Avaliação da dor no recém-nascido prematuro: parâmetros fisiológicos versus comportamentais

Abstract

ResumoIntrodução: A dor no período neonatal é motivo de inúmeros estudos, sendo fundamental para a sua abordagem uma avaliação criteriosa e adequada.Objetivo: Comparar as variáveis fisiológicas com as comportamentais para a avaliação da dor em recém-nascido (RN) prematuro. Métodos: Estudo realizado entre fevereiro de 2003 e maio de 2004, com recém-nascidos de idade gestacional (IG) abaixo de 34 semanas e peso de nascimento menor que 1500 g, submetidos à ventilação mecânica e não sedados. As variáveis fisiológicas estudadas foram as freqüências cardíaca (FC) e respiratória (FR) e a saturação de oxigênio (SatO 2 ); as variáveis comportamentais foram avaliadas por meio da escala de dor do recém-nascido -Neonatal Infant Pain Scale (NIPS). Todas as variáveis foram controladas no terceiro dia de vida do RN, antes, imediatamente após e cinco minutos após o procedimento de aspiração endotraqueal. Resultados: Foram estudados 50 RNs com IG média ao nascimento de 29,98 ± 2,24 semanas e peso médio de nascimento de 1087,20 ± 350,06 g, sendo 28 (56%) RN do sexo feminino e a doença das membranas hialinas foi diagnosticada em todos os RNs estudados. Pelo teste t-Student verificou-se diferença significante na SatO 2 nos momentos estudados, sendo o mesmo não observado em relação a FC e FR. A mediana da NIPS foi maior nos momentos pós aspiração. As variáveis fisiológicas mostraram-se pouco sensíveis à detecção da dor (FC: 40,7%, FR: 24,1%, SatO 2 : 6,6%), e a escala NIPS mostrou-se mais específica para a mesma avaliação (86,6%). Conclusão: As variáveis fisiológicas apresentaram pouca sensibilidade e especificidade para a avaliação da dor no RN prematuro, quando avaliadas isoladamente. Palavras-chave:Recém-nascido; dor; avaliação da dor. AbstractIntroduction: Pain in the neonatal period is the objective of several studies, being important for its approach an adequate evaluation. Objective: To compare the physiological and behavioral variables with the behavior for assessment of pain in premature newborns (NB). Methods: Prospective study carried out from February/2003 to May/2004, including premature infants with gestational age (GA) below 34 weeks and birth weight less than 1.500 g, submitted to mechanical ventilation and not sedation. The physiological variables studied were: heart rate (HR), respiratory rate (RR) and oxygen saturation (SatO 2 ); the behavioral variables were evaluated by NIPS. All the variables have been controlled in the third day of life of NB, immediately after and five minutes after the procedure of endotracheal suction. Results: Fifty premature infants were studied with GA at birth of 29.98 ± 2.24 weeks and birth weight 1087.20 ± 350.06 g and the respiratory distress syndrome was diagnosed in all NB studied. Using t-Student test, it was verified significant difference on SatO 2 at the different moments studied; however, there was no statistical significant difference in relation to HR and RR. The median of NIPS was high on moments following suction. The physiological variables showed: low sensitivity on detec...

The respiratory physiotherapy causes pain in newborns? A systematic review

“…After title and abstract reading, only those that evaluated any kind of relation between respiratory physiotherapy and pain in neonates were selected. From twelve selected articles, nine observed pain unleashed by procedures in neonates, in eight the intervention was suction (10,11,12,19,20,21,32). Thoracic vibrocompression technique was described as potentially painful in another study (13), while techniques as vibration, diaphragmatic stimulation, postural drainage associated to others techniques, passive respiratory exercises associated to neonate positioning, bag-squeezing, forced expiratory low and thoracic physiotherapy do not resulted in pain in six analyzed studies (5, 13, 18,20,22).…”

“…Studied population constitute of premature newborns interned in NICU in seven articles (5, 10, 18,19,20,22,32). Four articles studied term and preterm newborns (11, 12, 21).…”

“…Behavioral scales used were Neonatal infant pain scale (NIPS), neonatal facial coding system (NFCS), premature infant pain pro ile (PIPP). Six articles used some of these scales and physiological parameters, four utilized NIPS scale (19,20,32) and two NFCS (21,22).…”

Clinical management of pain in the newborn: perception of nurses from the neonatal intensive care unit

“…3,16 In this sense, although elapsed few weeks from birth, the newborn has the nerve endings needed to go through the sensory impulses and transmit pain and is therefore able to answer through their physiological or behavioral changes during this driving process until the arrival to the central nervous system and be recognized. And in practice of health professionals, especially those in nursing who spend 24 hours next to the neonate checking the changes in his body, it is important knowledge of driving mechanisms and especially the perception that he feels pain any external stimulus.…”

Evaluation of pain in neonates and children in intensive care

“…17 Among the physiological factors that manifest themselves in situations of pain, we highlight changes in heart and respiratory rate, blood pressure, oxygen saturation and hormonal level, linked to endocrine-metabolic response. 18 Among the behavioral, crying is considered a primary method of communication in newborns The crying was described as parameter in the interviews, but is aware that facial expressions are more specific and easily identified in pediatric pain. Participants attributed significant value to cry when pain assessment preverbal patient.…”