No abstract

In term infants sucrose given by mouth has been reported to reduce duration of crying after a hcel prick. This study was designed primarily to investigate the cffect of sucrose administered orally immediately before heel lancing on the nociceptive reaction in pretcrm infants as assessed by change in heart rate and duration of crying. A secondary objective was to document changes in cerebral blood volume during acute pain. We used a randomized, masked, placebo-controlled, crossover trial in a neonatal intermediate care unit in a level 3 perinatal center. The patients studied were 16 preterm infants; birth weight, 900-1900 g; gestational wk, 27-34; corrected postmenstrual age at time of investigation, 33-36 wk. Each infant was assessed twice receiving 2 m L of sucrose 50% or 2 mL of distilled water in random order immediately before heel lance. Heart rate, thoracic movcPreterm infants usually endure many heel pricks and other stressful events during their first hospital stay, even if they do not need intensive care. There was a general belief that preterm infants are lcss sensitive to pain than more mature infants; as a result, analgesics and anesthetic agents were rarely used in preterm babies. There has been growing evidence in the last decade that preterm infants are anatomically and physiologically capable of feeling pain. This evidence has led to a change in clinical practice (1-3).Pain involves subjective and emotional associations that are difficult to define in neonates. Nociception (response of the pain-reception neurones), although less often used, would be a better definition as it is a purely physiologic term (4). W e use "pain" in this restricted sense of "nociception."Reaction to pain can be assessed in three ways: 1) watching behavior, including facial expression, body movements, and cry; 2) monitoring physiologic variables, such as heart rate, blood pressure, transcutaneous blood gases; and 3) measuring the release of stress hormones, such as catecholamines and ments, and transcutaneous blood gases were monitored continuously. Crying during the procedure was documented by a videocamera. A change in cerebral blood volume was assessed by near-infrared spectroscopy. We found the heart rate increased by a mean of 35 beatslmin (bpm) after sucrose and 51 bpm aftcr placebo (median difference 16 bpm, interquartile range 1-30 bpm, p = 0.005). Infants cried 67% of time after sucrose and 88% after placebo (median difference lo%, interquartile range 3-33%, 17 = 0.002). Cerebral blood volume decreased in 5 of 14 infants after sucrose and in 6 of 14 infants after placebo (difference not significant). We concluded that sucrose administered orally before a heel lance reduces the pain reaction in preterm infants. Response of cerebral blood volume to pain does not seem to be altered by sucrose. (Pediatr Res 38: 332-335, 1995) cortisol (5-7). For the present study monitoring of physiologic variables was chosen because they can be continuously recorded and easily quantified, and, therefore, are best suited to ...

Delayed clamping of the umbilical cord improves cerebral oxygenation in preterm infants in the first 24 hours.

This new method has the potential for monitoring continuously, noninvasively, and simultaneously cerebral arterial and venous oxygen saturation and oxygen extraction in mechanically ventilated preterm infants.

SUMMARY A major change in toilet‐training was observed in two successive generations. The median onset of toilet‐training was postponed by 13 months between the First Zürich Longitudinal Study (320 children born between 1954 and 1956) and the Second Zurich Longitudinal Study (309 children bom between 1974 and 1984). Bladder control, both day and night, was not affected, but bowel control was delayed by 16 months, due not to a lack of training, but to the abandonment of maternal control. The results strongly confirm earlier findings that the development of bowel and bladder control is a maturational process which cannot be accelerated by early onset and high intensity of potty‐training. The child's initiative proved to be a reliable indicator that the child was developmentally capable of being clean and dry. Girls were consistently earlier than boys. indicating different maturation rates. No significant correlations were noted between the socioeconomic status and start and intensity of toilet‐training, onset of the child's initiative or development of bladder and bowel control. RÉSUMÉ Profondes modifications de l apprentissage de toilettes: interviettnent‐elles sur le connôte rectal et vésical? Durant les vingt annces séparant la première etude longitudinale de Zürich sur P apprentissage de la toilette (sur 320 enfants nés entre 1954 et 1956) et la scconde étude (sur 309 enfants nés entre 1974 et 1984), le médian du début de Tapprentissage de toilette fut retardé de 13 mois. Le contrôle vésical, de jour et de nuit, ne fut pas affecté mais le contrôle rectal fut différé de 16 mois, non par défaut d'apprentissage mais par abandon du contrôle maternel. Ces résultats confirment fortement des données antérieures indiquant que le développemcnt des contrôles rectaux et vésicaux est un processus de maturation qui ne peut être accéléré par un entra'nement précoce au pot. L'initiative de l'enfant s'est révélé un indicateur fidele du fait d'être pret à eCtre propre et sec, Les filles étaient plus précocemcnt continentes que les garçons, indiquant une vitesse différentc de maturation. Aucune corrélation significative n'a été notée entre le statut socto‐éconornique et le début et I'intensité de Tapprentissage de la toilette, le début des initiatives de l'enfant ou le développement du controle rectal et vésical. ZUSAMMENFASSUNG Grundlegende Veränderung bei der Sauberkeitserziehung: Wird dadurch die Darm‐ und Blasenkontrolle beeinfluβt? In den 20 Jahren zwischen der ersten Züricher Langzeitstudie über Sauberkeitserziehung (an 320 Kindern, die von 1954 bis 1956 geboren wurden) und der zweiten Studie (an 309 Kinder der Gcburtsjahre 1974 bis 1984) war der mittlerc Beginn der Sauberkeitserziehung urn 13 Monate postponieii wordcn. Die Blasenkontrolle bei Tag und bei Nacht wurde dadurch nicht beeinflußt, die Darmkontrolle jedoch wurde um 16 Monate verzögert, nicht aus Mangel an Training sondern aufgrund fehlender mütterlicher Kontrolle. Die Ergebnisse bestätigen frühere Befunde, die besagen, daß die Entwicklung der Blasen‐ und Darmk...