Assessment of Pain in the Newborn

Maxwell, Lynne G.; Fraga, María V.; Malavolta, Carrie P.

doi:10.1016/j.clp.2019.08.005

Cited by 99 publications

(70 citation statements)

References 61 publications

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“…6 Among the behavioral changes, the facial response to pain is one of the most important pain expressions, and it is an item evaluated in almost all 40 scales described to assess neonatal pain at bedside. 7 Despite the need for objective and uniform methods, neonatal pain assessment is intrinsically subjective and may be influenced by the examiner's demographic and emotional characteristics. 8 Image technologies such as visual tracking that allow the study of examiners' focus of attention may help to understand the professional decision process involved in detecting and treating neonatal pain.…”

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confidence: 99%

What Facial Features Does the Pediatrician Look to Decide That a Newborn Is Feeling Pain?

et al. 2021

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Objective The study aimed to analyze the gaze fixation of pediatricians during the decision process regarding the presence/absence of pain in pictures of newborn infants. Study Design Experimental study, involving 38 pediatricians (92% females, 34.6 ± 9.0 years, 22 neonatologists) who evaluated 20 pictures (two pictures of each newborn: one at rest and one during a painful procedure), presented in random order for each participant. The Tobii-TX300 equipment tracked eye movements in four areas of interest of each picture (AOI): mouth, eyes, forehead, and nasolabial furrow. Pediatricians evaluated the intensity of pain with a verbal analogue score from 0 to 10 (0 = no pain; 10 = maximum pain). The number of pictures in which pediatricians fixed their gaze, the number of gaze fixations, and the total and average time of gaze fixations were compared among the AOI by analysis of variance (ANOVA). The visual-tracking parameters of the pictures' evaluations were also compared by ANOVA according to the pediatricians' perception of pain presence: moderate/severe (score = 6–10), mild (score = 3–5), and absent (score = 0–2). The association between the total time of gaze fixations in the AOI and pain perception was assessed by logistic regression. Results In the 20 newborn pictures, the mean number of gaze fixations was greater in the mouth, eyes, and forehead than in the nasolabial furrow. Also, the average total time of gaze fixations was greater in the mouth and forehead than in the nasolabial furrow. Controlling for the time of gaze fixation in the AOI, each additional second in the time of gaze fixation in the mouth (odds ratio [OR]: 1.26; 95% confidence interval [CI]: 1.08–1.46) and forehead (OR: 1.16; 95% CI: 1.02–1.33) was associated with an increase in the chance of moderate/severe pain presence in the neonatal facial picture. Conclusion When challenged to say whether pain is present in pictures of newborn infants' faces, pediatricians fix their gaze preferably in the mouth. The longer duration of gaze fixation in the mouth and forehead is associated with an increase perception that moderate/severe pain is present. Key Points

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confidence: 99%

What Facial Features Does the Pediatrician Look to Decide That a Newborn Is Feeling Pain?

et al. 2021

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“…Sound pressures and light exposure should not be considered solely in terms of absolute intensity values but also in terms of numbers of hourly and daily peaks and SNR or light variations. Pioneering studies on the physiological and behavioural responses to different stimuli considered painful in NICUs [ 63 ] have served as a basis for the clinical evaluation scales in this area, leading to increased awareness and better management of neonatal pain [ 64 ].…”

Section: Discussionmentioning

confidence: 99%

Pain Behavioural Response to Acoustic and Light Environmental Changes in Very Preterm Infants

et al. 2021

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Noise and high light illumination in the neonatal intensive care unit (NICU) are recognized as stressors that could alter the well-being and development of vulnerable preterm infants. This prospective observational study evaluated the pain behaviours of very preterm infants (VPIs) to sound peaks (SPs) and light levels variations (LLVs) in the NICU. We measured spontaneously occurring SPs and LLVs in the incubators of 26 VPIs over 10 h. Their behavioural responses were analysed through video recordings using the “Douleur Aigue du Nouveau-né” (DAN) scale. We compared the maximum DAN scores before and after environmental stimuli and the percentage of VPIs with a score ≥ 3 according to the type of stimuli. A total of 591 SPs and 278 LLVs were analysed. SPs of 5 to 15 dBA and LLVs significantly increased the maximum DAN scores compared to baseline. The occurrence of DAN scores ≥ 3 increased with both stressors, with a total of 16% of SPs and 8% of LLVs leading to quantifiable pain behaviour. Altogether, this study shows that VPIs are sensitive to SPs and LLVs, with a slighter higher sensitivity to SPs. The mechanisms leading to pain behaviours induced by noise and light changes should be evaluated further in the context of VPIs brain development. Our results provide further arguments to optimize the NICU sensory environment of neonatal units and to adapt it to the expectations and sensory abilities of VPIs.

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“…The management of pain with opioids and paracetamol should always be considered, even in unventilated patients, because of the high prevalence of painful experiences in this population (RG I). Each unit should choose the tools for pain assessment in different populations (full‐term or preterm), contexts, and types of pain (procedural or postoperative) 26 …”

Section: Methodsmentioning

confidence: 99%

Chylothorax in the neonate—A stepwise approach algorithm

Rocha

Arnet

Soares

et al. 2021

Pediatric Pulmonology

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Background Chylothorax in neonates results from leakage of lymph from thoracic lymphatic ducts and is mainly congenital or posttraumatic. The clinical course of the effusion is heterogeneous, and consensus on treatment, timing, and modalities of measures has not yet been established. This review aims to present, along with levels of evidence and recommendation grades, all current therapeutic possibilities for the treatment of chylothorax in neonates. Methods An extensive search of publications between 1970 and 2020 was performed in the PubMed, Cochrane Database of Systematic Reviews, and UpToDate databases. A stepwise approach algorithm was proposed for both congenital and traumatic conditions to guide the clinician in a rational and systematic way for approaching the treatment of neonates with chylothorax. Discussion and Conclusion The treatment strategy for neonatal chylothorax generally involves supportive care and includes drainage and procedures to reduce chyle flow. A stepwise approach starting with the least invasive method is advocated. Progression in the invasiveness of treatment options is determined by the response to previous treatments. A practical stepwise approach algorithm is proposed for both, congenital and traumatic chylothoraces.

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Assessment of Pain in the Newborn

Cited by 99 publications

References 61 publications

What Facial Features Does the Pediatrician Look to Decide That a Newborn Is Feeling Pain?

What Facial Features Does the Pediatrician Look to Decide That a Newborn Is Feeling Pain?

Pain Behavioural Response to Acoustic and Light Environmental Changes in Very Preterm Infants

Chylothorax in the neonate—A stepwise approach algorithm

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