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Oulton K, Williams A, Gibson F. Acceptability of a novel device to improve child patient experience during venepuncture for blood sampling: Intervention with 'MyShield'. J Child Health Care 2024; 28:53-68. [PMID: 35544716 DOI: 10.1177/13674935221098297] [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: 11/15/2022]
Abstract
This study aimed to explore the acceptability of a novel device ('MyShield'): a device used for distraction during clinical procedures. It is a cardboard cuff, designed to fit around the arm, either above the elbow or around the wrist and used to hide the procedure from view. This device was tested in practice, to establish acceptability to children, parents and clinical staff. Fifty-eight children tried 'MyShield' during a venepuncture procedure. Feedback from 54 children, 58 parents/carers and 16 clinical staff was collected using surveys and interviews. In 24 cases, observational data were also collected. A large majority of children (94%, n = 51) and parents (96%, n = 56) reported a positive experience when using 'MyShield'; saying they would likely use it again. Potential of 'MyShield' in promoting parent/clinician interaction with the child was highlighted. Data suggests that 'MyShield' may be a useful device for children undergoing venepuncture, when used in conjunction with standard care, and subject to individual preferences and choice. Further work is required to establish mechanism of action and whether use of 'MyShield' has any impact across a range of short- and long-term outcome measures relating to patient experience and effectiveness.
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London, UK
| | | | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London, UK
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
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Daihimfar F, Babamohamadi H, Ghorbani R. A Comparison of the Effects of Acupressure and Music on Venipuncture Pain Intensity in Children: A Randomized Controlled Clinical Trial. Pain Res Manag 2024; 2024:2504732. [PMID: 38274399 PMCID: PMC10810694 DOI: 10.1155/2024/2504732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/27/2024]
Abstract
Pain from injections is common in children of all ages, and more than 90% of hospitalized children experience invasive and painful procedures such as venipuncture. In light of the complications associated with pain relief medications, nonpharmacological and complementary medicine approaches have gained attention. This study aims to compare the effects of acupressure and music on venipuncture pain intensity in children. This randomized controlled clinical trial involved 180 children aged 3-6 years who sought treatment at the Children's Medical Center Hospital Emergency Department at Tehran University of Medical Sciences, Iran. The children were randomly assigned to one of three groups: acupressure, music, or control. The interventions were given within 5 minutes, starting 3 minutes before the venipuncture and continuing until completion. The interventions included playing music through headphones and applying acupressure to the Hugo point. Venipuncture was carried out under identical conditions using an Angiocath 24G needle. Pain intensity was assessed using the Oucher scale. Data were analyzed using SPSS 24, employing the Kruskal-Wallis, chi-square, and Bonferroni pairwise comparison tests, with a significance level of 0.05. The mean pain intensity was 3.32 ± 1.44 in the music group, 4.82 ± 1.51 in the acupressure group, and 8.32 ± 1.10 in the control group. Pain intensity significantly differed among the three groups (p < 0.001). Specifically, pain intensity was lower in the music group compared to both the acupressure (p < 0.001) and control (p < 0.001) groups. Furthermore, pain intensity was lower in the acupressure group than in the control group (p < 0.001). Based on the results, music and acupressure methods effectively reduce pain intensity during venipuncture in children. Considering that music demonstrated a more pronounced effect in alleviating venipuncture pain than acupressure, the recommendation is to utilize music as a method of pain management during venipuncture in children. Iranian Registry of Clinical Trials, Trial No. IRCT20120109008665N15, was registered on 6 December 2021.
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Affiliation(s)
- Faezeh Daihimfar
- Student Research Committee, Semnan University of Medical Sciences, Semnan 3513138111, Iran
| | - Hassan Babamohamadi
- Nursing Care Research Center, Semnan University of Medical Sciences, Semnan 3513138111, Iran
- Department of Nursing, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan 3513138111, Iran
| | - Raheb Ghorbani
- Social Determinants of Health Research Center, Semnan University of Medical Sciences, Semnan, Iran
- Department of Social Medicine, School of Medicine, Semnan University of Medical Sciences, Semnan 3513138111, Iran
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Cotter JM, Hall M, Shah SS, Molloy MJ, Markham JL, Aronson PL, Stephens JR, Steiner MJ, McCoy E, Collins M, Tchou MJ. Variation in bacterial pneumonia diagnoses and outcomes among children hospitalized with lower respiratory tract infections. J Hosp Med 2022; 17:872-879. [PMID: 35946482 DOI: 10.1002/jhm.12940] [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: 03/23/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Current diagnostics do not permit reliable differentiation of bacterial from viral causes of lower respiratory tract infection (LRTI), which may lead to over-treatment with antibiotics for possible bacterial community-acquired pneumonia (CAP). OBJECTIVES We sought to describe variation in the diagnosis and treatment of bacterial CAP among children hospitalized with LRTIs and determine the association between CAP diagnosis and outcomes. DESIGN, SETTING AND PARTICIPANTS This multicenter cross-sectional study included children hospitalized between 2017 and 2019 with LRTIs at 42 children's hospitals. MAIN OUTCOME AND METHODS We calculated the proportion of children with LRTIs who were diagnosed with and treated for bacterial CAP. After adjusting for confounders, hospitals were grouped into high, moderate, and low CAP diagnosis groups. Multivariable regression was used to examine the association between high and low CAP diagnosis groups and outcomes. RESULTS We identified 66,581 patients hospitalized with LRTIs and observed substantial variation across hospitals in the proportion diagnosed with and treated for bacterial CAP (median 27%, range 12%-42%). Compared with low CAP diagnosing hospitals, high diagnosing hospitals had higher rates of CAP-related revisits (0.6% [95% confidence interval: 0.5, 0.7] vs. 0.4% [0.4, 0.5], p = .04), chest radiographs (58% [53, 62] vs. 46% [41, 51], p = .02), and blood tests (43% [33, 53] vs. 26% [19, 35], p = .046). There were no significant differences in length of stay, all-cause revisits or readmissions, CAP-related readmissions, or costs. CONCLUSION There was wide variation across hospitals in the proportion of children with LRTIs who were treated for bacterial CAP. The lack of meaningful differences in clinical outcomes among hospitals suggests that some institutions may over-diagnose and overtreat bacterial CAP.
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Affiliation(s)
- Jillian M Cotter
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas, USA
| | - Samir S Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Matthew J Molloy
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Jessica L Markham
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Paul L Aronson
- Departments of Pediatrics and Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - John R Stephens
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Michael J Steiner
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Elisha McCoy
- Department of Pediatrics and Medicine, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Megan Collins
- Department of Pediatrics, Children's Mercy Kansas City, University of Missouri Kansas City, Kansas City, Missouri, USA
| | - Michael J Tchou
- Department of Pediatrics, Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado, USA
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Simonini A, Brogi E, Cascella M, Vittori A. Advantages of ketamine in pediatric anesthesia. Open Med (Wars) 2022; 17:1134-1147. [PMID: 35859796 PMCID: PMC9263896 DOI: 10.1515/med-2022-0509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/13/2022] [Accepted: 05/16/2022] [Indexed: 12/29/2022] Open
Abstract
Although ketamine is primarily used for induction and maintenance of general anesthesia, it also presents sedative, amnestic, anesthetics, analgesic, antihyperalgesia, neuroprotective, anti-inflammatory, immunomodulant, and antidepressant effects. Its unique pharmacodynamics and pharmacokinetic properties allow the use of ketamine in various clinical settings including sedation, ambulatory anesthesia, and intensive care practices. It has also adopted to manage acute and chronic pain management. Clinically, ketamine produces dissociative sedation, analgesia, and amnesia while maintaining laryngeal reflexes, with respiratory and cardiovascular stability. Notably, it does not cause respiratory depression, maintaining both the hypercapnic reflex and the residual functional capacity with a moderate bronchodilation effect. In the pediatric population, ketamine can be administered through practically all routes, making it an advantageous drug for the sedation required setting such as placement of difficult vascular access and in uncooperative and oppositional children. Consequently, ketamine is indicated in prehospital induction of anesthesia, induction of anesthesia in potentially hemodynamic unstable patients, and in patients at risk of bronchospasm. Even more, ketamine does not increase intracranial pressure, and it can be safely used also in patients with traumatic brain injuries. This article is aimed to provide a brief and practical summary of the role of ketamine in the pediatric field.
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Affiliation(s)
- Alessandro Simonini
- Department of Pediatric Anaesthesia and Intensive Care, S.C. SOD Anestesia e Rianimazione Pediatrica, Ospedale G. Salesi , Ancona , 60123 , Italy
| | - Etrusca Brogi
- Department Anesthesia and Intensive Care, University of Pisa , Pisa , 56126 , Italy
| | - Marco Cascella
- Department of Supportive Care, Division of Anesthesia and Pain Medicine, Istituto Nazionale Tumori, IRCCS Fondazione G. Pascale , Naples , 80100 , Italy
| | - Alessandro Vittori
- Department of Anesthesia and Critical Care, ARCO Roma Ospedale Pediatrico Bambino Gesù IRCCS, Piazza S. Onofrio 4 , 00165 , Rome , Italy
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Grabinski ZG, Boscamp NS, Zuckerman WA, Zviti R, O'Brien A, Martinez M, Tsze DS. Efficacy of Distraction for Reducing Pain and Distress Associated With Venipuncture in the Pediatric Posttransplant Population: A Randomized Controlled Trial. Pediatr Emerg Care 2022; 38:e811-e815. [PMID: 34034337 DOI: 10.1097/pec.0000000000002458] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Distraction can reduce pain and distress associated with painful procedures but has never been studied in children with solid organ transplants. We aimed to determine whether there is a difference in pain and distress associated with venipuncture in pediatric posttransplant patients who receive distraction compared with those who do not. METHODS Randomized controlled trial of children aged 4 to 17 years with solid organ transplants undergoing venipuncture in the outpatient setting. Patients were randomized to receive distraction or no distraction. The primary outcome was the Faces Pain Scale-Revised. Secondary outcomes were the Observational Scale of Behavioral Distress-Revised; Faces, Leg, Activity, Cry, Consolability; and Children's Hospital of Eastern Ontario Pain Scale. Exploratory outcomes included the number of venipuncture attempts, time to successful venipuncture, and satisfaction of phlebotomists and parents. RESULTS Median age of the 40 children enrolled was 11.5 years. Type of transplants included the heart (67.5%), kidney (22.5%), liver (7.5%), and more than 1 organ (2.5%). There was no difference between the Faces Pain Scale-Revised scores in distraction and no distraction groups (1.4; 95% confidence interval, 0.9-1.9; and 1.3, 95% confidence interval, 0.5-2.1, respectively). There was also no difference in the Observational Scale of Behavioral Distress-Revised; Faces, Leg, Activity, Cry, Consolability; and Children's Hospital of Eastern Ontario Pain Scale scores, number of venipuncture attempts, or time to successful venipuncture. Phlebotomists were more satisfied with the venipuncture when distraction was implemented. CONCLUSIONS In children with solid organ transplants, there was no difference in pain and distress associated with venipuncture between those who did and did not receive distraction. There was also no difference in other procedure-related outcomes except for greater phlebotomist satisfaction when distraction was implemented.
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Affiliation(s)
- Zoe G Grabinski
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine
| | | | | | - Ronald Zviti
- Division of Nephrology, Department of Pediatrics
| | - Ann O'Brien
- Division of Nephrology, Department of Pediatrics
| | - Mercedes Martinez
- Division of Hepatology and Gastroenterology, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Daniel S Tsze
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine
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Addab S, Hamdy R, Thorstad K, May S, Tsimicalis A. Use of virtual reality in managing paediatric procedural pain and anxiety: An integrative literature review. J Clin Nurs 2022; 31:3032-3059. [DOI: 10.1111/jocn.16217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 12/16/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Sofia Addab
- Experimental Surgery Faculty of Medicine McGill University Montreal Quebec Canada
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Reggie Hamdy
- Experimental Surgery Faculty of Medicine McGill University Montreal Quebec Canada
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Kelly Thorstad
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Sylvie May
- CHU Ste‐Justine Montreal Quebec Canada
- Faculty of Nursing Université de Montréal Montreal Quebec Canada
| | - Argerie Tsimicalis
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
- Ingram School of Nursing McGill University Montreal Quebec Canada
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Dalawi I, Isa MR, Abd Malik K, Mohd Hatta FH, Fairuz Rahmat M. How Anxiety Our Adult Patients Before Venepuncture Procedure: A Study in UiTM Medical Centre Sungai Buloh (UiTMMC). JOURNAL OF MENTAL HEALTH AND SOCIAL BEHAVIOUR 2022; 4. [DOI: 10.33790/jmhsb1100163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
Background: Venepuncture is one of the commonest stressful invasive procedures in the health care setting. Unfortunately, to date, there was a lack of locally published studies that studied anxiety, especially before the procedure among adult patients. Hence, this study was conducted to determine the factors associated with the state and trait-anxiety among adult patients before the venepuncture procedure in UiTMMC.
Methods: A cross-sectional pilot study was conducted among patients while waiting for a venepuncture procedure in March 2020. Patients aged 18 years old and above, Malaysian, able to understand English or Malay and had experienced venepuncture in UiTMMC were recruited. Malay validated version of the State-Trait-Anxiety-Inventory (STAI) Questionnaire was used to assess the anxiety level. Data were analysed using IBM SPSS Version 26.0, and multiple linear regression was used to determine the associated factors for state and trait-anxiety before the venepuncture procedure.
Results: A total of 330 patients with a mean age of 46.34 ± 14.34 years participated in this study. The mean of the state-anxiety score was 38.02 ± 14.25 and the mean trait-anxiety score was 36.46 ± 11.47. The correlation between state-anxiety and trait-anxiety scores was highly significant (r=0.870, p<0.001). Factors associated with state-anxiety and trait-anxiety contributed with 72.6% and 58.5% variances, respectively.
Conclusions: Adult patients who waiting for venepuncture in were average low state and trait anxiety scores. Although the associated factors were majority non-modifiable, this finding still can instil awareness to the health care workers who are dealing with needle procedurals.
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Stephens JR, Hall M, Markham JL, Tchou MJ, Cotter JM, Shah SS, Steiner MJ, Gay JC. Outcomes Associated With High- Versus Low-Frequency Laboratory Testing Among Hospitalized Children. Hosp Pediatr 2021; 11:563-570. [PMID: 33952575 DOI: 10.1542/hpeds.2020-005561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous pediatric studies have revealed substantial variation in laboratory testing for specific conditions, but clinical outcomes associated with high- versus low-frequency testing are unclear. We hypothesized that hospitals with high- versus low-testing frequency would have worse clinical outcomes. METHODS We conducted a multicenter retrospective cohort study of patients 0 to 18 years old with low-acuity hospitalizations in the years 2018-2019 for 1 of 10 common All Patient Refined Diagnosis Related Groups. We identified hospitals with high-, moderate-, and low-frequency testing for 3 common groups of laboratory tests: complete blood cell count, basic chemistry studies, and inflammatory markers. Outcomes included length of stay, 7- and 30-day emergency department revisit and readmission rates, and hospital costs, comparing hospitals with high- versus low-frequency testing. RESULTS We identified 132 391 study encounters across 44 hospitals. Laboratory testing frequency varied by hospital and condition. We identified hospitals with high- (13), moderate- (20), and low-frequency (11) laboratory testing. When we compared hospitals with high- versus low-frequency testing, there were no differences in adjusted hospital costs (rate ratio 0.89; 95% confidence interval 0.71-1.12), length of stay (rate ratio 0.98; 95% confidence interval 0.91-1.06), 7-day (odds ratio 0.99; 95% confidence interval 0.81-1.21) or 30-day (odds ratio 1.01; 95% confidence interval 0.82-1.25) emergency department revisit rates, or 7-day (odds ratio 0.84; 95% confidence interval 0.65-1.25) or 30-day (odds ratio 0.91; 95% confidence interval 0.76-1.09) readmission rates. CONCLUSIONS In a multicenter study of children hospitalized for common low-acuity conditions, laboratory testing frequency varied widely across hospitals, without substantial differences in outcomes. Our results suggest opportunities to reduce laboratory overuse across conditions and children's hospitals.
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Affiliation(s)
- John R Stephens
- North Carolina Children's Hospital and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina;
| | - Matt Hall
- Children's Hospital Association, Overland Park, Kansas
| | - Jessica L Markham
- Children's Mercy Hospital and University of Missouri-Kansas City, Kansas City, Missouri
| | - Michael J Tchou
- Children's Hospital Colorado and School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Jillian M Cotter
- Children's Hospital Colorado and School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Samir S Shah
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio; and
| | - Michael J Steiner
- North Carolina Children's Hospital and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - James C Gay
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
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Mahon P, Grouchy K, McCartney H, Douglas K, Wu JK. Positive effects of ultrasound-guided peripheral IV insertion on pediatric sickle cell anemia/thalassemia patients receiving automated red cell exchange procedures or chronic transfusion therapy. J Clin Apher 2020; 36:143-148. [PMID: 33247605 DOI: 10.1002/jca.21856] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/16/2020] [Accepted: 11/06/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Peripheral vascular access and venipuncture are major causes of distress and anxiety for children and their parents. This is especially difficult for patients with hemoglobinopathies (thalassemia major and sickle cell disease) who require chronic blood transfusions. These patients require peripheral venous access for regular blood transfusions and (in the case of sickle cell disease) for automated red cell exchange procedures. Peripheral intravenous (PIV) catheters are much preferred to central venous lines as they carry far fewer risks. However, when patients experience multiple unsuccessful attempts to initiate a PIV, it can be traumatizing and cause anxiety for future visits. Establishing therapeutic trust and ensuring a smooth experience are of paramount importance for these chronic patients who require regular blood transfusions. AIM The purpose of this study was to determine whether ultrasound-guided PIV insertion decreases PIV-associated pain and anxiety, and whether the number of attempts and amount of time spent accessing PIVs in children with difficult peripheral intravenous (DPIV) access is reduced. MATERIALS AND METHODS This was a pilot study with both retrospective and prospective components. Hemoglobinopathies are relatively rare in our population and our study cohort was small (N = 18). RESULTS We identified four DPIV access patients. We recorded each time these patients had a PIV inserted as an encounter. DISCUSSION/CONCLUSION We found that while there was a small amount of time gained by using ultrasound-guided PIV insertion, patient and parent satisfaction was significantly improved.
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Affiliation(s)
- Paula Mahon
- British Columbia's Children's Hospital, Evidence to Innovation, BCCHR, University of British Columbia, School of Nursing, Vancouver, British Columbia, Canada
| | - Kathy Grouchy
- Hematology/Oncology/BMT Department, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Heather McCartney
- Hematology/Oncology/BMT Department, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kate Douglas
- Hematology/Oncology/BMT Department, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - John K Wu
- Division of Hematology/Oncology/BMT, UBC & BC Children's Hospital, Vancouver, British Columbia, Canada
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Markham JL, Thurm CW, Hall M, Shah SS, Quinonez R, Tchou MJ, Antoon JW, Genies MC, Parlar-Chun R, Johnson DP, Shah SP, Ittel M, Brady PW. Variation in Early Inflammatory Marker Testing for Infection-Related Hospitalizations in Children. Hosp Pediatr 2020; 10:851-858. [PMID: 32948631 DOI: 10.1542/hpeds.2020-0114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Inflammatory marker testing in children has been identified as a potential area of overuse. We sought to describe variation in early inflammatory marker (C-reactive protein and erythrocyte sedimentation rate) testing for infection-related hospitalizations across children's hospitals and to determine its association with length of stay (LOS), 30-day readmission rate, and cost. METHODS We conducted a cross-sectional study of children aged 0 to 17 years with infection-related hospitalizations using the Pediatric Health Information System. After adjusting for patient characteristics, we examined rates of inflammatory marker testing (C-reactive protein or erythrocyte sedimentation rate) during the first 2 days of hospitalization. We used k-means clustering to assign each hospital to 1 of 3 groups on the basis of similarities in adjusted diagnostic testing rates across 12 infectious conditions. Multivariable regression was used to examine the association between hospital testing group and outcomes. RESULTS We included 55 771 hospitalizations from 48 hospitals. In 7945 (14.3%), there was inflammatory marker testing in the first 2 days of hospitalization. We observed wide variation in inflammatory marker testing rates across hospitals and infections. Group A hospitals tended to perform more tests than group B or C hospitals (37.4% vs 18.0% vs 10.4%; P < .001) and had the longest adjusted LOS (3.2 vs 2.9 vs 2.8 days; P = .01). There was no significant difference in adjusted 30-day readmission rates or costs. CONCLUSIONS Inflammatory marker testing varied widely across hospitals. Hospitals with higher inflammatory testing for one infection tend to test more frequently for other infections and have longer LOS, suggesting opportunities for diagnostic stewardship.
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Affiliation(s)
- Jessica L Markham
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri;
- School of Medicine, University of Kansas, Kansas City, Kansas
| | | | - Matt Hall
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
- Children's Hospital Association, Lenexa, Kansas
| | - Samir S Shah
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Ricardo Quinonez
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Michael J Tchou
- Section of Pediatric Hospital Medicine, Department of Pediatrics, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - James W Antoon
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Marquita C Genies
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Raymond Parlar-Chun
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston and Children's Memorial Hermann Hospital, Houston, Texas; and
| | - David P Johnson
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Snehal P Shah
- Division of Hospitalist Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Molli Ittel
- Department of Pediatrics, Children's Mercy Kansas City and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri
- School of Medicine, University of Kansas, Kansas City, Kansas
| | - Patrick W Brady
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Rackini MJ, Shanmugapriya A, David A. Effectiveness of video game on bio- physiological parameters during intravenous cannulation among preschool children. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2020; 17:/j/jcim.ahead-of-print/jcim-2019-0056/jcim-2019-0056.xml. [PMID: 32406383 DOI: 10.1515/jcim-2019-0056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Accepted: 01/03/2020] [Indexed: 06/11/2023]
Abstract
Background Hospitalization is a completely new experience for infants and young children; they are too young to understand the stress of hospitalization. Distractions or diversions seek to divert the child's attention to interesting or challenging tasks to draw attention away from painful or distressful medical procedure. Therefore, the present study assesses the effectiveness of video game on bio-physiological parameters during intravenous cannulation among preschool children admitted in paediatric ward. Methods A randomized true experimental research design was used to assess the effectiveness of video game technique on pain and bio-physiological parameters during Intravenous Cannulation among preschool children admitted in paediatric ward at Sri Ramachandra Hospital in Chennai. The collected data were grouped and analysed using descriptive and inferential statistics, to assess the effectiveness of video games. Results There was a significant difference in the mean score of oxygen saturation of post-test compare to pre-test for both groups. The number of children feeling severe pain was more in the control group during intervention and this difference was highly significant. Oxygen saturation was more in control but not significant, but the heart rate was significantly higher in control group during intervention. There was no association during pre- post-test and oxygen saturation, with selected demographic variables of the preschool children in both groups, apart from the fact that children from low income group had significant low heart rate during pre- and post-test Discussion Video game is an effective method in reducing pain in children undergoing intravenous cannulation. In this framework, the intervention (showing video game) reduced perception of pain and changes in bio-physiological parameters such as, heart rate and oxygen saturation, during intravenous cannulation.
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Affiliation(s)
- M Jaya Rackini
- Faculty of Nursing, Sri Ramachandra Medical College and Research Institution (DU), Porur, Chennai, Tamil Nadu 600116, India
| | - A Shanmugapriya
- Faculty of Nursing, Sri Ramachandra Medical College and Research Institution (DU), Porur, Chennai, Tamil Nadu 600116, India
| | - Anita David
- Faculty of Nursing, Sri Ramachandra Medical College and Research Institution (DU), Porur, Chennai, Tamil Nadu 600116, India
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Kristensen HN, Sørensen EE, Stinson J, Haslund‐Thomsen H. An ongoing WE: A focused ethnographic study of the relationship between child and hospital clown during recurrent pain‐related procedures and conditions. ACTA ACUST UNITED AC 2019; 1:5-14. [PMID: 35546867 PMCID: PMC8974843 DOI: 10.1002/pne2.12005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 06/19/2019] [Accepted: 07/19/2019] [Indexed: 11/29/2022]
Abstract
Aim This study explored the interaction between child and hospital clown during recurrent hospitalizations for repeated pain‐related procedures and conditions. Background Despite improvements in the management of pain in hospitalized children, procedural pain in particular is a common experience for hospitalized children, and they continue to report undertreated pain. Hospital clowns are widely used as a nonpharmacological intervention in hospitalized children. Little research has examined the influence of hospital clowns during recurrent hospitalizations on repeated painful procedures. Design and methods Ethnographic fieldwork using focused ethnography was conducted. Data were collected during October–December 2017 using participant observation and informal interviews with children at one pediatric unit at a Danish university hospital. Data include 61 interactions between children aged 4–14 years and hospital clowns. The participants comprised 13 children undergoing recurrent hospitalizations. The data were coded using thematic analysis, and the research team verified the resulting themes. Results The overarching theme was defined as An ongoing WE, based on two identified themes, that is, Stronger in a WE and Hope in the WE. The WE was characterized by a responsive interaction between the child and clown, which evolved over the course of an ongoing relationship. Conclusion This study demonstrates how an ongoing WE was constructed with children during repeated painful procedures and conditions. Specifically, the study emphasizes the importance of developing a trusting relationship on the child's terms. Children seemed to experience enhanced coping with painful procedures during the recurring hospital clown encounters, thus reinforcing their competence and hope for coping with future painful procedures. These findings may improve psychosocial care for hospitalized children undergoing repeated painful procedures and conditions and may facilitate multidisciplinary initiatives, such as nurses’ advocacy for the inclusion of hospital clowns during recurrent hospitalizations for repeated painful procedures to ensure optimal pain management.
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Affiliation(s)
- Helle Nygaard Kristensen
- Department of Pediatrics Aalborg University Hospital Aalborg Denmark
- Clinical Nursing Research Unit Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing University of Toronto Toronto ON Canada
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | - Helle Haslund‐Thomsen
- Clinical Nursing Research Unit Aalborg University Hospital Aalborg Denmark
- Department of Clinical Medicine Aalborg University Aalborg Denmark
- Clinic for Anesthesiology Child Diseases, Circulation and Women Aalborg University Hospital Aalborg Denmark
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Tchou MJ, Hall M, Shah SS, Johnson DP, Schroeder AR, Antoon JW, Genies MC, Quinonez R, Miller CW, Shah SP, Brady PW. Patterns of Electrolyte Testing at Children's Hospitals for Common Inpatient Diagnoses. Pediatrics 2019; 144:e20181644. [PMID: 31171587 PMCID: PMC6615522 DOI: 10.1542/peds.2018-1644] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Overuse of laboratory testing contributes substantially to health care waste, downstream resource use, and patient harm. Understanding patterns of variation in hospital-level testing across common inpatient diagnoses could identify outliers and inform waste-reduction efforts. METHODS We conducted a multicenter retrospective cohort study of pediatric inpatients at 41 children's hospitals using administrative data from 2010 to 2016. Initial electrolyte testing was defined as testing occurring within the first 2 days of an encounter, and repeat testing was defined as subsequent testing within an encounter in which initial testing occurred. To examine if testing rates correlated across diagnoses at the hospital level, we compared risk-adjusted rates for gastroenteritis with a weighted average of risk-adjusted rates in other diagnosis cohorts. For each diagnosis, linear regression was performed to compare initial and subsequent testing. RESULTS In 497 719 patient encounters, wide variation was observed across hospitals in adjusted, initial, and repeat testing rates. Hospital-specific rates of testing in gastroenteritis were moderately to strongly correlated with the weighted average of testing in other conditions (initial: r = 0.63; repeat r = 0.83). Within diagnoses, higher hospital-level initial testing rates were associated with significantly increased rates of subsequent testing for all diagnoses except gastroenteritis. CONCLUSIONS Among children's hospitals, rates of initial and repeat electrolyte testing vary widely across 8 common inpatient diagnoses. For most diagnoses, hospital-level rates of initial testing were associated with rates of subsequent testing. Consistent rates of testing across multiple diagnoses suggest that hospital-level factors, such as institutional culture, may influence decisions for electrolyte testing.
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Affiliation(s)
- Michael J Tchou
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio;
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas
| | - Samir S Shah
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - David P Johnson
- Division of Hospital Medicine, Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Alan R Schroeder
- Department of Pediatrics, School of Medicine, Stanford University, Palo Alto, California
| | - James W Antoon
- Children's Hospital, University of Illinois, University of Illinois Hospital and Health Sciences System, Chicago, Illinois
| | - Marquita C Genies
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Ricardo Quinonez
- Section of Pediatric Hospital Medicine, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Christopher W Miller
- Division of Pediatric Inpatient Medicine, Department of Pediatrics, University of Utah, Salt Lake City, Utah; and
| | - Snehal P Shah
- Division of Hospitalist Medicine, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Patrick W Brady
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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14
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Atzori B, Hoffman HG, Vagnoli L, Patterson DR, Alhalabi W, Messeri A, Lauro Grotto R. Virtual Reality Analgesia During Venipuncture in Pediatric Patients With Onco-Hematological Diseases. Front Psychol 2018; 9:2508. [PMID: 30618938 PMCID: PMC6307499 DOI: 10.3389/fpsyg.2018.02508] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 11/26/2018] [Indexed: 12/31/2022] Open
Abstract
Background: Venipuncture is described by children as one of the most painful and frightening medical procedures. Objective: To evaluate the effectiveness of Virtual Reality (VR) as a distraction technique to help control pain in children and adolescents undergoing venipuncture. Methods: Using a within-subjects design, fifteen patients (mean age 10.92, SD = 2.64) suffering from oncological or hematological diseases received one venipuncture with "No VR" and one venipuncture with "Yes VR" on two separate days (treatment order randomized). "Time spent thinking about pain", "Pain Unpleasantness", "Worst pain" the quality of VR experience, fun during the venipuncture and nausea were measured. Results: During VR, patients reported significant reductions in "Time spent thinking about pain," "Pain unpleasantness," and "Worst pain". Patients also reported significantly more fun during VR, and reported a "Strong sense of going inside the computer-generated world" during VR. No side effects were reported. Conclusion: VR can be considered an effective distraction technique for children and adolescents' pain management during venipuncture. Moreover, VR may elicit positive emotions, more than traditional distraction techniques. This could help patients cope with venipuncture in a non-stressful manner. Additional research and development is needed.
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Affiliation(s)
- Barbara Atzori
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Hunter G. Hoffman
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
| | - Laura Vagnoli
- Pediatric Hospital’s Psychology, Meyer Children’s Hospital, Florence, Italy
| | - David R. Patterson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Wadee Alhalabi
- Department of Computer Science, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Computer Science, Effat University, Jeddah, Saudi Arabia
| | - Andrea Messeri
- Pain Service and Palliative Care, Meyer Children’s Hospital, Florence, Italy
| | - Rosapia Lauro Grotto
- Department of Health Sciences, University of Florence, Florence, Italy
- Multidisciplinary Analysis of Relationship in Health Care (MARHC) Lab, Pistoia, Italy
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15
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Orenius T, LicPsych, Säilä H, Mikola K, Ristolainen L. Fear of Injections and Needle Phobia Among Children and Adolescents: An Overview of Psychological, Behavioral, and Contextual Factors. SAGE Open Nurs 2018; 4:2377960818759442. [PMID: 33415191 PMCID: PMC7774419 DOI: 10.1177/2377960818759442] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/28/2017] [Accepted: 01/15/2018] [Indexed: 11/28/2022] Open
Abstract
The purpose of this clinical update is to provide an overview of the fear of needles and needle phobia in children and adolescents including characteristics and diagnosis, prevalence and epidemiology, etiological factors, and treatment options. Needle-related fear and needle phobia present as significant needle-related distress and avoidance behavior. The etiology is biopsychosocial. These challenging conditions are more common in children and adolescents than in adults. The nurse–patient relationship enables the provision of suitable preparation before injection procedures. Nurses can use exposure-based interventions and incorporate coping strategies and teaching of parents and children. Nurses play a pivotal role in noticing the need for further treatment. Procedural needle-related distress is a complex phenomenon representing a continuum ranging from needle fear to more severe needle phobia. For patients with needle fear management and training methods used by nurses can possibly prevent a progression of the condition into needle phobia. In cases of needle phobia, a correct diagnosis made by a psychiatrist is necessary and enables referral to a psychotherapist with experience in treating children and adolescents with needle phobia.
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Affiliation(s)
- Tage Orenius
- Orton Orthopaedic Hospital, Orton, Helsinki, Finland.,Orton Research Institute, Orton, Helsinki, Finland.,Helsinki University Central Hospital, Children's Hospital, Helsinki, Finland
| | - LicPsych
- Orton Orthopaedic Hospital, Orton, Helsinki, Finland
| | - Hanna Säilä
- Orton Research Institute, Orton, Helsinki, Finland
| | - Katriina Mikola
- Helsinki University Central Hospital, Children's Hospital, Helsinki, Finland
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Fumagalli S, Torricelli G, Massi M, Calvani S, Boni S, Roberts AT, Accarigi E, Manetti S, Marchionni N. Effects of a new device to guide venous puncture in elderly critically ill patients: results of a pilot randomized study. Aging Clin Exp Res 2017; 29:335-339. [PMID: 26914485 DOI: 10.1007/s40520-016-0547-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 02/05/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Novel devices based on the emission of near-infrared electromagnetic radiation (NIR) have been developed to minimize venous puncture failures. These instruments produce an "augmented reality" image, in which subcutaneous veins are depicted on a LCD display. We compared the new technique with standard venipuncture in a population of elderly patients. METHODS Patients admitted in Intensive Care Unit were randomized to standard or to NIR assisted procedure. RESULTS In the 103 enrolled patients (age 74 ± 12 years; standard venipuncture-N = 56; NIR-N = 47), no differences were found in procedure length, number of attempts, and referred pain. With NIR there was a lower incidence of hematomas and fewer anxiety and depressive symptoms. CONCLUSIONS The use of the novel NIR-based device is safer and more psychologically tolerable, and it is not associated to an increase of procedure length or number of attempts.
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Affiliation(s)
- Stefano Fumagalli
- Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy.
| | | | | | - Silvia Calvani
- Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy
| | - Serena Boni
- Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy
| | - Anna T Roberts
- Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy
| | - Elisabetta Accarigi
- Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy
| | | | - Niccolò Marchionni
- Intensive Care Unit, Geriatric Cardiology and Medicine Division, Experimental and Clinical Medicine Department, University of Florence and AOU Careggi, Florence, Italy
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Elhaik E. A "Wear and Tear" Hypothesis to Explain Sudden Infant Death Syndrome. Front Neurol 2016; 7:180. [PMID: 27840622 PMCID: PMC5083856 DOI: 10.3389/fneur.2016.00180] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/04/2016] [Indexed: 01/22/2023] Open
Abstract
Sudden infant death syndrome (SIDS) is the leading cause of death among USA infants under 1 year of age accounting for ~2,700 deaths per year. Although formally SIDS dates back at least 2,000 years and was even mentioned in the Hebrew Bible (Kings 3:19), its etiology remains unexplained prompting the CDC to initiate a sudden unexpected infant death case registry in 2010. Due to their total dependence, the ability of the infant to allostatically regulate stressors and stress responses shaped by genetic and environmental factors is severely constrained. We propose that SIDS is the result of cumulative painful, stressful, or traumatic exposures that begin in utero and tax neonatal regulatory systems incompatible with allostasis. We also identify several putative biochemical mechanisms involved in SIDS. We argue that the important characteristics of SIDS, namely male predominance (60:40), the significantly different SIDS rate among USA Hispanics (80% lower) compared to whites, 50% of cases occurring between 7.6 and 17.6 weeks after birth with only 10% after 24.7 weeks, and seasonal variation with most cases occurring during winter, are all associated with common environmental stressors, such as neonatal circumcision and seasonal illnesses. We predict that neonatal circumcision is associated with hypersensitivity to pain and decreased heart rate variability, which increase the risk for SIDS. We also predict that neonatal male circumcision will account for the SIDS gender bias and that groups that practice high male circumcision rates, such as USA whites, will have higher SIDS rates compared to groups with lower circumcision rates. SIDS rates will also be higher in USA states where Medicaid covers circumcision and lower among people that do not practice neonatal circumcision and/or cannot afford to pay for circumcision. We last predict that winter-born premature infants who are circumcised will be at higher risk of SIDS compared to infants who experienced fewer nociceptive exposures. All these predictions are testable experimentally using animal models or cohort studies in humans. Our hypothesis provides new insights into novel risk factors for SIDS that can reduce its risk by modifying current infant care practices to reduce nociceptive exposures.
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Affiliation(s)
- Eran Elhaik
- Department of Animal and Plant Sciences, University of Sheffield, Sheffield, UK
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