Non-pharmacological management of infant and young child procedural pain

Riddell, Rebecca Pillai; Bucsea, Oana; Shiff, Ilana; Chow, Cheryl H. T.; Gennis, Hannah; Badovinac, Shaylea; Racine, Nicole; Kohut, Sara Ahola; Lisi, Diana; Turcotte, Kara; Stevens, Bonnie; Uman, Lindsay S.

doi:10.1002/14651858.cd006275.pub4

Cited by 9 publications

(4 citation statements)

References 461 publications

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“…As a first step to overcome the current variations, we suggest that infants treated with LISA should receive non-pharmacologic interventions like swaddling and oral sucrose as these effectively reduce procedural pain. 22,23 In a second step, a standardized pain assessment could help identify infants who require additional pharmacologic analgosedation. This approach is feasible because LISA is typically not considered an emergency procedure.…”

Section: Discussionmentioning

confidence: 99%

Analgosedation for less‐invasive surfactant administration: Variations in practice

Muehlbacher,

Boos,

Geiger

et al. 2023

Pediatric Pulmonology

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BackgroundLess‐invasive surfactant administration (LISA) is widely used for surfactant delivery to spontaneously breathing preterm infants on nasal CPAP. However, the use of analgesia and/or sedation for the LISA procedure remains controversial.MethodsWe conducted a cross‐sectional survey of all tertiary neonatal intensive care units (NICUs) in Austria, Germany, and Switzerland to assess current practices of analgosedation for LISA in preterm infants.ResultsEighty‐eight of 172 (51.2%) NICUs responded to the survey, of which 83 (94.3%) perform LISA. Analgosedation for LISA is used in 60 (72.3%) NICUs. Twenty‐eight of those (46.7%) have unit protocols to guide analgosedation while 32 (53.3%) administer medication at the discretion of the attending physician. Ketamine (45.0% of NICUs), propofol (41.7%), fentanyl (21.7%), morphine (20.0%), and midazolam (20.0%) were most frequently used for analgosedation for LISA. Nine (10.7%) NICUs reported the use of pain or distress scores during LISA.ConclusionLISA is well established among tertiary NICUs in the German‐speaking countries. However, there are considerable variations regarding the use of analgosedation. More evidence is required to guide clinicians seeking to safely and effectively deliver surfactant via a thin catheter to spontaneously breathing preterm infants.

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Section: Discussionmentioning

confidence: 99%

Analgosedation for less‐invasive surfactant administration: Variations in practice

Muehlbacher,

Boos,

Geiger

et al. 2023

Pediatric Pulmonology

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“…Several reviews have demonstrated that parents can be part of the pain management for their infant ( 4 , 13 – 15 ) and that this is safe and effective ( 15 ). Some of the evaluated methods are almost solely performed by the mother (breastfeeding) or parent (SSC), whereas there are a number of methods that can be performed by the parents, other family members or health care professionals (e.g., facilitated tucking, providing non-nutritive sucking or swaddling) ( 16 ). There is moderate to high certainty evidence that skin-to-skin contact, and breastfeeding are effective pain-reducing methods, whereas other interventions should be seen as adjuvant or working best in combination with other ( 6 ).…”

Section: Reviewmentioning

confidence: 99%

Parent-led neonatal pain management—a narrative review and update of research and practices

Ullsten,

Campbell-Yeo,

Eriksson

2024

Front. Pain Res.

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IntroductionResearch related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents' vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills.MethodsIn this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research.ResultsParents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain-reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent's and infant's needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals' attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants' procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change.ConclusionParent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management.

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“…Multiple lines of systematically reviewed and synthesised evidence support the clinical effectiveness of oral sweet solutions, 7 10 breastfeeding, 11 skin-to-skin contact, 12 and non-nutritive sucking, facilitated tucking and swaddling 13 to prevent or treat pain from commonly performed procedures in the NICU. Of these, sucrose is one of the most implemented and studied treatments to mitigate procedural pain, either alone or in combination with other strategies, and there is moderate-certainty evidence on its effectiveness for single heel lances.…”

Section: Introductionmentioning

confidence: 99%

Cumulative sucrose exposure for repeated procedural pain in preterm neonates and neurodevelopment at 18 months of corrected age: a prospective observational longitudinal study

Bueno,

Ballantyne,

Campbell-Yeo

et al. 2024

bmjpo

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IntroductionOral sucrose is repeatedly administered to neonates in the neonatal intensive care unit (NICU) to treat pain from commonly performed procedures; however, there is limited evidence on its long-term cumulative effect on neurodevelopment. We examined the association between total sucrose volumes administered to preterm neonates for pain mitigation in the NICU and their neurodevelopment at 18 months of corrected age (CA).MethodsA prospective longitudinal single-arm observational study that enrolled hospitalised preterm neonates <32 weeks of gestational age at birth and <10 days of life was conducted in four level III NICUs in Canada. Neonates received 0.1 mL of 24% sucrose 2 min prior to all commonly performed painful procedures during their NICU stay. Neurodevelopment was assessed at 18 months of CA using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Multiple neonatal and maternal factors known to affect development were adjusted for in the generalised linear model analysis.Results172 preterm neonates were enrolled and 118 were included in the analysis at 18 months of CA. The total mean sucrose volume administered/neonate/NICU stay was 5.96 (±5.6) mL, and the mean Bayley-III composite scores were: cognitive 91 (±17), language 86 (±18) and motor 88 (±18). There was no association between Bayley-III scores and the total sucrose volume: cognitive (p=0.57), language (p=0.42) and motor (p=0.70).ConclusionCumulative sucrose exposure for repeated procedural pain in preterm neonates was neither associated with a delay in neurodevelopment nor neuroprotective effects at 18 months of CA. If sucrose is used, we suggest the minimally effective dose combined with other non-pharmacological interventions with demonstrated effectiveness such as skin-to-skin contact, non-nutritive sucking, facilitated tucking and swaddling.Trial registration numberNCT02725814.

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Non-pharmacological management of infant and young child procedural pain

Cited by 9 publications

References 461 publications

Analgosedation for less‐invasive surfactant administration: Variations in practice

Analgosedation for less‐invasive surfactant administration: Variations in practice

Parent-led neonatal pain management—a narrative review and update of research and practices

Cumulative sucrose exposure for repeated procedural pain in preterm neonates and neurodevelopment at 18 months of corrected age: a prospective observational longitudinal study

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