Do We Still Hurt Newborn Babies?

Simons, Sinno; Dijk, Monique van; Anand, K.J.S.; Roofthooft, Daniella; Lingen, Richard A. van; Tibboel, Dick

doi:10.1001/archpedi.157.11.1058

Cited by 492 publications

(139 citation statements)

References 62 publications

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“…• Neonatal procedural pain: Includes acute and chronic pain induced and experienced as a result of named procedures (Porter et al 1997;Simons et al 2003;Dodds 2003;Carbajal et al 2008 (Porter et al 1997;Andersen et al 2007;Bellini & Damato 2009). …”

Section: Definition Of Key Conceptsmentioning

confidence: 99%

Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

Khoza

Tjale

2014

curationis

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Background: Neonatal pain management has received increasing attention over the past four decades. Research into the effects of neonatal pain emphasises the professional, ethical and moral obligations of staff to manage pain for positive patient outcomes. However, evaluation studies continuously report evidence of inadequate neonate pain management and a gap between theory and practice.Objective: This study reviewed current practice in neonatal pain management to describe the knowledge, attitudes and practices of nurses and doctors regarding pain management for neonates in two academic hospitals.Method: A non-experimental, prospective quantitative survey, the modified Infant Pain Questionnaire, was used to collect data from 150 nurses and doctors working in the neonatal wards of two academic hospitals in central Gauteng.Results: The response rate was 35.33% (n = 53), most respondents being professional nurses (88.68%; n = 47) working in neonatal intensive care units (80.77%; n = 42); 24 (45.28%) had less than 5 years’ and 29 respondents 6 or more years’ working experience in neonatal care. A review of pain management in the study setting indicated a preference for pharmacological interventions to relieve moderate to severe pain. An association (p < 0.05) was found between pain ratings on 5 procedures and frequency of administration of pharmacological pain management. Two-thirds of respondents (64%) reported that there were no pain management guidelines in the neonatal wards in which they worked.Conclusion: The interventions to manage moderate neonatal pain are in line with international guidelines. However, neonatal pain management may not occur systematically based on prior assessment of neonatal pain, choice of most appropriate intervention and evaluation. This study recommends implementation of a guideline to standardise practice and ensure consistent and adequate pain management in neonates.

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Section: Definition Of Key Conceptsmentioning

confidence: 99%

Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

Khoza

Tjale

2014

curationis

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“…Porter and Anand [6] observed 144 patients and documented 7,672 procedures performed on that cohort. In a Dutch NICU, Simons [7] documented that 151 infants were exposed to 19,674 procedures, a mean of 14 (range 0 -53) procedures per day. In all three studies the investigators report analgesic therapy was rarely applied before invasive procedures.…”

Section: Epidemiology Of Neonatal Painmentioning

confidence: 99%

A systematic review of the effects of repeated painful procedures in infants: Is there a potential to mitigate future pain responsivity?

Hatfield

Meyers

Messing

2013

JNEP

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Background: Multiple lines of evidence suggest repeated painful procedures early in life may permanently disrupt the developing central nervous system. Painful diagnostic, medical, and minor surgical procedures performed in the neonatal intensive care unit such as venipunctures, heel lances, immunizations, and central venous catheter insertion are a significant portion of painful events experienced by infants. The objective of this systematic review is to synthesize findings from published clinical trials evaluating the effect of repeated painful procedures experienced during the plasticity of the developing peripheral and central nervous system and their influence on future pain responsivity. Methodology/Principal Findings:A systematic review of peer-refereed clinical trials was conducted. Clinical trials examining the effect of repeated painful procedures experienced during the plasticity of the developing peripheral and central nervous system and their influence on future pain responsivity were identified from electronic databases PUBMED, MEDLINE and CINAHL. Application of inclusion/exclusion criteria and limitations identified five clinical trials for critical reviewed. Findings suggest that repetitive pain experienced during a critical window of neurodevelopment alters the structure and function of an infant's nervous system, influences subsequent pain responses through childhood and may contribute to the development of chronic pain.Conclusions: Current research asserts that inadequate relief of infant pain and distress during tissue-damaging procedures may permanently decrease an individual's pain tolerance, and increase pain responses later in life.

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“…Infants in the NICU undergo, on average, more than 14 procedures per day. 28 Despite the fact that NICU clinicians rate the majority of these procedures as painful, only one-third of infants receive adequate analgesia for procedures. 28 In the presence of intense, repeated, or sustained painprovoking stimuli-as, for example, in physiotherapy treatment of burns and in splinting limbs with contracturesthe central nervous system may become sensitized, reducing the threshold and increasing the magnitude of subsequent nociceptive responses.…”

Section: The Impact Of Procedural Pain On Health Outcomes and Future mentioning

confidence: 99%

“…28 Despite the fact that NICU clinicians rate the majority of these procedures as painful, only one-third of infants receive adequate analgesia for procedures. 28 In the presence of intense, repeated, or sustained painprovoking stimuli-as, for example, in physiotherapy treatment of burns and in splinting limbs with contracturesthe central nervous system may become sensitized, reducing the threshold and increasing the magnitude of subsequent nociceptive responses. 29 In the event of central sensitization, even non-nociceptive afferent inputs are recruited for nociception, and spontaneous activity of nociceptors can occur.…”

Section: The Impact Of Procedural Pain On Health Outcomes and Future mentioning

confidence: 99%

Procedural Pain Management for Children Receiving Physiotherapy

Baeyer

Tupper²

2010

Physiotherapy Canada

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Purpose: This article provides an overview of literature relevant to the prevention and relief of pain and distress during physiotherapy procedures, with guidance for physiotherapists treating children. Summary of key points: Physiotherapists are generally well trained in assessing and managing pain as a symptom of injury or disease, but there is a need to improve the identification and management of pain produced by physiotherapy procedures such as stretching and splinting. In contrast to physiotherapy, other health care disciplines, such as dentistry, nursing, paediatrics, emergency medicine, and paediatric psychology, produce extensive literature on painful procedures. Procedural pain in children is particularly important because it can lead to later fear and avoidance of necessary medical care. Recommendations: We emphasize the need for physiotherapists to recognize procedural pain and fear in the course of treatment using verbal, nonverbal, and contextual cues. We present many methods that physiotherapists can use to prevent or relieve procedural pain and fear in paediatric patients and provide an example of a simple, integrated plan for prevention and relief of distress induced by painful procedures.Key Words: child, pain, painful procedures, paediatric, physiotherapy von Baeyer CL, Tupper SM. Procedural pain management for children receiving physiotherapy. Physiother Can. 2010;62:327-337 RÉ SUMÉObjectif : Cet article propose un survol de la documentation relative à la pré vention et au soulagement de la douleur et de l'anxié té qui surviennent pendant des interventions de physiothé rapie, et propose des avenues en ce sens aux physiothé rapeutes qui traitent des enfants. Ré sumé des principaux points : Les physiothé rapeutes sont gé né ralement bien formé s pour l'é valuation et la gestion de la douleur en tant que symptô me d'une blessure ou d'une maladie, mais des amé liorations sont né cessaires pour l'identification et la gestion de la douleur qui ré sultent des procé dures de physiothé rapie, comme les é tirements ou les contractions. Contrairement à la physiothé rapie, d'autres disciplines de la santé , notamment la dentisterie, les soins infirmiers, la pé diatrie, la mé decine d'urgence et la psychologie pé diatrique ont inspiré une abondante documentation sur les procé dures douloureuses. Les douleurs procé durales chez les enfants sont particuliè rement importantes, parce qu'elles peuvent les amener à avoir peur des soins mé dicaux né cessaires ou à les é viter. Recommandations : Nous insistons sur la né cessité pour les physiothé rapeutes de savoir reconnaître la douleur procé durale et la peur qui surviennent en cours de traitement à l'aide d'indices verbaux ou non verbaux et contextuels. Nous pré sentons plusieurs mé thodes que les physiothé rapeutes peuvent utiliser pour pré venir ou soulager la douleur procé durale et la peur chez les patients pé diatriques et donnons aussi un exemple de plan inté gré simple pour la pré vention et le soulagement de l'anxié té causé e par les procé dur...

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Do We Still Hurt Newborn Babies?

Cited by 492 publications

References 62 publications

Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

A systematic review of the effects of repeated painful procedures in infants: Is there a potential to mitigate future pain responsivity?

Procedural Pain Management for Children Receiving Physiotherapy

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