Procedural pain in newborns at risk for neurologic impairment

Stevens, Bonnie; McGrath, Patrick J.; Gibbins, Sharyn; Beyene, Joseph; Breau, Lynn M.; Camfield, Carol; Finley, G. Allen; Franck, Linda S.; Howlett, Alexandra; McKeever, Patricia; O’Brien, Karel; Ohlsson, Arne; Yamada, Janet

doi:10.1016/s0304-3959(03)00136-2

Cited by 130 publications

(105 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although it is recognized that procedures differ in pain intensity, in the absence of an empirical basis for assigning weights to every procedure, counting is used as a "marker" of infant acute pain exposure in the NICU. [32][33][34] In our study, the total number of skin-breaking procedures also provided a marker of overall stress exposure from birth to term. Total intravenous morphine exposure was calculated from birth to term as follows.…”

Section: Medical Chart Reviewmentioning

confidence: 90%

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

2004

View full text Add to dashboard Cite

ABSTRACT. Objectives. Stress systems may be altered in the long term in preterm infants for multiple reasons, including early exposure to procedural pain in neonatal intensive care. This question has received little attention beyond hospital discharge. Stress responses (cortisol) to visual novelty in preterm infants who were born at extremely low gestational age (ELGA; <28 weeks), very low gestational age (VLGA; 29 -32 weeks), and term were compared at 8 months of age corrected for prematurity (corrected chronological age [CCA]). In addition, among the preterm infants, we evaluated whether cortisol levels at 8 months were related to neonatal exposure to procedural pain and morphine in the neonatal intensive care unit.Methods. Seventy-six infants, 54 preterm (<32 weeks' GA at birth) and 22 term-born infants who were seen at 8 months CCA composed the study sample, after excluding those with major sensory, motor, or cognitive impairment. Salivary cortisol was measured before (basal) and 20 minutes after introduction of novel toys (post 1) and after developmental assessment (post 2).Results. Salivary cortisol was significantly higher in ELGA infants at 8 months, compared with the VLGA and term groups before and after introduction of visual novelty. Term-born and VLGA infants showed a slight decrease in cortisol when playing with novel toys, whereas the ELGA group showed higher basal and sustained levels of cortisol. After controlling for early illness severity and duration of supplemental oxygen, higher basal cortisol levels in preterm infants at 8 months' CCA were associated with higher number of neonatal skin-breaking procedures. In contrast, cortisol responses to novelty were predicted equally well by neonatal pain or GA at birth. No relationship between morphine dosing and cortisol response was demonstrated in these infants.Conclusions. ELGA preterm infants show a different pattern of cortisol levels before and after positive stimulation of visual novelty than more maturely born, VLGA preterm and term-born infants. Exposure to high numbers of skin-breaking procedures may contribute to "resetting" basal arousal systems in preterm infants. Pediatrics 2004;114:e77-e84. URL: http://www.pediatrics. org/cgi/content/full/114/1/e77; pain, stress, premature infants, novelty, cortisol, morphine.

show abstract

Section: Medical Chart Reviewmentioning

confidence: 90%

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

2004

View full text Add to dashboard Cite

show abstract

“…The prevention of pain is important not only because it is an ethical expectation but also because repeated painful exposures can have deleterious consequences. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] These consequences include altered pain sensitivity 5,[7][8][9] (which may last into adolescence 15 ) and permanent neuroanatomic and behavioral abnormalities, as found in animal studies. 5,14 It seems that altered pain sensitivity can be ameliorated if effective pain relief is provided.…”

Section: Introductionmentioning

confidence: 99%

“…Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest neonates) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU, 18 creating a "double-hit" phenomenon. Although effective pain relief is now usually provided for neonates during and after a major surgical procedure, 21 pain-reducing therapies are often underused for the numerous minor procedures that are a part of routine medical and nursing care for neonates.…”

Section: Introductionmentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

419

View full text Add to dashboard Cite

The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

show abstract

“…18,47,48,50 These procedures may include heel lances, venipuncture, venous or arterial cannulation, tracheal intubation and suction, chest-tube placement, and lumbar puncture. 22 Mechanical ventilation is provided to ϳ35 000 preterm neonates and 20 000 term neonates in the United States each year.…”

Section: Reasons To Consider Treatment Of Pain In Newborn Infantsmentioning

confidence: 99%

Summary Proceedings From the Neonatal Pain-Control Group

et al. 2006

View full text Add to dashboard Cite

Recent advances in neurobiology and clinical medicine have established that the fetus and newborn may experience acute, established, and chronic pain. They respond to such noxious stimuli by a series of complex biochemical, physiologic, and behavioral alterations. Studies have concluded that controlling pain experience is beneficial with respect to short-term and perhaps long-term outcomes. Yet, pain-control measures are adopted infrequently because of unresolved scientific issues and lack of appreciation for the need for control of pain and its long-term sequelae during the critical phases of neurologic maturation in the preterm and term newborn. The neonatal pain-control group, as part of the Newborn Drug Development Initiative (NDDI) Workshop I, addressed these concerns. The specific issues addressed were (1) management of pain associated with invasive procedures, (2) provision of sedation and analgesia during mechanical ventilation, and (3) mitigation of pain and stress responses during and after surgery in the newborn infant. The cross-cutting themes addressed within each category included (1) clinical-trial designs, (2) drug prioritization, (3) ethical constraints, (4) gaps in our knowledge, and (5) future research needs. This article provides a summary of the discussions and deliberations. Full-length articles on procedural pain, sedation and analgesia for ventilated infants, perioperative pain, and study designs for neonatal pain research were published in Clinical Therapeutics (June 2005).www.pediatrics.org/cgi

show abstract

Procedural pain in newborns at risk for neurologic impairment

Cited by 130 publications

References 51 publications

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

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

Prevention and Management of Pain in the Neonate: An Update

Summary Proceedings From the Neonatal Pain-Control Group

Contact Info

Product

Resources

About