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Devsam BU, Kinney S. The clinical utility of the pain assessment tool in ventilated, sedated, and muscle-relaxed neonates. Aust Crit Care 2020; 34:333-339. [PMID: 33223388 DOI: 10.1016/j.aucc.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The neonatal Pain Assessment Tool (PAT) is considered a reliable and valid tool for assessing neonatal pain. No research has been conducted on the clinical utility of the PAT when assessing pain in ventilated, sedated, and muscle-relaxed neonates. OBJECTIVE The objective of the study was to determine the clinical utility of the PAT when assessing pain in ventilated, sedated, and muscle-relaxed neonates. METHODS Neonatal nurses from the Royal Children's Hospital completed online surveys to assess the clinical utility of the PAT. Three focus groups were then conducted to further explore the variation of pain scores from the survey and clarify the challenges in interpreting the pain score. RESULTS Nurses perceived the PAT clinically useful in neonates who were ventilated and minimally sedated. However, the PAT was not clinically useful in neonates who were ventilated and heavily sedated or muscle-relaxed. Further exploration via focus groups highlighted two themes related to the 'variation in the timing of the pain score' and the 'integration of critical thinking and judgement' used when assessing pain in neonates. CONCLUSIONS The clinical utility of the PAT is acceptable for minimally sedated neonates; however, it decreases the more sedated a neonate becomes, and the PAT's usefulness is extremely poor in the muscle-relaxed neonate. A better understanding of the timing and interpretation of the pain score in relation to the neonate's clinical status may enable improved decision-making and pain management. The PAT requires further validity, reliability, and clinical utility research, particularly in critically ill and muscle-relaxed neonates.
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Affiliation(s)
- Bianca U Devsam
- Neonatal Intensive Care Unit (Butterfly Ward), The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Nursing Research Department, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Victoria, 3010, Australia.
| | - Sharon Kinney
- Nursing Research Department, The Royal Children's Hospital Melbourne, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Victoria, 3010, Australia
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Koutseff A, Reby D, Martin O, Levrero F, Patural H, Mathevon N. The acoustic space of pain: cries as indicators of distress recovering dynamics in pre-verbal infants. BIOACOUSTICS 2017. [DOI: 10.1080/09524622.2017.1344931] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Alexis Koutseff
- Equipe Neuro-Ethologie Sensorielle, ENES/Neuro-PSI CNRS UMR9197, University of Lyon/Saint-Etienne, Saint-Etienne, France
| | - David Reby
- School of Psychology, University of Sussex, Brighton, UK
| | | | - Florence Levrero
- Equipe Neuro-Ethologie Sensorielle, ENES/Neuro-PSI CNRS UMR9197, University of Lyon/Saint-Etienne, Saint-Etienne, France
| | - Hugues Patural
- SNA-EPIS EA4607, University of Lyon/Saint-Etienne, Saint-Etienne, France
| | - Nicolas Mathevon
- Equipe Neuro-Ethologie Sensorielle, ENES/Neuro-PSI CNRS UMR9197, University of Lyon/Saint-Etienne, Saint-Etienne, France
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Matar EM, Arabiat DH, Foster MJ. Oral glucose efficacy on neonate's pain responses at the NICU: A quasi experimental trial of two clinical procedures. Appl Nurs Res 2016; 32:36-40. [PMID: 27969048 DOI: 10.1016/j.apnr.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/04/2016] [Accepted: 04/05/2016] [Indexed: 11/16/2022]
Abstract
AIM This research was undertaken with the purpose of testing two research hypotheses regarding the efficacy of 10% oral glucose solution on procedural pain associated with venepuncture and nasopharyngeal suctioning within three neonatal intensive care units (NICU). The hypotheses were formulated from previous conclusions reached by other researchers highlighting the efficacy of sucrose solutions on neonates' pain responses during minor painful procedures. METHOD A quasi-experimental trial utilising a time series design with one group was used. Data from a total of 90 neonates included 60 neonates who underwent a venepuncture and 30 neonates who underwent a nasopharyngeal suctioning procedure for clinical purposes. The neonate's pain response for each procedure was scored using the Neonatal Pain Assessment Scale (NPAS) on two separate occasions over three time periods. The pre-procedural score (T0) when the neonate received no sucrose, the inter-procedural score (T1) when the neonate was given 2ml of 10% glucose solution two minutes before the procedure (intervention group) or where oral glucose was withheld (control group) and the post-procedural score (T2) being at the end of the procedure. RESULTS The results showed the mean NPAS scores in response to venepuncture or nasopharyngeal suctioning were significantly lower in the intervention group than the control group. CONCLUSION This showed that oral glucose (10%) had a positive effect on the pain response during venepuncture and nasopharyngeal suctioning procedures.
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Affiliation(s)
| | - Diana H Arabiat
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia; Faculty of Nursing, The University of Jordan, Amman, Jordan.
| | - Mandie J Foster
- School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia
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Abstract
Blood sampling for a newborn screening test is necessary for all neonates in South Korea. During the heel stick, an appropriate intervention should be implemented to reduce neonatal pain. This study was conducted to identify the effectiveness of kangaroo care (KC), skin contact with the mother, on pain relief during the neonatal heel stick. Twenty-six neonates undergoing KC and 30 control neonates at a university hospital participated in this study. Physiological responses of neonates, including heart rate, oxygen saturation, duration of crying and Premature Infant Pain Profile (PIPP) scores were measured and compared before, during and 1 min and 2 min after heel sticks. The heart rate of KC neonates was lower at both 1 and 2 min after sampling than those of the control group. Also, PIPP scores of KC neonates were significantly lower both during and after sampling. The duration of crying for KC neonates was around 10% of the duration of the control group. In conclusion, KC might be an effective intervention in a full-term nursery for neonatal pain management.
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Affiliation(s)
- Young Sun Seo
- Department of Nursing, Eulji University Hospital, Daejeon, 302-799 South Korea
| | - Joohyun Lee
- College of Nursing, Eulji University, Seongnam, 461-713 South Korea
| | - Hye Young Ahn
- College of Nursing, Eulji University, Daejeon, 301-746 South Korea
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Gao H, Xu G, Gao H, Dong R, Fu H, Wang D, Zhang H, Zhang H. Effect of repeated Kangaroo Mother Care on repeated procedural pain in preterm infants: A randomized controlled trial. Int J Nurs Stud 2015; 52:1157-65. [PMID: 25912524 DOI: 10.1016/j.ijnurstu.2015.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/29/2015] [Accepted: 04/03/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Preterm infants' repeated exposure to painful procedures may lead to negative consequences. Thus, non-pharmacological pain management is essential due to medication side effects. Kangaroo Mother Care, which aims at offering human care to neonates, has been established for the treatment of a single painful procedure, but the effectiveness of Kangaroo Mother Care across repeated painful procedures is unknown. OBJECTIVE To test the effectiveness of repeated Kangaroo Mother Care on repeated heel-stick pain in preterm neonates. DESIGN Randomized controlled trial. SETTING Level III Neonatal Intensive Care Unit at a large teaching hospital in northeast China. METHOD Preterm infants (gestational age less than 37 weeks) (n=80) were recruited and randomly assigned using a random table format to either an incubator group (n=40) or Kangaroo Mother Care group (n=40). Pain assessments were carried out during four routine heel stick procedures. For the first heel stick, preterm infants in each group received no intervention (routinely stayed in incubator). During the next three heel sticks, the infants in Kangaroo Mother Care group received heel sticks during Kangaroo Mother Care, while infants in the incubator group received heel sticks in incubator. The procedure of each heel stick included 3 phases: baseline, blood collection and recovery. Crying, grimacing and heart rate in response to pain were evaluated at each phase across four heel sticks by three trained independent observers who were blinded to the purpose of the study. Data were analyzed by analysis of variance (ANOVA), with repeated measures at different evaluation phases of heel stick. RESULTS 75 preterm infants completed the protocol. Between-group comparison revealed that preterm infants' heart rate was significantly lower, and the duration of crying and facial grimacing were both significantly shorter in the Kangaroo Mother Care group (n=38) than the incubator group (n=37) from the blood collection phase to recovery phase during repeated heel sticks. No significant within-group difference was found in heart rate between the baseline phase and recovery phase through repeated heel sticks for Kangaroo Mother Care group. In contrast, the incubator group experienced significant within group differences in heart rate between baseline and recovery through repeated heel sticks. CONCLUSION The effect of repeated Kangaroo Mother Care analgesia remains stable in preterm infants over repeated painful procedures. Given the many invasive procedures that are part of clinical care in preterm infants and most mothers preferred to provide comfort for their infants during painful procedures, Kangaroo Mother Care may be a safe analgesic alternative in preterm infants in whom it is feasible.
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Affiliation(s)
- Haixia Gao
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Guihua Xu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.
| | - Honglian Gao
- Binzhou Medical University Hospital, Binzhou, China
| | - Rongzhi Dong
- Binzhou Medical University Hospital, Binzhou, China
| | - Hongjie Fu
- Binzhou Medical University Hospital, Binzhou, China
| | - Danwen Wang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Heng Zhang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Hua Zhang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
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Abstract
This study aims to undertake the translation and cultural adaptation of the Échelle Douleur Inconfort Nouveau-Né scale into Brazilian Portuguese, following the steps recommended internationally: a) dual translation into Brazilian Portuguese; b) a synthesis of the translations; c) back translation into the original language; d) evaluation by a panel of judges; and e) pre-testing. All internationally recommended steps were performed satisfactorily. The panel of judges made alterations in most parts of the instrument, in order to keep the semantic, idiomatic, conceptual and cultural equivalences between the original and the translated versions. Pre-testing revealed the translated version is easy to understand and to fill out, and rapid to use. The translation and cultural adaption of the EDIN into Brazilian Portuguese were successfully completed.
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Abstract
Pain assessment and measurement are the cornerstones of pain management. Pain assessment connotes a comprehensive multidimensional description. Conversely, pain measurement provides a numeric quantitative description of each factor illustrating pain qualities. Pain scales provide a composite score used to guide practice and research. The type of infant pain instrument chosen is a significant factor in guiding pain management practice. The purpose of this review was to summarize current infant pain measures by introducing a conceptual framework for pain measurement. Although more than 40 infant pain instruments exist, many were devised solely for research purposes; several of the newly developed instruments largely overlap with existing instruments. Integration of pain management into daily practice remains problematic. Understanding how each instrument measures infant pain allows clinicians to make better decisions about what instrument to use with which infant and in what circumstances. In addition, novel new measurement techniques need further testing.
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Kostandy RR, Ludington-Hoe SM, Cong X, Abouelfettoh A, Bronson C, Stankus A, Jarrell JR. Kangaroo Care (skin contact) reduces crying response to pain in preterm neonates: pilot results. Pain Manag Nurs 2008; 9:55-65. [PMID: 18513662 DOI: 10.1016/j.pmn.2007.11.004] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Revised: 11/20/2007] [Accepted: 11/27/2007] [Indexed: 12/17/2022]
Abstract
Crying commonly occurs in response to heel stick and adversely affects the infant's physiologic stability. Minimal crying in response to pain is desired. "Kangaroo Care," skin contact between mother and infant, reduces pain and may reduce crying in response to pain. The purpose of this pilot study was to test Kangaroo Care's effect on the preterm infant's audible and inaudible crying response to heel stick. Inaudible crying has not been previously studied. A prospective randomized cross-over study with 10 preterm infants 2-9 days old (30-32 weeks' postmenstrual age) was conducted. Infants were randomly assigned to two sequences (sequence A: day 1 heel stick in Kangaroo Care [after 30 min of prone skin contact upright between maternal breasts] and day 2 heel stick in incubator [inclined, nested and prone]; or sequence B: opposite of sequence A) was conducted. Videotapes of baseline, heel warming, heel stick, and recovery phases were scored for audible and inaudible crying times. Audible and inaudible crying times for each subject in each phase were summed and analyzed by repeated-measures analysis of variance. Subject characteristics did not differ between those in the two sequences. Crying time differed between the study phases on both days (p <or= .001). When in Kangaroo Care compared with the incubator, crying time was less during the heel stick (p = .001) and recovery (p = .01) phases, regardless of sequence. Because Kangaroo Care reduced crying in response to heel stick in medically stable preterm infants, a definitive study is merited before making recommendations.
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Affiliation(s)
- Raouth R Kostandy
- College of Nursing, University of Akron, Akron, Ohio 44325-3701, USA.
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Abstract
Advances in neonatology now support the survival of the tiniest of infants. The peripherally inserted central catheter (PICC) has now become an integral part of routine practice in neonatal intensive care units around the world. Keen attention to safe maintenance of these devices is essential. A properly applied and maintained PICC dressing is the first line of defense to minimize the risk of complications such as dislodgement, migration, and infection. This article describes a neonatal PICC dressing change and discusses the frequently encountered quandaries surrounding this important procedure, including dressing materials, frequency, site preparation, barrier precautions, and other relevant concerns.
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