Behavioral and Physiological Signs for Pain Assessment in Preterm and Term Neonates During a Nociception-Specific Response: A Systematic Review

Relland, Lance M.; Gehred, Alison; Maitre, Nathalie L.

doi:10.1016/j.pediatrneurol.2018.10.001

Cited by 51 publications

(46 citation statements)

References 56 publications

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“…A systematic review that included 15 studies of very good methodological quality evaluated the physiological and behavioral signs that newborns have in response to nociceptive stimuli associated with stress ( 7 ) . This review concluded that the responses are associated with the gestational age and are fundamentally changes in the heart rate and oxygen saturation, facial expressions, such as frowning, squeezing the eyes shut and marking the nasolabial sulcus, crying, among other signs ( 8 ) . The mother experiences a high level of anxiety, stress related to the new role, emotional sensitivity and depressive symptoms ( 9 - 10 ) .…”

Section: Introductionmentioning

confidence: 99%

Effect of infant stimulation on the adaptation to birth: a randomized trial

Gualdrón

Villalobos

2019

Rev. Latino-Am. Enfermagem

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Objective: to measure the effect of an infant stimulation therapy (auditory, tactile, visual and vestibular) on the adaptation to postnatal life of the mother-child dyad. Method: an experimental and blind study composed of 120 dyads of first-time mothers and full-term newborns, who practiced breastfeeding. The follow-up was conducted during the first five weeks of life and the evaluation was carried at two different times. Results: the adaptive capacity was measured in two modes. The physiological adaptive mode (activity and exercise and neonatal nutrition) and the interdependence adaptive mode (appropriate affection and proper development); and statistically significant differences were found in favor of the experimental group. Regression models that show the collaborative relationship between mother and child, and their reciprocity in the process of adaptation were proposed. Conclusion: the early stimulation is a therapy with bidirectional effect, because it has favorable effects on the person who administers it; promotes health and prevents illness in the process of adaptation to birth; especially in contexts of vulnerability. It is recommended its teaching to mothers and its application in the home environment. This study was registered in the Australian New Zealand Clinical Trial Registry (ANZCTR) under protocol number: ACTRN12617000449336.

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Section: Introductionmentioning

confidence: 99%

Effect of infant stimulation on the adaptation to birth: a randomized trial

Gualdrón

Villalobos

2019

Rev. Latino-Am. Enfermagem

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“…Three decades after the development of the first reliable infant behavioral pain measure, 63 a recent integrative review uncovered 29 pain assessment scales for preterm and full‐term infants 64 . Many of these scales have conflicting evidence with regard to their accuracy and have incomplete psychometric testing 9 . Among all the studies in this review, six different pain scales were used (CRIES, 53,60,65 OPS, 44 PAT, 45 FLACC, 48,55,56 PIPP, 55 and EDIN 59 ), with only two of them (CRIES and FLACC) used in more than one study.…”

Section: Discussionmentioning

confidence: 99%

“…Altogether, there were no possible objective recommendations with regard to pain mitigation based on observable pain behaviors. This gap in knowledge is currently being addressed by our group and others, using neurally based measures that will contribute to future recommendations 9 …”

Section: Discussionmentioning

confidence: 99%

“…Painful stimuli in the neonatal period may have long‐term adverse consequences on the maturation of the nociceptive system and on behavioral outcomes, 4,5 resulting from untreated pain's effect on the construction of neurodevelopment systems 6 . Unfortunately, critically ill preverbal patients such as those in the NICU often experience multiple daily skin‐breaking procedures, 7,8 chronically painful conditions, and lengthy post‐operative recovery, without consistent use of reliable pain assessment tools or requests for anesthesiologist expertise 9,10 …”

Section: Introductionmentioning

confidence: 99%

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Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Relland

Neel

Gehred

et al. 2020

Pediatric Anesthesia

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This review examines the quality and quantity of literature regarding methods that measure efficacy in the context of reported safety of regional anesthesia techniques in preterm and term infants <1 year of age. Because the role of anesthesiologists continues to expand outside the operating room, we focused on all relevant settings with assessments that extend beyond 24 hours from the intraoperative period. All study designs were included from a search of MEDLINE, EMBASE, CINAHL, Scopus, and Cochrane databases from 1946 to the end of 2019. A total of 31 studies were included (n = 1038 participants), consisting of five randomized controlled trials and 26 observational studies. Twenty‐three studies examined neuraxial procedures, seven studies examined peripheral procedures, and one study examined both. Efficacy measures included pain assessment tools, analgesic use, and factors pertaining to the recovery of patients. Safety was assessed in multiple systems (neurological, cardiovascular, respiratory, pathological) and with vital signs and/or measures of systemic toxicity. Evidence in this review establishes that neuraxial and peripheral anesthesia treatments may be applied to neonates and infants with a high degree of safety. However, large gaps in the consistency of methods used to assess pain in these studies underline the need for rigorous prospective efficacy studies of these techniques in this population. This systematic review was registered on PROSPERO (CRD42018114466).

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“…For example, group-level measures of brain activity recorded by NIRS and EEG demonstrate correlation [31], and EEG-recorded noxious-evoked brain activity correlates with both reflex withdrawal [40] and facial expression changes [21,74]. However, this is not always the case – some individuals do not have correlated NIRS and EEG responses [31], noxious-evoked brain activity can be observed in the absence of facial expression responses[ [21,40,75]], behavioural and physiological measures are not always harmonious [76,77], and cry presence or amplitude does not correlate with noxious-evoked brain activity [78,79]. Additionally, contextual factors and interventions can disrupt the relationship between ordinarily concordant measures: stress [80] and prior pain [81] disturb the relationship between behavioural measures and noxious-evoked brain activity, sucrose reduces facial expression responses but does not alter noxious-evoked brain activity or reflex withdrawal [82], and gentle touch reduces noxious-evoked brain activity but does not appear to alter reflex withdrawal [83].…”

Section: Methods Of Pain Assessmentmentioning

confidence: 99%

Nociception and the neonatal brain

Gursul

Hartley

Slater

2019

Seminars in Fetal and Neonatal Medicine

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Measuring brain activity in infants provides an objective surrogate approach with which to infer pain perception following noxious events. Here we discuss different approaches which can be used to measure noxious-evoked brain activity, and discuss how these measures can be used to assess the analgesic efficacy of pharmacological and non-pharmacological interventions. We review factors that can modulate noxious-evoked brain activity, which may impact infant pain experience, including gestational age, sex, prior pain, stress, and illness.

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Behavioral and Physiological Signs for Pain Assessment in Preterm and Term Neonates During a Nociception-Specific Response: A Systematic Review

Cited by 51 publications

References 56 publications

Effect of infant stimulation on the adaptation to birth: a randomized trial

Effect of infant stimulation on the adaptation to birth: a randomized trial

Regional anesthesia in neonates and infants outside the immediate perioperative period: A systematic review of studies with efficacy and safety considerations

Nociception and the neonatal brain

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