Contact and nutrient caregiving effects on newborn infant pain responses

Abstract

To understand how the 'caregiving context' could affect responses to procedural pain, the authors sought to determine whether (1) the combined effects of sweet taste and holding (caregiving contact) were greater than the effects of either alone, (2) any combined effects were additive or interactive, and (3) the interventions had similar effects on behavioral (crying and facial activity) and physiological (heart rate, vagal tone) responses to the heel-stick procedure in newborn infants in a randomized two-factorial intervention trial. Eighty-five normally developing newborn infants were studied with a mean gestational age of 39.4 weeks on the 2nd or 3rd day of life. Infants were randomized in blocks of eight to receive (1) no holding and water taste (control participants), (2) no holding and sucrose taste (sucrose group), (3) holding and water taste (holding group), or (4) holding and sucrose taste (holding and sucrose group). Crying was reduced significantly by taste and holding, and the interventions combined additively. Facial activity was only significantly reduced by holding. For physiological measures, the interventions interacted with each other and preintervention levels to reduce heart rate and lower vagal tone more during the procedure in infants in whom heart rate and vagal tone were higher before intervention. Consequently, sweet taste and holding interventions combined in complex ways when acting on different behavioral and physiological response systems to modify stressful pain experiences. The results suggest that providing a caregiving context when painful procedures are performed may be a simple and practical method of reducing pain experience in infants, and that no one measure captures these effects.

Neonatal Procedural Pain and Preterm Infant Cortisol Response to Novelty at 8 Months

“…49 Recently it has been suggested that more attention needs to be paid to environmental adaptations to manage pain, complementary to use of pharmacologic agents. 50 Positioning and containment, 51 music, 52 sucking, 53 suckling, 54 and kangaroo care, 55 for example, may facilitate early "coping" with stressful intervention. Effective environmental interventions enhance homeostasis and stability in preterm infants in the NICU and are essential elements of neonatal nursing care.…”

A eficácia da sacarose no alívio de dor em neonatos: revisão sistemática da literatura

“…Sixteen of the 29 articles selected were studies of fullterm neonate patient samples, [17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] eleven studied preterm neonates [33][34][35][36][37][38][39][40][41][42][43] and two included comparisons between preterm and fullterm neonates. 44,45 The volume of sucrose used in the majority of the studies involving fullterm neonates was 2 ml, [17][18][19][20][21][22][23][24][25][27][28][29][30][31][32] with concentrations of 12%, 20,24,30,31 12.5%, 18,32 24%, …”

“…Eleven studies 18,19,21,24,26,30,32,35,36,41,42 assessed facial actions (brow bulge, eye squeeze, nasolabial furrow, open lips, mouth stretch (horizontal and vertical), lip purse, tongue tautening, and chin quiver,) using the Neonatal Facial Coding System (NFCS), which is a one-dimensional instrument validated for evaluation of the response to neonatal pain. Two studies 19,39 evaluated body movements (upper and lower limbs) using a validated one-dimensional instrument, the Infant Body Coding System (IBCS).…”

“…Other supplementary physiological and behavioral indicators were also used to assess reactions to pain, for example vagal tone, 24,31 saliva cortisol, 31,43 skin c o n d u c t a n c e , 4 0 r e s p i r a t o r y f r e q u e n c y , 2 9 , 3 3 , 3 4 crying [18][19][20][21][24][25][26][27][29][30][31][32]34,35,38,40,42 and sleep/wake state. 21,23,40 Modes of sucrose administration…”

“…In a similar manner, Gormally et al 26 identified a reduced duration of crying during a capillary puncture procedure among a group of fullterm neonates given 2.5 ml of sucrose at 24% and being and a group given just sucrose compared with a group given sterile water and held and another given just water. Heart rate was only reduced in the group of neonates given sucrose and held.…”