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Yarahmadi S, Pouralizadeh M, Atrkarroushan Z, Shahroudi P. The effect of the simulated intrauterine sound on behavioral and physiological indices of pain during capillary blood sampling for screening preterm infants: a randomized clinical trial study. BMC Pediatr 2024; 24:110. [PMID: 38350923 PMCID: PMC10863201 DOI: 10.1186/s12887-024-04604-6] [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: 04/26/2023] [Accepted: 01/30/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Due to medical procedures, preterm infants are at high risk for side effects of pain. In this regard, heel lancing for capillary blood sampling is a common painful procedure. The present study was conducted to assess the effectiveness of a simulated intrauterine sound on behavioral and physiological indices of pain due to heel-prick blood sampling in preterm infants. METHODS A double‑blind randomized clinical trial (RCT) was conducted. The data were collected from September 23 to December 22, 2019. We measured the effect of a simulated intrauterine sound on changes in the behavioral and physiological parameters of pain (heart rate, SPO2) caused by heel lance that was measured 5 min before the intervention, during the sampling, and 5 min after the procedure. We measured behavioral pain by video recording the infants' faces and then the scoring neonatal infant pain scale (NIPS). Heart rate and SPO2 were measured using a pulse oximeter device. The data were analyzed using analysis of variance (ANOVA) and independent t‑test in SPSS software version 20.0. RESULTS Eighty infants were randomized (40 in each group). Mean scores NIPS during and after intervention were in the intervention group (3.55 ± 0.84, 95% CI: 3.30-3.80(, and (1.15 ± 0.84, 95%: 0.95-1.35) and in the control group (5.57 ± 0.95, 95% CI:5.30-5.85) and (3.00 ± 0.98) respectively. There were significant differences in scores of NIPS between the two study groups during (p < 0.001) and five min after heel lancing (p < 0.001). Mean scores of heart rate in the three phases of before, during, and five min after the intervention were respectively in the intervention group (127.57 ± 4.45, 95% CI:126.27-128.99), (131.07 ± 6.54, 95% CI:129.20-133.22), (128.45 ± 5.15, 95% CI:127.02-130.07) and in the control group (128.67 ± 4.57, 95% CI:127.32-130.07), (136.07 ± 7.24, 95% CI:133.90-138.37), and (132.42 ± 6.47, 95% CI:130.37-134.49). There were significant differences in heart rate between the intervention and the control group during (p = 0.002) and five min after the heel lance (p = 0.003). Mean scores of SPO2 in the three phases of baseline, during, and five min after the intervention were respectively in the intervention group (96.72 ± 0.93, 95% CI:96.42-97.00), (91.47 ± 1.46, 95% CI:91.05-91.92), (94.17 ± 1.03, 95% CI:93.22-94.00) and in the control group (96.6 ± 0.84, 95% CI:96.35-96.85), (91.5 ± 1.24, 95% CI:91.12-91.87), and (93.60 ± 1.27, 95% CI:93.85-94.50). CONCLUSION This study showed that the simulated intrauterine sound reduces the behavioral pain and heart rate in the intervention group during and after heel lance. These results suggest using the method during the painful heel lancing to reduce pain parameters in preterm infants.
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Affiliation(s)
- Shamimeh Yarahmadi
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
| | - Moluk Pouralizadeh
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
- Beheshti School of Nursing and Midwifery, Guilan university of Medical Sciences, Hamidyan Ave, Rasht, Iran.
| | - Zahra Atrkarroushan
- Department of Biostatistics, Medical School, Guilan University of Medical Sciences, Rasht, Iran
| | - Parichehr Shahroudi
- Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Faqihi S, Ismail A, Hasan AAH. Neonatal Intensive Care Unit Nurses' Knowledge and Use of Sucrose for Neonatal Pain Management in Saudi Arabia. SAGE Open Nurs 2024; 10:23779608241234401. [PMID: 38410813 PMCID: PMC10896065 DOI: 10.1177/23779608241234401] [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: 07/27/2023] [Revised: 01/27/2024] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Sucrose is an evidence-based intervention used for short-term pain management and distress from minor procedures. Limited research exists on nurses' knowledge and use of sucrose in Neonatal Intensive Care Units in Saudi Arabia. Objective To assess nurses' knowledge and use of sucrose in Neonatal Intensive Care Units in Saudi Arabia. Methods A cross-sectional online survey was used to collect data from a convenience sample of 68 neonatal intensive care nurses in Saudi Arabia. A modified tool assessed the knowledge and use of sucrose. Logistic regression analysis was used to find the predictors for sucrose use. Results Most respondents never used sucrose for neonatal pain management and did not receive any training on sucrose. The mean knowledge of nurses regarding sucrose and its use was very low (38%): 16% had a high level of knowledge regarding sucrose, 13% moderate, 19% low, and 52% very low. Nurses who received training on sucrose use and nurses who read or heard about sucrose predicted the use of sucrose. Conclusion Nurses' knowledge and use of sucrose were inadequate. Interventional programs are needed to enhance the nurses' knowledge regarding sucrose and its use and to enhance the utilization of sucrose as a pain management intervention in the Neonatal Intensive Care Units in Saudi Arabia.
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Affiliation(s)
- Sumayah Faqihi
- Neonatal Intensive Care Nursing, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | - Ahmad Ismail
- Director of the Master Program in Neonatal Intensive Care Nursing, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | - Abd Al-Hadi Hasan
- Nursing Department, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
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Wu BY, Ou-Yang MC, Liu CT, Huang HC, Hu WL, Chen IL, Chang HY, Chung MY, Chen FS, Chen YH, Chen CC. Analgesic Effect of Low-Level Laser Therapy before Heel Lance for Pain Management in Healthy Term Neonates: A Randomized Controlled Trial. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1901. [PMID: 38136103 PMCID: PMC10741995 DOI: 10.3390/children10121901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023]
Abstract
Currently, the prevention, assessment, and management of procedural pain in neonates continues to challenge clinicians and researchers. Objective. To investigate the analgesic effect of low-level laser therapy (LLLT) during heel lance compared to breast milk (BM) feeding in healthy term neonates. In this randomized controlled trial, healthy term neonates who underwent heel lance were randomly assigned to an LLLT or a BM group. The LLLT group received laser therapy to the heel lance site for 20 s before heel lance. The BM group received 5 mL expressed BM via a syringe before heel lance. The primary outcomes were behavioral responses. The secondary outcomes were physiological responses and levels of salivary cortisol and α-amylase. A total of 125 neonates were included, of whom 55 in the LLLT group and 59 in the BM group completed the study. There were no significant differences in latency to first cry and cry duration between the two groups. The squeeze time was significantly shorter in the LLLT group than in the BM group (p = 0.047). There were no significant differences in pain scores, heart rate, respiratory rate, oxygen saturation, and blood pressure before and after heel lance between the two groups. There were no significant differences in salivary cortisol and α-amylase levels in the LLLT group before and after heel lance; however, the differences were significant in the BM group. These findings suggest that the analgesic effect of LLLT is similar to that of BM during heel lance in healthy term neonates. LLLT has potential as an analgesic treatment.
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Affiliation(s)
- Bei-Yu Wu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (B.-Y.W.); (C.-T.L.); (W.-L.H.)
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404333, Taiwan
- College of Nursing, Fooyin University, Kaohsiung 83102, Taiwan
| | - Mei-Chen Ou-Yang
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Chun-Ting Liu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (B.-Y.W.); (C.-T.L.); (W.-L.H.)
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404333, Taiwan
| | - Hsin-Chun Huang
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Wen-Long Hu
- Department of Chinese Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (B.-Y.W.); (C.-T.L.); (W.-L.H.)
- College of Nursing, Fooyin University, Kaohsiung 83102, Taiwan
- College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - I-Lun Chen
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Hsin-Yu Chang
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Mei-Yung Chung
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Feng-Shun Chen
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University, Taichung 404333, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
| | - Chih-Cheng Chen
- Division of Neonatology, Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83342, Taiwan; (M.-C.O.-Y.); (H.-C.H.); (I.-L.C.); (H.-Y.C.); (M.-Y.C.); (F.-S.C.)
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Shah PS, Torgalkar R, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 2023; 8:CD004950. [PMID: 37643989 PMCID: PMC10464660 DOI: 10.1002/14651858.cd004950.pub4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND Pain in the neonate is associated with acute behavioural and physiological changes. Cumulative pain is associated with morbidities, including adverse neurodevelopmental outcomes. Studies have shown a reduction in changes in physiological parameters and pain score measurements following pre-emptive analgesic administration in neonates experiencing pain or stress. Non-pharmacological measures (such as holding, swaddling and breastfeeding) and pharmacological measures (such as acetaminophen, sucrose and opioids) have been used for analgesia. This is an update of a review first published in 2006 and updated in 2012. OBJECTIVES The primary objective was to evaluate the effectiveness of breastfeeding or supplemental breast milk in reducing procedural pain in neonates. The secondary objective was to conduct subgroup analyses based on the type of control intervention, gestational age and the amount of supplemental breast milk given. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL and trial registries (ICTRP, ISRCTN and clinicaltrials.gov) in August 2022; searches were limited from 2011 forwards. We checked the reference lists of included studies and relevant systematic reviews. SELECTION CRITERIA We included randomised controlled trials (RCTs) or quasi-RCTs of breastfeeding or supplemental breast milk versus no treatment/other measures in neonates. We included both term (≥ 37 completed weeks postmenstrual age) and preterm infants (< 37 completed weeks' postmenstrual age) up to a maximum of 44 weeks' postmenstrual age. The study must have reported on either physiological markers of pain or validated pain scores. DATA COLLECTION AND ANALYSIS We assessed the methodological quality of the trials using the information provided in the studies and by personal communication with the authors. We extracted data on relevant outcomes, estimated the effect size and reported this as a mean difference (MD). We used the GRADE approach to assess the certainty of evidence. MAIN RESULTS Of the 66 included studies, 36 evaluated breastfeeding, 29 evaluated supplemental breast milk and one study compared them against each other. The procedures conducted in the studies were: heel lance (39), venipuncture (11), intramuscular vaccination (nine), eye examination for retinopathy of prematurity (four), suctioning (four) and adhesive tape removal as procedure (one). We noted marked heterogeneity in the control interventions and pain assessment measures amongst the studies. Since many studies included multiple arms with breastfeeding/supplemental breast milk as the main comparator, we were not able to synthesise all interventions together. Individual interventions are compared to breastfeeding/supplemental breast milk and reported. The numbers of studies/participants presented with the findings are not taken from pooled analyses (as is usual in Cochrane Reviews), but are the overall totals in each comparison. Overall, the included studies were at low risk of bias except for masking of intervention and outcome assessment, where nearly one-third of studies were at high risk of bias. Breastfeeding versus control Breastfeeding may reduce the increase in heart rate compared to holding by mother, skin-to-skin contact, bottle feeding mother's milk, moderate concentration of sucrose/glucose (20% to 33%) with skin-to-skin contact (low-certainty evidence, 8 studies, 784 participants). Breastfeeding likely reduces the duration of crying compared to no intervention, lying on table, rocking, heel warming, holding by mother, skin-to-skin contact, bottle feeding mother's milk and moderate concentration of glucose (moderate-certainty evidence, 16 studies, 1866 participants). Breastfeeding may reduce percentage time crying compared to holding by mother, skin-to-skin contact, bottle feeding mother's milk, moderate concentration sucrose and moderate concentration of sucrose with skin-to-skin contact (low-certainty evidence, 4 studies, 359 participants). Breastfeeding likely reduces the Neonatal Infant Pain Scale (NIPS) score compared to no intervention, holding by mother, heel warming, music, EMLA cream, moderate glucose concentration, swaddling, swaddling and holding (moderate-certainty evidence, 12 studies, 1432 participants). Breastfeeding may reduce the Neonatal Facial Coding System (NFCS) score compared to no intervention, holding, pacifier and moderate concentration of glucose (low-certainty evidence, 2 studies, 235 participants). Breastfeeding may reduce the Douleur Aigue Nouveau-né (DAN) score compared to positioning, holding or placebo (low-certainty evidence, 4 studies, 709 participants). In the majority of the other comparisons there was little or no difference between the breastfeeding and control group in any of the outcome measures. Supplemental breast milk versus control Supplemental breast milk may reduce the increase in heart rate compared to water or no intervention (low-certainty evidence, 5 studies, 336 participants). Supplemental breast milk likely reduces the duration of crying compared to positioning, massage or placebo (moderate-certainty evidence, 11 studies, 1283 participants). Supplemental breast milk results in little or no difference in percentage time crying compared to placebo or glycine (low-certainty evidence, 1 study, 70 participants). Supplemental breast milk results in little or no difference in NIPS score compared to no intervention, pacifier, moderate concentration of sucrose, eye drops, gentle touch and verbal comfort, and breast milk odour and verbal comfort (low-certainty evidence, 3 studies, 291 participants). Supplemental breast milk may reduce NFCS score compared to glycine (overall low-certainty evidence, 1 study, 40 participants). DAN scores were lower when compared to massage and water; no different when compared to no intervention, EMLA and moderate concentration of sucrose; and higher when compared to rocking or pacifier (low-certainty evidence, 2 studies, 224 participants). Due to the high number of comparator interventions, other measures of pain were assessed in a very small number of studies in both comparisons, rendering the evidence of low certainty. The majority of studies did not report on adverse events, considering the benign nature of the intervention. Those that reported on adverse events identified none in any participants. Subgroup analyses were not conducted due to the small number of studies. AUTHORS' CONCLUSIONS Moderate-/low-certainty evidence suggests that breastfeeding or supplemental breast milk may reduce pain in neonates undergoing painful procedures compared to no intervention/positioning/holding or placebo or non-pharmacological interventions. Low-certainty evidence suggests that moderate concentration (20% to 33%) glucose/sucrose may lead to little or no difference in reducing pain compared to breastfeeding. The effectiveness of breast milk for painful procedures should be studied in the preterm population, as there are currently a limited number of studies that have assessed its effectiveness in this population.
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Affiliation(s)
- Prakeshkumar S Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto and Mount Sinai Hospital, Toronto, Canada
| | - Ranjit Torgalkar
- Department of Paediatrics, Division of Neonatology, Kentucky Children's Hospital, University of Kentucky, Lexington, USA
| | - Vibhuti S Shah
- Department of Paediatrics and Institute of Health Policy, Management and Evaluation, University of Toronto and Mount Sinai Hospital, Toronto, Canada
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Minckas N, Kharel R, Ryan-Coker M, Lincetto O, Tunçalp Ö, Sacks E, Muzigaba M, Portela A. Measuring experience of and satisfaction with newborn care: a scoping review of tools and measures. BMJ Glob Health 2023; 8:e011104. [PMID: 37160360 PMCID: PMC10186411 DOI: 10.1136/bmjgh-2022-011104] [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] [Received: 10/30/2022] [Accepted: 03/10/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Standardised measures on experience of care are essential to understanding the care women and newborns receive and to designing appropriate interventions and responses. This review builds on ongoing work in the realm of maternity care and complements it by reviewing existing tools and measures to assess experience of and satisfaction with the care of the newborn. METHODS We conducted a scoping review of published literature to identify measures and tools of experience (physiological or indirect) and satisfaction with newborn care. We systematically searched five bibliographic databases from 1 January 2010 through 1 December 2022 and contacted professional networks. Using a predefined evidence template, we extracted data on the studies and the tools' characteristics. We mapped the tools and measures against the WHO quality of care frameworks to identify the most frequent measured domains of care and to highlight existing gaps. RESULT We identified 18 292 records of which 72 were eligible. An innovative finding of this review is the inclusion of newborn perspectives through behavioural responses, physiological signals, pain profiles as well as other non-verbal cues as markers of newborn experience. Domains related to parental participation and decision-making, ensuring continuity of care and receiving coordinated care, were the most measured across the included tools. CONCLUSION Comprehensive and validated instruments measuring all aspects of care are needed. Developing a robust theoretical ground will be fundamental to the design and utilisation of standardised tools and measures. PROTOCOL REGISTRATION DETAILS This review was registered and published on protocol.io (dx.doi.org/10.17504/protocols.io.bvk7n4zn).
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Affiliation(s)
- Nicole Minckas
- Institute for Global Health, University College London, London, UK
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Rashmi Kharel
- Institute for Global Health, University College London, London, UK
| | | | - Ornella Lincetto
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Emma Sacks
- Department of International Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Moise Muzigaba
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
| | - Anayda Portela
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland
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Pados BF. State of the Science on the Benefits of Human Milk for Hospitalized, Vulnerable Neonates. Nurs Womens Health 2023; 27:121-140. [PMID: 36871597 DOI: 10.1016/j.nwh.2023.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/16/2022] [Accepted: 01/26/2023] [Indexed: 03/06/2023]
Abstract
Research on human milk has increased dramatically in recent years. The purpose of this review is to describe the literature on the health benefits of human milk for hospitalized, vulnerable neonates. PubMed, CINAHL, and Embase were searched for research articles reporting the health outcomes of hospitalized neonates who were exposed to human milk. Human milk, particularly a mother's own milk, has the potential to reduce the risk of death and the risk and severity of necrotizing enterocolitis, infection, retinopathy of prematurity, bronchopulmonary dysplasia, intraventricular hemorrhage, kidney disease, and liver disease. Dose and timing of human milk is important, with more human milk and earlier introduction having a greater impact on health. When a mother's own milk is not available, donor human milk provides benefits over infant formula.
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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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Yildizdas HY, Erdem B, Karahan DY, Ozlu F, Sertdemir Y. Effect of whole body massage on pain scores of neonates during venous puncture and comparison with oral dextrose and Kangaroo care, a randomized controlled evaluator-blind clinical study. J Perinatol 2022; 43:590-594. [PMID: 36450853 DOI: 10.1038/s41372-022-01570-8] [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: 08/03/2022] [Revised: 11/10/2022] [Accepted: 11/18/2022] [Indexed: 12/02/2022]
Abstract
OBJECTIVE Newborns in NICUs experience many painful procedures. The aim of the study was to evaluate the effect of whole body massage therapy on pain scores during venipuncture and to compare with oral 10% dextrose and Kangaroo care. STUDY DESIGN Newborns with gestational age ≥34 weeks were randomly enrolled to one of three groups: dextrose, massage and Kangaroo care and a blinded investigator scored the pain using NIPS before and during the procedure. RESULTS There were 25, 26 and 23 newborns in dextrose, massage and Kangaroo care groups, respectively. Pain scores were similar before and during venipuncture in groups (p > 0.05). 36.5% of newborns (27/74) had severe pain scores. Number of newborns with no pain (score 0-2), moderate pain (score 3-4) and severe pain (score 5-7) were similar in each group. CONCLUSION Massage, Kangaroo and oral 10% dextrose had similar effects on pain scores during venipuncture.
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Affiliation(s)
- Hacer Yapicioglu Yildizdas
- Department of Pediatrics, Division of Neonatology, Çukurova University, Faculty of Medicine, Adana, Turkey
| | - Buket Erdem
- Department of Pediatrics, Newborn Intensive Care Unit, Çukurova University, Faculty of Medicine, Adana, Turkey
| | - Duygu Yildiz Karahan
- Department of Pediatrics, Newborn Intensive Care Unit, Çukurova University, Faculty of Medicine, Adana, Turkey
| | - Ferda Ozlu
- Department of Pediatrics, Division of Neonatology, Çukurova University, Faculty of Medicine, Adana, Turkey.
| | - Yaşar Sertdemir
- Department of Biostatistics, Çukurova University, Faculty of Medicine, Adana, Turkey
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Ethnonursing Study of Pain Management in Neonates in Pangandaran, West Java, Indonesia. Pain Manag Nurs 2022; 24:350-356. [DOI: 10.1016/j.pmn.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/04/2022] [Accepted: 10/09/2022] [Indexed: 11/19/2022]
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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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Multisensory Stimulation and Soft Tissue Therapy on Pain and Neurodevelopment Among Preterm Neonates. Pediatr Phys Ther 2022; 34:277-282. [PMID: 35385466 DOI: 10.1097/pep.0000000000000887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To determine the combined effects of multisensory stimulation (MSS) and soft tissue therapy (STT) in managing procedural pain and promoting neurodevelopment in neonates undergoing repetitive painful procedures during their neonatal intensive care unit (NICU) stay. METHODS Total of 104 preterm neonates admitted in NICU will be recruited for this trial. The intervention will be given for 5 consecutive days to both the groups. Experimental group will receive both MSS and STT; control group will receive routine NICU care. The premature infant pain profile and Neonatal Pain, Agitation, and Sedation Scale will be used for assessing procedural pain, and Infant Neurological International Battery and Premie-Neuro will be used for assessing neurodevelopmental maturity. Relevant parametric or nonparametric test will be used to analyze the data for all outcomes. DISCUSSION This is a study protocol analyzing the combined effects of nonpharmacological interventions (MSS and STT) in preterm neonates.
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Shen Q, Leng H, Shi Y, Chen Y, Zheng X. A protocol to develop a standard guideline for neonatal pain management. Transl Pediatr 2021; 10:1712-1720. [PMID: 34295786 PMCID: PMC8261575 DOI: 10.21037/tp-21-111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/11/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Hospitalized newborns experience a high frequency of painful procedures. Undertreated pain has a series of adverse physical and psychosocial effects on newborns. Guidelines successfully applied in clinical practice can effectively improve pain management in NICUs and reduce the incidence of pain. Neonatal care providers in China are in urgent need of a high-quality, evidence-based guideline for the treatment and management of neonatal pain. The National Clinical Research Center for Child Health and Disorders is leading the development of a standard guideline for neonatal pain management suitable for the medical environment in China providing empirical support and safety guarantees for clinical practice. The WHO Collaborating Centre for Guideline Implementation and Knowledge Translation will provide technical support and guidance. The purpose of this paper is to outline the detailed methodology and technical route of guideline development. METHODS We will follow the WHO principles and methods for the formulation of standard guidelines. The critical steps for developing the guideline are as follows: (I) definition of the guideline Scope; (II) establishment of guideline working groups; (III) selection of the clinical questions; (IV) performance of systematic reviews; (V) grading the quality of the body of evidence; and (VI) formulating recommendations and reaching consensus. DISCUSSION This protocol would ensure that the process of guideline development is normative, scientific, and transparent. The standard guideline for neonatal pain management based on the available high-quality evidence and tailored to the Chinese health care system will help neonatal caregivers in NICUs effectively manage neonatal pain. GUIDELINE REGISTRATION The guideline was registered at the International Practice Guidelines Registry Platform. The registration No. is IPGRP-2021CN044.
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Affiliation(s)
- Qiao Shen
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Hongyao Leng
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yuan Shi
- National Clinical Research Center for Child Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China.,Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Yaolong Chen
- Evidence-based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.,Guideline International Network Asia, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou University, Lanzhou, China.,Chinese GRADE Center, Lanzhou, China
| | - Xianlan Zheng
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China.,National Clinical Research Center for Child Health and Diseases, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China.,Chongqing Key Laboratory of Pediatrics, Chongqing, China
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13
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Assessment of four pain scales for evaluating procedural pain in premature infants undergoing heel blood collection. Pediatr Res 2021; 89:1724-1731. [PMID: 32599608 DOI: 10.1038/s41390-020-1034-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Revised: 06/11/2020] [Accepted: 06/15/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Procedural pain is underestimated in hospitalized preterm infants. The aim of this study was to assess the reliability, validity, and clinical utility of the Neonatal Facial Coding System (NFCS), Douleur Aiguë du Nouveau-né (DAN) scale, Neonatal Infant Pain Scale (NIPS), and Premature Infant Pain Profile (PIPP) in premature infants undergoing heel blood collection. We assume that the four scales were similar in reliablility and validity (but different in clinical utility). METHODS The pain assessments were performed on 111 premature infants using the four scales. Internal consistency was determined by Cronbach's α, and the reliability was determined by the intraclass correlation coefficients. Concurrent validity was evaluated by Spearman's rank correlations. Bland-Altman plots were used to investigate the convergent validity. RESULTS The internal consistency and their reliability of the scales were high (p < 0.001). Scores were significantly higher at the time of blood collection (p < 0.001). Mean scores of clinical utility of PIPP were significantly higher than NFCS and DAN (p < 0.05) but not higher than the NIPS (p > 0.05). CONCLUSIONS The four scales were reliable and valid. This study suggests that the PIPP and NIPS has good clinical utility and are better choice for evaluating procedural pain in premature infants. IMPACT The aim of this study was to assess the reliability, validity, and clinical utility of NFCS, DAN, NIPS, and PIPP in premature infants undergoing heel blood collection. The results showed that the four scales have high reliability and internal consistency; the PIPP and NIPS have good clinical utility and are better choice for evaluating procedural pain in premature infants. Our study results provided a reference for clinical workers in choosing pain assessment scales and conduction intervention.
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14
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Usta C, Tanyeri-Bayraktar B, Bayraktar S. Pain Control with Lavender Oil in Premature Infants: A Double-Blind Randomized Controlled Study. J Altern Complement Med 2020; 27:136-141. [PMID: 33259721 DOI: 10.1089/acm.2020.0327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Aromatherapy has become popular in pain control in recent years compared with other complementary methods. Lavender (Lavandula angustifolia Miller) is a fragrant essential oil used in aromatherapy for its antibacterial, antifungal, muscle-relaxing, and analgesic effects. The smell of lavender oil, known for its soothing effect on adults, has not been adequately investigated in regards to pain control in premature infants. The purpose of our study was to assign the effect of the scent of lavender oil on pain in preterm infants during heel lancing. Design: A double-blind randomized controlled clinical study. Settings/Location: The study was conducted in a third-level neonatal intensive care unit of Bezmialem Vakif University Hospital from March 2019 to November 2019. It consisted of two groups. Subjects: Sixty-one premature babies (24-37 weeks of gestation) were enrolled in the study. Interventions: Heel stick sampling for metabolic screening was used for both study groups. The interventions were performed by two experienced nurses. Heart rate, oxygen saturation, and the baby's facial expression were recorded by a camera 3 min before the intervention, during the sampling, and 3 min after the procedure. After collecting the data, the head researcher and the assistant researcher separately watched the videos and scored them by using the Premature Infant Pain Profile-Revised (PIPP-R). Outcome measures: The difference of pain scores (PIIP-R) between two groups. Results: There was a statistically significant difference between the two groups in terms of PIPP-R scores during and after the sampling (p = 0.008 and p = 0.03 respectively). The PIPP-R scores at the beginning of the procedure were not found to be significantly different between the groups (p > 0.05). Conclusions: Inhalation of lavender scent is effective in pain control in premature infants. It is safe and low cost; it does not interfere with medical care.
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Affiliation(s)
- Ceren Usta
- Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | | | - Süleyman Bayraktar
- Department of Pediatric Intensive Care, Haseki Training and Research Hospital, Istanbul, Turkey
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15
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Wade C, Frazer JS, Qian E, Davidson LM, Dash S, Te Water Naudé A, Ramakrishan R, Aluvaala J, Lakhoo K, English M. Development of locally relevant clinical guidelines for procedure-related neonatal analgesic practice in Kenya: a systematic review and meta-analysis. THE LANCET. CHILD & ADOLESCENT HEALTH 2020; 4:750-760. [PMID: 32735783 PMCID: PMC7507957 DOI: 10.1016/s2352-4642(20)30182-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/20/2020] [Accepted: 05/22/2020] [Indexed: 01/30/2023]
Abstract
Background Increasing numbers of neonates are undergoing painful procedures in low-income and middle-income countries, with adequate analgesia seldom used. In collaboration with a multi-disciplinary team in Kenya, we aimed to establish the first evidence-based guidelines for the management of routine procedure-related neonatal pain that consider low-resource hospital settings. METHODS We did a systematic review by searching MEDLINE, Embase, CINAHL, and CENTRAL databases for studies published from Jan 1, 1953, to March 31, 2019. We included data from randomised controlled trials using heart rate, oxygen saturation (SpO2), premature infant pain profile (PIPP) score, neonatal infant pain scale (NIPS) score, neonatal facial coding system score, and douleur aiguë du nouveau-né scale score as pain outcome measures. We excluded studies in which neonates were undergoing circumcision or were intubated, studies from which data were unextractable, or when pain was scored by non-trained individuals. We did a narrative synthesis of all studies, and meta-analysis when data were available from multiple studies comparing the same analgesics and controls and using the same outcome measures. 17 Kenyan health-care professionals formed our clinical guideline development panel, and we used the Grading of Recommendations, Assessment, Development and Evaluation framework and the panel's knowledge of the local health-care context to guide the guideline development process. This study is registered with PROSPERO, CRD42019126620. FINDINGS Of 2782 studies assessed for eligibility, data from 149 (5%) were analysed, with 80 (3%) of these further contributing to our meta-analysis. We found a high level of certainty for the superiority of breastfeeding over placebo or no intervention (standardised mean differences [SMDs] were -1·40 [95% CI -1·96 to -0·84] in PIPP score and -2·20 [-2·91 to -1·48] in NIPS score), and the superiority of oral sugar solutions over placebo or no intervention (SMDs were -0·38 [-0·61 to -0·16] in heart rate and 0·23 [0·04 to 0·42] in SpO2). We found a moderate level of certainty for the superiority for expressed breastmilk over placebo or no intervention (SMDs were -0·46 [95% CI -0·87 to -0·05] in heart rate and 0·48 [0·20 to 0·75] in SpO2). Therefore, the panel recommended that breastfeeding should be given as first-line analgesic treatment, initiated at least 2 min pre-procedure. Given contextual factors, for neonates who are unable to breastfeed, 1-2 mL of expressed breastmilk should be given as first-line analgesic, or 1-2 mL of oral sugar (≥10% concentration) as second-line analgesic. The panel also recommended parental presence during procedures with adjunctive provision of skin-to-skin care, or non-nutritive sucking when possible. INTERPRETATION We have generated Kenya's first neonatal analgesic guidelines for routine procedures, which have been adopted by the Kenyan Ministry of Health, and have shown a framework for clinical guideline development that is applicable to other low-income and middle-income health-care settings. FUNDING Wellcome Trust Research Programme, and the Africa-Oxford Initiative.
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Affiliation(s)
- Cian Wade
- Medical Sciences Division, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
| | | | - Evelyn Qian
- Medical Sciences Division, University of Oxford, Oxford, UK
| | | | - Suzanne Dash
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Rema Ramakrishan
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK; University of New South Wales, Faculty of Medicine, Sydney, NSW, Australia
| | - Jalemba Aluvaala
- KEMRI Wellcome Trust, Nairobi, Kenya; Department of Paediatrics, University of Nairobi, Nairobi, Kenya
| | - Kokila Lakhoo
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Mike English
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK; KEMRI Wellcome Trust, Nairobi, Kenya
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Kim THM, Delahunty-Pike A, Campbell-Yeo M. Effect of Fathers' Presence and Involvement in Newborn Care in the NICU on Mothers' Symptoms of Postpartum Depression. J Obstet Gynecol Neonatal Nurs 2020; 49:452-463. [PMID: 32663437 DOI: 10.1016/j.jogn.2020.05.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To determine the prevalence of symptoms of postpartum depression (PPD) and examine how fathers' presence and involvement in the care of their newborns affect symptoms of PPD within the first 2 weeks after birth among mothers with newborns in the NICU. DESIGN Observational cohort study. SETTING Open-bay, 40-bed, tertiary level NICU in Eastern Canada. PARTICIPANTS Mothers (N = 105) of newborns who were anticipated to survive and required more than 5 days of hospitalization in the NICU. METHODS Participants completed the Postpartum Depression Screening Scale (PDSS) 14 days after they gave birth. They kept daily diaries to record the amount of time that fathers spent by the newborns' bedsides (i.e., presence) and actively caring for their newborns (i.e., involvement such as skin to skin). Participants completed daily diaries from the time of enrollment in the study until their newborns were discharged home. We analyzed the data using linear regression; score on the PDSS was the dependent variable, and fathers' presence and involvement were the independent variables. We adjusted for covariates. RESULTS The prevalence of positive screening for symptoms of major PPD was 24.1% (n = 20), and the prevalence of significant symptoms of PPD was 27.7% (n = 23). Participants reported that fathers were present in the NICU an average of 3.8 hours per day and were actively involved with their newborns 53% of the time. Fathers' involvement was significantly associated with lower scores on the PDSS (adjusted β = -3.85; 95% confidence interval [CI] [-6.10, -1.60]). A history of anxiety was significantly associated with greater scores on the PDSS (adjusted β = 12.06, 95% CI [2.07, 22.05]). Maternal age and income less than $50,000 CAD were marginally associated with greater scores on the PDSS (adjusted β = -0.86, 95% CI [-1.77, 0.05] and adjusted β = 10.69, 95% CI [-0.73, 22.11], respectively). The overall explained variance in the PDSS scores with the independent variables was R2 = 0.35. CONCLUSION Fathers' involvement in the care of their newborns in the NICU was significantly associated with fewer symptoms of PPD among mothers. We recommend research with targeted interventions to promote fathers' involvement in the NICU to potentially mitigate the symptoms of PPD among mothers of newborns in the NICU.
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Comparing the Analgesic Effects of 4 Nonpharmacologic Interventions on Term Newborns Undergoing Heel Lance: A Randomized Controlled Trial. J Perinat Neonatal Nurs 2020; 34:338-345. [PMID: 32804876 DOI: 10.1097/jpn.0000000000000495] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This randomized trial compared the analgesic effect of 4 nonpharmacologic interventions (breastfeeding, oral sucrose, nonnutritive sucking, and skin-to-skin contact) on term newborns between 24 and 48 hours of age who underwent a heel lance. The Neonatal Pain, Agitation, and Sedation Scale was used to evaluate pain. The newborns (N = 226) were assigned to one of 4 intervention groups (n = 176) or a control group without pain intervention (n = 50). The results indicate that all intervention groups showed decreased pain levels when compared with the control group (P < .01). The oral sucrose group experienced a superior analgesic effect when compared with the skin-to-skin contact group (P < .01), but no difference was observed when compared with the breastfeeding group (P > .05) or the nonnutritive sucking group (P > .05). All intervention groups showed a shortened crying time (P < .01) and reduced procedural duration (P < .01) compared with the control group. All of these interventions are clinically applicable and acceptable when caring for a newborn during a minor painful procedure.
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Wu HP, Yin T, Hsieh KH, Lan HY, Feng RC, Chang YC, Liaw JJ. Integration of Different Sensory Interventions From Mother's Breast Milk for Preterm Infant Pain During Peripheral Venipuncture Procedures: A Prospective Randomized Controlled Trial. J Nurs Scholarsh 2019; 52:75-84. [PMID: 31762179 DOI: 10.1111/jnu.12530] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To compare the effects of integrating mother's breast milk (BM) with three different combinations of sensory stimuli on preterm infant pain during peripheral venipuncture procedures. DESIGN A prospective, repeated-measures randomized controlled trial. METHODS Preterm infants (gestational age between 28 and 37 weeks, and in stable condition) needing venipuncture were recruited by convenience sampling (N = 140) and randomly assigned to four treatment conditions: (a) routine care (condition 1); (b) BM odor or taste (condition 2); (c) BM odor or taste + heartbeat sounds (HBs; condition 3), and (d) BM odor or taste + HBs + non-nutritive sucking (NNS; condition 4). Pain scores were assessed based on the Premature Infant Pain Profile-Revised (PIPP-R) over nine phases: baseline (phase 0, 5 min without stimuli before venipuncture), disinfecting (phase 1), during venipuncture (phase 2), and a 10-min recovery (phases 3-8). FINDINGS Infants who received BM odor or taste + HBs + NNS had significantly lower increases in pain scores from baseline compared with controls across phases 1 through 8. Infants treated with either condition 2 or 3 demonstrated significant reductions in mild pain during disinfecting and recovery phases, as compared with the controls. When condition 2 was used as the reference, there were no significant differences in pain scores between the infants receiving condition 3 across the nine phases, suggesting mothers' HBs have only mild analgesic effects on venipuncture pain. CONCLUSIONS Integration of mother's BM odor or taste, HBs, and tactile NNS should be considered as an intervention for alleviation of procedural pain for preterm infants. CLINICAL RELEVANCE Clinicians should incorporate the integrated sensory intervention into caregiving support for preterm infants undergoing short painful procedures.
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Affiliation(s)
- Hsiang-Ping Wu
- Lambda Beta-At-Large, Doctoral Student, Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei City, Taiwan, R.O.C. and Lecturer, Department of Nursing, Chung-Jen Junior College of Nursing, Health Sciences and Management, Chia-Yi City, Taiwan, R.O.C
| | - Ti Yin
- Lambda Beta-At-Large, Assistant Professor, Nursing Department, Song-Shan Branch, Tri-Service General Hospital, Taipei City, Taiwan, R.O.C.,Lambda Beta-At-Large, Assistant Professor, School of Nursing, National Defense Medical Center, Taipei City, Taiwan, R.O.C
| | - Kao-Hsian Hsieh
- Department of Pediatrics, Tri-Service General Hospital, Taipei City, Taiwan, R.O.C
| | - Hsiang-Yun Lan
- Lambda Beta-At-Large, Assistant Professor, School of Nursing, National Defense Medical Center, Taipei City, Taiwan, R.O.C
| | - Rung-Chuang Feng
- Assistant Professor, National Defense Medical Center & Department of Nursing, Taipei City Hospital, Taipei City, Taiwan, R.O.C
| | - Yue-Cune Chang
- Professor, Department of Mathematics, Tamkang University, Taipei City, Taiwan, R.O.C
| | - Jen-Jiuan Liaw
- Lambda Beta-At-Large, Professor, School of Nursing, National Defense Medical Center, Taipei City, Taiwan, R.O.C
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Managing Procedural Pain in the Neonate Using an Opioid-sparing Approach. Clin Ther 2019; 41:1701-1713. [PMID: 31431300 DOI: 10.1016/j.clinthera.2019.07.014] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/15/2019] [Accepted: 07/16/2019] [Indexed: 12/20/2022]
Abstract
PURPOSE Pain in the neonate is often challenging to assess but important to control. Physicians often must balance the need for optimal pain control with the need to minimize oversedation and prolonged opioid use. Both inadequate pain control and overuse of opioids can have long-term consequences, including poor developmental outcomes. The aim of this review is to introduce a comprehensive approach to pain management for physicians, nurses, and surgeons caring for critically ill neonates, focusing on nonopioid alternatives to manage procedural pain. FINDINGS After review, categories of opioid-sparing interventions identified included (1) nonopioid pharmacologic agents, (2) local and regional anesthesia, and (3) nonpharmacologic alternatives. Nonopioid pharmacologic agents identified for neonatal use included acetaminophen, NSAIDs, dexmedetomidine, and gabapentin. Local and regional anesthesia included neuraxial blockade (spinals and epidurals), subcutaneous injections, and topical anesthesia. Nonpharmacologic agents uniquely available in the neonatal setting included skin-to-skin care, facilitated tucking, sucrose, breastfeeding, and nonnutritive sucking. IMPLICATIONS The use of various pharmacologic and interventional treatments for neonatal pain management allows for the incorporation of opioid-sparing techniques in neonates who are already at risk for poor neurodevelopmental outcomes. A multifactorial approach to pain control is paramount to optimize periprocedural comfort and to minimize the negative sequelae of uncontrolled pain in the neonate.
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Bueno M, Harrison D. What happened to the principle of equipoise in the planning, designing and conducting of placebo-controlled trials for neonatal procedural pain? Pediatr Neonatol 2019; 60:479-480. [PMID: 31186168 DOI: 10.1016/j.pedneo.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 05/14/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Mariana Bueno
- The Hospital for Sick Children, 686 Bay Street, 6th Floor, 06.9717 Admin Area, W10-West, Toronto, Ontario, M5G 0A4, Canada.
| | - Denise Harrison
- University of Ottawa, Health Sciences, and Children's Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
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Hsieh KH, Chen SJ, Tsao PC, Wang CC, Huang CF, Lin CM, Chou YL, Chen WY, Chan IC. The analgesic effect of non-pharmacological interventions to reduce procedural pain in preterm neonates. Pediatr Neonatol 2019; 60:481-482. [PMID: 31279689 DOI: 10.1016/j.pedneo.2019.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 04/01/2019] [Accepted: 05/10/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kao-Hsian Hsieh
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shu-Jen Chen
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Pei-Chen Tsao
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Chien Wang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Feng Huang
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Ming Lin
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ya-Ling Chou
- Department of Pediatrics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wei-Yu Chen
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicines, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - I-Ching Chan
- Children's Medical Center, Taipei Veterans General Hospital, Taipei, Taiwan
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Tarjoman A, Vasigh A, pouy S, Safari S, Borji M. Pain management in neonatal intensive care units: A cross sectional study of neonatal nurses in Ilam City. ACTA ACUST UNITED AC 2019. [DOI: 10.1016/j.jnn.2018.08.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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