflammation and oxidative stress, thermal hyperalgesia, and mechanical allodynia in neonatal rats. Intraperitoneal (i.p.) injection of LPS (2 mg/kg) or sterile saline was performed in postnatal day 5 (P5) rat pups, and IL-1ra (100 mg/kg) or saline was administered (i.p.) 5 min after LPS injection. Pain reflex behavior, spinal cord inflammation and oxidative stress were examined 24 h after LPS administration. Systemic LPS exposure led to a reduction of tactile threshold in the von Frey filament tests (mechanical allodynia) and pain response latency in the tail-flick test (thermal hyperalgesia) of P6 neonatal rats. Spinal cord inflammation was indicated by the increased numbers of activated glial cells including microglia (Iba1+) and astrocytes (GFAP+), and elevated levels of pro-inflammatory cytokine interleukin-1β (IL-1β), cyclooxygenase-2 (COX-2), and prostaglandin E2 (PGE2) 24 h after LPS treatment. LPS treatment induced spinal oxidative stress as evidenced by the increase in thiobarbituric acid reactive substances (TBARS) content in the spinal cord. LPS exposure also led to a significant increase in oligodendrocyte lineage population (Olig2+) and mature oligodendrocyte cells (APC+) in the neonatal rat spinal cord. IL-1ra treatment significantly reduced LPS-induced effects including hyperalgesia, allodynia, the increased number of activated microglia, astrocytes and oligodendrocytes, and elevated levels of IL-1β, COX-2, PGE2, and lipid peroxidation (TBARS) in the neonatal rat spinal cord. These data suggest that IL-1ra provides a protective effect against the development of pain hypersensitivity, spinal cord inflammation and oxidative stress in the neonatal rats following LPS exposure, which may be associated with the blockade of LPS-induced pro-inflammatory cytokine IL-1β.
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Affiliation(s)
- Cheng-Ta Hsieh
- School of Medicine, Fu Jen Catholic University, New Taipei City, 24205, Taiwan; Division of Neurosurgery, Department of Surgery, Cathay General Hospital, Taipei, 10630, Taiwan; Department of Chemistry, Fu Jen Catholic University, New Taipei City, 24205, Taiwan; Graduate Institute of Biomedical and Pharmaceutical Science, Fu Jen Catholic University, New Taipei City, 24205, Taiwan
| | - Yih-Jing Lee
- School of Medicine, Fu Jen Catholic University, New Taipei City, 24205, Taiwan
| | - Jonathan W Lee
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Silu Lu
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA; Department of Neurology, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Michelle A Tucci
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Xiaoli Dai
- Department of Anesthesiology, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Norma Beatriz Ojeda
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Hyun Joon Lee
- Department of Neurology, University of Mississippi Medical Center, Jackson, MS, 39216, USA; Research Services, G.V. (Sonny) Montgomery Veterans Administration Medical Center, Jackson, MS, 39216, USA
| | - Lir-Wan Fan
- Department of Pediatrics, Division of Newborn Medicine, University of Mississippi Medical Center, Jackson, MS, 39216, USA
| | - Lu-Tai Tien
- School of Medicine, Fu Jen Catholic University, New Taipei City, 24205, Taiwan.
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Hartley C, Farmer S, Berthouze L. Temporal ordering of input modulates connectivity formation in a developmental neuronal network model of the cortex. PLoS One 2020; 15:e0226772. [PMID: 31923200 PMCID: PMC6953763 DOI: 10.1371/journal.pone.0226772] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/06/2019] [Indexed: 12/13/2022] Open
Abstract
Preterm infant brain activity is discontinuous; bursts of activity recorded using EEG (electroencephalography), thought to be driven by subcortical regions, display scale free properties and exhibit a complex temporal ordering known as long-range temporal correlations (LRTCs). During brain development, activity-dependent mechanisms are essential for synaptic connectivity formation, and abolishing burst activity in animal models leads to weak disorganised synaptic connectivity. Moreover, synaptic pruning shares similar mechanisms to spike-timing dependent plasticity (STDP), suggesting that the timing of activity may play a critical role in connectivity formation. We investigated, in a computational model of leaky integrate-and-fire neurones, whether the temporal ordering of burst activity within an external driving input could modulate connectivity formation in the network. Connectivity evolved across the course of simulations using an approach analogous to STDP, from networks with initial random connectivity. Small-world connectivity and hub neurones emerged in the network structure—characteristic properties of mature brain networks. Notably, driving the network with an external input which exhibited LRTCs in the temporal ordering of burst activity facilitated the emergence of these network properties, increasing the speed with which they emerged compared with when the network was driven by the same input with the bursts randomly ordered in time. Moreover, the emergence of small-world properties was dependent on the strength of the LRTCs. These results suggest that the temporal ordering of burst activity could play an important role in synaptic connectivity formation and the emergence of small-world topology in the developing brain.
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Affiliation(s)
- Caroline Hartley
- Centre for Mathematics and Physics in the Life Sciences and Experimental Biology, University College London, London, United Kingdom
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Simon Farmer
- Institute of Neurology, University College London, London, United Kingdom
| | - Luc Berthouze
- Centre for Computational Neuroscience and Robotics, University of Sussex, Falmer, Brighton, United Kingdom
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Detmer MR, Evans K, Shina E, Walker K, DeLoach D, Malowitz JR. Multimodal Neurologic Enhancement Improves Preterm Infants' Developmental Outcomes: A Longitudinal Pilot Study. Neonatal Netw 2020; 39:16-23. [PMID: 31919289 DOI: 10.1891/0730-0832.39.1.16] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE The purpose of this study was to identify the long-term developmental effects of a NICU music therapy intervention, Multimodal Neurologic Enhancement, provided to preterm infants in the NICU. DESIGN Prospective randomized controlled study with one control group and one experimental group. SAMPLE Participants were medically stable preterm infants with a birth age of 31 and 6/7 weeks or less, admitted to a level-III NICU. A total of 84 participants were enrolled, and 48 completed the study. MAIN OUTCOME VARIABLE Post-discharge developmental scores on the Mullen Scales of Early Learning: AGS Edition. RESULTS The experimental group performed significantly better than the control group on the Visual Reception and Early Learning Composite scores.
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Yue ST, Zhang J, Ma DH. [Research advances in the effect of environmental stress in the neonatal intensive care unit on the neurodevelopment of preterm infants and its epigenetics]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:1144-1147. [PMID: 31753099 PMCID: PMC7389294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/06/2019] [Indexed: 11/12/2023]
Abstract
Adverse environmental stimulation in the neonatal intensive care unit (NICU) can affect neurodevelopment through epigenetic modification and thus has adverse effects on the long-term developmental outcome of preterm infants. Developmental care can reverse epigenetic changes in genes and promote neurodevelopment in preterm infants. This article reviews the influence of environmental stress in the NICU and developmental care on neurodevelopment in preterm infants, as well as related epigenetic effects, in order to provide a reference for epigenetic studies of preterm infants.
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Affiliation(s)
- Shao-Ting Yue
- Department of Nursing, Wuhan University School of Health Sciences, Wuhan 430071, China.
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Yue ST, Zhang J, Ma DH. [Research advances in the effect of environmental stress in the neonatal intensive care unit on the neurodevelopment of preterm infants and its epigenetics]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2019; 21:1144-1147. [PMID: 31753099 PMCID: PMC7389294 DOI: 10.7499/j.issn.1008-8830.2019.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 08/06/2019] [Indexed: 06/10/2023]
Abstract
Adverse environmental stimulation in the neonatal intensive care unit (NICU) can affect neurodevelopment through epigenetic modification and thus has adverse effects on the long-term developmental outcome of preterm infants. Developmental care can reverse epigenetic changes in genes and promote neurodevelopment in preterm infants. This article reviews the influence of environmental stress in the NICU and developmental care on neurodevelopment in preterm infants, as well as related epigenetic effects, in order to provide a reference for epigenetic studies of preterm infants.
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Affiliation(s)
- Shao-Ting Yue
- Department of Nursing, Wuhan University School of Health Sciences, Wuhan 430071, China.
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Adrenal function links to early postnatal growth and blood pressure at age 6 in children born extremely preterm. Pediatr Res 2019; 86:339-347. [PMID: 30631138 PMCID: PMC6561840 DOI: 10.1038/s41390-018-0243-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 11/09/2018] [Indexed: 11/08/2022]
Abstract
BACKGROUND Low birth weight in term-born individuals correlates with adverse cardiometabolic outcomes; excess glucocorticoid exposure has been linked to these relationships. We hypothesized that cortisol and adrenal androgens would correlate inversely with birthweight and directly with markers of cardiometabolic risk in school-aged children born extremely preterm; further, preterm-born would have increased cortisol and adrenal androgens compared to term-born children. METHODS Saliva samples were obtained at age 6 from 219 preterm-born children followed since birth and 40 term-born children and analyzed for dehydroepiandrosterone (DHEA) and cortisol. Cortisol was also measured at home (awakening, 30' later, evening). RESULTS For preterm-born children, cortisol and DHEA correlated inversely with weight and length Z-scores at 36 weeks PMA and positively with systolic BP. DHEA was higher in preterm-born than term-born children (boys p < 0.01; girls p = 0.04). Cortisol was similar between preterm-born and term-born at study visit; however, preterm-born children showed a blunted morning cortisol. In term-born children, DHEA correlated with BMI (p = 0.04), subscapular, and abdominal skinfold thicknesses (both p < 0.01). CONCLUSION Cortisol and DHEA correlated inversely with early postnatal growth and directly with systolic BP in extremely preterm-born children, suggesting perinatal programming. Blunted morning cortisol may reflect NICU stress, as seen after other adverse childhood experiences (ACEs).
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M Reyes L, Jaekel J, Wolke D. Effects of Gestational Age and Early Parenting on Children's Social Inhibition at 6 Years. CHILDREN (BASEL, SWITZERLAND) 2019; 6:E81. [PMID: 31261690 PMCID: PMC6678926 DOI: 10.3390/children6070081] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 06/18/2019] [Accepted: 06/25/2019] [Indexed: 11/25/2022]
Abstract
Preterm birth (<37 weeks' gestation) has been associated with problems in social functioning. Whether social inhibition is specifically related to preterm birth and whether early parenting may protect against social inhibition difficulties is unknown. To explore effects of gestational age and early parent-infant relationships on social inhibition, 1314 children born at 26-41 weeks gestational age were studied as part of the prospective Bavarian Longitudinal Study. Early parent-infant relationship quality was assessed postnatally with the parent-infant relationship index. Social inhibition was assessed at age 6 years using an experimental procedure, in which nonverbal and verbal responses were coded into social inhibition categories (disinhibited, normally responsive, inhibited). Multinomial logistic regressions indicated that children with lower gestational age showed more socially disinhibited (nonverbal: OR = 1.27 [95% CI = 1.17-1.40], verbal: OR = 1.23 [95% CI 1.13-1.35]) and inhibited (nonverbal: OR = 1.21 [95% CI = 1.11-1.32], verbal: OR = 1.11 [95% CI = 1.01-1.21]) responses. Good early parent-infant relationships were associated with less verbal disinhibition (OR = 0.70 [95% CI = 0.52-0.93]). Findings suggest that children with lower gestational age are at greater risk to be both socially inhibited and disinhibited. Early parenting affected risk of abnormal social responses. Supporting early parent-infant relationships may reduce preterm children's risk for social difficulties.
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Affiliation(s)
- Lucia M Reyes
- Department of Child and Family Studies, The University of Tennessee, Knoxville, TN 37996, USA
| | - Julia Jaekel
- Department of Child and Family Studies, The University of Tennessee, Knoxville, TN 37996, USA
- Department of Psychology, University of Warwick, Coventry CV47AL, UK
| | - Dieter Wolke
- Department of Psychology, University of Warwick, Coventry CV47AL, UK.
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