Painful procedures can affect post‐natal growth and neurodevelopment in preterm infants

Coviello, Caterina; Martinez, Marina Popple; Drovandi, Livia; Corsini, Iuri; Leonardi, Valentina; Lunardi, Clara; Antonelli, C.; Pratesi, Simone; Dani, Carlo

doi:10.1111/apa.14222

Cited by 29 publications

(28 citation statements)

References 25 publications

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“…The number of painful procedures experienced in the first month of life is associated with lower cognitive development and head circumference at 1 year, although this is unlikely to be direct cause and effect [145]. Whilst the comfort of the baby needs to be considered, there is a tension between appropriate analgesia and the effects of sedation causing harm particularly when there is an emphasis of minimising duration of invasive respiratory support.…”

Section: Pain and Sedationmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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As management of respiratory distress syndrome (RDS) advances, clinicians must continually revise their current practice. We report the fourth update of “European Guidelines for the Management of RDS” by a European panel of experienced neonatologists and an expert perinatal obstetrician based on available literature up to the end of 2018. Optimising outcome for babies with RDS includes prediction of risk of preterm delivery, need for appropriate maternal transfer to a perinatal centre and timely use of antenatal steroids. Delivery room management has become more evidence-based, and protocols for lung protection including initiation of CPAP and titration of oxygen should be implemented immediately after birth. Surfactant replacement therapy is a crucial part of management of RDS, and newer protocols for its use recommend early administration and avoidance of mechanical ventilation. Methods of maintaining babies on non-invasive respiratory support have been further developed and may cause less distress and reduce chronic lung disease. As technology for delivering mechanical ventilation improves, the risk of causing lung injury should decrease, although minimising time spent on mechanical ventilation using caffeine and, if necessary, postnatal steroids are also important considerations. Protocols for optimising general care of infants with RDS are also essential with good temperature control, careful fluid and nutritional management, maintenance of perfusion and judicious use of antibiotics all being important determinants of best outcome.

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Section: Pain and Sedationmentioning

confidence: 99%

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

et al. 2019

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“…Pain management in preterm infants starting immediately after birth and in the first days of life is important, to avoid subsequent responses to painful procedures 26 and because repeated painful stimuli early in life lead to serious sequelae 5,12 . These include abnormal brain development, with lower cognitive scores and altered somatosensory and stress response systems 11,12 . The main finding of our study was that the LISA group required significantly more nonpharmacological pain relief in the first three days of life than the INSURE group, which might reflect an ongoing preterm stress response.…”

Section: Discussionmentioning

confidence: 65%

“…The less invasive surfactant administration (LISA) technique involves administering surfactant while maintaining spontaneous breathing using a thin catheter 10 . Endotracheal intubation in preterm infants is regarded painful and has a negative impact on brain development 11 . Illness severity in the first 24 hours of life together with pain exposure contributes to a slower microstructural brain development (corticospinal tract) up to term‐equivalent age 12 .…”

Section: Introductionmentioning

confidence: 99%

Less invasive surfactant administration is associated with a higher need for nonpharmacological pain‐relieving interventions compared to the intubation‐surfactant extubation technique in preterm infants

Höck

Posod

Waltner-Romen

et al. 2020

Paediatric and Neonatal Pain

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Aim LISA is a promising method in improving preterm outcome. The aim of this study was to assess whether the INSURE (intubation‐surfactant extubation) technique or LISA (less invasive surfactant administration) procedure for surfactant administration is associated with more pain‐relieving interventions after the intervention in preterm infants. Methods Preterm infants born at <32 weeks gestational age admitted to the Neonatal Intensive Care Unit of Innsbruck University hospital between Jan 2012 and June 2017 subjected to INSURE or LISA were included in the study, which was performed as a retrospective analysis of routinely collected data. Pain assessments were made bedside using the Bernese Pain Scale for Neonates. Results During the study period 15 preterm infants (median gestational age 30.7 weeks; range: 25.9‐32.0 weeks) were subjected to INSURE technique and 59 (median gestational age 29.4 weeks; range: 25.1‐31.4 weeks) to LISA. Infants subjected to LISA showed a higher need for nonpharmacological pain‐relieving interventions in the first three days of life. Conclusion LISA procedure compared to INSURE technique was associated with a higher need for pain‐relieving interventions in the first three days of life. Prospective randomized controlled trials are needed to optimize this less invasive method for surfactant application with special focus on pain in neonates.

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“…Fortuitously, lag time problems may be useful in the identification of hypoglycemia in children with CHH where a spike in insulin and subsequent rapid drop in interstitial glucose may be earlier than a slower subsequent decrease in plasma glucose [11]. Current glucose monitoring requires frequent capillary sampling that exposes infants to procedural pain and stress that may contribute to altered neurodevelopment and affect short-term cog nitive scores in preterm infants [3,20]. It has been shown that the insertion of a CGMS device in preterm infants causes less pain than capillary blood sampling [21].…”

Section: All Glucose Measurementsmentioning

confidence: 99%

Experience with Real-Time Continuous Glucose Monitoring in Newborns with Congenital Hyperinsulinemic Hypoglycemia

Anık

Türkmen

Akcan

et al. 2020

Z Geburtshilfe Neonatol

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Background Effective treatment and close monitoring of hypoglycemia in children with congenital hyperinsulinemic hypoglycemia (CHH) is vital to prevent brain damage. The current use of capillary sampling schedules does not provide a comprehensive assessment of glycemic status and fails to detect asymptomatic hypoglycemia episodes. Aim To investigate the efficacy and accuracy of a real-time continuous glucose monitoring system (RT-CGMS) in neonates with CHH. Methods A sensor connected to RT-CGMS was inserted into the newborn patients and maintained for at least 6 days during their stay in the hospital. We compared the readings of CGMS with capillary blood glucose values using Bland-Altman analysis. Results A total of 110 blood glucose values were compared to readings from the CGMS. All results were calculated and plotted for CGMS values at 0–4, 5–9, 10–14, 15–19, 20–24, and 25–29 min after capillary blood glucose sampling. CGMS readings were highly correlated with blood glucose values, especially during normoglycemia. In case of hypoglycemia, the mean difference between the CGMS and capillary glucose values was higher. Although the false positive rate for hypoglycemia was relatively high in CGMS, RT-CGMS may show some episodes of hypoglycemia earlier than blood measurement. Conclusion RT-CGMS is accurate during normoglycemia, and it can reduce the number of capillary blood samples in children with CHH.

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Painful procedures can affect post‐natal growth and neurodevelopment in preterm infants

Abstract: Invasive painful procedures affected regular HC growth and short-term cognitive scores in preterm infants in the first year of life.

Cited by 29 publications

References 25 publications

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

European Consensus Guidelines on the Management of Respiratory Distress Syndrome – 2019 Update

Less invasive surfactant administration is associated with a higher need for nonpharmacological pain‐relieving interventions compared to the intubation‐surfactant extubation technique in preterm infants

Experience with Real-Time Continuous Glucose Monitoring in Newborns with Congenital Hyperinsulinemic Hypoglycemia

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