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Yaster M, Flack SH, Martin LD, Morgan PG. An interview with Dr. Anne Marie Lynn, a pioneering woman in medicine. Paediatr Anaesth 2021; 31:1040-1045. [PMID: 34293231 DOI: 10.1111/pan.14258] [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: 06/29/2021] [Accepted: 07/17/2021] [Indexed: 11/26/2022]
Abstract
Dr. Anne Marie Lynn (1949-present), Professor Emeritus of Anesthesiology, Pain Medicine, and Pediatrics at the University of Washington, Seattle, was one of the most influential women in pediatric anesthesiology of her generation. Dr. Lynn embodies the spirit of discovery and advancement that have created the practice of pediatric anesthesiology as we know it today. A pioneer in pain medicine pharmacology, particularly morphine and ketorolac, her research transformed pediatric anesthesia, pediatric pain medicine, and pediatric intensive care medicine. Through her journal articles, book chapters, national and international lectures, mentoring of residents, fellows, and faculty, and leadership in the Society for Pediatric Anesthesia, she inspired a generation of women and men physicians by demonstrating that gender should not be a barrier to undertaking roles once only held only by men. In 2017, for her many contributions, she was awarded the Society for Pediatric Anesthesia's Myron Yaster lifetime achievement award.
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Affiliation(s)
- Myron Yaster
- Departments of Anesthesiology, Critical Care Medicine and Pediatrics, The Johns Hopkins University, Baltimore, Maryland, USA
| | - Sean H Flack
- Department of Anesthesiology and Pain Medicine, Seattle Children's, University of Washington, Seattle, Washington, USA
| | - Lynn D Martin
- Department of Anesthesiology and Pain Medicine, Seattle Children's, University of Washington, Seattle, Washington, USA
| | - Philip G Morgan
- Department of Anesthesiology and Pain Medicine, Seattle Children's, University of Washington, Seattle, Washington, USA
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Jackson HJ, Lopez C, Miller S, Englehardt B. Feasibility of auricular acupressure as an adjunct treatment for neonatal opioid withdrawal syndrome (NOWS). Subst Abus 2020; 42:348-357. [PMID: 32635829 DOI: 10.1080/08897077.2020.1784360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND The opioid epidemic in the United States continues to threaten public health. As a result of this crisis, neonatal opioid withdrawal syndrome (NOWS) has risen exponentially and requires a multitude of non-pharmacologic treatments to ensure healthy neonatal outcomes. Methods: This feasibility study implemented an acupressure protocol as informed by the Near-Term Infant (NTI) conceptual framework for the treatment of NOWS. Aims of this study were to assess provider training, effective integration of acupressure within the standard of care, and acceptance of this treatment by mothers and healthcare providers. Results: With maternal consent, a total of 12 participants were enrolled and underwent auricular acupressure. Nurse Practitioners were credentialed (75%) and effectively administered neonatal acupressure (100%) in accordance with the study protocol. Mothers were very satisfied with acupressure for the treatment of NOWS (Client Satisfaction Questionaire-8 mean scores 3.8-4.0 of a possible 4.0), and the majority of healthcare providers were supportive (66%, mean scores 3.6 to 4.0 out of possible 5). Conclusions: Auricular acupressure was successfully implemented within the standard of care for NOWS. Future studies should incorporate outlined suggestions and include qualitative measures of acceptance as well as randomized controlled trials to evaluate efficacy.
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Affiliation(s)
- Heather J Jackson
- Vanderbilt Ingram Cancer Center and Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Cristina Lopez
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Sarah Miller
- College of Nursing, Medical University of South Carolina, Charleston, SC, USA
| | - Barbara Englehardt
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
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Landgren K, Hallström I, Tiberg I. The effect of two types of minimal acupuncture on stooling, sleeping and feeding in infants with colic: secondary analysis of a multicentre RCT in Sweden (ACU-COL). Acupunct Med 2020; 39:106-115. [PMID: 32375501 PMCID: PMC7961620 DOI: 10.1177/0964528420920308] [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] [Indexed: 11/17/2022]
Abstract
Background Evidence for the effect of minimal acupuncture in infants with colic is limited. Aim To compare the effect of standardized minimal acupuncture, individualized acupuncture (where traditional acupuncture points were chosen according to the infant’s symptoms) and no acupuncture on objective measures of stooling, feeding and sleeping in infants with colic (based on diaries) and perceived changes in these parameters (based on parental questionnaires). Methods This was a secondary analysis of a multicentre randomized controlled three-armed trial conducted in four counties in Sweden between January 2013 and May 2015 (ACU-COL). The effect on crying has already been published and showed a decrease in crying time for the acupuncture groups. Infants, 2–8 weeks old, who cried and fussed for more than 3 h/day for more than 3 days/week, and thereby fulfilled the criteria for infantile colic, received four extra visits to their ordinary child health centre. The infants (n = 147) were randomly allocated via a computer-generated list to standardized minimal acupuncture at LI4 for 5 s (group A, n = 48), semi-standardized individual acupuncture with a maximum of five insertions for up to 30 s (group B, n = 49), or no acupuncture (group C, n = 48). The parents and the ordinary staff were blinded. Data were collected using: (1) diaries at baseline, during the two intervention weeks and 1-week follow-up; and (2) questionnaires with quantitative and qualitative components used at the second and fourth visits and during a follow-up telephone call. Outcomes were the changes in frequency of stooling and in hours of sleep per day. Results There were no differences between groups for stooling, feeding, or sleeping at any time point according to data from the diaries. At the follow-up phone call, more parents in groups A and B (compared to group C) perceived that feeding and sleep had changed and that the symptoms of colic had improved.
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Affiliation(s)
- Kajsa Landgren
- Department of Health Sciences, Faculty of Medicine, 5193Lund University, Lund, Sweden
| | - Inger Hallström
- Department of Health Sciences, Faculty of Medicine, 5193Lund University, Lund, Sweden
| | - Iren Tiberg
- Department of Health Sciences, Faculty of Medicine, 5193Lund University, Lund, Sweden
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Holmer N, Artola E, Christianson E, Lynn AM, Whitlock KB, Norton S. Feasibility of Acupuncture to Induce Sleep for Brainstem Auditory Evoked Response Testing. Am J Audiol 2019; 28:895-907. [PMID: 31747523 DOI: 10.1044/2019_aja-19-0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose Brainstem auditory evoked response (BAER) testing is often performed under general anesthesia for children unable to complete behavioral audiologic evaluation. Alternatively, acupuncture treatment may be considered appropriate for BAER. Reports of acupuncture treatment in pediatric patients are scarce but are needed to demonstrate effectiveness. This study had 2 main objectives: (a) to examine the feasibility and effectiveness of acupuncture to achieve sleep to perform diagnostic BAER testing in medically complex (Cohort I) and nonmedically complex (Cohort II) children and (b) to assess acceptability to parents and audiologists of acupuncture as an alternative to anesthesia for BAER testing. Method A prospective feasibility study at Seattle Children's Hospital Outpatient Audiology Clinic from August 2015 through December 2018 was performed. A total of 31 pediatric patients were included. The median age for Cohort I was 29 months (interquartile range: 19-37 months), and the median age for Cohort II was 25.5 months (interquartile range: 16-32 months). Variables included number of BAER thresholds obtained, sleep indicators, and acceptability. The cost of BAER with acupuncture and the cost of BAER under anesthesia were compared. Results Acupuncture treatment effectively contributed to an adequate sleep state to obtain BAER results for most patients in both cohorts. Across cohorts, most patients (81%) fell asleep after acupuncture treatment. Complete test results were obtained in 48% of patients. Audiologists and parents reported high satisfaction rates with this procedure (87%). There were no adverse safety effects. Acupuncture treatment was less costly than anesthesia for BAER testing. Conclusions Acupuncture to induce sleep for BAER testing is effective, safe, and cost-efficient in small samples of medically and nonmedically complex pediatric patients. This procedure allowed earlier detection of hearing status and avoided potential adverse effects of anesthesia. Audiologists and parents reported that acupuncture treatment was an acceptable alternative to anesthesia for the BAER procedure.
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Affiliation(s)
- Nicole Holmer
- Division of Audiology, Seattle Children's Hospital, WA
| | - Elizabeth Artola
- Department of Anesthesia and Pain Medicine, Seattle Children's Hospital, WA
| | | | - Anne M. Lynn
- Department of Anesthesia and Pain Medicine, Seattle Children's Hospital, WA
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle
| | - Kathryn B. Whitlock
- Department of Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital, WA
- Center for Clinical and Translational Research, Seattle Children's Hospital, WA
| | - Susan Norton
- Division of Audiology, Seattle Children's Hospital, WA
- Childhood Communication Center, Seattle Children's Hospital, WA
- Department of Otolaryngology–Head and Neck Surgery, Seattle Children's Hospital, WA
- Department of Speech & Hearing Sciences, University of Washington, Seattle
- Department of Otolaryngology–Head and Neck Surgery, University of Washington, Seattle
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Stadler J, Raith W, Mileder LP, Schmölzer GM, Urlesberger B. Invasive and non-invasive acupuncture techniques for pain management in neonates: a systematic review. Acupunct Med 2019; 37:201-210. [PMID: 31271304 DOI: 10.1136/acupmed-2017-011549] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Neonatal pain is an extensive research field and there are many possibilities to treat pain in neonates. Acupuncture is one new and non-pharmacological option and a promising tool to reduce pain in neonates undergoing minor painful interventions during routine medical care. OBJECTIVES This review summarises trials of acupuncture for pain reduction in neonates undergoing painful interventions during routine medical care. DATA SOURCE MEDLINE, Embase, CINAHL, electronic clinical trials registry platforms and reference lists were systematically screened for trials from their dates of inception to February 2017 (English language database search). STUDY SELECTION Inclusion criteria were (1) preterm or term neonates, (2) acupuncture for painful medical interventions and (3) formal pain assessment as a primary or secondary study outcome. We included only randomised controlled trials. DATA EXTRACTION Data were extracted using a standardised protocol and individual risk of bias was assessed. RESULTS The literature search revealed a total of 12 196 records. After application of inclusion criteria, five studies were included in this review. Two studies demonstrated significant pain reduction, one found equal outcomes in comparison to standard care, and two showed significantly higher pain scores with acupuncture alone. LIMITATIONS The main limitation of the results is the heterogeneity across trials in acupuncture modality, acupuncture point selection, control groups and pain assessment (heterogeneity: I2=87%). CONCLUSION The results of this review suggest that acupuncture may have a positive pain-relieving effect in neonates. However, due to the low number of available high-quality trials and heterogeneity across the studies it is not possible to state clear recommendations.
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Affiliation(s)
- Jasmin Stadler
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2 Research Group for Paediatric Traditional Chinese Medicine, TCM Research Center Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
| | - Wolfgang Raith
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2 Research Group for Paediatric Traditional Chinese Medicine, TCM Research Center Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
| | - Lukas P Mileder
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Georg M Schmölzer
- 3 Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada.,4 Centre for the Studies of Asphyxia and Resuscitation, Neonatal Research Unit, Royal Alexandra Hospital, Edmonton, Alberta, Canada
| | - Berndt Urlesberger
- 1 Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,2 Research Group for Paediatric Traditional Chinese Medicine, TCM Research Center Graz (Acupuncture Research), Medical University of Graz, Graz, Austria
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Neonatal Abstinence Syndrome: An Integrative Review of Neonatal Acupuncture to Inform a Protocol for Adjunctive Treatment. Adv Neonatal Care 2019; 19:165-178. [PMID: 31140978 DOI: 10.1097/anc.0000000000000630] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The current opioid epidemic in the United States has given rise to a growing incidence of neonatal abstinence syndrome (NAS). Treatments for this condition optimize nonpharmacologic therapies in an effort to improve withdrawal symptoms and reduce or eliminate the need for opioid medications, thereby reducing hospital length of stay and improving healthy neonatal outcomes. PURPOSE The purpose of this review was to evaluate the current evidence for neonatal acupuncture treatments and identify essential characteristics that must be included in a treatment protocol for NAS. METHODS/SEARCH STRATEGY An integrative review was conducted under the guidance of the Whittemore and Knafl methodology and near-term infant conceptual framework. An evaluation of the quality and levels of evidence was also included. FINDINGS/RESULTS A total of 10 studies were identified in this review. Four of these studies were randomized controlled trials, and utilized acupuncture in the neonatal population to evaluate impact on pain, NAS, and weight gain. IMPLICATIONS FOR PRACTICE This review provided the essential elements for the development of a complementary acupuncture treatment protocol for the management of NAS. IMPLICATIONS FOR RESEARCH Future research should include the identified essential characteristics in high-quality, blinded, randomized controlled trials to assess the treatment effect of acupuncture on neonates experiencing withdrawal symptoms.
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Murg K, Raith W, Urlesberger B. Use of Acupuncture in an Infant with Restlessness and Agitation. MEDICINES 2018; 5:medicines5020055. [PMID: 29899266 PMCID: PMC6023510 DOI: 10.3390/medicines5020055] [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: 05/05/2018] [Revised: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 11/24/2022]
Abstract
Abstract: Background: We are reporting here about a 3-month-old boy with a history of failure to thrive, hypertrophic obstructive cardiomyopathy and neurological misbehaviour including hypotension in body muscles, who was found to have screaming attacks, agitation and restlessness. Methods/Results: Body and ear acupuncture was used both as supporting and integrative therapy to reduce the phases of restlessness and screaming and, simultaneously, the use of hypnotic drugs, as well as to improve the baby’s thriving. Conclusions: Our case has proved that standardised ear and body acupuncture applied by trained acupuncturist paediatricians is a helpful non-pharmacological treatment tool. While acupuncture is typically used in the outpatient setting, it can equally be used in the inpatient setting, as exemplified by the positive outcome of the presented case.
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Affiliation(s)
- Katharina Murg
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz 8036, Austria.
| | - Wolfgang Raith
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz 8036, Austria.
- Research Group for Paediatric Traditional Chinese Medicine, TCM Research Centre Graz, Medical University of Graz, Graz 8036, Austria.
| | - Berndt Urlesberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz 8036, Austria.
- Research Group for Paediatric Traditional Chinese Medicine, TCM Research Centre Graz, Medical University of Graz, Graz 8036, Austria.
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Matsumoto-Miyazaki J, Ushikoshi H, Suzuki K, Miyazaki N, Nawa T, Okada H, Yoshida S, Murata I, Ogura S, Minatoguchi S. Efficacy of Acupuncture Treatment for Improving the Respiratory Status in Patients Receiving Prolonged Mechanical Ventilation in Intensive Care Units: A Retrospective Observational Study. J Altern Complement Med 2018; 24:1076-1084. [PMID: 29741919 DOI: 10.1089/acm.2017.0365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Patients in critical care settings often require prolonged mechanical ventilation (MV) therapy and, occasionally, they cannot be weaned from MV. The authors evaluated the efficacy of acupuncture treatment for improving the respiratory status and promoting successful weaning from prolonged MV in patients at intensive care units (ICUs). DESIGN Retrospective observational study. SETTING Gifu University Hospital, Gifu, Japan. SUBJECTS The authors included 16 tracheostomized patients receiving MV for >21 days at the ICU of Gifu University Hospital, who underwent acupuncture therapy for improving their respiratory status. INTERVENTION Acupuncture treatment was conducted in four sessions per week. OUTCOME MEASURES The data of tidal volume (VT), respiratory rate (RR), heart rate (HR), oxygen saturation as measured by pulse oximetry (SpO2), dynamic lung compliance (Cdyn), rapid shallow breath index (RSBI; RR/VT) values before and immediately after acupuncture were extracted from the medical records. RESULTS The median number of days on MV before acupuncture initiation was 31 days. VT and Cdyn were significantly increased immediately after acupuncture (all p < 0.001), whereas RR, HR, and RSBI were significantly decreased (all p < 0.05). Eleven patients were successfully weaned from MV after acupuncture initiation. In the weaning success group, VT and Cdyn were significantly increased (all p < 0.01), whereas RR, HR, and RSBI were significantly decreased (all p < 0.05) after acupuncture. Conversely, in the weaning failure group, these values were not changed significantly. The increase in Cdyn after acupuncture was larger in the weaning success group than in the weaning failure group (p < 0.05). CONCLUSION Acupuncture treatment might have beneficial effects on the respiratory status of ICU patients receiving MV and may help in weaning from prolonged MV. Further large prospective cohort studies are warranted.
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Affiliation(s)
- Jun Matsumoto-Miyazaki
- 1 Department of Cardiology and Respirology, Gifu University Graduate School of Medicine , Gifu, Japan
| | - Hiroaki Ushikoshi
- 1 Department of Cardiology and Respirology, Gifu University Graduate School of Medicine , Gifu, Japan .,2 Advanced Critical Care Center, Gifu University Hospital , Gifu, Japan
| | - Kodai Suzuki
- 2 Advanced Critical Care Center, Gifu University Hospital , Gifu, Japan
| | - Nagisa Miyazaki
- 3 Department of Internal Medicine, Asahi University , Gifu, Japan
| | - Takahide Nawa
- 1 Department of Cardiology and Respirology, Gifu University Graduate School of Medicine , Gifu, Japan
| | - Hideshi Okada
- 2 Advanced Critical Care Center, Gifu University Hospital , Gifu, Japan .,4 Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine , Gifu, Japan
| | - Shozo Yoshida
- 2 Advanced Critical Care Center, Gifu University Hospital , Gifu, Japan .,4 Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine , Gifu, Japan
| | - Ichijiro Murata
- 1 Department of Cardiology and Respirology, Gifu University Graduate School of Medicine , Gifu, Japan .,5 Department of Chronic Kidney Disease, Gifu University Graduate School of Medicine , Gifu, Japan
| | - Shinji Ogura
- 2 Advanced Critical Care Center, Gifu University Hospital , Gifu, Japan .,4 Department of Emergency and Disaster Medicine, Gifu University Graduate School of Medicine , Gifu, Japan
| | - Shinya Minatoguchi
- 1 Department of Cardiology and Respirology, Gifu University Graduate School of Medicine , Gifu, Japan
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Skjeie H, Skonnord T, Brekke M, Klovning A, Fetveit A, Landgren K, Hallström IK, Brurberg KG. Acupuncture treatments for infantile colic: a systematic review and individual patient data meta-analysis of blinding test validated randomised controlled trials. Scand J Prim Health Care 2018; 36:56-69. [PMID: 29338487 PMCID: PMC5901442 DOI: 10.1080/02813432.2018.1426146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 11/19/2017] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE Needle acupuncture in small children has gained some acceptance in Western medicine. It is controversial, as infants and toddlers are unable to consent to treatment. We aimed to assess its efficacy for treating infantile colic. DESIGN A systematic review and a blinding-test validation based on individual patient data from randomised controlled trials. Primary end-points were crying time at mid-treatment, at the end of treatment and at a 1-month follow-up. A 30-min mean difference (MD) in crying time between acupuncture and control was predefined as a clinically important difference. Pearson's chi-squared test and the James and Bang indices were used to test the success of blinding of the outcome assessors [parents]. Eligibility criteria and data sources: We included randomised controlled trials of acupuncture treatments of infantile colic. Systematic searches were conducted in Cochrane CENTRAL, MEDLINE, EMBASE, CINAHL and AMED, and in the Chinese language databases CNKI, VIP, Wang fang, SinoMed and Chinese Clinical Trial Registry. RESULTS We included three randomised controlled trials with data from 307 participants. Only one of the included trials obtained a successful blinding of the outcome assessors in both the acupuncture and control groups. The MD in crying time between acupuncture intervention and no acupuncture control was -24.9 min [95% confidence interval, CI -46.2 to -3.6; three trials] at mid-treatment, -11.4 min [95% CI -31.8 to 9.0; three trials] at the end of treatment and -11.8 min [95% CI -62.9 to 39.2; one trial] at the 4-week follow-up. The corresponding standardised mean differences [SMDs] were -0.23 [95% CI -0.42 to -0.06], -0.10 [95% CI -0.29 to 0.08] and -0.09 [95% CI -0.48 to 0.30]. The heterogeneity was negligible in all analyses. The statistically significant result at mid-treatment was lost when excluding the apparently unblinded study in a sensitivity analysis: MD -13.8 min [95%CI -37.5 to 9.9] and SMD -0.13 [95%CI -0.35 to 0.09]. The registration of crying during treatment suggested more crying during acupuncture [odds ratio 7.7; 95% CI 2.7-20.6; one trial]. GRADE-Moderate quality evidence. CONCLUSIONS Percutaneous needle acupuncture treatments should not be recommended for infantile colic on a general basis. Systematic review registration: PROSPERO 2015:CRD42015023253 Key points The role of acupuncture in the treatment of infantile colic is controversial. Available trials are small and present conflicting results. There were no clinically important differences between infants receiving acupuncture and no acupuncture control in this IPD meta-analysis of randomised controlled trials. The data indicate that acupuncture induces some treatment pain in many of the children. The study results indicate that percutaneous needle acupuncture should not be recommended for treatment of infantile colic on a general basis.
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Affiliation(s)
- Holgeir Skjeie
- Department of General Practice, Institute of Health and Society University of Oslo, Oslo, Norway
| | - Trygve Skonnord
- Department of General Practice, Institute of Health and Society University of Oslo, Oslo, Norway
| | - Mette Brekke
- Department of General Practice, Institute of Health and Society University of Oslo, Oslo, Norway
| | - Atle Klovning
- Department of General Practice, Institute of Health and Society University of Oslo, Oslo, Norway
| | - Arne Fetveit
- Department of General Practice, Institute of Health and Society University of Oslo, Oslo, Norway
| | - Kajsa Landgren
- Faculty of Medicine Department of Health Sciences, Lund University, Lund, Sweden
| | | | - Kjetil Gundro Brurberg
- Norwegian Institute of Public Health Division for Health Services, Oslo, Norway
- Western Norway University for Applied Sciences Centre for Evidence Based Practice, Bergen, Norway
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Acupuncture in the neonatal intensive care unit-using ancient medicine to help today's babies: a review. J Perinatol 2017; 37:749-756. [PMID: 27977013 DOI: 10.1038/jp.2016.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/21/2016] [Accepted: 11/01/2016] [Indexed: 11/08/2022]
Abstract
Acupuncture has been used for thousands of years in Eastern medicine for a variety of conditions and illnesses, including pain. Neonatal intensive care, on the other hand, is a relatively new branch of medicine that has emerged as the pivotal influence in increasing survival of critically ill newborn infants only within the last 50 years. Unfortunately, pain is an inevitable part of treatment in a neonatal intensive care unit (NICU). The control and prevention of pain remains a major issue for clinicians despite recognition and understanding of the myriad of short- and long-term problems that are associated with both pain and its treatment within the NICU environment. In this review, we examine the potential role of acupuncture to decrease and treat pain in babies requiring neonatal intensive care and discuss future therapeutic and research implications for the use of this ancient therapy within the modern environment of the NICU.
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Abstract
BACKGROUND Current standard therapy for moderate to severe neonatal abstinence syndrome (NAS) includes opioid administration and often results in separation of mother and infant. Impaired maternal-infant bonding and extended neonatal opiate exposure may be associated with adverse developmental outcomes. Increased use of nonopioid adjunctive NAS therapies may decrease postnatal opioid exposure and length of stay (LOS), thereby promoting positive developmental outcomes for NAS-affected infants. PURPOSE To review the efficacy of rooming-in care and acupuncture as nonpharmacologic adjunctive agents to reduce the magnitude of postnatal opioid exposure and LOS. METHODS PubMed, Ovid Medline, Embase, and CINAHL databases were searched for primary studies on rooming-in care and acupuncture as adjunctive treatments for NAS; 8 are included in this review. FINDINGS Rooming-in care may decrease postnatal opioid exposure and LOS in NAS-affected infants. Acupuncture is safe in NAS patients; however, its definitive effect on narcotic use and length of hospitalization are inconclusive. IMPLICATIONS FOR PRACTICE Rooming-in care should be offered to NAS patients. Strong evidence does not exist to recommend acupuncture as a routine NAS treatment. IMPLICATIONS FOR RESEARCH Additional randomized clinical trials are necessary to assess the efficacy of acupuncture and to confirm the effect of rooming-in care on NAS outcomes, and delineate optimal elements of a rooming-in care model.
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Electrical stimulation of the heart 7 acupuncture site for preventing emergence agitation in children. Eur J Anaesthesiol 2016; 33:535-42. [DOI: 10.1097/eja.0000000000000379] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Skjeie H, Brekke M. 'Big needles, small bodies'-the absence of acupuncture treatment for infants in contemporary Shanghai: a qualitative study. BMJ Open 2015; 5:e009486. [PMID: 26553838 PMCID: PMC4654286 DOI: 10.1136/bmjopen-2015-009486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To explore contemporary practices and clinical recommendations regarding the use of acupuncture for infants by Traditional Chinese Medicine (TCM) practitioners in Shanghai. DESIGN A qualitative study consisting of four field visits between February 2014 and March 2015. Data was collected using participant observation, focus group interview, in-depth interview, textbook page analysis and informant validation. PARTICIPANTS 14 Shanghainese professionals, including interpreters and TCM practitioners, of which seven were acupuncturists. SETTING The Longhua Hospital (paediatric, acupuncture and Tui na departments) in southern Shanghai and the campus of the Shanghai University of Traditional Chinese Medicine. RESULTS The Longhua Hospital outpatient acupuncture clinic receives 400 consultations on average per day. Children, including patients from the paediatric department, are referred to this clinic. During 3 days of participant observations at this department, we saw two children. No infants. During 3 days at the paediatric department and 1 day at the Tui na department we saw no referrals. Formal interviews and informal conversations with acupuncturists and other TCM professionals revealed that acupuncture was neither routinely practiced nor recommended for infants and small children. Acupuncture was considered potentially painful for this young patient population. Alternative treatment options such as herbal treatments or medical massage were widely available and preferred. Western medical diagnostics and treatment were also used, recommended, and trusted. CONCLUSIONS Acupuncture for infants is not a preferred therapeutic method among TCM practitioners working in contemporary Shanghai. Acupuncture on broad indications in infants appears to be a Western practice with little basis in TCM modern-day practice.
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Affiliation(s)
- Holgeir Skjeie
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Mette Brekke
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
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Abbasoglu A, Cabioglu MT, Tugcu AU, Yapakci E, Tekindal MA, Tarcan A. Laser acupuncture before heel lancing for pain management in healthy term newborns: a randomised controlled trial. Acupunct Med 2015; 33:445-50. [PMID: 26438556 DOI: 10.1136/acupmed-2015-010765] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 01/29/2023]
Abstract
BACKGROUND Healthy term newborns commonly undergo painful procedures during routine follow-up visits. Non-pharmacological strategies have currently become more important than pharmacological analgesic agents in neonatal pain management. Acupuncture is a new non-pharmacological method for preventing pain in newborns. OBJECTIVE We aimed to investigate the effect of laser acupuncture (LA) at the Yintang point before heel lancing as a non-pharmacological intervention for procedural pain management in infants. METHODS Forty-two term newborns, who were undergoing heel lancing between postnatal days 3 to 8 as part of routine neonatal screening, were randomly assigned to the LA group or the oral sucrose group. In the LA group, 2 min before the heel lancing, 0.3 J of energy was applied to the Yintang point using a Laser PREMIO-30 unit for 30 s. In the sucrose group, each infant received 0.5 mL of 24% sucrose orally via syringe 2 min before the heel lancing. Each baby's behaviour was scored using the Neonatal Infant Pain Scale (NIPS), assessed blinded to group. RESULTS There were no significant differences between the LA and oral sucrose groups with respect to means for gestational week of age at birth, birth weight, actual weight, or Apgar score. Mean procedure time was significantly shorter in the LA group; however, mean crying time was longer and NIPS score was lower compared to the oral sucrose group. CONCLUSIONS Our results indicate that 0.3 J of LA at the Yintang point before heel lancing is less effective than oral sucrose for reducing the discomfort of this procedure. TRIAL REGISTRATION NUMBER KA14/09.
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Affiliation(s)
- Aslihan Abbasoglu
- Division of Neonatology, Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey
| | | | - Ali Ulas Tugcu
- Division of Neonatology, Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey
| | - Ece Yapakci
- Division of Neonatology, Department of Pediatrics, Güven Hospital, Ankara, Turkey
| | | | - Aylin Tarcan
- Division of Neonatology, Department of Pediatrics, Başkent University Faculty of Medicine, Ankara, Turkey
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Changes of locoregional skin temperature in neonates undergoing laser needle acupuncture at the acupuncture point large intestine 4. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:571857. [PMID: 25922612 PMCID: PMC4398935 DOI: 10.1155/2015/571857] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 03/06/2015] [Indexed: 12/15/2022]
Abstract
Laser acupuncture bears a potential risk for the skin surface, especially in neonates whose skin has histological and physiological peculiarities. We evaluated thermal changes of skin temperature in neonates during laser acupuncture by using a thermal camera (Flir i5, Flir Systems Inc., Portland, USA). Laserneedles (Laserneedle GmbH, Glienicke/Nordbahn, Germany) were fixed to the skin at Large Intestine 4 (LI 4, Hegu), bilaterally. Before application of laser acupuncture (685 nm, 15 mW, 500 μm), as well as after 1, 5, and 10 min, thermographic pictures of both hands were taken. The measuring was carried out on the 23rd day after birth (20 neonates, mean postmenstrual gestational age 38 + 2, mean weight 2604 g). Compared to the initial temperature of 34.2°C on the right hand, the skin temperature had increased to 35.3°C (P < 0.05) after 5 min and up to 36.1°C (P < 0.05) after 10 min of stimulation. Equally, on the left hand, an increase of the skin temperature from 34.5°C to 35.9°C (P < 0.05) and 35.9°C (P < 0.05) was measured. The highest measured skin temperature after 10 min of stimulation amounted to 38.7°C, without any clinically visible changes on the skin surface.
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Ochi JW. Acupuncture instead of codeine for tonsillectomy pain in children. Int J Pediatr Otorhinolaryngol 2013; 77:2058-62. [PMID: 24210291 DOI: 10.1016/j.ijporl.2013.10.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/06/2013] [Accepted: 10/09/2013] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Severe throat pain can result from tonsillectomy and last up to 10 days in children. Codeine elixir has long been used for pain relief, but has recently been banned by the Food and Drug Administration due to a recently recognized risk of death. We explored acupuncture as an alternative means of pain relief for children and adolescents after tonsillectomy. METHODS This was a retrospective review of children and adolescents who underwent tonsillectomy over a three-month period. No narcotics were prescribed after surgery. Patients who wanted help with pain relief were offered acupuncture. Perceived pain level was assessed before and after the acupuncture treatment. Following the 10-day recovery for tonsillectomy, patients or their parents were queried as to how long the pain relief from acupuncture intervention was perceived to last. RESULTS 56 children and adolescents underwent tonsillectomy in the three-month window selected for the retrospective review. 31 of these patients (ranging from 2 to 17 years in age) received an acupuncture intervention for postoperative pain. The mean reported pain level before acupuncture was 5.52 (SD = 2.28) out of 10. This fell to 1.92 (SD = 2.43) after acupuncture. Statistical analysis supported the general conclusion that pain reports decline after acupuncture in the sampled population. However, the limitations of the methodology and the sample suggest that this generalization should be treated as preliminary. 17 patients or their parents provided a post-recovery report for how long they believed the acupuncture intervention lasted. The mean duration of perceived acupuncture benefit was 61.24 h, though the standard deviation was large (64.58 h) with about 30% of patients reporting less than three hours of benefit and about 30% reporting more than 60 h. No adverse effects were observed as a result of acupuncture treatments. CONCLUSIONS The data tentatively suggest that acupuncture decreases perceived pain in children and adolescents after tonsillectomy. These data - combined with the cost effectiveness, safety and ease of administering acupuncture - suggest that further studies exploring the effectiveness of acupuncture in juveniles after tonsillectomy are merited.
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Affiliation(s)
- James W Ochi
- Children's ENT of San Diego, Inc., 477 North El Camino Real, Suite C303, Encinitas, CA 92024, United States.
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17
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Near-infrared spectroscopy for objectifying cerebral effects of laser acupuncture in term and preterm neonates. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:346852. [PMID: 23762122 PMCID: PMC3671269 DOI: 10.1155/2013/346852] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/22/2013] [Accepted: 04/26/2013] [Indexed: 12/22/2022]
Abstract
Laser acupuncture (LA) becomes more and more relevant in neonates and infants. With near-infrared spectroscopy (NIRS), a continuous and noninvasive measurement of tissue oxygenation is possible. Aim was to investigate, whether the application of LA was associated with any changes in regional cerebral oxygen saturation (rcSO2) in term and preterm neonates. The study included 20 neonates (12 males, 8 females). The Large Intestine 4 acupuncture point (LI 4, Hegu) was stimulated by a microlaser needle (10 mW, 685 nm laser needle EG GmbH, Germany) for 5 minutes, bilaterally. All neonates underwent polygraphic recording during undisturbed daytime sleep, including heart rate (HR), peripheral oxygen saturation (SpO2), and measurement of nasal flow. Using NIRS, rcSO2 was measured continuously. Cerebral fractional tissue oxygen extraction (cFTOE) was calculated. We did not observe any significant changes in SpO2 and HR values during the whole observation period. However, there was a significant decrease in rcSO2 (P = 0.003) within postintervention period, accompanied by a significant increase in cFTOE (P = 0.010) in postintervention period.
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18
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Efficacy and safety of acupuncture in preterm and term infants. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:739414. [PMID: 23878607 PMCID: PMC3710611 DOI: 10.1155/2013/739414] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 05/13/2013] [Accepted: 05/28/2013] [Indexed: 12/20/2022]
Abstract
The aim of the paper was to review the literature about safety and efficiency of acupuncture therapy in term and preterm infants. We searched Medline, EMBASE, and Cochrane Central Register of Controlled Trials using a predefined algorithm, reviewed abstracts from the Pediatric Academic Society annual meetings (2000–2012), and performed a manual search of references in narrative and systematic reviews. A total of 26 studies identified met our search criteria. Only 6 of these studies met our inclusion criteria; however, two studies had to be excluded because the manuscripts were published in Chinese. Hence, only four studies were included in our analysis. Three of the four studies evaluated the effects of acupuncture on infantile colic, and one assessed pain reduction during minor painful procedures in preterm babies. The limited data available suggests that acupuncture could be a safe nonpharmacologic treatment option for pain reduction in term and preterm infants and could also be a non-pharmacologic treatment option to treat infantile colic. Currently acupuncture in infants should be limited to clinical trials and studies evaluating short- and long-term effects and should be performed only by practitioners with adequate training and experience in neonatal/pediatric acupuncture.
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Rusy LM, Weisman SJ, Hainsworth KR. Developing an in-patient acupuncture treatment in a pediatric hospital. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2013; 10:/j/jcim.2013.10.issue-1/jcim-2012-0056/jcim-2012-0056.xml. [PMID: 23652642 DOI: 10.1515/jcim-2012-0056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2012] [Accepted: 02/01/2013] [Indexed: 11/15/2022]
Abstract
Little is known about the broad application of acupuncture as adjuvant treatment for in-patient pediatric populations. We review a series of cases involving acupuncture for conditions ranging from insomnia to cyclic vomiting. The details of the protocol for each are included. This case series illustrates the benefits of an in-patient acupuncture treatment service, as well as the subtleties of an acupuncture protocol when treating children and adolescents.
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Affiliation(s)
- Lynn M Rusy
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
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Raith W, Litscher G, Müller W, Urlesberger B. Laseracupuncture - a possible alternative treatment for agitation and pain in neonates? Paediatr Anaesth 2013; 23:205-6. [PMID: 23289778 DOI: 10.1111/pan.12089] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Gerhard Litscher
- Stronach Research Unit for Complementary and Integrative Laser Medicine, Research Unit of Biomedical Engineering in Anesthesia and Intensive Care Medicine and TCM Research Center Graz; Medical University of Graz; Graz; Austria
| | - Wilhelm Müller
- Division of Neonatology, Department of Paediatrics; Medical University of Graz; Graz; Austria
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21
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Thermographical measuring of the skin temperature using laser needle acupuncture in preterm neonates. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:614210. [PMID: 22666295 PMCID: PMC3359831 DOI: 10.1155/2012/614210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 03/07/2012] [Indexed: 11/18/2022]
Abstract
In children, laser acupuncture is used more often than needle acupuncture in Western countries, due to their aversion to needles. When applying laser acupuncture to premature babies and neonates, firstly the degree of the thermal increase to the skin has to be evaluated so as to guarantee safe application. The patients were premature neonates before their discharge from hospital. The measurements were carried out by means of a polygraphy while they were asleep shortly. The large intestine 4 acupoint (LI4, Hegu) was stimulated by a microlaser needle (10 mW, 685 nm) twice (5 and 10 min). Local thermographic pictures were taken with a thermal camera (Flir i5, Flir Systems Inc., Portland, USA), and the warmest point was determined and subsequently compared. The study included 10 premature neonates (7 male, 3 female). The measurements were carried out on the 33rd day of life (weight 2030 g, gestational age 36 + 3 weeks of pregnancy). In comparison to the initial temperature (32.9°C), after 5 minutes of stimulation (33.9°C) (P = 0.025) and also after 10 minutes of stimulation (34.0°C) (P = 0.01), there was found to be a significant increase in the skin temperature. The singular maximum value of 37.9°C bears a potential danger; however, compared to the local temperatures reached in transcutaneous blood gas measurements it appears not to entail any risks.
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