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Farinella R, Falchi F, Tavanti A, Tuoni C, Di Nino MG, Filippi L, Ciantelli M, Rizzato C, Campa D. The genetic variant SLC2A1 -rs1105297 is associated with the differential analgesic response to a glucose-based treatment in newborns. Pain 2024; 165:657-665. [PMID: 37703430 PMCID: PMC10859852 DOI: 10.1097/j.pain.0000000000003051] [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: 02/22/2023] [Revised: 07/21/2023] [Accepted: 07/27/2023] [Indexed: 09/15/2023]
Abstract
ABSTRACT Neonatal pain is a critical issue in clinical practice. The oral administration of glucose-based solutions is currently one of the most common and effective nonpharmacologic strategies for neonatal pain relief in daily minor procedures. However, a varying degree of analgesic efficacy has been reported for this treatment. Environmental, maternal, and genetic factors may explain this variability and potentially allow for a personalized analgesic approach, maximizing therapeutic efficacy and preventing side effects. We investigated the exposome (ie, the set of clinical and anthropometric variables potentially affecting the response to the therapy) and the genetic variability of the noradrenaline transporter gene (solute carrier family 6 member 2 [ SLC6A2 ]) and 2 glucose transporter genes (solute carrier family 2 member 1 [ SLC2A1 ] and 2 [ SLC2A2 ]) in relation to the neonatal analgesic efficacy of a 33% glucose solution. The study population consisted in a homogeneous sample of more than 1400 healthy term newborns. No association for the exposome was observed, whereas a statistically significant association between the G allele of SLC2A1 -rs1105297 and a fourfold decreased probability of responding to the therapy was identified after multiple-testing correction (odds ratio of 3.98, 95% confidence interval 1.95-9.17; P = 4.05 × 10 -4 ). This allele decreases the expression of SLC2A1-AS1 , causing the upregulation of SLC2A1 in the dorsal striatum, which has been suggested to be involved in reward-related processes through the binding of opioids to the striatal mu-opioid receptors. Altogether, these results suggest the involvement of SLC2A1 in the analgesic process and highlight the importance of host genetics for defining personalized analgesic treatments.
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Affiliation(s)
| | - Fabio Falchi
- Department of Biology, University of Pisa, Pisa, Italy
| | | | - Cristina Tuoni
- Division of Neonatology, Santa Chiara Hospital, Pisa, Italy
| | | | - Luca Filippi
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Massimiliano Ciantelli
- Neonatology and Neonatal Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- Centro Di Formazione e Simulazione Neonatale “NINA”, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Cosmeri Rizzato
- Department of Translational Research and of New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Daniele Campa
- Department of Biology, University of Pisa, Pisa, Italy
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Faqihi S, Ismail A, Hasan AAH. Neonatal Intensive Care Unit Nurses' Knowledge and Use of Sucrose for Neonatal Pain Management in Saudi Arabia. SAGE Open Nurs 2024; 10:23779608241234401. [PMID: 38410813 PMCID: PMC10896065 DOI: 10.1177/23779608241234401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 01/27/2024] [Accepted: 02/02/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Sucrose is an evidence-based intervention used for short-term pain management and distress from minor procedures. Limited research exists on nurses' knowledge and use of sucrose in Neonatal Intensive Care Units in Saudi Arabia. Objective To assess nurses' knowledge and use of sucrose in Neonatal Intensive Care Units in Saudi Arabia. Methods A cross-sectional online survey was used to collect data from a convenience sample of 68 neonatal intensive care nurses in Saudi Arabia. A modified tool assessed the knowledge and use of sucrose. Logistic regression analysis was used to find the predictors for sucrose use. Results Most respondents never used sucrose for neonatal pain management and did not receive any training on sucrose. The mean knowledge of nurses regarding sucrose and its use was very low (38%): 16% had a high level of knowledge regarding sucrose, 13% moderate, 19% low, and 52% very low. Nurses who received training on sucrose use and nurses who read or heard about sucrose predicted the use of sucrose. Conclusion Nurses' knowledge and use of sucrose were inadequate. Interventional programs are needed to enhance the nurses' knowledge regarding sucrose and its use and to enhance the utilization of sucrose as a pain management intervention in the Neonatal Intensive Care Units in Saudi Arabia.
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Affiliation(s)
- Sumayah Faqihi
- Neonatal Intensive Care Nursing, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | - Ahmad Ismail
- Director of the Master Program in Neonatal Intensive Care Nursing, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
| | - Abd Al-Hadi Hasan
- Nursing Department, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
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Lisanti AJ, Vittner DJ, Peterson J, Van Bergen AH, Miller TA, Gordon EE, Negrin KA, Desai H, Willette S, Jones MB, Caprarola SD, Jones AJ, Helman SM, Smith J, Anton CM, Bear LM, Malik L, Russell SK, Mieczkowski DJ, Hamilton BO, McCoy M, Feldman Y, Steltzer M, Savoca ML, Spatz DL, Butler SC. Developmental care pathway for hospitalised infants with CHD: on behalf of the Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2023; 33:2521-2538. [PMID: 36994672 PMCID: PMC10544686 DOI: 10.1017/s1047951123000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Infants and children born with CHD are at significant risk for neurodevelopmental delays and abnormalities. Individualised developmental care is widely recognised as best practice to support early neurodevelopment for medically fragile infants born premature or requiring surgical intervention after birth. However, wide variability in clinical practice is consistently demonstrated in units caring for infants with CHD. The Cardiac Newborn Neuroprotective Network, a Special Interest Group of the Cardiac Neurodevelopmental Outcome Collaborative, formed a working group of experts to create an evidence-based developmental care pathway to guide clinical practice in hospital settings caring for infants with CHD. The clinical pathway, "Developmental Care Pathway for Hospitalized Infants with Congenital Heart Disease," includes recommendations for standardised developmental assessment, parent mental health screening, and the implementation of a daily developmental care bundle, which incorporates individualised assessments and interventions tailored to meet the needs of this unique infant population and their families. Hospitals caring for infants with CHD are encouraged to adopt this developmental care pathway and track metrics and outcomes using a quality improvement framework.
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Affiliation(s)
- Amy J. Lisanti
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA, USA, Research Institute, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Dorothy J. Vittner
- Egan School of Nursing and Health Studies, Fairfield University Fairfield, CT, USA, Connecticut Children’s, Hartford, CT, USA
| | | | - Andrew H. Van Bergen
- Advocate Children’s Heart Institute, Advocate Children’s Hospital, Oak Lawn, IL, USA
| | - Thomas A. Miller
- Department of Pediatrics, Maine Medical Center, Portland, ME, USA
| | - Erin E. Gordon
- DO, Inpatient Cardiac Neurodevelopment Program, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Karli A Negrin
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, Delaware, USA
| | - Hema Desai
- Rehabilitation Services, CHOC Children’s Hospital, Orange, CA, USA
| | - Suzie Willette
- Department of Speech-Language Pathology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Melissa B Jones
- Cardiac Critical Care, Children’s National Hospital, Washington DC USA
| | - Sherrill D. Caprarola
- Heart Institute, Children’s Hospital Colorado, University of Colorado, Aurora, CO, USA
| | - Anna J. Jones
- Office of Advanced Practice Providers, UT Southwestern Medical Center, Dallas, TX, USA, Heart Center, Children’s Health, Dallas, TX, USA
| | - Stephanie M. Helman
- Department of Acute and Tertiary Care, University of Pittsburgh School of Nursing, Pittsburgh, PA, USA
| | - Jodi Smith
- Parent Representative, The Mended Hearts, Inc., Program Director, Richmond, VA, USA
| | - Corinne M. Anton
- Department of Psychology and Psychiatry, University of Texas Southwestern Medical Center, Dallas, Texas, USA, Department of Cardiology, Children’s Health, Dallas, Texas, USA
| | - Laurel M. Bear
- Department of Pediatrics, Medical College of Wisconsin, Children’s Wisconsin, Milwaukee, WI, USA
| | - Lauren Malik
- Department of Acute Care Therapy Services, Primary Children’s Hospital, Salt Lake City, UT, USA
| | - Sarah K. Russell
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, DE, USA
| | - Dana J. Mieczkowski
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, DE, USA
| | - Bridy O. Hamilton
- Department of Therapeutic and Rehabilitative Services, Nemours Children Hospital, Wilmington, Delaware, USA
| | - Meghan McCoy
- Pediatric and Congenital Heart Center, Duke University Hospital, Durham, NC, USA
| | - Yvette Feldman
- Nursing & Patient Care Center of Excellence, St. Luke’s Health System, Boise, ID, USA
| | - Michelle Steltzer
- Single Ventricle Center of Excellence, Ann & Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Melanie L Savoca
- Department of Clinical Nutrition, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Diane L. Spatz
- Department of Family & Community Health, University of Pennsylvania School of Nursing, The Center for Pediatric Nursing Research and Evidence Based Practice, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Samantha C. Butler
- Department of Psychiatry (Psychology), Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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Yamada J, Bueno M, Santos L, Haliburton S, Campbell-Yeo M, Stevens B. Sucrose analgesia for heel-lance procedures in neonates. Cochrane Database Syst Rev 2023; 8:CD014806. [PMID: 37655530 PMCID: PMC10466459 DOI: 10.1002/14651858.cd014806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND Sucrose has been examined for calming and pain-relieving effects in neonates for invasive procedures such as heel lance. OBJECTIVES To assess the effectiveness of sucrose for relieving pain from heel lance in neonates in terms of immediate and long-term outcomes SEARCH METHODS: We searched (February 2022): CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and three trial registries. SELECTION CRITERIA We included randomised controlled trials where term and/or preterm neonates received sucrose for heel lances. Comparison treatments included water/placebo/no intervention, non-nutritive sucking (NNS), glucose, breastfeeding, breast milk, music, acupuncture, facilitated tucking, and skin-to-skin care. DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. We reported mean differences (MD) with 95% confidence intervals (CI) using the fixed-effect model for continuous outcome measures. We assessed heterogeneity by the I2 test. We used GRADE to assess certainty of evidence. MAIN RESULTS We included 55 trials (6273 infants): 29 included term neonates, 22 included preterm neonates, and four included both. Heel lance was investigated in 50 trials; 15 investigated other minor painful procedures in addition to lancing. Sucrose vs control The evidence suggests that sucrose probably results in a reduction in PIPP scores compared to the control group at 30 seconds (MD -1.74 (95% CI -2.11 to -1.37); I2 = 62%; moderate-certainty evidence) and 60 seconds after lancing (MD -2.14, 95% CI -3.34 to -0.94; I2 = 0%; moderate-certainty evidence). The evidence is very uncertain about the effects of sucrose on DAN scores compared to water at 30 seconds after lancing (MD -1.90, 95% CI -8.58 to 4.78; heterogeneity not applicable (N/A); very low-certainty evidence). The evidence suggests that sucrose probably results in a reduction in NIPS scores compared to water immediately after lancing (MD -2.00, 95% CI -2.42 to -1.58; heterogeneity N/A; moderate-certainty evidence). Sucrose vs NNS The evidence is very uncertain about the effect of sucrose on PIPP scores compared to NNS during the recovery period after lancing (MD 0.60, 95% CI -0.30 to 1.50; heterogeneity not applicable; very low-certainty evidence) and on DAN scores at 30 seconds after lancing (MD -1.20, 95% CI -7.87 to 5.47; heterogeneity N/A; very low-certainty evidence). Sucrose + NNS vs NNS The evidence is very uncertain about the effect of sucrose + NNS on PIPP scores compared to NNS during lancing (MD -4.90, 95% CI -5.73 to -4.07; heterogeneity not applicable; very low-certainty evidence) and during recovery after lancing (MD -3.80, 95% CI -4.47 to -3.13; heterogeneity N/A; very low-certainty evidence). The evidence is very uncertain about the effects of sucrose + NNS on NFCS scores compared to water + NNS during lancing (MD -0.60, 95% CI -1.47 to 0.27; heterogeneity N/A; very low-certainty evidence). Sucrose vs glucose The evidence suggests that sucrose results in little to no difference in PIPP scores compared to glucose at 30 seconds (MD 0.26, 95% CI -0.70 to 1.22; heterogeneity not applicable; low-certainty evidence) and 60 seconds after lancing (MD -0.02, 95% CI -0.79 to 0.75; heterogeneity N/A; low-certainty evidence). Sucrose vs breastfeeding The evidence is very uncertain about the effect of sucrose on PIPP scores compared to breastfeeding at 30 seconds after lancing (MD -0.70, 95% CI -0.49 to 1.88; I2 = 94%; very low-certainty evidence). The evidence is very uncertain about the effect of sucrose on COMFORTneo scores compared to breastfeeding after lancing (MD -2.60, 95% CI -3.06 to -2.14; heterogeneity N/A; very low-certainty evidence). Sucrose vs expressed breast milk The evidence suggests that sucrose may result in little to no difference in PIPP-R scores compared to expressed breast milk during (MD 0.3, 95% CI -0.24 to 0.84; heterogeneity not applicable; low-certainty evidence) and at 30 seconds after lancing (MD 0.3, 95% CI -0.11 to 0.71; heterogeneity N/A; low-certainty evidence). The evidence suggests that sucrose probably may result in slightly increased PIPP-R scores compared to expressed breast milk 60 seconds after lancing (MD 1.10, 95% CI 0.34 to 1.86; heterogeneity N/A; low-certainty evidence). The evidence is very uncertain about the effect of sucrose on DAN scores compared to expressed breast milk 30 seconds after lancing (MD -1.80, 95% CI -8.47 to 4.87; heterogeneity N/A; very low-certainty evidence). Sucrose vs laser acupuncture There was no difference in PIPP-R scores between sucrose and music groups; however, data were reported as medians and IQRs. The evidence is very uncertain about the effect of sucrose on NIPS scores compared to laser acupuncture during lancing (MD -0.86, 95% CI -1.43 to -0.29; heterogeneity N/A; very low-certainty evidence). Sucrose vs facilitated tucking The evidence is very uncertain about the effect of sucrose on total BPSN scores compared to facilitated tucking during lancing (MD -2.27, 95% CI -4.66 to 0.12; heterogeneity N/A; very low-certainty evidence) and during recovery after lancing (MD -0.31, 95% CI -1.72 to 1.10; heterogeneity N/A; very low-certainty evidence). Sucrose vs skin-to-skin + water (repeated lancing) The evidence suggests that sucrose results in little to no difference in PIPP scores compared to skin-to-skin + water at 30 seconds after 1st (MD 0.13, 95% CI -0.70 to 0.96); 2nd (MD -0.56, 95% CI -1.57 to 0.45); or 3rd lancing (MD-0.15, 95% CI -1.26 to 0.96); heterogeneity N/A, low-certainty evidence for all comparisons. The evidence suggests that sucrose results in little to no difference in PIPP scores compared to skin-to-skin + water at 60 seconds after 1st (MD -0.61, 95% CI -1.55 to 0.33); 2nd (MD -0.12, 95% CI -0.99 to 0.75); or 3rd lancing (MD-0.40, 95% CI -1.48 to 0.68); heterogeneity N/A, low-certainty evidence for all comparisons. Minor adverse events required no intervention. AUTHORS' CONCLUSIONS Sucrose compared to control probably results in a reduction of PIPP scores 30 and 60 seconds after single heel lances (moderate-certainty evidence). Evidence is very uncertain about the effect of sucrose compared to NNS, breastfeeding, laser acupuncture, facilitated tucking, and the effect of sucrose + NNS compared to NNS in reducing pain. Sucrose compared to glucose, expressed breast milk, and skin-to-skin care shows little to no difference in pain scores. Sucrose combined with other nonpharmacologic interventions should be used with caution, given the uncertainty of evidence.
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Affiliation(s)
- Janet Yamada
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Canada
| | | | | | | | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health and Departments of Pediatrics, Psychology and Neuroscience, Dalhousie University and IWK Health, Halifax, Canada
| | - Bonnie Stevens
- Nursing Research, The Hospital for Sick Children, Toronto, Canada
- Research Institute, The Hospital for Sick Children, Toronto, Canada
- Lawrence S Bloomberg Faculty of Nursing Faculties of Medicine and Dentistry, University of Toronto, Toronto, Canada
- Centre for the Study of Pain, University of Toronto, Toronto, Canada
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Winnier JJ, Ratnaparkhi I, Joshi A, Haradwala Z, Manoj R, Naik SS. Evaluation of the effectiveness of sucrose versus xylitol application in minimizing pain related to dental injection in 5-7-year-old children - A randomized controlled pilot study. J Indian Soc Pedod Prev Dent 2023; 41:216-221. [PMID: 37861635 DOI: 10.4103/jisppd.jisppd_250_23] [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: 10/21/2023] Open
Abstract
Background Oral application of sweet-tasting solutions has found to be effective in minimizing pain on dental injection in children. Xylitol has never been tested in this regard. Aim The aim of this study was to compare the effectiveness of prior application of sucrose versus xylitol solution in minimizing pain on dental injection in 5-7-year-old children. Settings and Design This study was a randomized controlled clinical trial. Materials and Methods Informed consent was taken. A total of 30 children who required maxillary buccal infiltration injection were selected. The children were randomly allocated into the sucrose group, xylitol group, or control group by lottery method. In the sucrose and xylitol groups, 30% sucrose or 30% xylitol solution was applied on the lateral surface of the tongue for 2 min. In the control group, distilled water was applied. In all the groups, the topical anesthetic was applied at the site of injection followed by buccal infiltration. A video was taken during injection, and the sound eye-motor (SEM) scale was recorded by a blinded examiner. Patients were asked to self-evaluate using the Wong-Baker Faces Pain Scale (WBFPS). Statistical Analysis Mann-Whitney test was used to analyze the data. Results There was a statistically significant difference in the WBFPS and the SEM score between the sucrose and the control group (P < 0.05) and the xylitol and control group (P < 0.05). No statistically significant difference was found between the sucrose and xylitol group. Conclusion The application of xylitol solution before dental injection was as effective as sucrose solution in minimizing pain during the injection.
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Affiliation(s)
- J Jasmin Winnier
- Department of Pediatric and Preventive Dentistry, D.Y.Patil University, School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Ishani Ratnaparkhi
- Department of Pediatric and Preventive Dentistry, D.Y.Patil University, School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Amil Joshi
- Department of Pediatric and Preventive Dentistry, D.Y.Patil University, School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Zaineb Haradwala
- Department of Pediatric and Preventive Dentistry, D.Y.Patil University, School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Reema Manoj
- Department of Oral Medicine and Radiology, D.Y.Patil University, School of Dentistry, Navi Mumbai, Maharashtra, India
| | - Shilpa S Naik
- Department of Pediatric and Preventive Dentistry, D.Y.Patil University, School of Dentistry, Navi Mumbai, Maharashtra, India
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[Evidence-based guideline for neonatal pain management in China (2023)]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:109-127. [PMID: 36854686 PMCID: PMC9979385 DOI: 10.7499/j.issn.1008-8830.2210052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/06/2022] [Indexed: 03/02/2023]
Abstract
Pain disrupts neonatal vital signs and internal environment homeostasis and affects the recovery process, and recurrent pain stimulation is one of the important risk factors for neurodevelopmental disorders and some chronic diseases. In order to standardize pain management practice in neonatal wards in China and effectively prevent and reduce the adverse effects of pain on the physical and mental development of neonates, National Clinical Research Center for Child Health and Diseases (Children's Hospital of Chongqing Medical University) convened a multidisciplinary panel to formulate the evidence-based guideline for neonatal pain management in China (2023 edition) following the principles and methods for the guideline development issued by the World Health Organization. Based on the best evidence and expert consensus, this guideline gives 26 recommendations for nine clinical issues, i.e., the classification and definition of neonatal pain, common sources of pain, pain assessment principles, pain assessment methods, analgesic principle, non-pharmaceutical analgesic methods, pharmaceutical analgesic methods, parental participation in pain management, and recording methods for pain management, so as to provide medical staff with guidance and a decision-making basis for neonatal pain assessment and analgesia management.
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Modanloo S, Barrowman N, Martelli B, Yoxon H, Wilding J, Dragic S, Vaillancourt R, Long D, Larocque C, Reszel J, Harrison D. Be Sweet to Hospitalized Toddlers During Venipuncture: A Randomized Controlled Trial of Sucrose Compared With Water. Clin J Pain 2021; 38:41-48. [PMID: 34699407 DOI: 10.1097/ajp.0000000000000998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 08/02/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES High-quality evidence demonstrates analgesic effects of sweet-tasting solutions for infants during painful procedures. However, evidence of the analgesic effects of sucrose beyond 12 months of age is less certain. The aim of this study was to ascertain the efficacy of oral sucrose in hospitalized toddlers (ages 12 to 36 mo) compared with placebo (water) during venipuncture. MATERIALS AND METHODS Blinded, 2-armed randomized controlled trial including hospitalized toddlers aged 12 to 36 months. Toddlers were randomized to either 25% sucrose or water before venipuncture, stratified by age (12 to 24 mo and more than 24 to 36 mo). Standard of care included topical anesthetics for both groups. Pain assessment included cry duration and FLACC (Face, Legs, Activity, Cry, Consolability) scores. Descriptive statistics and linear models were used to report the percentage of time crying and mean differences in FLACC scores. Data analysis was performed using R, version 3.6.3. RESULTS A total of 95 toddlers were randomized and 85 subsequently studied. The median percentage of time spent crying between insertion of the first needle and 30 seconds after the end of procedure in both groups was 81% (interquartile range=66%). There was no significant difference in crying time and FLACC scores between groups (P>0.05). When examining effects of sucrose for the younger toddlers (less than 24 mo of age) there was a reduction in crying time of 10% and a 1.2-point reduction in mean FLACC scores compared with the toddlers older than 24 months. DISCUSSION Findings highlight that toddlers become highly distressed during venipuncture, despite the standard care of topical anesthetics. In addition, sucrose does not effectively reduce distress especially in the older group of toddlers.
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Affiliation(s)
- Shokoufeh Modanloo
- University of Ottawa-School of Nursing, Faculty of Health Sciences
- Children's Hospital of Eastern Ontario (CHEO)
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario (CHEO) Research Institute
| | | | - Helen Yoxon
- Children's Hospital of Eastern Ontario (CHEO)
| | - Jodi Wilding
- Children's Hospital of Eastern Ontario (CHEO) Research Institute
| | | | | | - Deborah Long
- EORLA (Eastern Ontario Regional Laboratory Association), Children's Hospital of Eastern Ontario (CHEO) site, Ottawa, ON, Canada
| | | | - Jessica Reszel
- Children's Hospital of Eastern Ontario (CHEO) Research Institute
| | - Denise Harrison
- University of Ottawa-School of Nursing, Faculty of Health Sciences
- Department of Nursing, School of Health Sciences, Faculty of Medicine, Dentistry, and Health Sciences, University of Melbourne, Melbourne, Vic., Australia
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Mandee S, Buachai K, Aroonpruksakul N, Tantemsapya N, Buasuk T. Effects of Sucrose and Nonnutritive Sucking on Pain Behavior in Neonates and Infants undergoing Wound Dressing after Surgery: A Randomized Controlled Trial. Eur J Pediatr Surg 2021; 31:439-444. [PMID: 32942327 DOI: 10.1055/s-0040-1716883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Wound dressing, a procedure that pediatric patients are commonly exposed to postoperatively, can cause strong physiological and pain behavioral responses despite being brief. This study evaluated the effects of using 24% sucrose plus a pacifier versus a pacifier alone to reduce the pain response from dressing wounds in neonates and infants. MATERIALS AND METHODS Thirty-two neonates and infants who underwent surgery and required postoperative wound dressing were randomized to a pacifier group (n = 16) and a 24% sucrose plus pacifier group ("sucrose group"; n = 16). Demographic data, crying time, and pain behaviors were recorded using a video recorder. The pain behaviors were assessed independently using the neonatal infant pain scale (NIPS) by three assessors, who were expert in pediatric pain assessment and blinded to the subject allocations. RESULTS Participants in the sucrose group were older than those in the pacifier group (6.19 ± 2.95 vs. 3.88 ± 3.2 months). While there were no differences in the NIPS scores of the two groups at 30, 120, and 240 seconds, the incidence of moderate-to-severe pain was lower in the sucrose group than the pacifier group at 120 seconds (37.5 vs. 50%). The crying time was lower in the sucrose group, but without statistical significance. CONCLUSION The 24% sucrose plus pacifier was not superior to the pacifier alone in decreasing pain behavioral responses. Dressing wound pain produced a high-intensity pain behavioral response. A pain management strategy should be developed to lessen the postoperative procedural pain in pediatric patients.
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Affiliation(s)
- Sahatsa Mandee
- Department of Anesthesiology, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
| | - Kusuma Buachai
- Department of Anesthesiology, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
| | - Naiyana Aroonpruksakul
- Department of Anesthesiology, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
| | - Niramol Tantemsapya
- Department of Surgery, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
| | - Tarinee Buasuk
- Department of Anesthesiology, Faculty of Medicine, Mahidol University, Siriraj Hospital, Bangkok, Thailand
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Pediatric Critical Care Nurses' Practices Related to Sedation and Analgesia. Dimens Crit Care Nurs 2021; 40:280-287. [PMID: 34398564 DOI: 10.1097/dcc.0000000000000491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Pediatric intensive care unit (PICU) nurses may consider additional factors beyond validated tools when managing pain and sedation of children. However, these other factors and related beliefs, practices, and decision-making for analgesia and sedation have not been well described. OBJECTIVES This study describes nurses' beliefs, practices, and decision-making related to sedation and analgesia for mechanically ventilated children on a PICU and a pediatric cardiovascular ICU at a tertiary academic children's medical center in the United States. METHODS A 35-item web-based survey tool was developed to more fully identify nurses' pain, sedation, comfort, and analgesia beliefs, decisions, planning, and procedures for children who were mechanically ventilated in the ICU. It was distributed to 102 nurses in the PICU, pediatric cardiovascular ICU, and pediatric critical care float pool. RESULTS Twenty-six nurses (25%) responded; a majority worked the night shift and had 5 years or less of ICU experience. While participants believed intubated pediatric patients required moderate to deep sedation, approximately only half reported patients were adequately sedated. They reported that they were more likely to manage pain and sedation using specific behaviors and changes in vital signs than scores on a standardized scale. Nurses also reported routinely incorporating nonpharmacologic comfort measures. Premedication was more common for invasive procedures than for routine nursing care. DISCUSSION Pediatric ICU nurses in this study considered factors beyond standardized scales when evaluating and managing pain and sedation of ventilated children. Nurses prioritized children's specific behaviors, vital signs, and their own nursing judgment above standardized scales. Research is needed to describe nurses' practices beyond this small study and to define and validate additional assessment parameters to incorporate into decision-making to improve management and care outcomes.
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Ghaderi F, Ahmadbeigi M, Vossoughi M, Sardarian A. The efficacy of administrating a sweet-tasting solution for reducing the pain related to dental injections in children: A randomized controlled trial. Int J Paediatr Dent 2021; 31:184-190. [PMID: 32757418 DOI: 10.1111/ipd.12697] [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: 03/22/2020] [Revised: 06/12/2020] [Accepted: 07/20/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Anaesthetic injections are an unpleasant experience for children in the dental office. Oral intake of sweet substances by newborns has been shown to be effective in reducing pain. AIM The purpose of this study was to determine whether a prior administration of a sweet-tasting solution has an effect on dental injection pain. DESIGN A total of 56 healthy children needing bilateral maxillary primary canine extraction were included in this split-mouth randomized clinical trial. In the test side, dental injection (local infiltration) was applied after the patient received a sweet-tasting solution, while in the control side sterile water was administered. The patients' demographic characteristics, body mass index (BMI), and sweet taste preference were recorded. Pain perception during injection was measured using visual analogue scale (VAS) and sound, eye, body movement (SEM). RESULTS Mean VAS (28.30 ± 6.43) and SEM (2.14 ± 0.78) in the test side were lower than the control side (45.80 ± 7.17 and 2.95 ± 1.00). It was shown that higher BMI was associated with reduction in the analgesic effect, while the individual's tendency to sweetness increased pain reduction. CONCLUSIONS Sweet taste administration before dental injections in children helps to control the associated pain. This effect is influenced by the individual's sweet taste tendency and BMI.
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Affiliation(s)
- Faezeh Ghaderi
- Department of Pediatric Dentistry, School of Dentistry, Shiraz University of Medical Science, Shiraz, Fars, Iran
| | - Mahboobe Ahmadbeigi
- School of Dentistry, Shaherkord University of Medical Sciences, Shahrekord, Chaharmahal Bakhtiari, Iran
| | - Mehrdad Vossoughi
- Oral and Dental Disease Research Center, Department of Dental Public Health, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
| | - Ahmadreza Sardarian
- Orthodontic Research Center, Department of Orthodontics, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Fars, Iran
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Qian ZJ, Alyono JC, Jin MC, Cooperman SP, Cheng AG, Balakrishnan K. Opioid Prescribing Patterns Following Pediatric Tonsillectomy in the United States, 2009-2017. Laryngoscope 2020; 131:E1722-E1729. [PMID: 33026683 DOI: 10.1002/lary.29159] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/01/2020] [Accepted: 09/16/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Assess national trends in opioid prescription following pediatric tonsillectomy: 1) overall percentage receiving opioids and mean quantity, 2) changes during 2009-2017, and 3) determinants of prescription patterns. METHODS Cross-sectional analysis using 2009-2017 Optum claims data to identify opioid-naïve children aged 1-18 with claims codes for tonsillectomy (n = 82,842). Quantities of opioids filled in outpatient pharmacies during the perioperative period were extracted and converted into milligram morphine equivalents (MMEs) for statistical comparison. Demographic, clinical, and socioeconomic predictors of opioid fill rate and quantity were determined using regression analyses. RESULTS In 2009, 83.3% of children received opioids, decreasing to 58.3% by 2017. Rates of all-cause readmissions and post-tonsillectomy hemorrhages were similar over time. Mean quantity received was 153.47MME (95% confidence intervals [95%CI]: 151.19, 155.76) and did not significantly change during 2009-2017. Opioids were more likely in older children and those with higher household income, but less likely in children with obstructive sleep apnea, other comorbidities, and Hispanic race. Higher quantities of opioids were more likely in older children, while lower quantities were associated with female sex, Hispanic race, and higher household income. Outpatient steroids were prescribed to 8.04% of patients, who were less likely to receive opioids. CONCLUSION While the percentage of children receiving post-tonsillectomy opioids decreased during 2009-2017, prescribed quantities remain high and have not decreased over time. Prescription practices were also influenced by clinical and sociodemographic factors. These results highlight the need for guidance, particularly with regard to opioid quantity, in children after tonsillectomy. LEVEL OF EVIDENCE N/A Laryngoscope, 131:E1722-E1729, 2021.
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Affiliation(s)
- Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Jennifer C Alyono
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Michael C Jin
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Shayna P Cooperman
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Alan G Cheng
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
| | - Karthik Balakrishnan
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California, U.S.A
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Aroke EN, Powell-Roach KL, Jaime-Lara RB, Tesfaye M, Roy A, Jackson P, Joseph PV. Taste the Pain: The Role of TRP Channels in Pain and Taste Perception. Int J Mol Sci 2020; 21:E5929. [PMID: 32824721 PMCID: PMC7460556 DOI: 10.3390/ijms21165929] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/12/2020] [Accepted: 08/16/2020] [Indexed: 12/11/2022] Open
Abstract
Transient receptor potential (TRP) channels are a superfamily of cation transmembrane proteins that are expressed in many tissues and respond to many sensory stimuli. TRP channels play a role in sensory signaling for taste, thermosensation, mechanosensation, and nociception. Activation of TRP channels (e.g., TRPM5) in taste receptors by food/chemicals (e.g., capsaicin) is essential in the acquisition of nutrients, which fuel metabolism, growth, and development. Pain signals from these nociceptors are essential for harm avoidance. Dysfunctional TRP channels have been associated with neuropathic pain, inflammation, and reduced ability to detect taste stimuli. Humans have long recognized the relationship between taste and pain. However, the mechanisms and relationship among these taste-pain sensorial experiences are not fully understood. This article provides a narrative review of literature examining the role of TRP channels on taste and pain perception. Genomic variability in the TRPV1 gene has been associated with alterations in various pain conditions. Moreover, polymorphisms of the TRPV1 gene have been associated with alterations in salty taste sensitivity and salt preference. Studies of genetic variations in TRP genes or modulation of TRP pathways may increase our understanding of the shared biological mediators of pain and taste, leading to therapeutic interventions to treat many diseases.
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Affiliation(s)
- Edwin N. Aroke
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.N.A.); (P.J.)
| | | | - Rosario B. Jaime-Lara
- Sensory Science and Metabolism Unit (SenSMet), National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA; (R.B.J.-L.); (M.T.); (A.R.)
| | - Markos Tesfaye
- Sensory Science and Metabolism Unit (SenSMet), National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA; (R.B.J.-L.); (M.T.); (A.R.)
| | - Abhrabrup Roy
- Sensory Science and Metabolism Unit (SenSMet), National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA; (R.B.J.-L.); (M.T.); (A.R.)
| | - Pamela Jackson
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL 35294, USA; (E.N.A.); (P.J.)
| | - Paule V. Joseph
- Sensory Science and Metabolism Unit (SenSMet), National Institute of Nursing Research, National Institutes of Health, Bethesda, MD 20892, USA; (R.B.J.-L.); (M.T.); (A.R.)
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Uccula A, Enna M, Mulatti C. Care vs Food as an Emotional Regulation Strategy in Elementary School Children: The Role of the Attachment Style. The Journal of Genetic Psychology 2020; 181:336-347. [PMID: 32496891 DOI: 10.1080/00221325.2020.1768504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
According to attachment theory, potentially threatening stimuli tend to activate the attachment system for the search of the protective figure. In secure attachments, the experience of responsive relationships increases the probability of resorting to available figures as a strategy for regulating emotions in stressful situations. The aim of the research was to verify whether, in conditions of mild threat, children's attachment styles affect the choice between caring relationships and food as a form of emotion regulation. We used a mixed experimental design to perform this research. Here, we presented children (N = 65; Mage= 9.4) with threatening and neutral images and, afterwards, asked them to select from images of caring relationship or images of food. The results indicate that securely and ambivalently attached but not avoidantly attached children under both the neutral and threatening image conditions chose the care pictures over the food pictures. Second, only the securely attached increased their choice of care over food images in the threatening condition, and third, this difference was significant when compared with the avoidant children. In conclusion, the results show that although in general the choice of care is primary with respect to food, children with insecure attachments differ from secure children between the two options of emotional regulation.
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Affiliation(s)
- Arcangelo Uccula
- Department of History, Human Sciences and Education, University of Sassari, Sassari, Italy
| | - Mauro Enna
- Department of History, Human Sciences and Education, University of Sassari, Sassari, Italy
| | - Claudio Mulatti
- Department of Psychology and Cognitive Science, University of Trento, Trento, Italy
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McNair C, Campbell-Yeo M, Johnston C, Taddio A. Nonpharmacologic Management of Pain During Common Needle Puncture Procedures in Infants: Current Research Evidence and Practical Considerations: An Update. Clin Perinatol 2019; 46:709-730. [PMID: 31653304 DOI: 10.1016/j.clp.2019.08.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. Numerous nonpharmacologic interventions are available that may be used for these painful procedures, including swaddling/containment, pacifier/non-nutritive sucking, rocking/holding, breastfeeding and breastmilk, skin-to-skin care, sweet tasting solutions, music therapy, sensorial saturation, and parental presence. Adoption these interventions into routine clinical practice is feasible and should be a standard of care in quality health care for infants. This review summarizes the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions.
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Affiliation(s)
- Carol McNair
- Nursing and Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Avenue, Toronto M5G 1X8, Canada
| | - Marsha Campbell-Yeo
- Department of Pediatrics, IWK Health Centre, School of Nursing, Faculty of Health Professions, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Celeste Johnston
- Ingram School of Nursing, McGill University, Montreal, Canada; IWK Health Centre, 5850/5980 University Avenue, Halifax B3K 6R8, Canada
| | - Anna Taddio
- Clinical, Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Child Health Evaluative Sciences, The Hospital for Sick Children, 144 College Street, Toronto, Ontario M5S 3M2, Canada.
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Effectiveness of Sucrose Used Routinely for Pain Relief and Neonatal Clinical Risk in Preterm Infants: A Nonrandomized Study. Clin J Pain 2019; 34:713-722. [PMID: 29300197 DOI: 10.1097/ajp.0000000000000584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Preterm infants (PI) requiring the neonatal intensive care unit are exposed to early repetitive pain/distress. Little is known about how pain relief strategies interact with infants' clinical health status, such as severity of illness with pain responses. This study aimed to examine main and interactive effects of routine sucrose intervention and neonatal clinical risk (NCR) on biobehavioral pain reactivity-recovery in PI during painful blood collection procedures. METHODS Very low birth weight PI (<1500 g; n=104) were assigned to low and high clinical risk groups, according to the Clinical Risk Index for Babies. Sucrose group (n=52) received sucrose solution (25%; 0.5 mL/kg) 2 minutes before the procedures and control group received standard care. Biobehavioral pain reactivity-recovery was assessed according to the Neonatal Facial Coding System, sleep-wake state scale, crying time, and heart rate at 5 phases (baseline, antisepsis, puncture (P), recovery-dressing, and recovery-resting [R]). Repeated measure ANOVA with mixed-design was performed considering pain assessment phases, intervention group, and NCR. RESULTS Independent of NCR, sucrose presented main effect in decreasing neonates' facial activity pain responses and crying time, during P and R. Independent of NCR level or routine sucrose intervention, all neonates displayed activated state in P and decreased biobehavioral responses in R phase. Although no sucrose or NCR effects were observed on physiological reactivity, all neonates exhibited physiological recovery 10 minutes after P, reaching the same heart rate patterns as the baseline. CONCLUSIONS Independent of NCR level, sucrose intervention for pain relief during acute painful procedures was effective to reduce pain intensity and increase biobehavioral regulation.
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Bueno M, Moreno-Ramos MC, Forni E, Kimura AF. Adaptation and Initial Validation of the Premature Infant Pain Profile–Revised (PIPP-R) in Brazil. Pain Manag Nurs 2019; 20:512-515. [DOI: 10.1016/j.pmn.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 12/28/2018] [Accepted: 02/02/2019] [Indexed: 12/12/2022]
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Evaluation of pain in children of 2, 4 and 6 months after the application of non-pharmacological analgesia methods during vaccination. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2018.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Tanyeri-Bayraktar B, Bayraktar S, Hepokur M, Güzel Kıran G. Comparison of two different doses of sucrose in pain relief. Pediatr Int 2019; 61:797-801. [PMID: 31206956 DOI: 10.1111/ped.13914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 05/03/2019] [Accepted: 06/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Procedural pain is one of the most significant problems in neonates, especially in premature babies. Harmless and effective pain relief modalities in newborns should thus be applied. Although sucrose is the most commonly used agent, the most effective dose and concentration of sucrose is not clear. In this study, we compared the efficacy of two different doses of sucrose during venepuncture in neonates. METHODS This was a prospective, randomized, double-blind study. The study was conducted during venous sampling. Oral 24% sucrose (Tool sweet™ Natus Medical, San Carlos, CA, USA) was given by sterile syringe onto the anterior part of the tongue. Group 1 (n = 65) received 0.2 mL/kg 24% sucrose and group 2 (n = 64) received 0.5 mL/kg 24% sucrose. The Bernese Pain Scale for Neonates (BPSN) was used to assess the pain scores before, during and after the procedure. RESULTS One hundred and twenty-nine premature infants were enrolled in the study, consisting of 67 girls (51.9%) and 62 boys (48.1%) aged 1-24 days (mean age, 8.34 ± 6.25 days). There was no significant difference in BPSN score between the groups (P > 0.05). There was also no statistically significant difference in BPSN subscale scores between the groups (P > 0.05). CONCLUSIONS Twenty-four percent sucrose 0.2 mL/kg may be the minimum effective dose to relieve pain during venepuncture procedures in premature babies.
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Affiliation(s)
| | - Süleyman Bayraktar
- Department of Pediatric Intensive Care, Haseki Research and Training Hospital, Istanbul, Turkey
| | - Mervenur Hepokur
- Department of Neonatology, Bezmialem Vakif University, Istanbul, Turkey
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Cwynar CM, Osborne K. Immunization-Associated Pain: Taking Research to the Bedside. J Pediatr Health Care 2019; 33:446-454. [PMID: 31036444 DOI: 10.1016/j.pedhc.2018.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/26/2018] [Accepted: 12/16/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Immunization-associated pain is the number one cause of pain in pediatric settings. Untreated pain has many short- and long-term detrimental effects. The purpose of this project was to implement a nonpharmaceutical immunization-associated-pain prevention program. METHOD This project was implemented at a pediatric primary care clinic. Staff were educated about immunization-associated pain and techniques for decreasing/preventing pain. Families were educated about pain control, and the practitioner and parent/child picked interventions to decrease pain. Preimplementation and postimplementation data were collected using previously validated pain and satisfaction scales. RESULTS Pain prevention interventions decreased pain for children between 2 months and 7 years of age by 4.7 points on a Faces, Legs, Activity, Cry, Consolability (i.e., FLACC) scale. For children 7 years and older, pain during immunization decreased on average by 1.76 points on the visual analog scale. CONCLUSION Non-pharmaceutical interventions are effective in decreasing immunization-associated pain.
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Abstract
The taste of sucrose is commonly used to provide pain relief in newborn humans and is innately analgesic to neonatal rodents. In adulthood, sucrose remains a strong motivator to feed, even in potentially hazardous circumstances (ie, threat of tissue damage). However, the neurobiological mechanisms of this endogenous reward-pain interaction are unclear. We have developed a simple model of sucrose drinking-induced analgesia in Sprague-Dawley rats (6-10 weeks old) and have undertaken a behavioral and pharmacological characterization using the Hargreaves' test of hind-paw thermal sensitivity. Our results reveal an acute, potent, and robust inhibitory effect of sucrose drinking on thermal nociceptive behaviour that unlike the phenomenon in neonates is independent of endogenous opioid signalling and does not seem to operate through classical descending inhibition of the spinal cord circuitry. Experience of sucrose drinking had a conditioning effect whereby the apparent expectancy of sucrose enabled water alone (in euvolemic animals) to elicit a short-lasting placebo-like analgesia. Sweet taste alone, however, was insufficient to elicit analgesia in adult rats intraorally perfused with sucrose. Instead, the sucrose analgesia phenomenon only appeared after conditioning by oral perfusion in chronically cannulated animals. This sucrose analgesia was completely prevented by systemic dosing of the endocannabinoid CB1 receptor antagonist rimonabant. These results indicate the presence of an endogenous supraspinal analgesic circuit that is recruited by the context of rewarding drinking and is dependent on endocannabinoid signalling. We propose that this hedonic sucrose-drinking model may be useful for further investigation of the supraspinal control of pain by appetite and reward.
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Sylvetsky AC, Hiedacavage A, Shah N, Pokorney P, Baldauf S, Merrigan K, Smith V, Long MW, Black R, Robien K, Avena N, Gaine C, Greenberg D, Wootan MG, Talegawkar S, Colon‐Ramos U, Leahy M, Ohmes A, Mennella JA, Sacheck J, Dietz WH. From biology to behavior: a cross-disciplinary seminar series surrounding added sugar and low-calorie sweetener consumption. Obes Sci Pract 2019; 5:203-219. [PMID: 31275594 PMCID: PMC6587329 DOI: 10.1002/osp4.334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/06/2019] [Accepted: 02/10/2019] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION This report presents a synopsis of a three-part, cross-sector, seminar series held at the George Washington University (GWU) in Washington, DC from February-April, 2018. The overarching goal of the seminar series was to provide a neutral forum for diverse stakeholders to discuss and critically evaluate approaches to address added sugar intake, with a key focus on the role of low-calorie sweeteners (LCS). METHODS During three seminars, twelve speakers from academic institutions, federal agencies, non-profit organizations, and the food and beverage industries participated in six interactive panel discussions to address: 1) Do Farm Bill Policies Impact Population Sugar Intake? 2) What is the Impact of Sugar-sweetened Beverage (SSB) Taxes on Health and Business? 3) Is Sugar Addictive? 4) Product Reformulation Efforts: Progress, Challenges, and Concerns? 5) Low-calorie Sweeteners: Helpful or Harmful, and 6) Are Novel Sweeteners a Plausible Solution? Discussion of each topic involved brief 15-minute presentations from the speakers, which were followed by a 25-minute panel discussion moderated by GWU faculty members and addressed questions generated by the audience. Sessions were designed to represent opposing views and stimulate meaningful debate. Given the provocative nature of the seminar series, attendee questions were gathered anonymously using Pigeonhole™, an interactive, online, question and answer platform. RESULTS This report summarizes each presentation and recapitulates key perspectives offered by the speakers and moderators. CONCLUSIONS The seminar series set the foundation for robust cross-sector dialogue necessary to inform meaningful future research, and ultimately, effective policies for lowering added sugar intakes.
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Affiliation(s)
- A. C. Sylvetsky
- Milken Institute School of Public HealthThe George Washington University
| | - A. Hiedacavage
- Milken Institute School of Public HealthThe George Washington University
| | - N. Shah
- Milken Institute School of Public HealthThe George Washington University
| | - P. Pokorney
- Milken Institute School of Public HealthThe George Washington University
| | - S. Baldauf
- Milken Institute School of Public HealthThe George Washington University
| | - K. Merrigan
- Milken Institute School of Public HealthThe George Washington University
- Swette Center for Sustainable Food SystemsArizona State University
| | - V. Smith
- Department of Agricultural EconomicsMontana State University
| | - M. W. Long
- Milken Institute School of Public HealthThe George Washington University
| | - R. Black
- Quadrant D Consulting, LLCTufts University Friedman School of Nutrition Science & Policy
| | - K. Robien
- Milken Institute School of Public HealthThe George Washington University
| | - N. Avena
- Department of NeuroscienceMount Sinai School of Medicine
- Department of PsychologyPrinceton University
| | | | - D. Greenberg
- PepsiCo Inc. (Current affiliation NutriSci Inc.)
| | | | - S. Talegawkar
- Milken Institute School of Public HealthThe George Washington University
| | - U. Colon‐Ramos
- Milken Institute School of Public HealthThe George Washington University
| | - M. Leahy
- Food, Nutrition & Policy Solutions LLC
| | | | | | - J. Sacheck
- Milken Institute School of Public HealthThe George Washington University
| | - W. H. Dietz
- Milken Institute School of Public HealthThe George Washington University
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Oral Sucrose Versus Breastfeeding in Managing Infants' Immunization-Related Pain: A Randomized Controlled Trial. MCN Am J Matern Child Nurs 2019; 44:108-114. [PMID: 30807328 DOI: 10.1097/nmc.0000000000000512] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Treating pain during immunization should be a part of pediatric primary healthcare around the world, as untreated pain in children has short- and long-term consequences. Few studies of pharmacologic and nonpharmacologic methods of pain relief during immunization have been conducted in low- and middle-income countries. Finding pain-mitigating interventions that are low-cost, effective, and feasible across all settings, including with low-resourced settings could improve primary healthcare. PURPOSE To evaluate the effectiveness of oral sucrose versus breastfeeding as methods of pain management during immunization of infants through 6 months of age. METHODS A randomized controlled experimental design was used; 120 infants were randomly assigned to control, sucrose, or breastfeeding groups. Data were collected in an Egyptian primary health center. Outcome measures including pain (as per the FLACC pain scale), crying time, and heart rate were measured at three time points. RESULTS There were significant differences in pain scores and crying duration during and after immunization (p < .001) for the breastfeeding group compared with the sucrose and control groups. IMPLICATIONS FOR PRACTICE Health staff and parents need education and support in use of breastfeeding for pain management during immunization. More studies are needed to evaluate effectiveness of breastfeeding versus other pain management methods for managing infants' immunization-related pain.
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Remick K, Gausche-Hill M, Joseph MM, Brown K, Snow SK, Wright JL, Wright J, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N, Joseph MM, Alade K, Amato C, Avarello JT, Baldwin S, Barata IA, Benjamin LS, Berg K, Brown K, Bullard-Berent J, Dietrich AM, Friesen P, Gerardi M, Heins A, Holtzman DK, Homme J, Horeczko T, Ishimine P, Lam S, Long K, Mayz K, Mehta S, Mellick L, Ojo A, Paul AZ, Pauze DR, Pearson NM, Perina D, Petrack E, Rayburn D, Rose E, Russell WS, Ruttan T, Saidinejad M, Sanders B, Simpson J, Solari P, Stoner M, Valente JH, Wall J, Wallin D, Waseem M, Whiteman PJ, Woolridge D, Young T, Foresman-Capuzzi J, Johnson R, Martin H, Milici J, Brandt C, Nelson N. Pediatric Readiness in the Emergency Department. J Emerg Nurs 2019; 45:e3-e18. [DOI: 10.1016/j.jen.2018.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Kristoffersen L, Malahleha M, Duze Z, Tegnander E, Kapongo N, Støen R, Follestad T, Eik-Nes SH, Bergseng H. Randomised controlled trial showed that neonates received better pain relief from a higher dose of sucrose during venepuncture. Acta Paediatr 2018; 107:2071-2078. [PMID: 30188590 DOI: 10.1111/apa.14567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 08/14/2018] [Accepted: 09/03/2018] [Indexed: 11/29/2022]
Abstract
AIM We compared the effect of two different doses of sucrose on neonatal pain scores during venepuncture. METHODS This randomised crossover study focused on neonates born weighing more than 1000 g from December 2014 to June 2016, who received neonatal intensive care at two hospitals: one in Empangeni, South Africa, and one in Trondheim, Norway. During two consecutive venepuncture procedures, 27 neonates from South Africa and 26 neonates from Norway were randomised to receive 0.2 mL or 0.5 mL sucrose. Half was administered two minutes before venepuncture and the rest immediately before the procedure. South Africa used 25% sucrose and Norway 24%. Pain scores were measured twice using the Premature Infant Pain Profile-Revised: during skin puncture and after the needle was removed. RESULTS The mean pain scores during skin puncture were significantly lower with 0.5 mL sucrose than with 0.2 mL (5.3 versus 6.8, p=0.008), but the mean pain scores after the needle was removed were similar with both doses (4.7 versus 5.4, p=0.29). We found no significant association between weight and pain scores. CONCLUSION We showed that neonates received better pain relief from 0.5 mL than 0.2 mL sucrose during venepuncture but not after the needle was removed.
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Affiliation(s)
- Laila Kristoffersen
- Department of Neonatology; St. Olavs University Hospital; Trondheim Norway
- Department of Clinical and Molecular Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Moelo Malahleha
- Paediatric Department; Neonatal Unit; Lower Umfolozi Regional War Memorial Hospital; Empangeni South Africa
| | - Zama Duze
- Paediatric Department; Neonatal Unit; Lower Umfolozi Regional War Memorial Hospital; Empangeni South Africa
| | - Eva Tegnander
- Department of Clinical and Molecular Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- National Center for Fetal Medicine; St. Olavs University Hospital; Trondheim Norway
| | - Ndaye Kapongo
- Paediatric Department; Neonatal Unit; Lower Umfolozi Regional War Memorial Hospital; Empangeni South Africa
- Nelson R. Mandela School of Medicine; University of KwaZulu-Natal; Durban South Africa
| | - Ragnhild Støen
- Department of Neonatology; St. Olavs University Hospital; Trondheim Norway
- Department of Clinical and Molecular Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
| | - Turid Follestad
- Department of Public Health and Nursing; NTNU; Trondheim Norway
| | - Sturla H. Eik-Nes
- Department of Clinical and Molecular Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
- National Center for Fetal Medicine; St. Olavs University Hospital; Trondheim Norway
| | - Håkon Bergseng
- Department of Neonatology; St. Olavs University Hospital; Trondheim Norway
- Department of Clinical and Molecular Medicine; Norwegian University of Science and Technology (NTNU); Trondheim Norway
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Nieto García A, Berbel Tornero O, Monleón Sancho J, Alberola-Rubio J, López Rubio ME, Picó Sirvent L. [Evaluation of pain in children of 2, 4 and 6 months after the application of non-pharmacological analgesia methods during vaccination]. An Pediatr (Barc) 2018; 91:73-79. [PMID: 30448108 DOI: 10.1016/j.anpedi.2018.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/28/2018] [Accepted: 10/03/2018] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION Young children perceive pain as much, or even more than adults, and the pain may have short- and long-term consequences. The literature describes the use of non-pharmacological interventions to alleviate pain during vaccination. The aim of this study was to assess 3such interventions for analgesia during vaccination: non-nutritive sucking (NNS), breastfeeding (BF), and administration of a 50% dextrose solution (D50W). MATERIALS AND METHODS A prospective, non-randomised cohort study was carried out on infants aged 2, 4 and 6 months that received 1, 2, or 3 vaccines, respectively, according to the routine immunisation schedule. There were 3treatments: NNS, BF, and 2mL of D50W combined with NNS. Pain was assessed using the LLANTO scale, and the duration of crying. RESULTS The study included 387 infants. The mean scores in the LLANTO scale at ages 2 and 6 months were significantly lower in breastfed infants compared to infants managed with NNS (P=.025 and P<.001, respectively), or infants given D50W (P=.025 and P=.001), and the difference was not statistically significant at age 4 months (P=.21 and P=.27). There were no significant differences between infants managed with NNS and D50W at 2, 4, and 6 months (P=.66, P=.93 and P=.45, respectively). The duration of crying was significantly lower at age 6 months in breastfeed infants compared to infants managed with NNS or D50W (P=.013 and P=.017). No breastfed child (n=129) experienced side effects. CONCLUSIONS In infants born to term with adequate weight for gestational age, breastfeeding reduces pain on the administration of 1 or 2 vaccines. When 3 vaccines are given, the reduction is minimal. Administration of D50W does not have any additional analgesic effect in infants compared to being held by a parent combined with NNS during vaccination. BF during vaccination is not associated with any side effects.
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Affiliation(s)
| | - Octavio Berbel Tornero
- Pediatría, Centro de Salud de Paterna, Departamento de Valencia-Arnau de Vilanova-Lliria; Facultad de Medicina. Universidad Católica San Vicente Mártir, Valencia
| | - Javier Monleón Sancho
- Unidad de Patología Uterina, Hospital Universitario Politécnico La Fe, Valencia, España
| | | | | | - Leandro Picó Sirvent
- Servicio de Pediatría, Hospital Universitario Casa Salud, Valencia, España; Facultad de Medicina. Universidad Católica San Vicente Mártir, Valencia
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Remick K, Gausche-Hill M, Joseph MM, Brown K, Snow SK, Wright JL, Adirim T, Agus MS, Callahan J, Gross T, Lane N, Lee L, Mazor S, Mahajan P, Timm N, Heiss KF, Beierle E, Besner GE, Downard CD, Fallat ME, Gow KW, Alade K, Amato C, Avarello JT, Baldwin S, Barata IA, Benjamin LS, Berg K, Bullard-Berent J, Dietrich AM, Friesen P, Gerardi M, Heins A, Holtzman DK, Homme J, Horeczko T, Ishimine P, Lam S, Long K, Mayz K, Mehta S, Mellick L, Ojo A, Paul AZ, Pauze DR, Pearson NM, Perina D, Petrack E, Rayburn D, Rose E, Russell WS, Ruttan T, Saidinejad M, Sanders B, Simpson J, Solari P, Stoner M, Valente JH, Wall J, Wallin D, Waseem M, Whiteman PJ, Woolridge D, Young T, Foresman-Capuzzi J, Johnson R, Martin H, Milici J, Brandt C, Nelson N. Pediatric Readiness in the Emergency Department. Pediatrics 2018; 142:peds.2018-2459. [PMID: 30389843 DOI: 10.1542/peds.2018-2459] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
This is a revision of the previous joint Policy Statement titled "Guidelines for Care of Children in the Emergency Department." Children have unique physical and psychosocial needs that are heightened in the setting of serious or life-threatening emergencies. The majority of children who are ill and injured are brought to community hospital emergency departments (EDs) by virtue of proximity. It is therefore imperative that all EDs have the appropriate resources (medications, equipment, policies, and education) and capable staff to provide effective emergency care for children. In this Policy Statement, we outline the resources necessary for EDs to stand ready to care for children of all ages. These recommendations are consistent with the recommendations of the Institute of Medicine (now called the National Academy of Medicine) in its report "The Future of Emergency Care in the US Health System." Although resources within emergency and trauma care systems vary locally, regionally, and nationally, it is essential that ED staff, administrators, and medical directors seek to meet or exceed these recommendations to ensure that high-quality emergency care is available for all children. These updated recommendations are intended to serve as a resource for clinical and administrative leadership in EDs as they strive to improve their readiness for children of all ages.
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Affiliation(s)
- Katherine Remick
- National Emergency Medical Services for Children Innovation and Improvement Center, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Dell Medical School, The University of Texas at Austin, Austin, Texas
- Dell Children’s Medical Center, Austin, Texas
| | - Marianne Gausche-Hill
- Los Angeles County Emergency Medical Services Agency, Santa Fe Springs, California
- Department of Emergency Medicine and Pediatrics, David Geffen School of Medicine and Harbor–University of California, Los Angeles Medical Center, University of California, Los Angeles, Los Angeles, California
- Department of Emergency Medicine, Los Angeles Biomedical Research Institute, Los Angeles, California
| | - Madeline M. Joseph
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine and Pediatrics, University of Florida College of Medicine–Jacksonville, Jacksonville, Florida
- University of Florida Health Sciences Center–Jacksonville, Jacksonville, Florida
| | - Kathleen Brown
- Departments of Pediatrics and Emergency Medicine, School of Medicine and Health Sciences, George Washington University and Children’s National Medical Center, Washington, District of Columbia
| | | | - Joseph L. Wright
- University of Maryland Capital Region Health, University of Maryland Medical System, Cheverly, Maryland; and
- Department of Family Science, University of Maryland School of Public Health, College Park, Maryland
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Abstract
BACKGROUND Idiopathic clubfoot treatment is treated by manipulation and casting utilizing the Ponseti technique which can make the infant fussy and irritable. The goal of this study was to determine which intervention could decrease this pain response in infants undergoing Ponseti casting for idiopathic clubfeet. Our hypothesis was that the administration of oral sucrose solution or milk would be the most effective in accomplishing that goal. METHODS We conducted a double-blinded randomized controlled trial at a tertiary pediatric orthopaedic center on 33 children (average age=17.94 d; SD=20.51 d) undergoing clubfoot manipulation and casting and their guardians. Each cast was considered a new event and was randomized to an oral 20% sucrose solution (S), water (W), or milk (M) in a bottle (breast or nonbreast). We assessed the Neonatal Infant Pain Scale (NIPS), heart rate, and oxygen saturation before, during, and after the casting. RESULTS A total of 131 casts were randomized and 118 analyzed (37 M, 42 S, 39 W). Each child underwent an average of 3.97 casts (SD=1.74). There were no significant differences seen between the groups before casting in their mean NIPS score (M=2.2; SD=2.38, S=1.84, SD=2.18, W=1.61, SD=2.12). However during casting, mean NIPS score for both milk, 0.91 (SD=1.26, P=0.0005) and sucrose, 0.64 (SD=1.27, P<0.0001) were significantly less than water, 2.27 (SD=2.03) but not different from each other (P=0.33). Postcasting, the sucrose NIPS score, 0.69 (SD=1.53) continued to be significantly less than milk, 2.11 (SD=2.37, P=0.0065. There was no correlation between heart rate or oxygen saturation and NIPS. CONCLUSIONS Sucrose solution and milk during Ponseti casting and manipulation were effective in decreasing the pain response in children undergoing manipulation and casting for clubfeet. The sucrose solution administration continued the pain relief into the postcasting period. In addition to the benefits of improving the patient experience during casting, a less irritable child may result in better casting. LEVEL OF EVIDENCE Level 1 evidence.
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Galderisi A, Lago P, Steil GM, Ghirardo M, Cobelli C, Baraldi E, Trevisanuto D. Procedural Pain during Insertion of a Continuous Glucose Monitoring Device in Preterm Infants. J Pediatr 2018; 200:261-264.e1. [PMID: 29861315 DOI: 10.1016/j.jpeds.2018.03.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/13/2018] [Accepted: 03/15/2018] [Indexed: 01/06/2023]
Abstract
Procedural pain was compared between the insertion of a continuous glucose monitoring sensor and heel stick using the Premature Infant Pain Profile in a single-blinded controlled trial in preterm infants (≤32 weeks of gestation or birth weight ≤1500 g) (ClinicalTrials.govNCT02583776). Continuous glucose monitoring insertion was associated with lower pain scores compared with the heel stick.
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Affiliation(s)
- Alfonso Galderisi
- Neonatal Intensive Care Unit, Department of Women and Children's Health, University of Padova, Padova, Italy; Department of Pediatrics, Yale University, New Haven, CT.
| | - Paola Lago
- Neonatal Intensive Care Unit, Department of Women and Children's Health, University of Padova, Padova, Italy
| | - Garry M Steil
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Martina Ghirardo
- Neonatal Intensive Care Unit, Department of Women and Children's Health, University of Padova, Padova, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University Hospital of Padova, Padova, Italy
| | - Eugenio Baraldi
- Neonatal Intensive Care Unit, Department of Women and Children's Health, University of Padova, Padova, Italy
| | - Daniele Trevisanuto
- Neonatal Intensive Care Unit, Department of Women and Children's Health, University of Padova, Padova, Italy
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31
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Sugar in Infants, Children and Adolescents: A Position Paper of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition Committee on Nutrition. J Pediatr Gastroenterol Nutr 2017; 65:681-696. [PMID: 28922262 DOI: 10.1097/mpg.0000000000001733] [Citation(s) in RCA: 168] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The consumption of sugars, particularly sugar-sweetened beverages (SSBs; beverages or drinks that contain added caloric sweeteners (ie, sucrose, high-fructose corn syrup, fruit juice concentrates), in European children and adolescents exceeds current recommendations. This is of concern because there is no nutritional requirement for free sugars, and infants have an innate preference for sweet taste, which may be modified and reinforced by pre- and postnatal exposures. Sugar-containing beverages/free sugars increase the risk for overweight/obesity and dental caries, can result in poor nutrient supply and reduced dietary diversity, and may be associated with increased risk of type 2 diabetes mellitus, cardiovascular risk, and other health effects. The term "free sugars," includes all monosaccharides/disaccharides added to foods/beverages by the manufacturer/cook/consumer, plus sugars naturally present in honey/syrups/unsweetened fruit juices and fruit juice concentrates. Sugar naturally present in intact fruits and lactose in amounts naturally present in human milk or infant formula, cow/goat milk, and unsweetened milk products is not free sugar. Intake of free sugars should be reduced and minimised with a desirable goal of <5% energy intake in children and adolescents aged ≥2 to 18 years. Intake should probably be even lower in infants and toddlers <2 years. Healthy approaches to beverage and dietary consumption should be established in infancy, with the aim of preventing negative health effects in later childhood and adulthood. Sugar should preferably be consumed as part of a main meal and in a natural form as human milk, milk, unsweetened dairy products, and fresh fruits, rather than as SSBs, fruit juices, smoothies, and/or sweetened milk products. Free sugars in liquid form should be replaced by water or unsweetened milk drinks. National Authorities should adopt policies aimed at reducing the intake of free sugars in infants, children and adolescents. This may include education, improved labelling, restriction of advertising, introducing standards for kindergarten and school meals, and fiscal measures, depending on local circumstances.
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Procedural pain and oral glucose in preterm neonates: brain development and sex-specific effects. Pain 2017; 159:515-525. [DOI: 10.1097/j.pain.0000000000001123] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Walter-Nicolet E, Chary-Tardy AC, Tourniaire B. [Do analgesic sweet solutions in neonates influence glycemia? A literature review]. Arch Pediatr 2017; 24:1281-1286. [PMID: 29174110 DOI: 10.1016/j.arcped.2017.09.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 09/26/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
Sweet solutions are one of the most widely used nonpharmacologic analgesics used for newborns. They alleviate mild to moderate pain induced by painful procedures. They are used daily in neonatal intensive care units before a venepuncture or a heel stick, especially for a blood-sugar measurement. It is agreed that analgesic sweet solutions do not modify glycemia results. This nevertheless remains a recurrent question that the present review attempts to answer.
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Affiliation(s)
- E Walter-Nicolet
- Service de néonatologie-maternité, groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France.
| | - A C Chary-Tardy
- Service de pédiatrie néonatale et réanimations, centre hospitalier universitaire de Dijon, 14, rue Gaffarel, 21000 Dijon, France
| | - B Tourniaire
- Unité fonctionnelle de lutte contre la douleur, centre de la douleur et de la migraine de l'enfant, hôpital Armand-Trousseau, Assistance publique-Hôpitaux de Paris, 26, avenue Arnold-Netter, 75012 Paris, France
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34
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The Needle-Less Treatment of Pain and Anxiety in the Pediatric Patient. CURRENT EMERGENCY AND HOSPITAL MEDICINE REPORTS 2017. [DOI: 10.1007/s40138-017-0141-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Britto C, P N Rao S. Assessment of Neonatal Pain During Heel Prick: Lancet vs Needle-A Randomized Controlled Study. J Trop Pediatr 2017; 63:346-351. [PMID: 28110270 DOI: 10.1093/tropej/fmw093] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Heel prick is a frequent painful procedure in newborns. A lancet or a 26-gauge needle is used for a heel prick in India. OBJECTIVE To compare the pain caused by heel prick with a lancet or a 26-gauge needle in newborns admitted in the neonatal intensive care unit (NICU) using the preterm infant pain profile (PIPP). METHODS This randomized controlled trial was conducted over 2 months in a Level III NICU with a sample size of 40 subjects (20 in each group), which was required for the study to have a power of 80% with an alpha error of 0.05. Hemodynamically stable newborns on at least those on partial oral feeds undergoing heel prick for routine glucose monitoring were randomized into two groups within 48 h of NICU admission after informed parental consent: heel prick with a lancet or with a 26-gauge needle using computer-generated random numbers. Two milliliters of expressed breast milk was given 2 min before the heel prick. Pain before, during and after (1 and 5 min) was assessed using the PIPP score. The primary outcome measure was the PIPP score. The secondary outcome measures were the duration of audible cry and the number of pricks needed for an adequate sample. Statistical analysis was done using the Mann Whitney U test and Friedman's test on SPSS v.21. A p value of < 0.05 was significant. RESULTS There were 40 neonates, 24 males and 16 females included in the study with a median age of 7 days. The mean birth weight was 2441 g (SD: 699) at a mean gestation of 34.4 weeks (SD: 3.2). The median PIPP scores at 0-30 s after heel prick were 7.05 ± 3.57 with a lancet vs. 9.35 ± 3.68 a needle (p = 0.052). There was a significantly lower duration of audible cry with use of lancet (10.5 ± 18.5 s vs. 75.2 ± 12.0 s with needle; p = 0.03). All heel pricks resulted in adequate sampling. CONCLUSION Heel prick with a lancet causes less crying than a 26-gauge needle, though the PIPP scores are not significantly different.
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Affiliation(s)
- Carl Britto
- St. John's Medical College, Bengaluru 560034, India
| | | | - Suman P N Rao
- Department of Neonatology, St. John's Medical College Hospital, Bengaluru 560034, India
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Frie J, Bartocci M, Lagercrantz H, Kuhn P. Cortical Responses to Alien Odors in Newborns: An fNIRS Study. Cereb Cortex 2017; 28:3229-3240. [DOI: 10.1093/cercor/bhx194] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jakob Frie
- Neonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Neonatal Medicine, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Marco Bartocci
- Neonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Neonatal Medicine, Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Hugo Lagercrantz
- Neonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
| | - Pierre Kuhn
- Neonatal Research Unit, Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Service de Médecine et Réanimation du Nouveau-né, Hôpital de Hautepierre, Centre Hospitalier Universitaire de Strasbourg, France
- Institut de Neurosciences Cellulaires et Intégratives, Centre National de la Recherche Scientifique et Unistra, Strasbourg, France
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Chen S, Zhang Q, Xie RH, Wen SW, Harrison D. What is the Best Pain Management During Gastric Tube Insertion for Infants Aged 0-12months: A Systematic Review. J Pediatr Nurs 2017; 34:78-83. [PMID: 28024900 DOI: 10.1016/j.pedn.2016.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/15/2016] [Accepted: 12/16/2016] [Indexed: 10/20/2022]
Abstract
PROBLEM Synthesized evidence on the effectiveness of pain management for nasogastric tube (NGT) and orogastric tube (OGT) insertions in infants is lacking. This paper is a systematic review of the effectiveness of pain management for gastric tube (GT) insertion in infants. ELIGIBILITY CRITERIA Randomized control trial (RCT) or quasi-experimental studies published up to April 2016, on pain management strategies during GT insertions (either NGT or OGT) in infants up to 12months of age. Databases searched included seven English databases and three Chinese databases. RESULTS Six English studies out of 1236 screened met the eligibility criteria and were included in the review. Two studied OGT insertion and four studies focused on NGT insertion. All six studies evaluated oral sweet solutions (24%-30% sucrose and 25% glucose) compared to placebo (water) or no treatment and all focused on newborn infants. Data from four studies which used the Premature Infant Pain Profile (PIPP) were pooled for meta-analysis. Results showed a significant reduction in PIPP scores during or immediately after the procedure for sweet solution interventions (MD=-2.18, 95% CI (-3.86, -0.51), P=0.01), compared to no intervention or placebo. CONCLUSIONS Small volumes of oral sweet solutions reduce pain during GT insertion procedure in newborn infants. IMPLICATIONS Oral sweet solutions can be recommended before GT insertion for newborns in clinical practice. Further studies determining the effect of sweet solution beyond the newborn period, different concentrations of sweet solution and comparison with other pain management strategies are warranted. Systematic review registration number: CRD42016038535. http://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Shaolin Chen
- School of Nursing of Hunan University of Medicine, Huaihua, China
| | - Qing Zhang
- School of Nursing of Hunan University of Medicine, Huaihua, China
| | - Ri-Hua Xie
- School of Nursing of Hunan University of Medicine, Huaihua, China; McLaughlin Center for Population Health Risk Assessment, Institute of Population Health, University of Ottawa, Ottawa, Canada
| | - Shi Wu Wen
- OMNI Research Group, Department of Obstetrics and Gynecology, University of Ottawa Faculty of Medicine, Canada; The Ottawa Hospital Research Institute Clinical Epidemiology Program, Ottawa, Canada; School of Epidemiology, Public Health, and Preventive Medicine, University of Ottawa Faculty of Medicine, Ottawa, Canada
| | - Denise Harrison
- University of Ottawa and Children's Hospital of Eastern Ontario, Canada.
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Randomized Clinical Trial of 24% Oral Sucrose to Decrease Pain Associated With Peripheral Intravenous Catheter Insertion in Preterm and Term Newborns. Adv Neonatal Care 2017; 17:E3-E11. [PMID: 27533333 DOI: 10.1097/anc.0000000000000326] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE To determine whether 24% sucrose solution given orally before insertion of a peripheral intravenous (PIV) catheter decreases neonatal pain. BACKGROUND Prior studies of pain caused by heel and arterial needlesticks found oral administration of 24% sucrose to significantly blunt pain during these painful procedures. No studies have evaluated this treatment with needlestick pain associated with PIV catheter insertion. METHODS Oral 24% sucrose or placebo solution was administered 2 minutes prior to PIV catheter insertion. Outcome measures were obtained prior to, during, and for 5 minutes after PIV catheter insertion. Investigators and caregivers were blinded to group assignment. Data were analyzed with longitudinal analysis of repeated measures, with P < .05 for significance. RESULTS A total of 40 neonates (24% sucrose: N = 20; placebo: N = 20) were studied. Pain scores significantly increased from 3.2 ± 1.6 to a maximum of 7.6 ± 3.8 at the time of catheter insertion, returning to baseline levels 8 minutes after PIV catheter insertion (P < .001). No significant differences were found in pain, heart rate, or noninvasive oxygen saturation (SpO2) between the sucrose and placebo groups (P > 0.05). IMPLICATIONS FOR PRACTICE Results from this study did not find that 24% sucrose administered prior to PIV catheter insertion altered the infant's pain response. IMPLICATIONS FOR RESEARCH Since this is the first study to evaluate the pain-blunting effects of 24% sucrose administration before PIV catheter insertion, replication of this study is needed before widespread application of findings.
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Harrison D, Larocque C, Bueno M, Stokes Y, Turner L, Hutton B, Stevens B. Sweet Solutions to Reduce Procedural Pain in Neonates: A Meta-analysis. Pediatrics 2017; 139:peds.2016-0955. [PMID: 27986905 DOI: 10.1542/peds.2016-0955] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/10/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Abundant evidence of sweet taste analgesia in neonates exists, yet placebo-controlled trials continue to be conducted. OBJECTIVE To review all trials evaluating sweet solutions for analgesia in neonates and to conduct cumulative meta-analyses (CMAs) on behavioral pain outcomes. DATA SOURCES (1) Data from 2 systematic reviews of sweet solutions for newborns; (2) searches ending 2015 of CINAHL, Medline, Embase, and psychINFO. DATA EXTRACTION AND ANALYSIS Two authors screened studies for inclusion, conducted risk-of-bias ratings, and extracted behavioral outcome data for CMAs. CMA was performed using random effects meta-analysis. RESULTS One hundred and sixty-eight studies were included; 148 (88%) included placebo/no-treatment arms. CMA for crying time included 29 trials (1175 infants). From the fifth trial in 2002, there was a statistically significant reduction in mean cry time for sweet solutions compared with placebo (-27 seconds, 95% confidence interval [CI] -51 to -4). By the final trial, CMA was -23 seconds in favor of sweet solutions (95% CI -29 to -18). CMA for pain scores included 50 trials (3341 infants). Results were in favor of sweet solutions from the second trial (0.5, 95% CI -1 to -0.1). Final results showed a standardized mean difference of -0.9 (95% CI -1.1 to -0.7). LIMITATIONS We were unable to use or obtain data from many studies to include in the CMA. CONCLUSIONS Evidence of sweet taste analgesia in neonates has existed since the first published trials, yet placebo/no-treatment, controlled trials have continued to be conducted. Future neonatal pain studies need to select more ethically responsible control groups.
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Affiliation(s)
- Denise Harrison
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada; .,School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Catherine Larocque
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.,School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Mariana Bueno
- Departamento Enfermagem Materno-Infantil e Psiquiátrica (ENP), University of São Paulo, São Paulo, Brazil
| | - Yehudis Stokes
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada.,School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Lucy Turner
- Institute of Health Economics, Edmonton, Alberta, Canada
| | - Brian Hutton
- Ottawa Hospital Research Institute (OHRI), Ottawa, Ontario, Canada
| | - Bonnie Stevens
- The Hospital for Sick Children, Toronto, Ontario, Canada; and.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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Effect of Vibration on Pain Response to Heel Lance: A Pilot Randomized Control Trial. Adv Neonatal Care 2016; 16:439-448. [PMID: 27533335 DOI: 10.1097/anc.0000000000000315] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Applied mechanical vibration in pediatric and adult populations has been shown to be an effective analgesic for acute and chronic pain, including needle pain. Studies among the neonatal population are lacking. According to the Gate Control Theory, it is expected that applied mechanical vibration will have a summative effect with standard nonpharmacologic pain control strategies, reducing behavioral and physiologic pain responses to heel lancing. PURPOSE To determine the safety and efficacy of mechanical vibration for relief of heel lance pain among neonates. METHODS In this parallel design randomized controlled trial, eligible enrolled term or term-corrected neonates (n = 56) in a level IV neonatal intensive care unit were randomized to receive either sucrose and swaddling or sucrose, swaddling, and vibration for heel lance analgesia. Vibration was applied using a handheld battery-powered vibrator (Norco MiniVibrator, Hz = 92) to the lateral aspect of the lower leg along the sural dermatome throughout the heel lance procedure. Neonatal Pain, Agitation, and Sedation Scale (N-PASS) scores, heart rate, and oxygen saturations were collected at defined intervals surrounding heel lancing. RESULTS Infants in the vibration group (n = 30) had significantly lower N-PASS scores and more stable heart rates during heel stick (P = .006, P = .037) and 2 minutes after heel lance (P = .002, P = .016) than those in the nonvibration group. There were no adverse behavioral or physiologic responses to applied vibration in the sample. IMPLICATIONS FOR PRACTICE AND RESEARCH Applied mechanical vibration is a safe and effective method for managing heel lance pain. This pilot study suggests that mechanical vibration warrants further exploration as a nonpharmacologic pain management tool among the neonatal population.
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Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 2016; 7:CD001069. [PMID: 27420164 PMCID: PMC6457867 DOI: 10.1002/14651858.cd001069.pub5] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Administration of oral sucrose with and without non-nutritive sucking is the most frequently studied non-pharmacological intervention for procedural pain relief in neonates. OBJECTIVES To determine the efficacy, effect of dose, method of administration and safety of sucrose for relieving procedural pain in neonates as assessed by validated composite pain scores, physiological pain indicators (heart rate, respiratory rate, saturation of peripheral oxygen in the blood, transcutaneous oxygen and carbon dioxide (gas exchange measured across the skin - TcpO2, TcpCO2), near infrared spectroscopy (NIRS), electroencephalogram (EEG), or behavioural pain indicators (cry duration, proportion of time crying, proportion of time facial actions (e.g. grimace) are present), or a combination of these and long-term neurodevelopmental outcomes. SEARCH METHODS We used the standard methods of the Cochrane Neonatal. We performed electronic and manual literature searches in February 2016 for published randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, Issue 1, 2016), MEDLINE (1950 to 2016), EMBASE (1980 to 2016), and CINAHL (1982 to 2016). We did not impose language restrictions. SELECTION CRITERIA RCTs in which term or preterm neonates (postnatal age maximum of 28 days after reaching 40 weeks' postmenstrual age), or both, received sucrose for procedural pain. Control interventions included no treatment, water, glucose, breast milk, breastfeeding, local anaesthetic, pacifier, positioning/containing or acupuncture. DATA COLLECTION AND ANALYSIS Our main outcome measures were composite pain scores (including a combination of behavioural, physiological and contextual indicators). Secondary outcomes included separate physiological and behavioural pain indicators. We reported a mean difference (MD) or weighted MD (WMD) with 95% confidence intervals (CI) using the fixed-effect model for continuous outcome measures. For categorical data we used risk ratio (RR) and risk difference. We assessed heterogeneity by the I(2) test. We assessed the risk of bias of included trials using the Cochrane 'Risk of bias' tool, and assessed the quality of the evidence using the GRADE system. MAIN RESULTS Seventy-four studies enrolling 7049 infants were included. Results from only a few studies could be combined in meta-analyses and for most analyses the GRADE assessments indicated low- or moderate-quality evidence. There was high-quality evidence for the beneficial effect of sucrose (24%) with non-nutritive sucking (pacifier dipped in sucrose) or 0.5 mL of sucrose orally in preterm and term infants: Premature Infant Pain Profile (PIPP) 30 s after heel lance WMD -1.70 (95% CI -2.13 to -1.26; I(2) = 0% (no heterogeneity); 3 studies, n = 278); PIPP 60 s after heel lance WMD -2.14 (95% CI -3.34 to -0.94; I(2) = 0% (no heterogeneity; 2 studies, n = 164). There was high-quality evidence for the use of 2 mL 24% sucrose prior to venipuncture: PIPP during venipuncture WMD -2.79 (95% CI -3.76 to -1.83; I(2) = 0% (no heterogeneity; 2 groups in 1 study, n = 213); and intramuscular injections: PIPP during intramuscular injection WMD -1.05 (95% CI -1.98 to -0.12; I(2) = 0% (2 groups in 1 study, n = 232). Evidence from studies that could not be included in RevMan-analyses supported these findings. Reported adverse effects were minor and similar in the sucrose and control groups. Sucrose is not effective in reducing pain from circumcision. The effectiveness of sucrose for reducing pain/stress from other interventions such as arterial puncture, subcutaneous injection, insertion of nasogastric or orogastric tubes, bladder catherization, eye examinations and echocardiography examinations are inconclusive. Most trials indicated some benefit of sucrose use but that the evidence for other painful procedures is of lower quality as it is based on few studies of small sample sizes. The effects of sucrose on long-term neurodevelopmental outcomes are unknown. AUTHORS' CONCLUSIONS Sucrose is effective for reducing procedural pain from single events such as heel lance, venipuncture and intramuscular injection in both preterm and term infants. No serious side effects or harms have been documented with this intervention. We could not identify an optimal dose due to inconsistency in effective sucrose dosage among studies. Further investigation of repeated administration of sucrose in neonates is needed. There is some moderate-quality evidence that sucrose in combination with other non-pharmacological interventions such as non-nutritive sucking is more effective than sucrose alone, but more research of this and sucrose in combination with pharmacological interventions is needed. Sucrose use in extremely preterm, unstable, ventilated (or a combination of these) neonates needs to be addressed. Additional research is needed to determine the minimally effective dose of sucrose during a single painful procedure and the effect of repeated sucrose administration on immediate (pain intensity) and long-term (neurodevelopmental) outcomes.
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Affiliation(s)
- Bonnie Stevens
- The Hospital for Sick ChildrenNursing Research555 University AvenueTorontoONCanadaM5G 1X8
- The Hospital for Sick ChildrenResearch InstituteTorontoONCanada
- University of TorontoLawrence S Bloomberg Faculty of Nursing Faculties of Medicine and DentistryTorontoONCanada
- University of TorontoCentre for the Study of PainTorontoONCanada
| | - Janet Yamada
- Ryerson UniversityDaphne Cockwell School of NursingTorontoONCanada
| | - Arne Ohlsson
- University of TorontoDepartments of Paediatrics, Obstetrics and Gynaecology and Institute of Health Policy, Management and Evaluation600 University AvenueTorontoONCanadaM5G 1X5
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Rosenberg RE, Klejmont L, Gallen M, Fuller J, Dugan C, Budin W, Olsen-Gallagher I. Making Comfort Count: Using Quality Improvement to Promote Pediatric Procedural Pain Management. Hosp Pediatr 2016; 6:359-368. [PMID: 27173738 DOI: 10.1542/hpeds.2015-0240] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND AND OBJECTIVES Pediatric procedural pain management (PPPM) is best practice but was inconsistent in our large multisite general academic medical center. We hypothesized that quality improvement (QI) methods would improve and standardize PPPM in our health system within inpatient pediatric units. We aimed to increase topical anesthetic use from 10% to 40%, improve nursing pediatric pain knowledge, and increase parent satisfaction around procedures for children admitted to a general tertiary academic medical center. METHODS We used QI methods including needs assessment, self-identified champions, small tests of change, leadership accountability, data transparency, and a train-the-peer-trainer approach to implement PPPM. We measured inpatient use of topical anesthetic (goal of 40% of admissions), nursing pain knowledge, and parent satisfaction with child comfort during procedures. We used statistical process control and basic statistics to analyze data in this interrupted time series design. RESULTS Over 18 months, use of topical lidocaine rose from 10% to 36.5% for all inpatient admissions, resulting in a centerline shift. Nursing pain knowledge scores increased 7%. Mean parent satisfaction around procedural comfort increased from 83% to 88%. CONCLUSIONS A child-focused QI initiative around PPPM can succeed in a multisite general academic medical center. Key success factors for this effort included accountability, multidisciplinary core leadership, housewide training in a novel educational evidence-based framework, and use of data and champions to promote nurse and physician engagement. Future work will focus on sustaining and monitoring change.
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Affiliation(s)
- Rebecca E Rosenberg
- Department of Pediatrics, New York University School of Medicine, New York, New York; NYU Langone Medical Center, New York, New York;
| | - Liana Klejmont
- Department of Pharmacy, Westchester Medical Center, Valhalla, New York
| | | | | | | | - Wendy Budin
- NYU Langone Medical Center, New York, New York; New York University School of Nursing, New York, New York
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Cerritelli S, Hirschberg S, Hill R, Balthasar N, Pickering AE. Activation of Brainstem Pro-opiomelanocortin Neurons Produces Opioidergic Analgesia, Bradycardia and Bradypnoea. PLoS One 2016; 11:e0153187. [PMID: 27077912 PMCID: PMC4831707 DOI: 10.1371/journal.pone.0153187] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 03/14/2016] [Indexed: 11/19/2022] Open
Abstract
Opioids are widely used medicinally as analgesics and abused for hedonic effects, actions that are each complicated by substantial risks such as cardiorespiratory depression. These drugs mimic peptides such as β-endorphin, which has a key role in endogenous analgesia. The β-endorphin in the central nervous system originates from pro-opiomelanocortin (POMC) neurons in the arcuate nucleus and nucleus of the solitary tract (NTS). Relatively little is known about the NTSPOMC neurons but their position within the sensory nucleus of the vagus led us to test the hypothesis that they play a role in modulation of cardiorespiratory and nociceptive control. The NTSPOMC neurons were targeted using viral vectors in a POMC-Cre mouse line to express either opto-genetic (channelrhodopsin-2) or chemo-genetic (Pharmacologically Selective Actuator Modules). Opto-genetic activation of the NTSPOMC neurons in the working heart brainstem preparation (n = 21) evoked a reliable, titratable and time-locked respiratory inhibition (120% increase in inter-breath interval) with a bradycardia (125±26 beats per minute) and augmented respiratory sinus arrhythmia (58% increase). Chemo-genetic activation of NTSPOMC neurons in vivo was anti-nociceptive in the tail flick assay (latency increased by 126±65%, p<0.001; n = 8). All effects of NTSPOMC activation were blocked by systemic naloxone (opioid antagonist) but not by SHU9119 (melanocortin receptor antagonist). The NTSPOMC neurons were found to project to key brainstem structures involved in cardiorespiratory control (nucleus ambiguus and ventral respiratory group) and endogenous analgesia (periaqueductal gray and midline raphe). Thus the NTSPOMC neurons may be capable of tuning behaviour by an opioidergic modulation of nociceptive, respiratory and cardiac control.
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Affiliation(s)
- Serena Cerritelli
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences Building, University of Bristol, Bristol, BS8 1TD, United Kingdom
| | - Stefan Hirschberg
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences Building, University of Bristol, Bristol, BS8 1TD, United Kingdom
| | - Rob Hill
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences Building, University of Bristol, Bristol, BS8 1TD, United Kingdom
| | - Nina Balthasar
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences Building, University of Bristol, Bristol, BS8 1TD, United Kingdom
| | - Anthony E. Pickering
- School of Physiology, Pharmacology & Neuroscience, Biomedical Sciences Building, University of Bristol, Bristol, BS8 1TD, United Kingdom
- Department of Anaesthesia, University Hospitals Bristol, Bristol, BS2 8HW, United Kingdom
- * E-mail:
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Oral Sucrose for Pain in Neonates During Echocardiography: A Randomized Controlled Trial. Indian Pediatr 2016; 52:493-7. [PMID: 26121725 DOI: 10.1007/s13312-015-0663-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To test the efficacy of oral sucrose in reducing pain/stress during echocardiography as estimated by Premature Infant Pain Profile score. DESIGN Double-blind, parallel-group, randomized control trial. SETTING Tertiary-care neonatal care unit located in Western India. PARTICIPANTS Neonates with established enteral feeding, not on any respiratory support and with gestational age between 32 and 42 weeks requiring echocardiography. INTERVENTIONS Neonates in intervention group received oral sucrose prior to echocardiography. MAIN OUTCOME MEASURES Assessment was done using Premature Infant Pain Profile score. RESULTS There were 104 examinations; 52 in each group. Baseline characteristics like mean gestational age (37.6 vs. 37.1), birth weight (2.20 vs. 2.08), and feeding status (Breastfeeding- 59.6% vs. 44.2%, paladai feeding- 13.5% vs. 13.5%, and gavage feeding- 26.9% vs. 42.3%) were comparable. The mean (SD) premature infant pain profile score was significantly higher in control group [(7.4 (3.78) vs. 5.2 (1.92), P <0.001]. CONCLUSION Oral sucrose significantly reduces pain, and is safe to administer to neonates.
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Abstract
The prevention of pain in neonates should be the goal of all pediatricians and health care professionals who work with neonates, not only because it is ethical but also because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor, yet painful procedures. Therefore, every health care facility caring for neonates should implement (1) a pain-prevention program that includes strategies for minimizing the number of painful procedures performed and (2) a pain assessment and management plan that includes routine assessment of pain, pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and measures for minimizing pain associated with surgery and other major procedures.
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Despriee ÅW, Langeland E. The effect of sucrose as pain relief/comfort during immunisation of 15-month-old children in health care centres: a randomised controlled trial. J Clin Nurs 2016; 25:372-80. [PMID: 26818364 DOI: 10.1111/jocn.13057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2015] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To investigate the effect of 30% sucrose compared with a placebo (water) as pain relief and comfort during immunisation of 15-month-old children in health care centres. BACKGROUND Children experience different levels of pain and distress during immunisation. Sweet solutions function as pain relief during immunisation for infants up to one year of age. However, there are few studies of older children. DESIGN An experimental design in which the participants (15-month-old infants) were randomly assigned to an intervention group that received a 30% sugar solution or a control group that received a placebo (water). METHODS The study was performed at three health care centres in a large Norwegian municipality. The parents of all 15-month-old infants who were recommended for vaccination (for measles, mumps and rubella) between 5 September 2013 and 31 March 2014 were invited to have their infant participate. Duration of crying was the outcome measure. RESULTS A total of 114 children were included (59 in the intervention group, 55 in the control group). The intervention group infants' crying was shorter (18 seconds mean) compared with the control group infants (33 seconds mean). The difference in crying duration between the groups was both statistically and clinically significant. CONCLUSION This trial revealed that 30% sucrose orally has a calming and pain-relieving effect on 15-month-old infants during immunisation. RELEVANCE TO CLINICAL PRACTICE Public health nurses should use a 30% sucrose solution for pain relief during immunisation of 15-month-old infants.
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Affiliation(s)
| | - Eva Langeland
- Faculty of Health and Social Sciences, Institute of Nursing, Bergen University College, Bergen, Norway
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Ali S, Chambers A, Johnson DW, Newton AS, Vandermeer B, Williamson J, Curtis SJ. Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians. CAN J EMERG MED 2016; 16:352-60. [PMID: 25227643 DOI: 10.2310/8000.2013.131261] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVES To describe pediatric emergency medicine (PEM) physicians' reported pain management practices across Canada and explore factors that facilitate or hinder pain management. METHODS This study was a prospective survey of Canadian pediatric emergency physicians. The Pediatric Emergency Research Canada physician database was used to identify participants, and a modified Dillman's Total Design Survey Method was used for recruitment. RESULTS The survey response rate was 68% (139 of 206). Most physicians were 31 to 50 years old (82%) with PEM training (56%) and had been in practice for less than 10 years (55%). Almost all pain screening in emergency departments (EDs) occurred at triage (97%). Twenty-four percent of physicians noted institutionally mandated pain score documentation. Ibuprofen and acetaminophen were commonly prescribed in the ED for mild to moderate pain (88% and 83%, respectively). Over half of urinary catheterizations (60%) and intravenous (53%) starts were performed without any analgesia. The most common nonpharmacologic interventions used for infants and children were pacifiers and distraction, respectively. Training background and gender of physicians affected the likelihood of using nonpharmacologic interventions. Physicians noted time restraints to be the greatest barrier to optimal pain management (55%) and desired improved access to pain medications (32%), better policies and procedures (30%), and further education (25%). CONCLUSIONS When analgesia was reported as provided, ibuprofen and acetaminophen were most commonly used. Both procedural and presenting pain remained suboptimally managed. There is a substantial evidence practice gap in children's ED pain management, highlighting the need for further knowledge translation strategies and policies to support optimal treatment.
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Randomized placebo-controlled trial of sucrose analgesia on neonatal skin blood flow and pain response during heel lance. Clin J Pain 2015; 31:451-8. [PMID: 24918475 DOI: 10.1097/ajp.0000000000000126] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate the effect of oral sucrose on skin blood flow (SBF; perfusion units; PU) measured by Laser Doppler Imager (LDI) in term newborns and pain response (Neonatal Infant Pain Scale score; NIPS score) during heel lance; (2) determine SBF changes during heel lance; and (3) the relationship between SBF and NIPS. MATERIALS AND METHODS Term infants ≤7 days old (n=56) undergoing routine heel lance were randomized to pretreatment with 2.0 mL oral 24% sucrose (n=29) or sterile water (n=27) in a double-blinded, placebo-controlled trial. SBF was assessed by LDI scans and NIPS scores at 10 minutes before lance, immediately after lancing, and 5 minutes after blood extraction. Mean SBF and median NIPS scores were compared between groups using General Linear Model or Kruskal-Wallis. Regressions examined the relationship between SBF immediately after heel lance and NIPS score. RESULTS Mean SBF and median NIPS scores immediately after heel lance were lower in sucrose-treated infants (167.9±15.5 vs. 205.4±16.0 PU, P=0.09; NIPS 1 [interquartile range 0 to 4] vs. NIPS 3 [interquartile range 0 to 6], P=0.02), although no significant difference in mean SBF. During heel lance NIPS score was predictive of SBF. An increase of 1 in NIPS score was associated with 11 PU increase in SBF (R=0.21; P=0.09) for sucrose, and 16 PU increase for placebo-treated infants (R=0.20; P=0.014). CONCLUSIONS Increased SBF assessed by LDI is a pain response among term neonates after routine heel lance, which was not completely attenuated by oral sucrose administration. Increased SBF is associated with NIPS scores. Sucrose analgesic efficacy evidenced by decreased NIPS scores for the sucrose group. Association of SBF with NIPS scores suggests that LDI is potentially useful for assessing newborn procedural pain.
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Leng HY, Zheng XL, Zhang XH, He HY, Tu GF, Fu Q, Shi SN, Yan L. Combined non-pharmacological interventions for newborn pain relief in two degrees of pain procedures: A randomized clinical trial. Eur J Pain 2015; 20:989-97. [PMID: 26685099 DOI: 10.1002/ejp.824] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND Non-pharmacological interventions are effective neonatal pain reduction strategies. We aimed to study the effects of non-nutritive sucking (NNS) and swaddling on infants' behavioural and physiological parameters during shallow or deep heel stick procedures. METHOD In this prospective, multi-centred, randomized controlled clinical trial, we enrolled 671 newborns. The infants undergoing shallow or deep heel stick procedures were randomized into four groups: oral sucrose (routine care, group S), oral sucrose combined with NNS (group NS), oral sucrose combined with swaddling (group SS) and oral sucrose combined with NNS and swaddling (group NSS). The behavioural responses were evaluated by the Revised Neonatal Facial Coding System and the physiological signals were monitored by electrocardiogram monitors. RESULTS A significant synergistic analgesic effect was observed between the NS and SS groups in both the shallow (F = 5.952, p = 0.015) and deep heel stick (F = 7.452, p = 0.007) procedure. NSS group exhibited the lowest pain score. For the deep heel stick procedure, the NS group had a significantly lower increase in heart rate (HR)% and decrease in SPO2 % than the S group (F = 17.540, p = 0.000, F = 10.472, p = 0.001), while this difference was not observed in the shallow heel stick procedure. No difference was found between the S and SS groups, in terms of different physiological parameters. CONCLUSION Non-nutritive sucking and swaddling had synergistic effects on pain relief when used with oral sucrose. For the deep heel stick procedure, oral sucrose combined with NNS and swaddling provided the best pain relief effect. For the shallow heel stick procedure, addition of NNS and swaddling did not improve the effects.
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Affiliation(s)
- H-Y Leng
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - X-L Zheng
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - X-H Zhang
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - H-Y He
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
| | - G-F Tu
- Department of Nursing, Chengdu Women's & Children's Central Hospital, Chengdu City, China
| | - Q Fu
- Department of Nursing, Shenzhen Children's Hosptial, Shenzhen City, China
| | - S-N Shi
- Department of Nursing, Hunan Children's Hosptial, Changsha City, China
| | - L Yan
- Department of PICU, Children's Hospital of Chongqing Medical University, Chongqing City, China
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Sedation and analgesia practices among Spanish neonatal intensive care units. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.anpede.2015.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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