Taking Up the Challenge of Measuring Prolonged Pain in (Premature) Neonates

Dijk, Monique van; Roofthooft, Daniella; Anand, K.J.S.; Guldemond, Fleur; Graaf, Joke de; Simons, Sinno; Jager, Youette de; Goudoever, Johannes B. van; Tibboel, Dick

doi:10.1097/ajp.0b013e3181a5b52a

Cited by 190 publications

(145 citation statements)

References 42 publications

Supporting

Mentioning

142

Contrasting

Unclassified

Order By: Relevance

“…Studies from NICUs in different countries likewise have shown a similar trend with a range from 6 to 17.3 procedures per patient per day [1,2,3,19,20,21]. Suctioning, venous catheter placement and heel lancing are most frequent across all settings.…”

Section: Discussionmentioning

confidence: 77%

See 1 more Smart Citation

Eight Years Later, Are We Still Hurting Newborn Infants?

Roofthooft

Simons²,

Anand³

et al. 2014

Neonatology

Self Cite

183

142

View full text Add to dashboard Cite

Objective: To study whether new pharmacological and nonpharmacological guidelines lowered numbers of painful procedures in neonates and changed the amount and frequency of analgesic therapy as compared to the results of our previous study in 2001. Design: A prospective observational study. Setting: Level III NICU of the Erasmus MC-Sophia Children's Hospital, Rotterdam. Participants: Neonates admitted at postnatal ages less than 3 days with length of stay at least 72 h. Main Outcome Measures: Number of all potentially painful procedures and analgesic therapy recorded at the bedside during the first 14 days of NICU stay. Results: A total number of 21,076 procedures were performed in the 175 neonates studied during 1,730 patient-days (mean 12.2). The mean number of painful procedures per neonate per day was 11.4 (SD 5.7), significantly lower than the number of 14.3 (SD 4.0) in 2001 (p < 0.001). The use of analgesics was 36.6% compared to 60.3% in 2001. Sixty-three percent of all peripheral arterial line insertions failed versus 37.5% in 2001 and 9.1% venipunctures failed versus 21% in 2001. Conclusions: The mean number of painful procedures per NICU patient per day declined. Nonpharmacological pain- or stress-reducing strategies like NIDCAP and sucrose were fully embedded in our pain management. As further reduction of the number of painful procedures is unlikely, we should apply more nonpharmacological interventions and explore newer pharmacological agents.

show abstract

Section: Discussionmentioning

confidence: 77%

“…Nurses assessed the neonates' pain with the Numeric Rating Scale (NRS; from 1 to 10) and the COMFORTneo Scale at least once during every 8-hour shift [18,19]. The COMFORTneo Scale has been validated, and its cutoff value for pain is a score of 14 and higher combined with an NRS score of 4 and higher.…”

Section: Methodsmentioning

confidence: 99%

Eight Years Later, Are We Still Hurting Newborn Infants?

Roofthooft

Simons²,

Anand³

et al. 2014

Neonatology

Self Cite

183

142

View full text Add to dashboard Cite

show abstract

“…In our hospital, a modified version of the COMFORT-behavior scale, the COMFORTneo scale, was designed and validated to assess prolonged pain in premature neonates [14]. …”

Section: Introductionmentioning

confidence: 99%

Infants Operated on for Necrotizing Enterocolitis: Towards Evidence-Based Pain Guidelines

et al. 2016

Self Cite

View full text Add to dashboard Cite

Background: Necrotizing enterocolitis (NEC) is known as an extremely painful childhood condition. Objectives: The objective of this study was to explore pain management around NEC-related surgery in our neonatal intensive care unit (NICU) from a chart review of prospectively collected data on 60 operated NEC patients admitted between 2008 and 2013 with a median (IQR) gestational age of 28.3 (25.5-31.6) weeks. Methods: Pain medication data and pain scores (i.e. COMFORTneo and Numerical Rating Scale pain and distress scores) from 72 h before until 72 h after surgery were collected. Results: Preoperatively, 95% of the patients received morphine versus 100% postoperatively, with a median dosage of 10.0 (IQR 9.7-14.5) and 16.9 (IQR 10.1-20.0) μg/kg/h, respectively. Postoperatively, 28 patients (46.7%) received additional fentanyl intermittently and 14 (23.3%) received midazolam, which was part of palliative treatment for 6 patients (42.9%). In patients receiving pain medication, median COMFORTneo scores were 10 (IQR 10-11) preoperatively and 11 (10-12) postoperatively. The pain scores were comparable with those of other patients admitted to the NICU in the same time period. Conclusions: Continuous morphine of 10 μg/kg/h preoperatively, with an increase to 15 μg/kg/h postoperatively, seems to constitute a good starting dose for further individualized pain management guided by pain scores.

show abstract

“…As differences in alarms were not expected to occur, an additional scale to measure the obtrusiveness was constructed, the so‐called collection intolerance. Because a validated scale for this purpose did not exist, a modified five‐point Likert‐type scale based on the facial expression section of the COMFORTneo scale was generated 13 (Table 2). A form was used to register these Likert scores (Appendix S1).…”

Section: Methodsmentioning

confidence: 99%

Pilot study demonstrates that salivary oxytocin can be measured unobtrusively in preterm infants

et al. 2016

View full text Add to dashboard Cite

AimThis study assessed the feasibility and obtrusiveness of measuring salivary oxytocin in preterm infants receiving Kangaroo care, because this is a period of maximal bonding or co‐regulation. We also analysed possible influential determinants, including maternal oxytocin.MethodsThe saliva of preterm infants and their mothers was collected prior to, and during, Kangaroo care using cotton swabs and pooled into vials until sufficient volumes were obtained to measure oxytocin levels using a radioimmunoassay. The obtrusiveness of the infants’ collections was measured with a Likert scale.ResultsSaliva was collected unobtrusively prior to, and during, 30 Kangaroo care sessions in 21 preterm infants. This resulted in three vials with sufficient volumes of before‐Kangaroo care saliva and three with during‐Kangaroo care saliva. Oxytocin was detectable in all six vials. The Kangaroo care duration and the intensity of the mother–infant interaction before and during Kangaroo care seemed to be the most important determinants, and these should preferably be standardised in any future trials.ConclusionOxytocin was measured unobtrusively in the pooled saliva of preterm infants both before and during Kangaroo care and could therefore be investigated as a biomarker in future studies.

show abstract

Taking Up the Challenge of Measuring Prolonged Pain in (Premature) Neonates

Cited by 190 publications

References 42 publications

Eight Years Later, Are We Still Hurting Newborn Infants?

Eight Years Later, Are We Still Hurting Newborn Infants?

Infants Operated on for Necrotizing Enterocolitis: Towards Evidence-Based Pain Guidelines

Pilot study demonstrates that salivary oxytocin can be measured unobtrusively in preterm infants

Contact Info

Product

Resources

About