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[Evidence-based guideline for neonatal pain management in China (2023)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:109-127. [PMID: 36854686 PMCID: PMC9979385 DOI: 10.7499/j.issn.1008-8830.2210052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/06/2022] [Indexed: 03/02/2023]
Abstract
Pain disrupts neonatal vital signs and internal environment homeostasis and affects the recovery process, and recurrent pain stimulation is one of the important risk factors for neurodevelopmental disorders and some chronic diseases. In order to standardize pain management practice in neonatal wards in China and effectively prevent and reduce the adverse effects of pain on the physical and mental development of neonates, National Clinical Research Center for Child Health and Diseases (Children's Hospital of Chongqing Medical University) convened a multidisciplinary panel to formulate the evidence-based guideline for neonatal pain management in China (2023 edition) following the principles and methods for the guideline development issued by the World Health Organization. Based on the best evidence and expert consensus, this guideline gives 26 recommendations for nine clinical issues, i.e., the classification and definition of neonatal pain, common sources of pain, pain assessment principles, pain assessment methods, analgesic principle, non-pharmaceutical analgesic methods, pharmaceutical analgesic methods, parental participation in pain management, and recording methods for pain management, so as to provide medical staff with guidance and a decision-making basis for neonatal pain assessment and analgesia management.
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Avcin E, Kucukoglu S. The Effect of Breastfeeding, Kangaroo Care, and Facilitated Tucking Positioning in Reducing the Pain During Heel Stick in Neonates. J Pediatr Nurs 2021; 61:410-416. [PMID: 34687988 DOI: 10.1016/j.pedn.2021.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/26/2021] [Accepted: 10/04/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Invasive intervention can negatively affect prognosis, behavior, environmental adaptation in neonates. Some nonpharmacological pain management methods are used for effective pain treatment. This study investigated the effect of breastfeeding, kangaroo care, and facilitated tucking positioning on heel-stick pain in neonates. DESIGN A quasi-experimental design was employed. The study was conducted in three family health centers in Kütahya/Turkey. The sample consisted of 140 healthy neonates with the gestational age of 37 weeks or more, birth weight greater than 2500 g, and no sucking problems. The sample was divided into four groups (breastfeeding, kangaroo care, facilitated tucking position, and control). Data were collected using a Baby-Mother Characteristics Questionnaire, a Physiological Parameter Follow-up Form, and the Neonatal Infant Pain Scale. Data were analyzed using chi-square, the one-way analysis of variance (ANOVA), Kruskal-Wallis, Student t-test, and Mann-Whitney U tests. The research adhered to ethical principles. RESULTS The facilitated tucking position group cried less and experienced less pain during heel stick than the other groups (p < 0.05). Breastfeeding, kangaroo care, and facilitating tucking help reduce heel-stick pain but facilitating tucking causes less crying and imposes less pain on neonates than the other methods. CONCLUSION Facilitated tucking position may be preferred to reduce pain during heel stick. PRACTICE IMPLICATIONS Using facilitated tucking positions and breastfeeding methods can assist healthcare professionals as supportive methods in pain management.
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Affiliation(s)
- Emel Avcin
- Yalova University, Termal Vocational School, Turkey
| | - Sibel Kucukoglu
- Selcuk University, Faculty of Nursing, Department of Child Health and Disease Nursing, Turkey.
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Ullsten A, Andreasson M, Eriksson M. State of the Art in Parent-Delivered Pain-Relieving Interventions in Neonatal Care: A Scoping Review. Front Pediatr 2021; 9:651846. [PMID: 33987153 PMCID: PMC8112545 DOI: 10.3389/fped.2021.651846] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction: Parents' active involvement during painful procedures is considered a critical first step in improving neonatal pain practices. Of the non-pharmacological approaches in use, the biopsychosocial perspective supports parent-delivered interventions, in which parents themselves mediate pain relief, consistent with modern family-integrated care. This scoping review synthesizes the available research to provide an overview of the state of the art in parent-delivered pain-relieving interventions. Methods: A scoping review was performed to achieve a broad understanding of the current level of evidence and uptake of parent-driven pain- and stress-relieving interventions in neonatal care. Results: There is a strong evidence for the efficacy of skin-to-skin contact and breastfeeding, preferably in combination. These parent-delivered interventions are safe, valid, and ready for prompt introduction in infants' pain care globally. Research into parents' motivations for, and experiences of, alleviating infant pain is scarce. More research on combined parent-delivered pain alleviation, including relationship-based interventions such as the parent's musical presence, is needed to advance infant pain care. Guidelines need to be updated to include infant pain management, parent-delivered interventions, and the synergistic effects of combining these interventions and to address parent involvement in low-income and low-tech settings. Conclusions: A knowledge-to-practice gap currently remains in parent-delivered pain management for infants' procedure-related pain. This scoping review highlights the many advantages of involving parents in pain management for the benefit not only of the infant and parent but also of health care.
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Affiliation(s)
- Alexandra Ullsten
- Center for Clinical Research, Region Värmland, Karlstad, Sweden
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Matilda Andreasson
- Faculty of Medicine and Health, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Mats Eriksson
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
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Gomes Neto M, da Silva Lopes IA, Araujo ACCLM, Oliveira LS, Saquetto MB. The effect of facilitated tucking position during painful procedure in pain management of preterm infants in neonatal intensive care unit: a systematic review and meta-analysis. Eur J Pediatr 2020; 179:699-709. [PMID: 32222816 DOI: 10.1007/s00431-020-03640-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 02/13/2020] [Accepted: 03/18/2020] [Indexed: 12/14/2022]
Abstract
We performed a systematic review and meta-analysis to investigate the effects of facilitated tucking position during painful procedure in pain management of preterm infants. We searched MEDLINE, PEDro, SciELO and the Cochrane Library (until June 2019) for randomized controlled trials. An α value ≤ 0.05 was considered significant. Heterogeneity among studies was examined with Cochran's Q and I2 statistic, in which values greater than 40% were considered indicative of high heterogeneity and random-effects model was chosen. Analyses were performed with Review Manager 5.3. Fifteen studies met the eligibility criteria, including 664 preterm infants. The meta-analyses showed a significant reduction in pain of - 1.02 (95% CI - 1.7 to - 0.4, N = 216) during endotraqueal suctioning for participants in the facilitated tucking position group (FTPG) compared with routine care group. The meta-analyses showed a non-significant difference in pain - 0.3 (95% CI - 2.05 to - 1.4, N = 88) during heel stick for participants in the FTPG compared with oral glucose group. The meta-analyses showed a non-significant difference in pain for participants in the FTPG compared with oral opioid group 0.2 (95% CI - 1.4 to 1.8, N = 140).Conclusion: Facilitated tucking position may improve the pain during painful procedures.What is Known:• Exposure of premature babies to painful procedures is associated with changes in brain development, regardless of other factors.• Facilitated tucking reduces the expression of pain in premature infants.What is New:• Facilitated tucking position was efficient in pain management of preterm infants when compared to routine care.• Facilitated tucking compared to opioid or oral glucose did not achieve a significant reduction in pain intensity.
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Affiliation(s)
- Mansueto Gomes Neto
- Physiotherapy Department, Physiotherapy Course, Federal University of Bahia, Salvador, Bahia, Brazil.,Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil.,Graduate Program in Medicine and Health, Faculty of Medicine of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil
| | | | | | - Lucas Silva Oliveira
- Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Micheli Bernardone Saquetto
- Physiotherapy Department, Physiotherapy Course, Federal University of Bahia, Salvador, Bahia, Brazil. .,Physiotherapy Research Group, Federal University of Bahia, Salvador, Bahia, Brazil. .,Graduate Program in Medicine and Health, Faculty of Medicine of Bahia, Federal University of Bahia, Salvador, Bahia, Brazil. .,Departamento de Fisioterapia, Curso de Fisioterapia, Instituto de Ciências da Saúde, Universidade Federal da Bahia-UFBA, Av. Reitor Miguel Calmon s/n - Vale do Canela, Salvador, BA, CEP 40110-100, Brazil.
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Apaydin Cirik V, Efe E. The effect of expressed breast milk, swaddling and facilitated tucking methods in reducing the pain caused by orogastric tube insertion in preterm infants: A randomized controlled trial. Int J Nurs Stud 2020; 104:103532. [DOI: 10.1016/j.ijnurstu.2020.103532] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/18/2019] [Accepted: 01/17/2020] [Indexed: 01/23/2023]
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McNair C, Campbell-Yeo M, Johnston C, Taddio A. Nonpharmacologic Management of Pain During Common Needle Puncture Procedures in Infants: Current Research Evidence and Practical Considerations: An Update. Clin Perinatol 2019; 46:709-730. [PMID: 31653304 DOI: 10.1016/j.clp.2019.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. Numerous nonpharmacologic interventions are available that may be used for these painful procedures, including swaddling/containment, pacifier/non-nutritive sucking, rocking/holding, breastfeeding and breastmilk, skin-to-skin care, sweet tasting solutions, music therapy, sensorial saturation, and parental presence. Adoption these interventions into routine clinical practice is feasible and should be a standard of care in quality health care for infants. This review summarizes the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions.
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Affiliation(s)
- Carol McNair
- Nursing and Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada
| | - Marsha Campbell-Yeo
- Department of Pediatrics, IWK Health Centre, School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Celeste Johnston
- Ingram School of Nursing, McGill University, Montreal, Canada; IWK Health Centre, 5850/5980 University Avenue, Halifax B3K 6R8, Canada
| | - Anna Taddio
- Clinical, Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Child Health Evaluative Sciences, The Hospital for Sick Children, 144 College Street, Toronto, Ontario M5S 3M2, Canada.
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Kyololo OM, Stevens BJ, Songok J. Mothers' Perceptions about Pain in Hospitalized Newborn Infants in Kenya. J Pediatr Nurs 2019; 47:51-57. [PMID: 31039509 DOI: 10.1016/j.pedn.2019.04.015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/13/2019] [Accepted: 04/13/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Explore views of mothers about pain and pain treatment practices in hospitalized newborn infants. DESIGN AND METHODS A Qualitative descriptive study using photo-elicitation technique was conducted in a level I and a level II neonatal units in Kenya. Fifteen semi-structured interviews were conducted with mothers of hospitalized infants. The interviews were audio-recorded, transcribed verbatim and analysed using inductive content analysis approach. RESULTS Mothers described the experience of witnessing their infants undergo painful procedures as emotionally and psychologically traumatic. Participants felt helpless for not being able to protect their infants from pain a situation which was made worse by health care providers who appeared less concerned about pain relief during procedures. Mothers' views demonstrated a good understanding of pain-relief strategies; they identified strategies that health care providers should routinely use to relief pain in hospitalized infants. Furthermore, participants desired to be involved in comforting their infants during clinical procedures. CONCLUSION Repeated and untreated painful procedures continue to define the hospitalisation experience of newborn infants despite the presence of mothers who desire to be involved in comforting their infants during procedures. PRACTICE IMPLICATION Minimizing the burden of pain and using pain-relieving interventions could reduce parental stress and optimize parental role attainment following hospitalisation.
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Affiliation(s)
| | - Bonnie J Stevens
- University of Toronto, Toronto, Canada; The Hospital for Sick Children, Toronto, Canada
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Gautheyrou L, Durand S, Jourdes E, De Jonckheere J, Combes C, Cambonie G. Facilitated tucking during early neonatologist-performed echocardiography in very preterm neonates. Acta Paediatr 2018; 107:2079-2085. [PMID: 30144169 DOI: 10.1111/apa.14555] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 08/04/2018] [Accepted: 08/22/2018] [Indexed: 11/27/2022]
Abstract
AIM To assess the effect of facilitated tucking (FT), a nonpharmacologic nursing intervention, on echocardiographic parameters and infant comfort collected prospectively during neonatologist-performed echocardiography. METHODS Echocardiography was performed twice, in standard conditions and with FT; the order was randomised by computer. Echocardiography provided data on pulmonary artery flow and pressure, right and left ventricular function, and persistent ductus arteriosus. Comfort was assessed by a behavioural scale of pain, variations in heart rate (HR) and SpO2 , and a newborn infant parasympathetic evaluation index based on the high-frequency variability in HR. RESULTS Fifty newborns, with mean gestational age of 28 [26.6-29.0] weeks and mean birthweight of 950 [780-1190] g, were studied at a postnatal age of 13 [9-27] hours. FT was associated with longer acceleration time/right ventricular ejection time in the main pulmonary artery (p = 0.006), reduced averaged HR variations (p = 0.03) and lower pain scores (p < 0.001). The other haemodynamic parameters and the parasympathetic index were not influenced by FT. CONCLUSION Echocardiography performed soon after birth in very premature neonates may generate mild discomfort. FT during echocardiography is associated with lower pulmonary artery pressures and improves infant's comfort during this examination.
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Affiliation(s)
- Laurène Gautheyrou
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Sabine Durand
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Emilie Jourdes
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Julien De Jonckheere
- EA 4489, Perinatal Growth and Environment; Lille University; Montpellier Cedex 5 France
- CIC-IT 1403; Lille University Hospital; Lille France
| | - Clémentine Combes
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
| | - Gilles Cambonie
- Neonatal Intensive Care Unit; Arnaud de Villeneuve Hospital; Montpellier University Hospital; Montpellier Cedex 5 France
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Ho LP, Ho SSM, Leung DYP, So WKW, Chan CWH. A feasibility and efficacy randomised controlled trial of swaddling for controlling procedural pain in preterm infants. J Clin Nurs 2016; 25:472-82. [PMID: 26818372 DOI: 10.1111/jocn.13075] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2015] [Indexed: 01/29/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to investigate the feasibility and efficacy of swaddling to control procedural pain among preterm infants. BACKGROUND Swaddling has been recommended for controlling neonatal pain. However, the feasibility for use is uncertain and insufficient evidence is available among preterm infants. DESIGN A two-arm randomised controlled trial with repeated measures. METHOD The study was conducted in a 21-bed neonatal intensive care unit of a regional hospital in Hong Kong. Preterm infants who required heelstick procedure were eligible. Fifty-four preterm infants between 30-37 gestational weeks were randomly assigned to swaddling (n = 27) and control (standard care, n = 27) groups. Pain assessment was performed pre, during, immediate, two, four, six and eight minutes after heelstick procedure using the Premature Infant Pain Profile. RESULTS The mean Premature Infant Pain Profile scores were significantly reduced in the intervention group compared to the control group during, immediate, two, four, and six minutes after the heelstick procedure. The mean changes of heart rate and oxygen saturation in the intervention group were significantly lower than that of the control group at all measured time points. Notably, the swaddled infants quickly resumed to the baseline level at two minutes whereas the control group reached the stable state at an extended period of six minutes. CONCLUSION The findings show that swaddling is feasible and efficacious in controlling pain for heelstick procedure among preterm infants. No adverse effects were observed. RELEVANCE TO CLINICAL PRACTICE This article presents the feasibility and efficacy of swaddling as a non-pharmacological and non-invasive intervention to relieve pain during the heelstick procedures among preterm infants. Swaddling can contribute to control minor procedural pain in neonates as one of the simple, safe, cost effective, humanistic and natural analgesia alternatives.
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Affiliation(s)
- Lai Ping Ho
- Neonatal Unit, Prince of Wales Hospital, Hong Kong SAR, China
| | - Simone S M Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Doris Y P Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Carmen W H Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong SAR, China
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McNair C, Campbell Yeo M, Johnston C, Taddio A. Nonpharmacological management of pain during common needle puncture procedures in infants: current research evidence and practical considerations. Clin Perinatol 2013; 40:493-508. [PMID: 23972753 DOI: 10.1016/j.clp.2013.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
All infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. Numerous nonpharmacologic interventions are available for these painful procedures, including swaddling, holding, skin-to-skin care, pacifier, sweet-tasting solutions, and breast-feeding. Adoption of nonpharmacologic pain-relieving interventions into routine clinical practice is feasible and should be a standard of care in the delivery of quality health care for infants. This review summarizes current knowledge about the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions for future research.
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Affiliation(s)
- Carol McNair
- Nursing, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, Canada
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Cone S, Pickler RH, Grap MJ, McGrath J, Wiley PM. Endotracheal suctioning in preterm infants using four-handed versus routine care. J Obstet Gynecol Neonatal Nurs 2013; 42:92-104. [PMID: 23316894 DOI: 10.1111/1552-6909.12004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To evaluate the effect of four-handed care on preterm infants' physiologic and behavioral responses to and recovery from endotracheal suctioning versus routine endotracheal (ETT) suctioning. DESIGN Randomized crossover design with infants as their own controls. SETTING Single-family-room newborn intensive care unit in an academic health center. PARTICIPANTS Ten intubated infants on conventional ventilation with inline suctioning who were fewer than 37 weeks gestation at birth, and less than one week of age. METHODS Each infant was observed twice on a single day. One observation involved routine ETT suctioning and one involved four-handed care. Physiologic and behavioral response data were collected. RESULTS No differences were noted when comparing baseline heart rate (HR) or oxygen saturation (SpO(2)) data to those obtained during and after suctioning while in the routine care condition. In the four-handed care condition, mean SpO(2) increased from preobservation 95.49 to during observation saturation 97.75 (p = .001). Salivary cortisol levels did not differ between groups at baseline or postsuctioning. No significant difference in behavior state was observed between the two conditions. More stress and defense behaviors occurred postsuctioning when infants received routine care as opposed to four-handed care (p = .001) and more self-regulatory behaviors were exhibited by infants during (p = .019) and after suctioning (p = .016) when receiving four-handed care. No statistical difference was found in the number of monitor call-backs postsuctioning. CONCLUSIONS Four-handed care during suctioning was associated with a decrease in stress and defense behaviors and an increase in self-regulatory behaviors.
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Affiliation(s)
- Sharon Cone
- Children's Hospital of Richmond-Virginia Commonwealth University, Richmond, VA 23298, USA.
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