1
|
Amodei N, Nixon E, Zhang S, Hu Y, Vance A, Maye M. Associations between sociodemographic characteristics and neonatal length of the stay. J Perinatol 2024; 44:851-856. [PMID: 38773215 DOI: 10.1038/s41372-024-01976-6] [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] [Received: 10/29/2023] [Revised: 03/29/2024] [Accepted: 04/16/2024] [Indexed: 05/23/2024]
Abstract
BACKGROUND Infants with past NICU admission have a significantly higher risk of developing neurodevelopmental disorders. Studies have demonstrated an iatrogenic effect of the NICU environment on neurodevelopmental outcomes, even while accounting for physical factors. It is, therefore, critical that an infant's LOS is driven by physical needs versus sociodemographic barriers. METHODS We leveraged electronic health records and a backward selection regression model to explore physical and sociodemographic predictors of infant LOS. RESULTS Our results demonstrated that physical predictors (birthweight and ventilator use) accounted for the majority of variance in our model but that a sociodemographic predictor, mean visits per day, was also significant. CONCLUSIONS Infants who were visited more frequently experienced a shorter LOS, possibly due to increased parental involvement resulting in more individualized care and directly impacting infant stability and morbidity. By supporting visitation, we can reduce the costs of lengthy NICU hospitalizations while improving infant and parent health and well-being.
Collapse
Affiliation(s)
- Natalie Amodei
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Ellen Nixon
- American Hospital Association, Chicago, IL, USA
| | | | - Yong Hu
- Henry Ford Health, Detroit, MI, USA
| | - Ashlee Vance
- Henry Ford Health and Michigan State University Health Sciences (HFH+MSU Health Sciences), Center for Health Policy and Health Services Research, One Ford Place, Detroit, MI, USA
| | - Melissa Maye
- Henry Ford Health and Michigan State University Health Sciences (HFH+MSU Health Sciences), Center for Health Policy and Health Services Research, One Ford Place, Detroit, MI, USA.
| |
Collapse
|
2
|
Dutton A, Patel CD, Taylor SA, Garland CR, Turnbaugh EM, Alers-Velazquez R, Mehrbach J, Nautiyal KM, Leib DA. Asymptomatic neonatal herpes simplex virus infection in mice leads to long-term cognitive impairment. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.22.590596. [PMID: 38712140 PMCID: PMC11071430 DOI: 10.1101/2024.04.22.590596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Neonatal herpes simplex virus (nHSV) is a devastating infection impacting approximately 14,000 newborns globally each year. Infection is associated with high neurologic morbidity and mortality, making early intervention and treatment critical. Clinical outcomes of symptomatic nHSV infections are well-studied, but little is known about the frequency of, or outcomes following, sub-clinical or asymptomatic nHSV. Given the ubiquitous nature of HSV infection and frequency of asymptomatic shedding in adults, subclinical infections are underreported, yet could contribute to long-term neurological damage. To assess potential neurological morbidity associated with subclinical nHSV infection, we developed a low-dose (100 PFU) HSV infection protocol in neonatal C57BL/6 mice. At this dose, HSV DNA was detected in the brain by PCR but was not associated with acute clinical symptoms. However, months after initial inoculation with 100 PFU of HSV, we observed impaired mouse performance on a range of cognitive and memory performance tasks. Memory impairment was induced by infection with either HSV-1 or HSV-2 wild-type viruses, but not by a viral mutant lacking the autophagy-modulating Beclin-binding domain of the neurovirulence gene γ34.5. Retroviral expression of wild type γ34.5 gene led to behavioral pathology in mice, suggesting that γ34.5 expression may be sufficient to cause cognitive impairment. Maternal immunization and HSV-specific antibody treatment prevented offspring from developing neurological sequelae following nHSV-1 infection. Altogether, these results support the idea that subclinical neonatal infections may lead to cognitive decline in adulthood, with possible profound implications for research on human neurodegenerative disorders such as Alzheimer's Disease.
Collapse
|
3
|
Barone G, Natile M, Nigro CS, D'Andrea V, Ancora G. Prospective case series study on the use of a novel analgosedation protocol for ultrasound-guided catheterization in Neonatal Intensive Care Unit. Eur J Pediatr 2024:10.1007/s00431-024-05557-9. [PMID: 38592483 DOI: 10.1007/s00431-024-05557-9] [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: 02/21/2024] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 04/10/2024]
Abstract
Critically ill newborns admitted to Neonatal Intensive Care Unit often require a centrally inserted central catheters (CICCs) inserted by ultrasound-guided puncture of the internal jugular or brachio-cephalic vein. Achieving an appropriate level of sedation and analgesia is paramount for procedure success and patient safety, avoiding the potential risks associated with excessive deep sedation. The aim of this study is to evaluate the feasibility of a novel protocol of sedation. Data from 46 patients were prospectively collected. The feasibility was assessed throughout the monitoring of adverse events and the incidence of spontaneous movements. The procedure was completed in 100% of cases. There were no cases of escalation of the baseline ventilatory support despite the procedure and no case of hypotension, and all spontaneous movements were controlled with additional boluses when required. CONCLUSION Our study represents the very first step towards the design of a validated protocol for analgosedation during ultrasound-guided CICC insertion in NICU. WHAT IS KNOWN • Critically ill newborns admitted to Neonatal Intensive Care Unit often require a centrally inserted central catheter. • Achieving an appropriate level of sedation and analgesia is paramount for procedure success and patient safety, avoiding the potential risks associated with excessive deep sedation. WHAT IS NEW • The use of this new protocol for analgosedation is able to achieve a good level of sedation and pain control without significant adverse event. • Ultrasound-guided CICC insertion can be performed even in non-ventilated newborns.
Collapse
Affiliation(s)
- Giovanni Barone
- Neonatal Intensive Care Unit, Infermi Hospital Rimini, AUSL della Romagna, Viale Settembrini, n 2, Rimini, Italy.
| | - Miria Natile
- Neonatal Intensive Care Unit, Infermi Hospital Rimini, AUSL della Romagna, Viale Settembrini, n 2, Rimini, Italy
| | | | - Vito D'Andrea
- Neonatal Intensive Care Unit, Fondazione Policlinico A. Gemelli, Rome, Italy
| | - Gina Ancora
- Neonatal Intensive Care Unit, Infermi Hospital Rimini, AUSL della Romagna, Viale Settembrini, n 2, Rimini, Italy
| |
Collapse
|
4
|
Lee J. Neonatal family-centered care: evidence and practice models. Clin Exp Pediatr 2024; 67:171-177. [PMID: 37321589 PMCID: PMC10990654 DOI: 10.3345/cep.2023.00367] [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: 02/20/2023] [Revised: 05/16/2023] [Accepted: 06/07/2023] [Indexed: 06/17/2023] Open
Abstract
Although advances in neonatology have reduced the mortality rate of high-risk infants, sick newborns or pre-mature infants undergo more intensive monitoring, pain-ful procedures, and lengthy hospitalization, leading to pro-longed separation from their parents. In recent decades, the importance of parent-infant closeness early in life has become more apparent, especially in preterm infants who are prone to neurodevelopmental deficits. There is an increasing body of evidence regarding the benefits of family-centered care (FCC) in neonatal intensive care units. Key aspects related to neonatal FCC include the parents' presence in the ward and their participation in infants' daily care and decision-making processes. In addition, an environment that supports a private and comfortable space for each family member and infant, such as a single-family room, should be provided. To successfully implement FCC in neonatal intensive care units, the culture of care and hospital policies should be changed to successfully implement FCC in neonatal intensive care units, and appropriate training for medical staff is also required.
Collapse
Affiliation(s)
- Juyoung Lee
- Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
| |
Collapse
|
5
|
Askarinia S, Razban F, Nematollahi M, Mangolian Shahrbabaki P. Comparing the effect of aromatherapy with breast milk, Lavandula stoechas, and Rosa damascena on venipuncture pain in preterm infants. Explore (NY) 2024; 20:206-211. [PMID: 37635050 DOI: 10.1016/j.explore.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/29/2023]
Abstract
INTRODUCTION AND OBJECTIVES Since preterm infants frequently undergo painful diagnostic and therapeutic procedures, pain management, especially through non-pharmacological methods, will be extremely beneficial. Accordingly, the present study aimed to compare the effects of aromatherapy with breast milk, Lavandula stoechas, and Rosa damascena on venipuncture pain in preterm infants. METHODS In this interventional study, preterm infants were randomly divided into four groups of aromatherapy with breast milk (25 infants), Lavandula stoechas (25 infants), Rosa damascena (25 infants), and sham (25 infants). One minute before, during, and two minutes after venipuncture, the Neonatal Infant Pain Scale (NIPS) as well as heart rate and SPO2 were measured. RESULTS The results indicated that pain intensity was significantly lower during and after venipuncture in all the aromatherapy methods compared with the sham group (P < 0.001). Breast milk odor decreased the pain more than the other two odors during and after venipuncture (P < 0.001); however, there was no significant difference between Lavandula stoechas and Rosa damascena (P = 0.94). SPO2 was significantly higher in infants in the Lavandula stoechas (P < 0.001) and Rosa damascena (P = 0.03) groups compared with the sham infants. CONCLUSION All three aromatherapy methods were effective in decreasing preterm infants' venipuncture pain. Since no study on the effect of aromatherapy with Rosa damascena was found in this regard, the effectiveness of aromatherapy with Rosa damascena is of great importance, and future studies are recommended to analyze this topic in greater depth.
Collapse
Affiliation(s)
- Soheila Askarinia
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Farideh Razban
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Monirsadat Nematollahi
- Department of Pediatric and Neonatal Intensive Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.
| |
Collapse
|
6
|
Racine N, Chow C, Hamwi L, Bucsea O, Cheng C, Du H, Fabrizi L, Jasim S, Johannsson L, Jones L, Laudiano-Dray MP, Meek J, Mistry N, Shah V, Stedman I, Wang X, Riddell RP. Health Care Professionals' and Parents' Perspectives on the Use of AI for Pain Monitoring in the Neonatal Intensive Care Unit: Multisite Qualitative Study. JMIR AI 2024; 3:e51535. [PMID: 38875686 DOI: 10.2196/51535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/24/2023] [Accepted: 12/17/2023] [Indexed: 06/16/2024]
Abstract
BACKGROUND The use of artificial intelligence (AI) for pain assessment has the potential to address historical challenges in infant pain assessment. There is a dearth of information on the perceived benefits and barriers to the implementation of AI for neonatal pain monitoring in the neonatal intensive care unit (NICU) from the perspective of health care professionals (HCPs) and parents. This qualitative analysis provides novel data obtained from 2 large tertiary care hospitals in Canada and the United Kingdom. OBJECTIVE The aim of the study is to explore the perspectives of HCPs and parents regarding the use of AI for pain assessment in the NICU. METHODS In total, 20 HCPs and 20 parents of preterm infants were recruited and consented to participate from February 2020 to October 2022 in interviews asking about AI use for pain assessment in the NICU, potential benefits of the technology, and potential barriers to use. RESULTS The 40 participants included 20 HCPs (17 women and 3 men) with an average of 19.4 (SD 10.69) years of experience in the NICU and 20 parents (mean age 34.4, SD 5.42 years) of preterm infants who were on average 43 (SD 30.34) days old. Six themes from the perspective of HCPs were identified: regular use of technology in the NICU, concerns with regard to AI integration, the potential to improve patient care, requirements for implementation, AI as a tool for pain assessment, and ethical considerations. Seven parent themes included the potential for improved care, increased parental distress, support for parents regarding AI, the impact on parent engagement, the importance of human care, requirements for integration, and the desire for choice in its use. A consistent theme was the importance of AI as a tool to inform clinical decision-making and not replace it. CONCLUSIONS HCPs and parents expressed generally positive sentiments about the potential use of AI for pain assessment in the NICU, with HCPs highlighting important ethical considerations. This study identifies critical methodological and ethical perspectives from key stakeholders that should be noted by any team considering the creation and implementation of AI for pain monitoring in the NICU.
Collapse
Affiliation(s)
- Nicole Racine
- School of Psychology, University of Ottawa, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Cheryl Chow
- Department of Psychology, York University, Toronto, ON, Canada
| | - Lojain Hamwi
- Department of Psychology, York University, Toronto, ON, Canada
| | - Oana Bucsea
- Department of Psychology, York University, Toronto, ON, Canada
| | - Carol Cheng
- Department of Nursing, Mount Sinai Hospital, Toronto, ON, Canada
| | - Hang Du
- Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | - Lorenzo Fabrizi
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Sara Jasim
- Department of Psychology, York University, Toronto, ON, Canada
| | | | - Laura Jones
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Maria Pureza Laudiano-Dray
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Judith Meek
- Neonatal Care Unit, University College London Hospitals, London, United Kingdom
| | - Neelum Mistry
- Department of Neuroscience, Physiology and Pharmacology, University College London, London, United Kingdom
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada
| | - Ian Stedman
- School of Public Policy and Administration, York University, Toronto, ON, Canada
| | - Xiaogang Wang
- Department of Mathematics and Statistics, York University, Toronto, ON, Canada
| | | |
Collapse
|
7
|
Pirlotte S, Beeckman K, Ooms I, Cools F. Non-pharmacological interventions for the prevention of pain during endotracheal suctioning in ventilated neonates. Cochrane Database Syst Rev 2024; 1:CD013353. [PMID: 38235838 PMCID: PMC10795104 DOI: 10.1002/14651858.cd013353.pub2] [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] [Indexed: 01/19/2024]
Abstract
BACKGROUND Pain, when treated inadequately, puts preterm infants at a greater risk of developing clinical and behavioural sequelae because of their immature pain system. Preterm infants in need of intensive care are repeatedly and persistently exposed to noxious stimuli, and this happens during a critical window of their brain development with peak rates of brain growth, exuberant synaptogenesis and the developmental regulation of specific receptor populations. Nearly two-thirds of infants born at less than 29 weeks' gestation require mechanical ventilation for some duration during the newborn period. These neonates are endotracheally intubated and require repeated endotracheal suctioning. Endotracheal suctioning is identified as one of the most frequent and most painful procedures in premature infants, causing moderate to severe pain. Even with improved nursing performance and standard procedures based on neonatal needs, endotracheal suctioning remains associated with mild pain. OBJECTIVES To evaluate the benefits and harms of non-pharmacological interventions for the prevention of pain during endotracheal suctioning in mechanically ventilated neonates. Non-pharmacological interventions were compared to no intervention, standard care or another non-pharmacological intervention. SEARCH METHODS We conducted searches in June 2023 in the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE via PubMed, Embase, CINAHL and three trial registries. We searched the reference lists of related systematic reviews, and of studies selected for inclusion. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs and cluster-RCTs that included term and preterm neonates who were mechanically ventilated via endotracheal tube or via tracheostomy tube and required endotracheal suctioning performed by doctors, nurses, physiotherapists or other healthcare professionals. DATA COLLECTION AND ANALYSIS Our main outcome measures were validated composite pain scores (including a combination of behavioural, physiological and contextual indicators). Secondary outcomes included separate physiological and behavioural pain indicators. We used standard methodological procedures expected by Cochrane. For continuous outcome measures, we used a fixed-effect model and reported mean differences (MDs) with 95% confidence intervals (CIs). For categorical outcomes, we reported the typical risk ratio (RR) and risk difference (RD) and 95% CIs. We assessed risk of bias using the Cochrane RoB 1 tool, and assessed the certainty of the evidence using GRADE. MAIN RESULTS We included eight RCTs (nine reports), which enroled 386 infants, in our review. Five of the eight studies were included in a meta-analysis. All studies enrolled preterm neonates. Facilitated tucking versus standard care (four studies) Facilitated tucking probably reduces Premature Infant Pain Profile (PIPP) score during endotracheal suctioning (MD -2.76, 95% CI 3.57 to 1.96; I² = 82%; 4 studies, 148 infants; moderate-certainty evidence). Facilitated tucking probably has little or no effect during endotracheal suctioning on: heart rate (MD -3.06 beats per minute (bpm), 95% CI -9.33 to 3.21; I² = 0%; 2 studies, 80 infants; low-certainty evidence); oxygen saturation (MD 0.87, 95% CI -1.33 to 3.08; I² = 0%; 2 studies, 80 infants; low-certainty evidence); or stress and defensive behaviours (SDB) (MD -1.20, 95% CI -3.47 to 1.07; 1 study, 20 infants; low-certainty evidence). Facilitated tucking may result in a slight increase in self-regulatory behaviours (SRB) during endotracheal suctioning (MD 0.90, 95% CI 0.20 to 1.60; 1 study, 20 infants; low-certainty evidence). No studies reported intraventricular haemorrhage (IVH). Familiar odour versus standard care (one study) Familiar odour during endotracheal suctioning probably has little or no effect on: PIPP score (MD -0.30, 95% CI -2.15 to 1.55; 1 study, 40 infants; low-certainty evidence); heart rate (MD -6.30 bpm, 95% CI -16.04 to 3.44; 1 study, 40 infants; low-certainty evidence); or oxygen saturation during endotracheal suctioning (MD -0.80, 95% CI -4.82 to 3.22; 1 study, 40 infants; low-certainty evidence). No studies reported SRB, SDB or IVH. White noise (one study) White noise during endotracheal suctioning probably has little or no effect on PIPP (MD -0.65, 95% CI -2.51 to 1.21; 1 study, 40 infants; low-certainty evidence); heart rate (MD -1.85 bpm, 95% CI -11.46 to 7.76; 1 study, 40 infants; low-certainty evidence); or oxygen saturation (MD 2.25, 95% CI -2.03 to 6.53; 1 study, 40 infants; low-certainty evidence). No studies reported SRB, SDB or IVH. AUTHORS' CONCLUSIONS Facilitated tucking / four-handed care / gentle human touch probably reduces PIPP score. The evidence of a single study suggests that facilitated tucking / four-handed care / gentle human touch slightly increases self-regulatory and approach behaviours during endotracheal suctioning. Based on a single study, familiar odour and white noise have little or no effect on any of the outcomes compared to no intervention. The use of expressed breast milk or oral sucrose suggests that there is no discernible advantage of one method over the other for reducing pain during endotracheal suctioning. None of the studies reported on any of the prespecified secondary outcomes of adverse events.
Collapse
Affiliation(s)
| | - Katrien Beeckman
- Midwifery Research, Education and Policymaking, Universiteit Antwerpen, Brussel, Belgium
| | - Isabel Ooms
- Physiotherapy and Neonatology, UZ Brussel, Jette, Belgium
| | - Filip Cools
- Neonatology, UZ Brussel, Jette, Belgium
- CEBAM, Belgian Centre for Evidence-Based Medicine, Leuven, Belgium
- Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
8
|
Vieira MF, Méio MDBB, Reis ABR, Villela LD, de Rodrigues MCC, de Almeida Di Maio Ferreira FCP, de Paula Barros LB, Costa RP, Menezes ER, Campos CO, Moreira MEL, Gomes-Junior SCS. High-risk children and social isolation: the importance of family functioning. Front Psychol 2023; 14:1190438. [PMID: 37425187 PMCID: PMC10325665 DOI: 10.3389/fpsyg.2023.1190438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 06/02/2023] [Indexed: 07/11/2023] Open
Abstract
High-risk newborns are exposed to neonatal conditions such as prematurity, very low birth weight, and congenital malformations that can affect development and behavior. Coronavirus disease 2019 (COVID-19) restraint and control measures have been identified as important stressor events and cumulative risk factors for behavioral changes in these children. This study examined social isolation-related factors that contribute to internalizing and externalizing behavior problems in children already at risk for neurodevelopmental disorders. This cross-sectional, multicenter study included 113 children (18 months to 9 years) who were followed in reference services for neonatal follow-up in tertiary units of the public health system in the city of Rio de Janeiro, Brazil. Behavior was assessed using the child behavior checklist, and a structured questionnaire was used to assess sociodemographic aspects. In the bivariate analysis, prematurity was associated with externalizing problems and change in eating habits with internalizing problems. The logistic model indicated that both parents having completed high school and both sharing care of the child were protective factors for behavioral problems; however, reports of sleep problems and living with another child were risk factors. In conclusion, the study identified internalizing and externalizing behavior problems related to prematurity and aspects of family structure and routine in children at risk. The findings confirm the importance of family functioning for child health and family-centered interventions.
Collapse
Affiliation(s)
- Maria Fernanda Vieira
- Follow-Up Clinic, Department of Neonatology, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maria Dalva Barbosa Baker Méio
- Follow-Up Clinic, Department of Neonatology, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
- Pesquisa Clínica Aplicada, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Ana Beatriz Rodrigues Reis
- Follow-Up Clinic, Department of Neonatology, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Letícia Duarte Villela
- Follow-Up Clinic, Department of Neonatology, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Maura Calixto Cecherelli de Rodrigues
- High-risk Newborn Follow-Up Clinic, Department of Pediatrics, Hospital Universitário Pedro Ernesto, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Letícia Baptista de Paula Barros
- Statistics Division, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Roozeméria Pereira Costa
- Follow-Up Clinic, Department of Neonatology, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Elaine Rego Menezes
- High-risk Newborn Follow-Up Clinic, Department of Pediatrics, Hospital Universitário Pedro Ernesto, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Camila Oliveira Campos
- Follow-Up Clinic, Hospital Gaffrée Guinle, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Maria Elisabeth Lopes Moreira
- Pesquisa Clínica Aplicada, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Saint Clair S. Gomes-Junior
- Pesquisa Clínica Aplicada, Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| |
Collapse
|
9
|
Hakimi N, Shahbakhti M, Horschig JM, Alderliesten T, Van Bel F, Colier WNJM, Dudink J. Respiratory Rate Extraction from Neonatal Near-Infrared Spectroscopy Signals. SENSORS (BASEL, SWITZERLAND) 2023; 23:s23094487. [PMID: 37177691 PMCID: PMC10181728 DOI: 10.3390/s23094487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Background: Near-infrared spectroscopy (NIRS) relative concentration signals contain 'noise' from physiological processes such as respiration and heart rate. Simultaneous assessment of NIRS and respiratory rate (RR) using a single sensor would facilitate a perfectly time-synced assessment of (cerebral) physiology. Our aim was to extract respiratory rate from cerebral NIRS intensity signals in neonates admitted to a neonatal intensive care unit (NICU). Methods: A novel algorithm, NRR (NIRS RR), is developed for extracting RR from NIRS signals recorded from critically ill neonates. In total, 19 measurements were recorded from ten neonates admitted to the NICU with a gestational age and birth weight of 38 ± 5 weeks and 3092 ± 990 g, respectively. We synchronously recorded NIRS and reference RR signals sampled at 100 Hz and 0.5 Hz, respectively. The performance of the NRR algorithm is assessed in terms of the agreement and linear correlation between the reference and extracted RRs, and it is compared statistically with that of two existing methods. Results: The NRR algorithm showed a mean error of 1.1 breaths per minute (BPM), a root mean square error of 3.8 BPM, and Bland-Altman limits of agreement of 6.7 BPM averaged over all measurements. In addition, a linear correlation of 84.5% (p < 0.01) was achieved between the reference and extracted RRs. The statistical analyses confirmed the significant (p < 0.05) outperformance of the NRR algorithm with respect to the existing methods. Conclusions: We showed the possibility of extracting RR from neonatal NIRS in an intensive care environment, which showed high correspondence with the reference RR recorded. Adding the NRR algorithm to a NIRS system provides the opportunity to record synchronously different physiological sources of information about cerebral perfusion and respiration by a single monitoring system. This allows for a concurrent integrated analysis of the impact of breathing (including apnea) on cerebral hemodynamics.
Collapse
Affiliation(s)
- Naser Hakimi
- Artinis Medical Systems, B.V., Einsteinweg 17, 6662 PW Elst, The Netherlands
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Mohammad Shahbakhti
- Artinis Medical Systems, B.V., Einsteinweg 17, 6662 PW Elst, The Netherlands
| | - Jörn M Horschig
- Artinis Medical Systems, B.V., Einsteinweg 17, 6662 PW Elst, The Netherlands
| | - Thomas Alderliesten
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Frank Van Bel
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Willy N J M Colier
- Artinis Medical Systems, B.V., Einsteinweg 17, 6662 PW Elst, The Netherlands
| | - Jeroen Dudink
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| |
Collapse
|
10
|
Kinoshita M, Stempel KS, Borges do Nascimento IJ, Bruschettini M. Systemic opioids versus other analgesics and sedatives for postoperative pain in neonates. Cochrane Database Syst Rev 2023; 3:CD014876. [PMID: 36870076 PMCID: PMC9983301 DOI: 10.1002/14651858.cd014876.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND Neonates may undergo surgery because of malformations such as diaphragmatic hernia, gastroschisis, congenital heart disease, and hypertrophic pyloric stenosis, or complications of prematurity, such as necrotizing enterocolitis, spontaneous intestinal perforation, and retinopathy of prematurity that require surgical treatment. Options for treatment of postoperative pain include opioids, non-pharmacological interventions, and other drugs. Morphine, fentanyl, and remifentanil are the opioids most often used in neonates. However, negative impact of opioids on the structure and function of the developing brain has been reported. The assessment of the effects of opioids is of utmost importance, especially for neonates in substantial pain during the postoperative period. OBJECTIVES To evaluate the benefits and harms of systemic opioid analgesics in neonates who underwent surgery on all-cause mortality, pain, and significant neurodevelopmental disability compared to no intervention, placebo, non-pharmacological interventions, different types of opioids, or other drugs. SEARCH METHODS We searched Cochrane CENTRAL, MEDLINE via PubMed and CINAHL in May 2021. We searched the WHO ICTRP, clinicaltrials.gov, and ICTRP trial registries. We searched conference proceedings, and the reference lists of retrieved articles for RCTs and quasi-RCTs. SELECTION CRITERIA: We included randomized controlled trials (RCTs) conducted in preterm and term infants of a postmenstrual age up to 46 weeks and 0 days with postoperative pain where systemic opioids were compared to 1) placebo or no intervention; 2) non-pharmacological interventions; 3) different types of opioids; or 4) other drugs. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were pain assessed with validated methods, all-cause mortality during initial hospitalization, major neurodevelopmental disability, and cognitive and educational outcomes in children more than five years old. We used the fixed-effect model with risk ratio (RR) and risk difference (RD) for dichotomous data and mean difference (MD) for continuous data. We used GRADE to assess the certainty of evidence for each outcome. MAIN RESULTS We included four RCTs enrolling 331 infants in four countries across different continents. Most studies considered patients undergoing large or medium surgical procedures (including major thoracic or abdominal surgery), who potentially required pain control through opioid administration after surgery. The randomized trials did not consider patients undergoing minor surgery (including inguinal hernia repair) and those individuals exposed to opioids before the beginning of the trial. Two RCTs compared opioids with placebo; one fentanyl with tramadol; and one morphine with paracetamol. No meta-analyses could be performed because the included RCTs reported no more than three outcomes within the prespecified comparisons. Certainty of the evidence was very low for all outcomes due to imprecision of the estimates (downgrade by two levels) and study limitations (downgrade by one level). Comparison 1: opioids versus no treatment or placebo Two trials were included in this comparison, comparing either tramadol or tapentadol with placebo. No data were reported on the following critical outcomes: pain; major neurodevelopmental disability; or cognitive and educational outcomes in children more than five years old. The evidence is very uncertain about the effect of tramadol compared with placebo on all-cause mortality during initial hospitalization (RR 0.32, 95% Confidence Interval (CI) 0.01 to 7.70; RD -0.03, 95% CI -0.10 to 0.05, 71 participants, 1 study; I² = not applicable). No data were reported on: retinopathy of prematurity; or intraventricular hemorrhage. Comparison 2: opioids versus non-pharmacological interventions No trials were included in this comparison. Comparison 3: head-to-head comparisons of different opioids One trial comparing fentanyl with tramadol was included in this comparison. No data were reported on the following critical outcomes: pain; major neurodevelopmental disability; or cognitive and educational outcomes in children more than five years old. The evidence is very uncertain about the effect of fentanyl compared with tramadol on all-cause mortality during initial hospitalization (RR 0.99, 95% CI 0.59 to 1.64; RD 0.00, 95% CI -0.13 to 0.13, 171 participants, 1 study; I² = not applicable). No data were reported on: retinopathy of prematurity; or intraventricular hemorrhage. Comparison 4: opioids versus other analgesics and sedatives One trial comparing morphine with paracetamol was included in this comparison. The evidence is very uncertain about the effect of morphine compared with paracetamol on COMFORT pain scores (MD 0.10, 95% CI -0.85 to 1.05; 71 participants, 1 study; I² = not applicable). No data were reported on the other critical outcomes, i.e. major neurodevelopmental disability; cognitive and educational outcomes in children more than five years old, all-cause mortality during initial hospitalization; retinopathy of prematurity; or intraventricular hemorrhage. AUTHORS' CONCLUSIONS Limited evidence is available on opioid administration for postoperative pain in newborn infants compared to either placebo, other opioids, or paracetamol. We are uncertain whether tramadol reduces mortality compared to placebo; none of the studies reported pain scores, major neurodevelopmental disability, cognitive and educational outcomes in children older than five years old, retinopathy of prematurity, or intraventricular hemorrhage. We are uncertain whether fentanyl reduces mortality compared to tramadol; none of the studies reported pain scores, major neurodevelopmental disability, cognitive and educational outcomes in children older than five years old, retinopathy of prematurity, or intraventricular hemorrhage. We are uncertain whether morphine reduces pain compared to paracetamol; none of the studies reported major neurodevelopmental disability, cognitive and educational outcomes in children more than five years old, all-cause mortality during initial hospitalization, retinopathy of prematurity, or intraventricular hemorrhage. We identified no studies comparing opioids versus non-pharmacological interventions.
Collapse
Affiliation(s)
- Mari Kinoshita
- Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
- Fetal Medicine Research Center, University of Barcelona, Barcelona, Spain
| | | | - Israel Junior Borges do Nascimento
- School of Medicine and University Hospital, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics, Lund University, Skåne University Hospital, Lund, Sweden
- Cochrane Sweden, Lund University, Skåne University Hospital, Lund, Sweden
| |
Collapse
|
11
|
Sırtbaş-Işık G, Yardımcı-Lokmanoğlu BN, Livanelioğlu A, Mutlu A. Sensory processing and sleep characteristics in preterm infants in the early period of life. Sleep Med 2023; 106:78-83. [PMID: 37054558 DOI: 10.1016/j.sleep.2023.03.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/09/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
OBJECTIVE The present study aimed to investigate the following: (i) differences in sensory processing and sleep characteristics between preterm infants born at < 32 weeks', vs. those born at ≥ 32 weeks' gestation; (ii) differences in sleep characteristics between preterm infants with typical vs. atypical sensory processing; and (iii) relationship between sensory processing and sleep characteristics in preterm infants at 3 months of age. METHODS A total of 189 preterm infants, 54 born at < 32 weeks' gestation (26 females; mean gestational age [standard deviation (SD)], 30.1 [1.7] weeks), and 135 born at ≥ 32 weeks' gestation (78 females; mean gestational age [SD], 34.9 [0.9] weeks) were included in the present study. Sleep characteristics were evaluated using the Brief Infant Sleep Questionnaire, and sensory processing was assessed using the Infant Sensory Profile-2. RESULTS There were no significant differences in sensory processing (P > 0.05) or sleep characteristics (P > 0.05) between the preterm groups; however, more infants snored in the <32 weeks' gestation group (P = 0.035). Preterm infants with atypical sensory processing showed lower nighttime (P = 0.027) and total sleep durations (P = 0.032), and higher rates of nocturnal wakefulness (P = 0.038) and snoring (P = 0.001) than preterm infants with typical sensory processing. A significant relationship, therefore, was observed between sensory processing and sleep characteristics (P < 0.05). CONCLUSIONS Sensory processing patterns may play an important role in understanding sleep problems in preterm infants. The early detection of sleep problems and sensory processing difficulties are necessary for early intervention.
Collapse
|
12
|
Us MC, Saran MG, Cebeci B, Akkuş E, Şeker E, Aybar ŞSŞ. A Randomized Comparative Effectiveness Study of Reflexology, Sucrose, and Other Treatments for Needle Procedures in Newborns. Pediatr Neurol 2023; 140:78-85. [PMID: 36608413 DOI: 10.1016/j.pediatrneurol.2022.11.019] [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: 03/07/2022] [Revised: 11/28/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Approximately 10 to 14 painful procedures per day are performed in infants during the hospital stay. We aimed to determine the effect of reflexology applied to the sole during painful procedures on pain perception in newborns compared with other nonpharmacologic methods. METHODS Our study was planned as a randomized controlled trial in term infants being followed up in the neonatal intensive care unit and maternity ward. To reduce pain during collection of venous blood or heel lance reflexology on the soles of the foot, 24% sucrose solution, kangaroo care, and classical music listening were applied to the infants. The Neonatal Infant Pain Scale (NIPS) was used to assess newborns during acute pain. RESULTS A total of 300 patients were enrolled in the study. Higher pain scores and crying times were observed during heel blood collection. All analgesic methods significantly reduced NIPS scores during heel blood collection. Sucrose was the most effective method, followed by reflexology. The best method that significantly shortened the crying time was again sucrose solution followed by reflexology, kangaroo care, and classical music, during heel blood collection. However, none of the nonpharmacologic methods was effective during venous blood collection. CONCLUSIONS Although sucrose was the most effective method, reflexology has significant positive effects, especially on average heartbeat, reducing pain, and shortening crying times during heel blood sampling. Reflexology might be considered among the nonpharmacologic methods to be applied before routine interventions, but still, there is a need for further studies to investigate the efficiency.
Collapse
Affiliation(s)
- Mahmut Caner Us
- Division of Social Pediatrics, Department of Pediatrics, Marmara University Faculty of Medicine, İstanbul, Turkey; Department of Pediatrics, Haseki Training and Research Hospital, Istanbul, Turkey.
| | - Mine Güneş Saran
- Maternity Ward, Esenler Maternity and Child Health Hospital Istanbul, Istanbul, Turkey
| | - Burcu Cebeci
- Department of Neonatology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Erkan Akkuş
- Department of Pediatrics, Esenler Maternity and Child Health Hospital Istanbul, Istanbul, Turkey
| | - Esma Şeker
- Neonatal Intensive Care Unit, Esenler Maternity, and Child Health Hospital Istanbul, Turkey
| | | |
Collapse
|
13
|
Cortisol reactivity and negative affect among preterm infants at 12 months during a mother-infant interaction task. Infant Behav Dev 2023; 70:101784. [PMID: 36401957 DOI: 10.1016/j.infbeh.2022.101784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/26/2022] [Accepted: 10/27/2022] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to investigate correlates of preterm (PT) infant's cortisol reactivity and the association to infant negative affect, during a mother-infant interaction procedure. Participants included 48 infants born prematurely (gestational age < 37 weeks) and their mothers, assessed when infants were 12 months old corrected for prematurity. The examined variables comprised both neonatal and environmental dimensions including maternal interactive behavior. Infant negative affect and maternal interactive behavior were assessed with a standardized mother-infant interaction task. A baseline infant saliva sample was collected before the interaction began, and a second sample after the interaction episodes ended. Results revealed that decrease of infant's cortisol concentration was significantly associated with the exposure to more sensitive, and less intrusive maternal behaviors. However, once controlled for neonatal risk, family SES and maternal psychological distress, the associations were rendered non-significant. Although the association between cortisol reactivity and negative affect trended toward significance, maternal intrusiveness was the only significant predictor of observed infant negative affect. Findings suggest the importance of primary relational experiences on PT infants' early regulatory competencies.
Collapse
|
14
|
Chaudhari AJ, Nimbalkar SM, Patel DV, Phatak AG. Effect of Kangaroo Mother Care on Cerebral Hemodynamics in Preterm Neonates Assessed by Transcranial Doppler Sonography in Middle Cerebral Artery. Indian Pediatr 2023; 60. [PMID: 36333897 PMCID: PMC9885412 DOI: 10.1007/s13312-023-2690-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Objective To study the effect of KMC in premature newborns on cerebral hemodynamics in the middle cerebral artery (MCA) using transcranial doppler sonography. Methods In this descriptive study, 40 clinically stable preterm neonates admitted to the neonatal intensive care unit of our institute and undergoing Kangaroo mother care (KMC) were enrolled. Physiological and cerebral blood flow parameters of MCA were obtained by using transcranial doppler sonography at baseline, at 60 minutes of KMC, and after 60 minutes of stopping KMC. Results Of the 40 enrolled neonates (24 males), the mean (SD) birth weight, gestation age, and postnatal age were 1698.25 (495.44) g, 33.00 (1.67) wk, and 6.80 (4.51) days, respectively. The mean (SD) cerebral blood flow velocities increased (peak systolic velocity (PSV), P=0.03; end diastolic velocity, P<0.001; mean velocity, P<0.001) and doppler indices decreased (resistive index, P=0.001; pulsatility index, P<0.001) significantly; whereas, heart rate (P<0.001) decreased but SpO2 (P=0.001) and mean blood pressure (P=0.003) increased significantly at 60 minutes of KMC as compared to baseline. Sixty minutes after stopping KMC, all parameters (except PSV) were higher than baseline, indicating post KMC effect. Conclusion KMC improves cerebral hemodynamics in clinically stable preterm neonates.
Collapse
Affiliation(s)
- Anal J. Chaudhari
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat India
| | - Somashekhar M. Nimbalkar
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat India
- Central Research Services, Charutar Arogya Mandal, Bhaikaka University, Karamsad, Gujarat India
| | - Dipen V. Patel
- Department of Neonatology, Pramukhswami Medical College, Bhaikaka University, Karamsad, Gujarat India
| | - Ajay G. Phatak
- Central Research Services, Charutar Arogya Mandal, Bhaikaka University, Karamsad, Gujarat India
| |
Collapse
|
15
|
D’Angeli G, Mesce M, Cerniglia L, Cimino S. Observational Tools Using Video Recordings of Parent-Child Feeding Interactions: A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121924. [PMID: 36553367 PMCID: PMC9776560 DOI: 10.3390/children9121924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Current research has confirmed that the quality of the caregiver-child relationship influences the child's emotional and behavioral development. Play and feeding contexts, for example, are the best contexts to observe mother-child or father-child interaction. The observation of feeding interaction establishes involvement on the part of both parties and identifies relationship characteristics. The purpose of this study is to select and describe the most frequently used observational methods during feeding interactions in the first three years of a child's life. Instruments that employ video recordings of mealtimes will be detailed to highlight the relevance that specific tools have nowadays. Finally, the SVIA (Scala di Valutazione delle Interazioni Alimentari), a technique for analyzing food interactions by observation that has also been utilized remotely, will be offered. This is intended to provide practitioners and researchers with an overview of tools while also taking into consideration the present scenario in which digital tools are increasingly being employed in health and clinical settings. Furthermore, the purpose of this paper is to review the various observational methods of the parent-child relationship to assist future practitioners and researchers in the field in making an accurate assessment of caregiver-child interaction and selecting a valid tool for the early recognition of problematic relationships and identifying the most appropriate treatment modalities.
Collapse
Affiliation(s)
- Gessica D’Angeli
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, 00186 Rome, Italy
| | - Martina Mesce
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, 00186 Rome, Italy
| | - Luca Cerniglia
- Faculty of Psychology, International Telematic University Uninettuno, 00186 Rome, Italy
- Correspondence: ; Tel.: +39-06697621
| | - Silvia Cimino
- Department of Dynamic, Clinical and Health Psychology, Sapienza University of Rome, 00186 Rome, Italy
| |
Collapse
|
16
|
Kumar S, Priyadarshi M, Singh P, Pallapothu B, Chaurasia S, Basu S. Correlation of clinical pain scores with cerebral oxygenation in preterm neonates during acute painful procedures: a prospective observational study. J Perinatol 2022; 43:584-589. [PMID: 36271296 DOI: 10.1038/s41372-022-01543-x] [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: 09/07/2022] [Revised: 10/06/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The present study evaluated the correlation of Neonatal Infant Pain Scale (NIPS) and Premature Infant Pain Profile-Revised (PIPP-R), with changes in cerebral oxygenation (ΔcrSO2; measured by near-infrared spectroscopy) in preterm infants during acute painful procedures (heel lance and venepuncture). STUDY DESIGN Prospective observational study. METHODS Sixty-four stable preterm (28-36 weeks) neonates were videotaped. NIPS and PIPP-R scores were assessed on video-recordings by two independent assessors. The primary outcome was correlation of ΔcrSO2 with NIPS and PIPP-R scores. RESULTS Moderate to strong correlations were observed between ΔcrSO2 and NIPS, and ΔcrSO2 and PIPP-R (r = 0.71 and 0.78 during heel lance and r = 0.66 and 0.75 during venepuncture, respectively). NIPS score was found easy to understand and perform by the bedside nurses, and took lesser time as compared to PIPP-R during both the procedures. CONCLUSION Both pain scores, NIPS and PIPP-R, had good correlation with ΔcrSO2 during acute painful procedures.
Collapse
Affiliation(s)
- Sourabh Kumar
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Mayank Priyadarshi
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Poonam Singh
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Bhrajishna Pallapothu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Suman Chaurasia
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sriparna Basu
- Department of Neonatology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.
| |
Collapse
|
17
|
Assessment of neonatal pain: uni- and multidimensional evaluation scales. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Abstract
Neonatal pain is a problem that is easily overlooked. According to the status quo of neonatal pain management, commonly 9 scales are used for evaluation of neonatal pain; details of the specific indicators, such as the applicable neonatal gestational age range, score, and the type of pain, for the domestic references are provided so as to provide reference for the proper evaluation and standardized management of neonatal pain, as well as to promote the management level of neonatal pain.
Collapse
|
18
|
Visoiu M. Evolving approaches in neonatal postoperative pain management. Semin Pediatr Surg 2022; 31:151203. [PMID: 36038217 DOI: 10.1016/j.sempedsurg.2022.151203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Neonates experience significant moderate and severe postoperative pain. Effective postoperative pain management in neonates is required to minimize acute and long-term effects of neonatal pain. Protecting the developing nervous system from persistent sensitization of pain pathways and developing primary hyperalgesia is essential. Opioids and acetaminophen are commonly analgesics used for pain control. Regional anesthesia provides adequate intraoperative and postoperative analgesia in neonates. It decreases exposure to opioids, reduces adverse drug effects, and facilitates early extubation. It suppresses the stress response and can prevent long-term behavioral responses to pain. The most common blocks performed in neonates are neuraxial blocks. Using ultrasound increased the number of peripheral nerve blocks performed in neonates. Recently, various peripheral nerve blocks (paravertebral, transverse abdominis plane, rectus sheath, quadratus lumborum, erector spinae plane blocks) were safely used. Many studies support analgesic efficacy but highlight neonates' unpredictability and variability of fascial blocks.
Collapse
Affiliation(s)
- Mihaela Visoiu
- Associate Professor of Anesthesiology and Perioperative Medicine, Department of Anesthesiology and Perioperative Medicine; UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, PA, United States of America.
| |
Collapse
|
19
|
Soares JDCA, Barros MCDM, da Silva GVT, Carlini LP, Heiderich TM, Orsi RN, Balda RDCX, Silva PASO, Thomaz CE, Guinsburg R. Looking at neonatal facial features of pain: do health and non-health professionals differ? J Pediatr (Rio J) 2022; 98:406-412. [PMID: 34914897 PMCID: PMC9432145 DOI: 10.1016/j.jped.2021.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyze the regions that trigger the attention of adults' gaze when assessing pain in newborn infants' pictures and to verify if there are differences between health and non-health professionals. METHOD Experimental study with 84 health professionals and 59 non-health professionals, who evaluated two images of 10 neonates, one at rest and the other during a painful procedure. Each image was shown for 7 seconds on a computer screen, while eye movements were tracked by the Tobii TX300 EyeTracker. After evaluating each image, participants gave a score from 0 (absent pain) to 10 (maximum pain), according to their perception of neonatal pain. For each image, the number and total time of gaze fixations in the forehead, eyes, nasolabial furrow, and mouth were studied. Comparisons between both groups of adults were made by an intraclass correlation coefficient, Student's t-test, and Bland Altman graphic. RESULTS Health professionals (93% female; 34 ± 9 years old), compared to non-health professionals (64% female; 35 ± 11 years old), gave lower scores for images at rest (0.81 ± 0.50 vs. 1.59 ± 0.76; p = 0.010), with no difference for those obtained during the painful procedure (6.98 ± 1.08 vs. 6.73 ± 0.82). There was a strong or almost perfect correlation for the number of fixations in the mouth, eyes, forehead, and for the total fixation time in the eyes and forehead. CONCLUSIONS Adults, irrespective of their profession, showed a homogeneous gaze pattern when evaluating pictures of neonates at rest or during a painful procedures.
Collapse
Affiliation(s)
- Juliana do Carmo Azevedo Soares
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Pediatrics, Division of Neonatal Medicine, São Paulo, SP, Brazil
| | - Marina Carvalho de Moraes Barros
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Pediatrics, Division of Neonatal Medicine, São Paulo, SP, Brazil.
| | - Giselle Valério Teixeira da Silva
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Pediatrics, Division of Neonatal Medicine, São Paulo, SP, Brazil
| | - Lucas Pereira Carlini
- Centro Universitario FEI, Department of Electrical Engineering, Image Processing Laboratory, São Bernardo do Campo, SP, Brazil
| | - Tatiany Marcondes Heiderich
- Centro Universitario FEI, Department of Electrical Engineering, Image Processing Laboratory, São Bernardo do Campo, SP, Brazil
| | - Rafael Nobre Orsi
- Centro Universitario FEI, Department of Electrical Engineering, Image Processing Laboratory, São Bernardo do Campo, SP, Brazil
| | - Rita de Cássia Xavier Balda
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Pediatrics, Division of Neonatal Medicine, São Paulo, SP, Brazil
| | | | - Carlos Eduardo Thomaz
- Centro Universitario FEI, Department of Electrical Engineering, Image Processing Laboratory, São Bernardo do Campo, SP, Brazil
| | - Ruth Guinsburg
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Pediatrics, Division of Neonatal Medicine, São Paulo, SP, Brazil
| |
Collapse
|
20
|
Steinbauer P, Monje FJ, Kothgassner O, Goreis A, Eva C, Wildner B, Schned H, Deindl P, Seki D, Berger A, Olischar M, Giordano V. The consequences of neonatal pain, stress and opiate administration in animal models: An extensive meta-analysis concerning neuronal cell death, motor and behavioral outcomes. Neurosci Biobehav Rev 2022; 137:104661. [PMID: 35427643 DOI: 10.1016/j.neubiorev.2022.104661] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 01/21/2023]
Abstract
This systematic review and meta-analysis aimed to investigate the association of neonatal exposure to pain, stress, opiate administration alone, as well as opiate administration prior to a painful procedure on neuronal cell death, motor, and behavioral outcomes in rodents. In total, 36 studies investigating the effect of pain (n = 18), stress (n = 15), opiate administration (n = 13), as well as opiate administration prior to a painful event (n = 7) in rodents were included in our meta-analysis. The results showed a large effect of pain (g = 1.37, 95% CI 1.00-1.74, p < .001) on neuronal cell death. Moreover, higher number of neonatal pain events were significantly associated with increased neuronal cell death, increased anxiety (b = -1.18, SE = 0.43, p = .006), and depressant-like behavior (b = 1.74, SE = 0.51, p = .027) in rodents. Both opiates and pain had no impact on motor function (g = 0.26, 95% CI 0.18-0.70, p = .248).
Collapse
Affiliation(s)
- Philipp Steinbauer
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria.
| | - Francisco J Monje
- Department of Neurophysiology and Neuropharmacology, Center for Physiology and Pharmacology, Medical University of Vienna, Vienna, Austria
| | - Oswald Kothgassner
- Department of Child and Adolescent Psychiatry, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Andreas Goreis
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria; Outpatient Unit for Research, Teaching and Practice, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Chwala Eva
- Information Retrieval Office, University Library of the Medical University of Vienna, Vienna, Austria
| | - Brigitte Wildner
- Information Retrieval Office, University Library of the Medical University of Vienna, Vienna, Austria
| | - Hannah Schned
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Philipp Deindl
- Department of Neonatology and Pediatric Intensive Care Medicine, University Children's Hospital, University Medical Center Hamburg, Eppendorf, Germany
| | - David Seki
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria; Department of Microbiology and Ecosystem Science Division of Microbial Ecology, Vienna, Austria
| | - Angelika Berger
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Monika Olischar
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| | - Vito Giordano
- Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
21
|
Emotional regulation and psychomotor development after threatening preterm labor: a prospective study. Eur Child Adolesc Psychiatry 2022; 31:473-481. [PMID: 33585967 DOI: 10.1007/s00787-021-01733-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 01/28/2021] [Indexed: 01/09/2023]
Abstract
A threatened preterm labor (TPL) represents an adverse prenatal event that may affect fetal neurodevelopment, even in absence of prematurity. Indeed, late-preterm infants, without neurological complications, also exhibit neurodevelopment impairment with psychomotor delay as well as emotional regulation disturbances, considered early manifestations of neuropsychiatric disorders. The aim of this study is to examine the impact of TPL on infant's psychomotor development and temperament. This prospective cohort study recruited mothers who suffered from a TPL and a control group of mothers without TPL and full-term gestation (n = 61). TPL infants were classified into three groups depending on delivery time: Full-Term (n = 37), Late-Preterm (n = 66), and Very-Preterm (n = 38). Neurodevelopmental assessment was performed at 6 months using the Ages & Stages Questionnaires for psychomotor development and the Infant Behaviour Questionnaire-Revised for temperament. After controlling for potential cofounders (multiple pregnancy and in vitro fertilization), Full-Term TPL infants, relative to the control group, exhibited development delay in Communication (p = 0.044) and Personal-social domains (p = 0.005) as well as temperament disturbances with higher Negative Affect (p = 0.013), lower Positive Affect (p = 0.010), and worse Emotional Regulation (p < 0.001) compared to Control. No differences were found between Full-Term and Late-Preterm TPL infants. TPL may represent a risk factor for neurodevelopmental disturbances in the offspring, affecting both psychomotor and emotional infant competences, even when infants were born at term.
Collapse
|
22
|
Seraphin SB, Sanchez MM, Whitten PL, Winslow JT. The behavioral neuroendocrinology of dopamine systems in differently reared juvenile male rhesus monkeys (Macaca mulatta). Horm Behav 2022; 137:105078. [PMID: 34823146 DOI: 10.1016/j.yhbeh.2021.105078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 11/23/2022]
Abstract
Dopamine (DA) is a critical neuromodulator of behavior. With propensities for addiction, hyper-activity, cognitive impairment, aggression, and social subordinance, monkeys enduring early maternal deprivation evoke human disorders involving dopaminergic dysfunction. To examine whether DA system alterations shape the behavioral correlates of adverse rearing, male monkeys (Macaca mulatta) were either mother-reared (MR: N = 6), or separated from their mothers at birth and nursery-reared (NR: N = 6). Behavior was assessed during 20-minute observations of subjects interacting with same- or differently-reared peers. Cerebrospinal fluid (CSF) biogenic amines, and serum testosterone (T), cortisol (CORT), and prolactin (PRL) were collected before and after pharmacologic challenge with saline or the DA receptor-2 (DRD2) antagonist Raclopride (RAC). Neuropeptide correlations observed in MR were non-existent in NR monkeys. Compared to MR, NR showed reduced DA tone; higher basal serum T; and lower CSF serotonin (5-HT). RAC increased PRL, T and CORT, but the magnitude of responses varied as a function of rearing. Levels of PRL significantly increased following RAC in MR, but not NR. Elevations in T following RAC were only significant among MR. Contrastingly, the net change (RAC CORT - saline CORT) in CORT was greater in NR than MR. Finally, observations conducted during the juvenile phase in a novel play-arena revealed more aggressive, self-injurious, and repetitive behaviors, which negatively correlated with indexes of dopaminergic tone in NR monkeys. In conclusion, early maternal deprivation alters brain DA systems, and thus may be associated with characteristic cognitive, social, and addiction outcomes.
Collapse
Affiliation(s)
- Sally B Seraphin
- Department of Anthropology, Emory University, 207 Anthropology Building, 1557 Dickey Drive, Atlanta, GA 30322-1003, United States; Center for Behavioral Neuroscience and Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd. NE, Atlanta, GA 30322-0001, United States.
| | - Mar M Sanchez
- Center for Behavioral Neuroscience and Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd. NE, Atlanta, GA 30322-0001, United States; Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322-1003, United States
| | - Patricia L Whitten
- Department of Anthropology, Emory University, 207 Anthropology Building, 1557 Dickey Drive, Atlanta, GA 30322-1003, United States; Center for Behavioral Neuroscience and Yerkes National Primate Research Center, Emory University, 954 Gatewood Rd. NE, Atlanta, GA 30322-0001, United States
| | - James T Winslow
- NIMH IRP Neurobiology Primate Core, NIHAC Bldg. 110, National Institutes of Health (NIH), 9000 Rockville Pike, Bethesda, MD 20892-0001, United States
| |
Collapse
|
23
|
Marchal A, Melchior M, Dufour A, Poisbeau P, Zores C, Kuhn P. Pain Behavioural Response to Acoustic and Light Environmental Changes in Very Preterm Infants. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8121081. [PMID: 34943277 PMCID: PMC8700556 DOI: 10.3390/children8121081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/12/2021] [Accepted: 11/19/2021] [Indexed: 04/12/2023]
Abstract
Noise and high light illumination in the neonatal intensive care unit (NICU) are recognized as stressors that could alter the well-being and development of vulnerable preterm infants. This prospective observational study evaluated the pain behaviours of very preterm infants (VPIs) to sound peaks (SPs) and light levels variations (LLVs) in the NICU. We measured spontaneously occurring SPs and LLVs in the incubators of 26 VPIs over 10 h. Their behavioural responses were analysed through video recordings using the "Douleur Aigue du Nouveau-né" (DAN) scale. We compared the maximum DAN scores before and after environmental stimuli and the percentage of VPIs with a score ≥ 3 according to the type of stimuli. A total of 591 SPs and 278 LLVs were analysed. SPs of 5 to 15 dBA and LLVs significantly increased the maximum DAN scores compared to baseline. The occurrence of DAN scores ≥ 3 increased with both stressors, with a total of 16% of SPs and 8% of LLVs leading to quantifiable pain behaviour. Altogether, this study shows that VPIs are sensitive to SPs and LLVs, with a slighter higher sensitivity to SPs. The mechanisms leading to pain behaviours induced by noise and light changes should be evaluated further in the context of VPIs brain development. Our results provide further arguments to optimize the NICU sensory environment of neonatal units and to adapt it to the expectations and sensory abilities of VPIs.
Collapse
Affiliation(s)
- Audrey Marchal
- Service de Médecine et Réanimation du Nouveau-né, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, 67000 Strasbourg, France; (A.M.); (C.Z.)
| | - Meggane Melchior
- Institut des Neurosciences Cellulaires et Intégratives (INCI, CNRS UPR-3212), Centre National de la Recherche Scientifique, 67000 Strasbourg, France; (M.M.); (P.P.)
| | - André Dufour
- Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA, CNRS UMR-7364), Centre National de la Recherche Scientifique, Université de Strasbourg, 67000 Strasbourg, France;
| | - Pierrick Poisbeau
- Institut des Neurosciences Cellulaires et Intégratives (INCI, CNRS UPR-3212), Centre National de la Recherche Scientifique, 67000 Strasbourg, France; (M.M.); (P.P.)
| | - Claire Zores
- Service de Médecine et Réanimation du Nouveau-né, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, 67000 Strasbourg, France; (A.M.); (C.Z.)
- Laboratoire de Neurosciences Cognitives et Adaptatives (LNCA, CNRS UMR-7364), Centre National de la Recherche Scientifique, Université de Strasbourg, 67000 Strasbourg, France;
| | - Pierre Kuhn
- Service de Médecine et Réanimation du Nouveau-né, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, 67000 Strasbourg, France; (A.M.); (C.Z.)
- Institut des Neurosciences Cellulaires et Intégratives (INCI, CNRS UPR-3212), Centre National de la Recherche Scientifique, 67000 Strasbourg, France; (M.M.); (P.P.)
- Correspondence: ; Tel.: +33-388127779
| |
Collapse
|
24
|
Della Longa L, Mento G, Farroni T. The Development of a Flexible Bodily Representation: Behavioral Outcomes and Brain Oscillatory Activity During the Rubber Hand Illusion in Preterm and Full-Term School-Age Children. Front Hum Neurosci 2021; 15:702449. [PMID: 34594191 PMCID: PMC8476838 DOI: 10.3389/fnhum.2021.702449] [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: 04/29/2021] [Accepted: 08/20/2021] [Indexed: 11/30/2022] Open
Abstract
During childhood, the body undergoes rapid changes suggesting the need to constantly update body representation based on the integration of multisensory signals. Sensory experiences in critical periods of early development may have a significant impact on the neurobiological mechanisms underpinning the development of the sense of one’s own body. Specifically, preterm children are at risk for sensory processing difficulties, which may lead to specific vulnerability in binding together sensory information in order to modulate the representation of the bodily self. The present study aims to investigate the malleability of body ownership in preterm (N = 21) and full-term (N = 19) school-age children, as reflected by sensitivity to the Rubber Hand Illusion. The results revealed that multisensory processes underlying the ability to identify a rubber hand as being part of one’s own body are already established in childhood, as indicated by a higher subjective feeling of embodiment over the rubber hand during synchronous visual-tactile stimulation. Notably, the effect of visual-tactile synchrony was related to the suppression of the alpha band oscillations over frontal, central, and parietal scalp regions, possibly indicating a greater activation of somatosensory and associative areas underpinning the illusory body ownership. Moreover, an interaction effect between visual-tactile condition and group emerged, suggesting that preterm children showed a greater suppression of alpha oscillatory activity during the illusion. This result together with lower scores of subjective embodiment over the rubber hand reported by preterm children indicate that preterm birth may affect the development of the flexible representation of the body. These findings provide an essential contribution to better understand the processes of identification and differentiation of the bodily self from the external environment, in both full-term and preterm children, paving the way for a multisensory and embodied approach to the investigation of social and cognitive development.
Collapse
Affiliation(s)
- Letizia Della Longa
- Developmental Psychology and Socialization Department, University of Padua, Padua, Italy
| | - Giovanni Mento
- General Psychology Department, University of Padua, Padua, Italy.,PNC Padua Neuroscience Centre, University of Padua, Padua, Italy
| | - Teresa Farroni
- Developmental Psychology and Socialization Department, University of Padua, Padua, Italy.,PNC Padua Neuroscience Centre, University of Padua, Padua, Italy
| |
Collapse
|
25
|
Davis SM, Burman MA. Maternal separation with neonatal pain influences later-life fear conditioning and somatosenation in male and female rats. Stress 2021; 24:504-513. [PMID: 33043804 PMCID: PMC8039057 DOI: 10.1080/10253890.2020.1825674] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Early life adversity, including that which occurs in a medical setting, has been increasingly shown to have lasting consequences on both physical and mental health. In order to understand the lasting effects of early-life adversity, such as that might occur in the neonatal intensive care unit (NICU), several rodent models have been developed including maternal separation, neonatal handling, and repeated needle prick pain. However, in the clinical scenario, these stressors are often combined. Thus, the current study seeks to observe the lasting impacts of both neonatal pain and maternal separation in a rodent model. Rats were separated from their dam for 6 h per day during the first 7 days of life, during which they were subjected to repeated needle prick pain or handling. A separate group was left undisturbed. All rats were subsequently tested for threat processing using a 3-day Pavlovian fear conditioning model and for somatosensation using measures of mechanical and thermal thresholds. Results indicated that rats subjected to maternal separation and pain had enhanced fear conditioning in adolescence as well as displaying a modest age-independent tactile hypersensitivity compared to undisturbed controls. These data show that experiencing combined neonatal pain and maternal separation may create a latent vulnerability to subsequent stressors.
Collapse
Affiliation(s)
- Seth M. Davis
- Department of Psychology, University of New England
- Center for Excellence in the Neurosciences, University of
New England
| | - Michael A. Burman
- Department of Psychology, University of New England
- Center for Excellence in the Neurosciences, University of
New England
| |
Collapse
|
26
|
Filippa M, Monaci MG, Spagnuolo C, Serravalle P, Daniele R, Grandjean D. Maternal speech decreases pain scores and increases oxytocin levels in preterm infants during painful procedures. Sci Rep 2021; 11:17301. [PMID: 34453088 PMCID: PMC8397753 DOI: 10.1038/s41598-021-96840-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/11/2021] [Indexed: 12/28/2022] Open
Abstract
Preterm infants undergo early separation from parents and are exposed to frequent painful clinical procedures, with resultant short- and long-term effects on their neurodevelopment. We aimed to establish whether the mother's voice could provide an effective and safe analgesia for preterm infants and whether endogenous oxytocin (OXT) could be linked to pain modulation. Twenty preterm infants were exposed to three conditions-mother's live voice (speaking or singing) and standard care-in random order during a painful procedure. OXT levels (pg/mL) in saliva and plasma cortisol levels were quantified, and the Premature Infant Pain Profile (PIPP) was blindly coded by trained psychologists. During the mother's live voice, PIPP scores significantly decreased, with a concomitant increase in OXT levels over baseline. The effect on pain perception was marginally significant for singing. No effects on cortisol levels were found. The mother's live voice modulated preterm infants' pain indicators. Endogenous OXT released during vocal contact is a promising protective mechanism during early painful interventions in at-risk populations.
Collapse
Affiliation(s)
- Manuela Filippa
- Swiss Center of Affective Sciences, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland.
- Department of Social Sciences, University of Valle D'Aosta, Aosta, Italy.
| | | | | | | | - Roberta Daniele
- Department of Clinical Pathology, Parini Hospital, Aosta, Italy
| | - Didier Grandjean
- Swiss Center of Affective Sciences, Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| |
Collapse
|
27
|
Hadas IM, Joseph M, Luba Z, Michal KL. Maturation of the cardiac autonomic regulation system, as function of gestational age in a cohort of low risk preterm infants born between 28 and 32 weeks of gestation. J Perinat Med 2021; 49:624-629. [PMID: 33600674 DOI: 10.1515/jpm-2020-0482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 01/07/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The maturation of the sympathetic nervous system (SNS) occurs steadily throughout gestation while the myelinated vagus has accelerated maturation periods, between 25 and 32 weeks of gestation and a further increase around 37-38 weeks of gestation. The aim was to quantify the cardiac autonomic regulation maturation, as a function of gestational age (GA) in a cohort of low risk preterm infants born between 28 and 32 weeks of gestation by assessing heart rate variability (HRV) at week 32, and at week 35 postmenstrual age (PMA). METHODS Forty preterm infants were recruited, 24 h recordings of breathing rate and RR intervals were obtained at week 32 and week 35 PMA. RESULTS A significant difference was noted between preterm infants born before 32 weeks GA and preterm infants born at week 32; the latter present higher HRV values throughout the follow-up period. No significant change over time was noted for the parasympathetic HRV measures while a significant increase was found in the sympathetic system. Moreover, a significant interaction effect of time and system was found, the increase in values of the sympathetic system over time was significantly larger than the change noted in the vagal HRV measures. CONCLUSIONS Given the beneficial influence of vagal tone on health and developmental outcomes in preterm infants, the findings of the current study highlight the need for further studies on the impact of specifics gestational age on vagal development and later assessing interventions associate with its continue development and maturation at these specific periods.
Collapse
Affiliation(s)
- Israeli-Mendlovic Hadas
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Zuk Luba
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Katz-Leurer Michal
- Physical Therapy Department, School of Health Professions, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
28
|
Kodama Y, Okamoto J, Imai K, Asano H, Uchiyama A, Masamune K, Wada M, Muragaki Y. Video-based neonatal state assessment method for timing of procedures. Pediatr Int 2021; 63:685-692. [PMID: 33034092 DOI: 10.1111/ped.14501] [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: 06/08/2020] [Revised: 09/09/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Procedures should be performed when an infant is most receptive to disruptions in order to reduce the stress on the infant. However, frequent direct observations place a heavy burden on medical staff. There is therefore a need for a method for quantitatively and automatically evaluating the neonatal state. METHODS Ten infants in our hospital were enrolled in this study. The states of the infants were assessed by medical staff using the Brazelton Neonatal Behavioral Assessment Scale and were recorded on video at the same time. The recorded states were reclassified as activity levels, a new state classification method that includes middle activity, which is the appropriate time for a procedure. Using image analysis, motions of the infant were quantified as two indices: activity and pause time. Activity and pause time were compared for each activity level. The cutoff values of the indices were calculated, and the sensitivity and specificity of the middle activity were calculated. RESULTS There was a significant difference between all groups of activity level (P < 0.01). The maximum sensitivity and specificity of middle activity were 71.7% and 51.2%, respectively. CONCLUSIONS The neonatal state of infants can be quantitatively and automatically evaluated using video cameras, and the activity level can be used to determine an appropriate time for procedures in infants. This will reduce the burden on medical staff and lead to less stressful procedures for infants.
Collapse
Affiliation(s)
- Yu Kodama
- Institute of Advanced Biomedical Engineering & Science, Tokyo Women's Medical University, Tokyo, Japan.,Human Resources and General Affairs Department, Atom Medical Corporation, Tokyo, Japan
| | - Jun Okamoto
- Institute of Advanced Biomedical Engineering & Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Ken Imai
- Department of Neonatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hidetsugu Asano
- Institute of Advanced Biomedical Engineering & Science, Tokyo Women's Medical University, Tokyo, Japan.,Technical Department, Atom Medical Corporation, Tokyo, Japan
| | - Atsushi Uchiyama
- Department of Neonatology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Pediatrics, Tokai University School of Medicine, Kanagawa, Japan
| | - Ken Masamune
- Institute of Advanced Biomedical Engineering & Science, Tokyo Women's Medical University, Tokyo, Japan
| | - Masaki Wada
- Department of Neonatology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yoshihiro Muragaki
- Institute of Advanced Biomedical Engineering & Science, Tokyo Women's Medical University, Tokyo, Japan.,Department of Neurosurgery, Neurological Institute, Tokyo Women's Medical University, Tokyo, Japan
| |
Collapse
|
29
|
Wang J, Han J, Wang S, Duan Y, Bao C, Luo Y, Xue Q, Cao X. Forebrain GluN2A overexpression impairs fear extinction and NMDAR-dependent long-term depression in the lateral amygdala. Brain Res Bull 2021; 174:1-10. [PMID: 34058285 DOI: 10.1016/j.brainresbull.2021.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/24/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
N-methyl-d-aspartic acid receptor (NMDAR)-dependent synaptic plasticity at the thalamus-lateral amygdala (T-LA) synapses is related to acquisition and extinction of auditory fear memory. However, the roles of the NMDAR GluN2A subunit in acquisition and extinction of auditory fear memory as well as synaptic plasticity at T-LA synapses remain unclear. Here, using electrophysiologic, molecular biological techniques and behavioral methods, we found that the forebrain specific GluN2A overexpression transgenic (TG) mice exhibited normal acquisition but impaired extinction of auditory fear memory. In addition, in vitro electrophysiological data showed normal basal synaptic transmission and NMDAR-dependent long-term potentiation (LTP) at T-LA synapses, but deficit in NMDAR-dependent long-term depression (LTD) at T-LA synapses in GluN2A TG mice. Consistent with the reduced NMDAR-dependent LTD, α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) internalization was also weakened during NMDAR-dependent LTD in GluN2A TG mice. Taken together, our findings for the first time indicate that GluN2A overexpression impairs extinction of auditory fear memory and NMDAR-dependent LTD at T-LA synapses, which further confirms the close relationship between NMDAR-dependent LTD and fear extinction.
Collapse
Affiliation(s)
- Jiayue Wang
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
| | - Jiao Han
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
| | - Shugen Wang
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
| | - Yanhong Duan
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China
| | - Chengrong Bao
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Luo
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Qingsheng Xue
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Xiaohua Cao
- Key Laboratory of Brain Functional Genomics, Ministry of Education, School of Life Sciences, East China Normal University, 3663 North Zhongshan Road, Shanghai, 200062, China.
| |
Collapse
|
30
|
Davis SM, Zuke JT, Berchulski MR, Burman MA. Amygdalar Corticotropin-Releasing Factor Signaling Is Required for Later-Life Behavioral Dysfunction Following Neonatal Pain. Front Physiol 2021; 12:660792. [PMID: 34045975 PMCID: PMC8144524 DOI: 10.3389/fphys.2021.660792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 03/31/2021] [Indexed: 11/13/2022] Open
Abstract
Neonatal pain such as that experienced by infants in the neonatal intensive care unit is known to produce later-life dysfunction including heightened pain sensitivity and anxiety, although the mechanisms remain unclear. Both chronic pain and stress in adult organisms are known to influence the corticotropin-releasing factor (CRF) system in the Central Nucleus of the Amygdala, making this system a likely candidate for changes following neonatal trauma. To examine this, neonatal rats were subjected to daily pain, non-painful handling or left undisturbed for the first week of life. Beginning on postnatal day, 24 male and female rats were subjected to a 4-day fear conditioning and sensory testing protocol. Some subjects received intra-amygdalar administration of either Vehicle, the CRF receptor 1 (CRF1) receptor antagonist Antalarmin, or the CRF receptor 2 (CRF2) receptor antagonist Astressin 2B prior to fear conditioning and somatosensory testing, while others had tissue collected following fear conditioning and CRF expression in the CeA and BLA was assessed using fluorescent in situ hybridization. CRF1 antagonism attenuated fear-induced hypersensitivity in neonatal pain and handled rats, while CRF2 antagonism produced a general antinociception. In addition, neonatal pain and handling produced a lateralized sex-dependent decrease in CRF expression, with males showing a diminished number of CRF-expressing cells in the right CeA and females showing a similar reduction in the number of CRF-expressing cells in the left BLA compared to undisturbed controls. These data show that the amygdalar CRF system is a likely target for alleviating dysfunction produced by early life trauma and that this system continues to play a major role in the lasting effects of such trauma into the juvenile stage of development.
Collapse
Affiliation(s)
- Seth M Davis
- Department of Psychology, University of New England, Biddeford, ME, United States.,Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, United States
| | - Jared T Zuke
- Department of Psychology, University of New England, Biddeford, ME, United States.,Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, United States
| | - Mariah R Berchulski
- Department of Psychology, University of New England, Biddeford, ME, United States.,Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, United States
| | - Michael A Burman
- Department of Psychology, University of New England, Biddeford, ME, United States.,Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, United States
| |
Collapse
|
31
|
Kinoshita M, Stempel KS, Borges do Nascimento IJ, Bruschettini M. Systemic opioids versus other analgesics and sedatives for postoperative pain in neonates. Cochrane Database Syst Rev 2021. [DOI: 10.1002/14651858.cd014876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Mari Kinoshita
- Fetal Medicine Research Center; University of Barcelona; Barcelona Spain
- Department of Pediatrics; Lund University; Lund Sweden
| | | | - Israel Junior Borges do Nascimento
- School of Medicine and University Hospital; Universidade Federal de Minas Gerais (UFMG); Belo Horizonte Brazil
- Department of Medicine; Medical College of Wisconsin; Milwaukee Wisconsin USA
| | - Matteo Bruschettini
- Department of Clinical Sciences Lund, Paediatrics; Lund University, Skåne University Hospital; Lund Sweden
- Cochrane Sweden; Lund University, Skåne University Hospital; Lund Sweden
| |
Collapse
|
32
|
Filippa M, Della Casa E, D’amico R, Picciolini O, Lunardi C, Sansavini A, Ferrari F. Effects of Early Vocal Contact in the Neonatal Intensive Care Unit: Study Protocol for a Multi-Centre, Randomised Clinical Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18083915. [PMID: 33917889 PMCID: PMC8068283 DOI: 10.3390/ijerph18083915] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/04/2021] [Accepted: 04/05/2021] [Indexed: 11/16/2022]
Abstract
Preterm infants are at risk for developing altered trajectories of cognitive, social, and linguistic competences compared to a term population. This is mainly due to medical and environmental factors, as they are exposed to an atypical auditory environment and simultaneously, long periods of early separation from their parents. The short-term effects of early vocal contact (EVC) on an infant’s early stability have been investigated. However, there is limited evidence of its impact on the infant’s autonomic nervous system maturation, as indexed by heart rate variability, and its long-term impact on infant neurodevelopment. Our multi-centric study aims to investigate the effects of EVC on a preterm infant’s physiology, neurobehaviour, and development. Eighty stable preterm infants, born at 25–32 weeks and 6 days gestational age, without specific abnormalities, will be enrolled and randomised to either an intervention or control group. The intervention group will receive EVC, where mothers will talk and sing to their infants for 10 min three times per week for 2 weeks. Mothers in the control group will be encouraged to spend the same amount of time next to the incubator and observe the infant’s behaviour through a standard cluster of indicators. Infants will be assessed at baseline; the end of the intervention; term equivalent age; and 3, 6, 12, and 24 months corrected age, with a battery of physiological, neurobehavioral, and developmental measures. Early interventions in the neonatal intensive care unit have demonstrated effects on the neurodevelopment of preterm infants, thereby lowering the negative long-term effects of an atypical auditory and interactional environment. Our proposed study will provide new insight into mother–infant early contact as a protective intervention against the sequelae of prematurity during this sensitive period of development. Early intervention, such as EVC, is intuitive and easy to implement in the daily care of preterm infants. However, its long-term effects on infant neurodevelopment and maternal sensitivity and stress are still unclear. Trial Registration: NCT04759573, retrospectively registered, 17 February 2021.
Collapse
Affiliation(s)
- Manuela Filippa
- Department of Psychology and Educational Sciences, University of Geneva, 24, rue General Dufour, 1211 Geneva, Switzerland
- Department of Social Sciences, University of Valle d’Aosta, Str. Cappuccini, 2, 11100 Aosta, Italy
- Correspondence:
| | - Elisa Della Casa
- Neonatal Intensive Care Unit, Department of Medical and Surgical Science of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy; (E.D.C.); (F.F.)
| | - Roberto D’amico
- Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy;
| | - Odoardo Picciolini
- Pediatric Physical Medicine & Rehabilitation Unit, IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122 Milan, Italy;
| | - Clara Lunardi
- Department of Neurosciences, Psychology, Drug Research and Children’s Health, University of Florence, Viale Pieraccini, 6, 50139 Florence, Italy;
| | - Alessandra Sansavini
- Department of Psychology “Renzo Canestrari”, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy;
| | - Fabrizio Ferrari
- Neonatal Intensive Care Unit, Department of Medical and Surgical Science of the Mother, Children and Adults, University of Modena and Reggio Emilia, Via del Pozzo 41, 41124 Modena, Italy; (E.D.C.); (F.F.)
| |
Collapse
|
33
|
Dean S, Long M, Ryan E, Tarnoviski K, Mondal A, Lisanti AJ. Assessment of an Educational Tool for Pediatric Cardiac Nurses on Individualized Family-Centered Developmental Care. Crit Care Nurse 2021; 41:e17-e27. [PMID: 33791757 DOI: 10.4037/ccn2021213] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Prevention of neurodevelopmental sequelae is a high priority in the care of infants with congenital heart defects. Individualized family-centered developmental care has been identified as a promising approach to promote infant neurodevelopment during hospitalization. OBJECTIVE To educate nurses on the concept of individualized family-centered developmental care and its application to nursing practice and to reduce perceived barriers to its implementation. METHODS Two evidence-based visual educational tools called "developmental care flowers" were created and implemented in the inpatient and procedural units of a cardiac center. Each flower petal represented a core component of individualized family-centered developmental care: cue-based care, patient positioning, supportive environment, and parent engagement. Surveys were administered before and after the educational intervention to assess changes in nurses' knowledge and perceptions of individualized family-centered developmental care. RESULTS Nurses reported that the developmental care flowers improved their understanding of individualized family-centered developmental care. The educational tools reduced some perceived barriers to implementation of this care model and increased nurse-reported inclusion of parents in care. Qualitative feedback from staff members regarding the tools was positive and acknowledged that individualized family-centered developmental care should be an ongoing priority. CONCLUSIONS The inpatient and procedural developmental care flowers are useful tools for educating nurses about individualized family-centered developmental care. They could be revised into more interactive tools that might be used to educate parents and further support the integration of this care concept into nursing practice.
Collapse
Affiliation(s)
- Spencer Dean
- Spencer Dean is an advanced practice provider, Cardiac Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Meghan Long
- Meghan Long is a clinical nurse, Cardiac Center, Children's Hospital of Philadelphia
| | - Edie Ryan
- Edie Ryan is a cardiac catheterization lab supervisor, Children's Hospital of Philadelphia
| | - Kelly Tarnoviski
- Kelly Tarnoviski is a clinical nurse, Cardiac Center, Children's Hospital of Philadelphia
| | - Antara Mondal
- Antara Mondal is a biostatistician, Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia
| | - Amy Jo Lisanti
- Amy Jo Lisanti is a nurse scientist-clinical nurse specialist, Cardiac Nursing, Center for Pediatric Nursing Research and Evidence-Based Practice, Children's Hospital of Philadelphia, and an adjunct assistant professor, University of Pennsylvania School of Nursing, Philadelphia
| |
Collapse
|
34
|
Rasheed MA, Bharuchi V, Mughis W, Hussain A. Development and feasibility testing of a play-based psychosocial intervention for reduced patient stress in a pediatric care setting: experiences from Pakistan. Pilot Feasibility Stud 2021; 7:63. [PMID: 33673877 PMCID: PMC7936486 DOI: 10.1186/s40814-021-00781-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 01/25/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Hospitalization can be a source of great stress for children and their families. In high-income countries, there are specialized staff to help children cope using different techniques including play. However, it is a major challenge in low and middle-income countries (LMIC) due to financial constraints and untrained human resource. The objective of study was to develop and test the feasibility and acceptance of a psychology trainee-delivered model postulated on employing play as a means of enhancing child-parent interactions leading to reduced stress during hospitalization. METHODS This study was conducted in the paediatric ward of a tertiary care private hospital in Pakistan. Pre-intervention survey revealed that parental stress stemmed mainly from seeing their child irritable, distressed, or in pain. Using a theory of change model, a play-based psychosocial intervention was developed to address these factors. The intervention approach was informed by principles of Nurturing Care Framework and play therapy. Children between birth and 6 years admitted in the acute care ward were eligible. The intervention was delivered between March 2019 and December 2020 by psychology trainees who were supervised by a clinical psychologist. The play-based sessions were delivered at the bedside and ranged from 20 to 40 min. Parents receiving the intervention were later interviewed for their stress, child emotions, and feedback about the service using structured surveys administered by psychology graduates. The trainees delivering the intervention were requested to provide their feedback as a written qualitative open-ended narrative. These narratives were analyzed using an inductive approach. RESULTS The survey was conducted with 223 families with about half of the sample having children under 2 years of age. Forty-five percent of parents reported play intervention to be one of 3 key factors in improving their experience during hospital stay. Only 5% of parents reported feeling stressed about the child illness after the intervention. Ninety to 96% parents felt respected, listened to, and understood by the therapists. Thematic analysis of the feedback by trainees indicated the internship to be a useful experience and a new avenue for professional life whereas physicians appreciated the interventions. CONCLUSIONS The authors conclude that psychology trainees can feasibly deliver a play-based intervention under supervision for reduced stress in children and their parents during hospitalization with mutual benefits.
Collapse
Affiliation(s)
- Muneera A. Rasheed
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Vardah Bharuchi
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | - Waliyah Mughis
- Department of Paediatrics & Child Health, Aga Khan University, Karachi, Pakistan
| | | |
Collapse
|
35
|
Skin-to-Skin Care by Mother vs. Father for Preterm Neonatal Pain: A Randomized Control Trial (ENVIRON Trial). Int J Pediatr 2021; 2021:8886887. [PMID: 33488739 PMCID: PMC7803418 DOI: 10.1155/2021/8886887] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 12/21/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To compare skin-to-skin care (SSC) given by mother and father for preterm neonatal pain control by premature infant pain profile (PIPP) score. Methods 64 stable preterm (28-36 weeks gestational age) neonates born at a level-3 neonatal intensive care unit were included in the trial. Random allocation with the help of a computer-generated sequence was done. In group A, SSC was given by the mother 15 minutes before the first heel-stick, and subsequently, SSC was given by the father before the second heel-stick. In group B, the sequence of SSC provider was reversed. Blinded PIPP score assessment at 0, 1, and 5 minutes of heel-stick were done by two independent assessors using video recording. Results The mean (SD) birth weight was 1665.18 (339.35) grams, and mean (SD) gestational age was 34.28 (2.24) weeks. The PIPP score at 0, 1, and 5 minutes had no statistical or clinically significant differences between both groups (PIPP score mean (SD) at 0 minute = 3.20 (1.11) vs. 3.01 (1.29), p value = 0.38; 1 minute = 8.59 (4.27) vs. 8.26 (4.08), p value = 0.66; 5 minutes = 3.79 (1.40) vs. 3.93 (1.99), p value = 0.65 in SSC by mother and father group, respectively). Furthermore, there was no statistical difference between the groups for any components of the PIPP score (all p values > 0.05). The PIPP score at 5 minutes almost attained the 0-minute level in both the groups. Conclusion Father is as effective as the mother for providing skin-to-skin care for preterm neonatal pain control. This trial is registered with CTRI/2018/01/016783.
Collapse
|
36
|
Non-pharmaceutical intervention and pain management situation for neonatal analgesia. FRONTIERS OF NURSING 2021. [DOI: 10.2478/fon-2020-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Neonatal pain management is an important issue which should have great attention. More and more researches have proved that neonates can feel pain when undergoes painful procedures such as vaccination, heel stick, and so on, and it will result in short-term and long-term outcomes. So it is very important to manage neonatal pain. This article summarized some non-pharmaceutical interventions, including sucrose or glucose, non-nutritional sucking (NNS), breastfeeding, facilitated tucking (FT), kangaroo mother care (KMC), swaddling, heel warming, sensorial saturation (SS), and music therapy, which showed obvious effects for neonatal pain. In addition, this article summarized the progress of neonatal pain intervention in various countries and showed that many countries have not paid enough attention to this problem, while some countries have carried out promotion programs for neonatal pain management which give some clinical enlightenment to our country that we need to pay more attention to this problem.
Collapse
|
37
|
Rabie A, Ghoneim T. Ultrasound guided continuous caudal epidural analgesia in neonates undergoing thoracotomy. EGYPTIAN JOURNAL OF ANAESTHESIA 2021. [DOI: 10.1080/11101849.2021.1914961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Aliaa Rabie
- Lecturer of Anesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | | |
Collapse
|
38
|
Puyana-Romero V, Núñez-Solano D, Fernández-Zacarías F, Jara-Muñoz E, Hernández-Molina R. The Importance of Reverberation for the Design of Neonatal Incubators. Front Pediatr 2021; 9:584736. [PMID: 33898352 PMCID: PMC8058181 DOI: 10.3389/fped.2021.584736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 03/08/2021] [Indexed: 11/13/2022] Open
Abstract
Low frequency noises are predominant in neonatal intensive care units (NICUs). Some studies affirm that neonates can perceive noises from 113 Hz, and can therefore be affected by sound sources with high spectral content at low frequencies (e.g., incubator engine, air fan). Other studies suggest that reverberation amplifies noise within incubators. In this paper, the reverberation time (T, T 30) within an incubator with standard dimensions was measured in one-third octave bands. To get reliable results, the T was measured in 15 positions at the neonate's ear height, in a room with low T values (to reduce the influence of the room in the results), using an impulsive sound method. Results show a heterogeneous T distribution at the neonate's ear height, with maximum average T differences between positions of 1.07 s. The highest average T of all microphone positions is 2.27 s at 125 Hz, an extremely high mean value for such a small space. As the frequency of electrical devices in America is 60 Hz, some harmonics lay within the one-third octave band of 125 Hz, and therefore may create a very reverberant and inappropriate acoustic environment within the audible spectrum of neonates. As the acoustic environment of the incubator and the room are coupled, it is expected that the results are higher in the NICUs than in the room where the measurements were conducted, as NICUs are more reverberant. Therefore, it is recommended that the T will be limited in the international standards, and that incubator designers take it into account.
Collapse
Affiliation(s)
- Virginia Puyana-Romero
- Grupo de Investigación Entornos Acústicos, Facultad de Ingeniería y Ciencias Aplicadas, Universidad de Las Américas, Quito, Ecuador
| | - Daniel Núñez-Solano
- Grupo de Investigación Entornos Acústicos, Facultad de Ingeniería y Ciencias Aplicadas, Universidad de Las Américas, Quito, Ecuador
| | | | | | | |
Collapse
|
39
|
Feasibility of non-contact cardiorespiratory monitoring using impulse-radio ultra-wideband radar in the neonatal intensive care unit. PLoS One 2020; 15:e0243939. [PMID: 33370375 PMCID: PMC7769476 DOI: 10.1371/journal.pone.0243939] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/26/2020] [Indexed: 11/23/2022] Open
Abstract
Background Current cardiorespiratory monitoring equipment can cause injuries and infections in neonates with fragile skin. Impulse-radio ultra-wideband (IR-UWB) radar was recently demonstrated to be an effective contactless vital sign monitor in adults. The purpose of this study was to assess heart rates (HRs) and respiratory rates (RRs) in the neonatal intensive care unit (NICU) using IR-UWB radar and to evaluate its accuracy and reliability compared to conventional electrocardiography (ECG)/impedance pneumography (IPG). Methods The HR and RR were recorded in 34 neonates between 3 and 72 days of age during minimal movement (51 measurements in total) using IR-UWB radar (HRRd, RRRd) and ECG/IPG (HRECG, RRIPG) simultaneously. The radar signals were processed in real time using algorithms for neonates. Radar and ECG/IPG measurements were compared using concordance correlation coefficients (CCCs) and Bland-Altman plots. Results From the 34 neonates, 12,530 HR samples and 3,504 RR samples were measured. Both the HR and RR measured using the two methods were highly concordant when the neonates had minimal movements (CCC = 0.95 between the RRRd and RRIPG, CCC = 0.97 between the HRRd and HRECG). In the Bland-Altman plot, the mean biases were 0.17 breaths/min (95% limit of agreement [LOA] -7.0–7.3) between the RRRd and RRIPG and -0.23 bpm (95% LOA -5.3–4.8) between the HRRd and HRECG. Moreover, the agreement for the HR and RR measurements between the two modalities was consistently high regardless of neonate weight. Conclusions A cardiorespiratory monitor using IR-UWB radar may provide accurate non-contact HR and RR estimates without wires and electrodes for neonates in the NICU.
Collapse
|
40
|
Boggini T, Pozzoli S, Schiavolin P, Erario R, Mosca F, Brambilla P, Fumagalli M. Cumulative procedural pain and brain development in very preterm infants: A systematic review of clinical and preclinical studies. Neurosci Biobehav Rev 2020; 123:320-336. [PMID: 33359095 DOI: 10.1016/j.neubiorev.2020.12.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 12/05/2020] [Accepted: 12/15/2020] [Indexed: 01/16/2023]
Abstract
Very preterm infants may manifest neurodevelopmental impairments, even in the absence of brain lesions. Pathogenesis is complex and multifactorial. Evidence suggests a role of early adversities on neurodevelopmental outcomes, via epigenetic regulation and changes in brain architecture. In this context, we focused on cumulative pain exposure which preterm neonates experience in neonatal intensive care unit (NICU). We systematically searched for: i) evidence linking pain with brain development and exploring the potential pathogenetic role of epigenetics; ii) preclinical research supporting clinical observational studies. Nine clinical neuroimaging studies, during neonatal or school age, mostly from the same research group, revealed volume reduction of white and gray matter structures in association with postnatal pain exposure. Three controlled animal studies mimicking NICU settings found increased cell death or apoptosis; nevertheless, eligible groups were limited in size. Epigenetic modulation (SLC6A4 promoter methylation) was identified in only two clinical trials. We call for additional research and, although knowledge gaps, we also point out the urgent need of minimizing painful procedures in NICUs.
Collapse
Affiliation(s)
- Tiziana Boggini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy.
| | - Sara Pozzoli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, Milan, Italy
| | - Paola Schiavolin
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Raffaele Erario
- University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Fabio Mosca
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy; University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - Paolo Brambilla
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Department of Neurosciences and Mental Health, Milan, Italy; University of Milan, Department of Pathophysiology and Transplantation, Milan, Italy
| | - Monica Fumagalli
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, NICU, Milan, Italy; University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| |
Collapse
|
41
|
Zubareva OE, Postnikova TY, Grifluk AV, Schwarz AP, Smolensky IV, Karepanov AA, Vasilev DS, Veniaminova EA, Rotov AY, Kalemenev SV, Zaitsev AV. Exposure to bacterial lipopolysaccharidein early life affects the expression of ionotropic glutamate receptor genes and is accompanied by disturbances in long-term potentiation and cognitive functions in young rats. Brain Behav Immun 2020; 90:3-15. [PMID: 32726683 DOI: 10.1016/j.bbi.2020.07.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 07/21/2020] [Accepted: 07/22/2020] [Indexed: 01/20/2023] Open
Abstract
Infections in childhood play an essential role in the pathogenesis of cognitive and psycho-emotional disorders. One of the possible mechanisms of these impairments is changes in the functional properties of NMDA and AMPA glutamate receptors in the brain. We suggest that bacterial infections during the early life period, which is critical for excitatory synapse maturation, can affect the subunit composition of NMDA and AMPA receptors. In the present study, we investigated the effect of repetitive lipopolysaccharide (LPS) intraperitoneal (i.p.) administration (25 μg/kg/day on P14, 16, and 18), mimicking an infectious disease, on the expression of subunits of NMDA and AMPA receptors in young rats. We revealed a substantial decrease of GluN2B subunit expression in the hippocampus at P23 using Western blot analysis and real-time polymerase chain reaction assay. Moderate changes were also found in GluN1, GluN2A, and GluA1 mRNA expression. The LPS-treated rats exhibited decreased exploratory and locomotor activity in the open field test and the impairment of spatial learning in the Morris water maze. Behavioral impairments were accompanied by a significant reduction in long-term hippocampal synaptic potentiation. Our data indicate that LPS-treatment in the critical period for excitatory synapse maturation alters ionotropic glutamate receptor gene expression, disturbs synaptic plasticity, and alters behavior.
Collapse
Affiliation(s)
- Olga E Zubareva
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia; Laboratory of Neurobiology of the Brain Integrative Functions, Pavlov Department of Physiology, Institute of Experimental Medicine, St. Petersburg, Russia
| | - Tatyana Y Postnikova
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Alexandra V Grifluk
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Alexander P Schwarz
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Ilya V Smolensky
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Anton A Karepanov
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Dmitry S Vasilev
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Ekaterina A Veniaminova
- Laboratory of Neurobiology of the Brain Integrative Functions, Pavlov Department of Physiology, Institute of Experimental Medicine, St. Petersburg, Russia
| | - Alexander Y Rotov
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Sergey V Kalemenev
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia
| | - Aleksey V Zaitsev
- Laboratory of Molecular Mechanisms of Neuronal Interactions, Sechenov Institute of Evolutionary Physiology and Biochemistry, Russian Academy of Sciences, St. Petersburg, Russia.
| |
Collapse
|
42
|
Chen Q, Jiang X, Liu X, Lu C, Wang L, Chen W. Non-Contact Heart Rate Monitoring in Neonatal Intensive Care Unit using RGB Camera. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2020:5822-5825. [PMID: 33019298 DOI: 10.1109/embc44109.2020.9175651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Heart rate (HR) measurement is crucial for newborn infant monitoring in the neonatal intensive care unit (NICU). The widely used contact HR measurement methods based on electrocardiography (ECG) and photoplethysmography (PPG) signals can lead to discomfort and possible skin irritation on neonates, which limit its application in NICU scenarios. In this work, we propose a non-contact HR monitoring method simply using a RGB camera. Eulerian video magnification (EVM) is employed to detect the subtle changes of neonatal faces results from blood circulation. The magnified signal is then transformed to the spectral domain to extract HR information. Compared with the widely investigated independent component analysis (ICA)-based HR measurement method using video recordings, the proposed method can achieve the real time HR measurement, which is a significant superiority in NICU neonatal monitoring. To the best of our knowledge, this is the first study to employ EVM algorithm in real time neonatal HR monitoring.
Collapse
|
43
|
Kinoshita M, Stempel K, do Nascimento IJB, Vejayaram DN, Norman E, Bruschettini M. Opioids and alpha-2-agonists for analgesia and sedation in newborn infants: protocol of a systematic review. Syst Rev 2020; 9:183. [PMID: 32819417 PMCID: PMC7441710 DOI: 10.1186/s13643-020-01436-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/29/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hospitalized newborn infants may require analgesia and sedation either for the management of procedural pain, during or after surgery, and other painful conditions. The benefits and harms of opioids administered at different doses and routes of administration have been reported in numerous trials and systematic reviews. The use of alpha-2-agonists such as clonidine and dexmedetomidine in newborn infants is more recent, and they might be prescribed to reduce the total amount of opioids which are thought to have more side effects. Moreover, alpha-2-agonists might play an important role in the management of agitation and discomfort. METHODS We will conduct a systematic review and meta-analysis on the use of opioids, alpha-2-agonists, or the combination of both drugs. We will include randomized controlled trials to assess benefits and harms and observational studies to assess adverse events and pharmacokinetics; preterm and term infants; studies on any opioids or alpha-2-agonists administered for any indication and by any route except spinal, intraosseous, or administration for nerve blocks and wound infusions. The use of opioids or alpha-2-agonists will be compared to no intervention; placebo with normal saline or other non-sedative, non-analgesic drug; control with oral sugar solution or non-pharmacological intervention; same drug of different dose or route; or a different drug (not limiting to opioids and alpha-2-agonists) or combinations of such drugs. The primary outcomes for this review will be all-cause mortality during initial hospitalization and hypotension requiring medical therapy. We will conduct a search in the following databases: The Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library), MEDLINE, Embase, and CINAHL. Two review authors will independently screen records for inclusion, undertake data abstraction using a data extraction form and assess the risk of bias of all included trials using the Cochrane "Risk of bias" tool. DISCUSSION This systematic review will summarize and update our knowledge about neonatal analgesia and sedation including pharmacokinetics/pharmacodynamics, and provide a platform for developing evidence-based guidelines that we can immediately apply to our clinical practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO 2020 CRD42020170852.
Collapse
Affiliation(s)
- Mari Kinoshita
- Faculty of Medicine, Lund University, Lund, Sweden. .,Keio University School of Medicine, Tokyo, Japan.
| | | | - Israel Junior Borges do Nascimento
- School of Medicine at Universidade Federal de Minas Gerais, Minas Gerais, Belo Horizonte, Brazil.,Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Elisabeth Norman
- Lund University, Skane University Hospital, Department of Clinical Sciences Lund, Pediatrics, Lund, Sweden
| | | |
Collapse
|
44
|
Anand KJS, Roue JM, Rovnaghi CR, Marx W, Bornmann L. Historical roots of pain management in infants: A bibliometric analysis using reference publication year spectroscopy. PAEDIATRIC & NEONATAL PAIN 2020; 2:22-32. [PMID: 35548591 PMCID: PMC8975229 DOI: 10.1002/pne2.12035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 07/03/2020] [Accepted: 07/03/2020] [Indexed: 11/08/2022]
Abstract
Retrospective evaluations of the historical role of previously published research are often fraught with subjective bias and misrepresentation, which leads to contested scientific claims. This paper investigates the historical roots of infant pain management using novel quantitative methods to identify the published literature and evaluate its relative importance. A bibliometric analysis named “reference publication year spectroscopy” (RPYS), was performed using the program CitedReferencesExplorer (CRExplorer) to avoid the subjectivity associated with comparative evaluations of individual research studies. Web of Science (WoS) search queries on infant‐related synonyms, pain‐related synonyms, and analgesia or anesthesia‐related synonyms were combined using the Boolean operator “AND,” to identify all publications related to pain management in infants. The RPYS analyses were based on 8697 papers in our publication set containing the citations for 86268 references. Selected cited publications were associated with peak citation years in 1951, 1954, 1957, 1965, 1987, 1990, 1997, 1999, and 2000. Subsequent analyses suggested that research on infant pain management made rapid progress during 1982‐1992. Landmark publications were defined as those belonging to the top 10% of the most frequently referenced publications for longer than 25 years. Through this analysis, we identified and ranked 24 landmark publications to illustrate the historical background and early research on infant pain management. From the first‐ever application of RPYS (an objective, reproducible approach to study the early history of any scholarly activity) to pain research, infant pain management appears rooted in the scientific rationale for neonatal pain perception, randomized trials of opioid anesthesia/analgesia, and studies describing the facial expressions and crying activity following heel‐lance procedures in newborns.
Collapse
Affiliation(s)
- Kanwaljeet J S Anand
- Department of Pediatrics Stanford University School of Medicine Palo Alto CA USA.,Pain/Stress Neurobiology Lab Maternal & Child Health Research Institute Stanford University School of Medicine Palo Alto CA USA
| | - Jean-Michel Roue
- Neonatal & Pediatric Intensive Care Unit Brest University Hospital University of Western Brittany Brest France
| | - Cynthia R Rovnaghi
- Pain/Stress Neurobiology Lab Maternal & Child Health Research Institute Stanford University School of Medicine Palo Alto CA USA
| | - Werner Marx
- Max Planck Institute for Solid State Research Stuttgart Germany
| | - Lutz Bornmann
- Division for Science and Innovation Studies Administrative Headquarters The Max Planck Society Munich Germany
| |
Collapse
|
45
|
Brahnam S, Nanni L, McMurtrey S, Lumini A, Brattin R, Slack M, Barrier T. Neonatal pain detection in videos using the iCOPEvid dataset and an ensemble of descriptors extracted from Gaussian of Local Descriptors. APPLIED COMPUTING AND INFORMATICS 2020. [DOI: 10.1016/j.aci.2019.05.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Diagnosing pain in neonates is difficult but critical. Although approximately thirty manual pain instruments have been developed for neonatal pain diagnosis, most are complex, multifactorial, and geared toward research. The goals of this work are twofold: 1) to develop a new video dataset for automatic neonatal pain detection called iCOPEvid (infant Classification Of Pain Expressions videos), and 2) to present a classification system that sets a challenging comparison performance on this dataset. The iCOPEvid dataset contains 234 videos of 49 neonates experiencing a set of noxious stimuli, a period of rest, and an acute pain stimulus. From these videos 20 s segments are extracted and grouped into two classes: pain (49) and nopain (185), with the nopain video segments handpicked to produce a highly challenging dataset. An ensemble of twelve global and local descriptors with a Bag-of-Features approach is utilized to improve the performance of some new descriptors based on Gaussian of Local Descriptors (GOLD). The basic classifier used in the ensembles is the Support Vector Machine, and decisions are combined by sum rule. These results are compared with standard methods, some deep learning approaches, and 185 human assessments. Our best machine learning methods are shown to outperform the human judges.
Collapse
|
46
|
Filippa M, Menin D, Panebianco R, Monaci MG, Dondi M, Grandjean D. Live Maternal Speech and Singing Increase Self-Touch and Eye-Opening in Preterm Newborns: A Preliminary Study. JOURNAL OF NONVERBAL BEHAVIOR 2020. [DOI: 10.1007/s10919-020-00336-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
47
|
Nimbalkar S, Shukla VV, Chauhan V, Phatak A, Patel D, Chapla A, Nimbalkar A. Blinded randomized crossover trial: Skin-to-skin care vs. sucrose for preterm neonatal pain. J Perinatol 2020; 40:896-901. [PMID: 32152488 DOI: 10.1038/s41372-020-0638-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 02/14/2020] [Accepted: 02/25/2020] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare skin-to-skin care (SSC) and oral sucrose for preterm neonatal pain control. METHODS Preterm neonates (28-36 weeks gestation) requiring heel-stick were eligible. In group-A, SSC was given 15-min before first heel-stick, and sucrose was given 2-min before second heel-stick. In group-B, the sequence was reversed. Blinded premature infant pain profile (PIPP) score assessment was done at 0, 1, and 5-min of heel-stick by two assessors. RESULTS A hundred neonates were enrolled. The inter-rater agreement for the PIPP score was good. The behavior state component was significantly lower in the sucrose group at all assessment points. The mean (SD) difference between 1-min and 0 min was similar [SSC 3.58(3.16) vs. sucrose 4.09(3.82), p = 0.24] between groups. The PIPP score attained baseline values at 5-min in both groups. CONCLUSION Albeit sucrose indicated instantaneous action, SSC and sucrose have comparable clinical efficacy for preterm neonatal pain control. Multisensory stimulation with SSC may result in a higher behavioral state component of the PIPP score.
Collapse
Affiliation(s)
| | - Vivek V Shukla
- Pramukhswami Medical College, Anand, Gujarat, India. .,University of Alabama at Birmingham, Birmingham, AL, USA.
| | | | - Ajay Phatak
- Pramukhswami Medical College, Anand, Gujarat, India
| | - Dipen Patel
- Pramukhswami Medical College, Anand, Gujarat, India
| | | | | |
Collapse
|
48
|
Menin D, Dondi M. Methodological Issues in the Study of the Development of Pain Responsivity in Preterm Neonates: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103507. [PMID: 32429581 PMCID: PMC7277564 DOI: 10.3390/ijerph17103507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/14/2020] [Accepted: 05/16/2020] [Indexed: 11/16/2022]
Abstract
The study of the development of neonatal pain responses is of key importance, both for research and for clinical reasons, with particular regard to the population of preterm neonates, given the amount of painful procedures they are exposed to on a daily basis. The aim of this work was to systematize our knowledge about the development of pain responses in prematurely born neonates by focusing on some key methodological issues. Studies on the impact of age variables, namely gestational age (GA), postmenstrual age (PMA) and chronological age (CH), on pain responsivity in premature neonates were identified using Medline and Scopus. Studies (N = 42) were categorized based on terminological and methodological approaches towards age variables, and according to output variables considered (facial, nonfacial behavioral, physiological). Distinct multidimensional developmental patterns were found for each age-sampling strategy. Overall, each of the three age variables seems to affect pain responsivity, possibly differently across age windows. Targeted as well as integrated approaches, together with a renewed attention for methodological consistency, are needed to further our knowledge on this topic.
Collapse
Affiliation(s)
| | - Marco Dondi
- Correspondence: ; Tel.: +39-0532-293538; Fax: +39-0532-455234
| |
Collapse
|
49
|
Avila‐Alvarez A, Pertega‐Diaz S, Vazquez Gomez L, Sucasas Alonso A, Romero Rey H, Eiriz Barbeito D, Cabana Vazquez M. Pain assessment during eye examination for retinopathy of prematurity screening: Skin conductance versus PIPP-R. Acta Paediatr 2020; 109:935-942. [PMID: 31630433 DOI: 10.1111/apa.15066] [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: 08/25/2019] [Accepted: 10/17/2019] [Indexed: 11/30/2022]
Abstract
AIM To assess changes in skin conductance during retinopathy of prematurity screening and to study the correlation between the skin conductance and a validated pain scale. METHODS Prospective observational study. Fifty-three eye examinations were performed in 32 preterm infant candidates for retinopathy of prematurity screening. Outcome measures were changes in Premature Infant Pain Profile-Revised (PIPP-R) scale and number of skin conductance fluctuations. RESULTS There was a significant increase from baseline in the number of skin conductance fluctuations and PIPP-R during the procedure. The maximum value of number of skin conductance fluctuations was 0.64 ± 0.44 peaks/sec, and the maximum value of PIPP-R was 10.8 ± 3.3. A correlation between the skin conductance and PIPP-R was not found at any time during the eye examination. Repeated measures correlation analyses showed only a moderate positive correlation between PIPP-R and number of skin conductance fluctuation values. CONCLUSION There were significant changes in both PIPP-R and number of skin conductance fluctuations during retinopathy of prematurity screening, reaffirming that this procedure is painful and stressful. The number of skin conductance fluctuations and PIPP-R are not significantly correlated, which likely reflects that these parameters evaluate different but complementary aspects of neonatal pain responses.
Collapse
Affiliation(s)
- Alejandro Avila‐Alvarez
- Department of Neonatology Complexo Hospitalario Universitario de A Coruña A Coruña Spain
- A Coruña Biomedical Research Institute (INIBIC) A Coruña Spain
| | - Sonia Pertega‐Diaz
- A Coruña Biomedical Research Institute (INIBIC) A Coruña Spain
- Research Support Unit Complexo Hospitalario Universitario A Coruña A Coruña Spain
| | - Lorena Vazquez Gomez
- Department of Neonatology Complexo Hospitalario Universitario de A Coruña A Coruña Spain
| | - Andrea Sucasas Alonso
- Department of Neonatology Complexo Hospitalario Universitario de A Coruña A Coruña Spain
| | - Henar Romero Rey
- Department of Neonatology Complexo Hospitalario Universitario de A Coruña A Coruña Spain
| | - Dolores Eiriz Barbeito
- Department of Neonatology Complexo Hospitalario Universitario de A Coruña A Coruña Spain
| | | |
Collapse
|
50
|
Abstract
Background: The recent addition of intranasal medication options for procedural sedation and analgesia has decreased the need for additional painful procedures such as intravenous lines for medication administration. Intranasal fentanyl (INF) has been used in the prehospital setting, as well as in the emergency department for several years, and is increasingly utilized in other locations such as the neonatal intensive care unit (NICU). A paucity of data exists in these smallest children, so we sought to explore trends in INF use in our NICU. Objective: The objective of the study was to describe INF use in the NICU from December 2014 to December 2017. Design/Methods: A retrospective cohort study was conducted of patients receiving INF in the NICU of a large free-standing quaternary inner-city children's hospital from December 2014 to 2017. Demographic data were abstracted from the medical record including gestational age on administration, post-menstrual age, day of life on administration, sex, medication initial and total dose, reported indication, and documented adverse events. This study was approved by our local institutional review board. Results: A total of 54 patients received a total of 67 INF administrations: 32 women (59%), median day of life on administration = 57.1 (interquartile range [IQR] = 33.7-110.4), median weeks gestation = 26.0 (IQR = 24.1-36.1), post-menstrual age = 38.1 weeks (IQR = 33.1-45.4). Initial doses of medications were 1.49 µg/kg/dose INF (range = 0.5-2 µg/kg). Conclusions: Intranasal adjuncts are increasingly used in the NICU. Starting dose of INF is 1.5 µg/kg/dose, and typically, one dose is given.
Collapse
|