Neonatal Facial Coding System Score Research Articles

Pharmacological interventions for the management of pain and discomfort during lumbar puncture in newborn infants.

Lumbar puncture (LP) is a common invasive procedure, most frequently performed to diagnose infection. Physicians perform LP in newborn infants with the help of an assistant using a strict aseptic technique; it is important to monitor the infant during all the steps of the procedure. Without adequate analgesia, LP can cause considerable pain and discomfort. As newborns have increased sensitivity to pain, it is crucial to adequately manage the procedural pain of LP in this population. To assess the benefits and harms, including pain, discomfort, and success rate, of any pharmacological intervention during lumbar puncture in newborn infants, compared to placebo, no intervention, non-pharmacological interventions, or other pharmacological interventions. We searched CENTRAL, PubMed, Embase, and three trial registries in December 2022. We also screened the reference lists of included studies and related systematic reviews for studies not identified by the database searches. We included randomized controlled trials (RCTs) and quasi-RCTs comparing drugs used for pain management, sedation, or both, during LP. We considered the following drugs suitable for inclusion. • Topical anesthetics (e.g. eutectic mixture of local anesthetics [EMLA], lidocaine) • Opioids (e.g. morphine, fentanyl) • Alpha-2 agonists (e.g. clonidine, dexmedetomidine) • N-Methyl-D-aspartate (NMDA) receptor antagonists (e.g. ketamine) • Other analgesics (e.g. paracetamol) • Sedatives (e.g. benzodiazepines such as midazolam) DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We used the fixed-effect model with risk ratio (RR) for dichotomous data and mean difference (MD) or standardized mean difference (SMD) for continuous data, with their 95% confidence intervals (CIs). Our main outcomes were successful LP on first attempt, total number of LP attempts, episodes of bradycardia, pain assessed with validated scales, episodes of desaturation, number of episodes of apnea, and number of infants with one or more episodes of apnea. We used the GRADE approach to evaluate the certainty of the evidence. We included three studies (two RCTs and one quasi-RCT) that enrolled 206 newborns. One study included only term infants. All studies assessed topical treatment versus placebo or no intervention. The topical anesthetics were lidocaine 4%, lidocaine 1%, and EMLA. We identified no completed studies on opioids, non-steroidal anti-inflammatory drugs, alpha-2 agonists, NMDA receptor antagonists, other analgesics, sedatives, or head-to-head comparisons (drug A versus drug B). Based on very low-certainty evidence from one quasi-RCT of 100 LPs in 76 infants, we are unsure if topical anesthetics (lidocaine), compared to no anesthesia, has an effect on the following outcomes. • Successful LP on first attempt (first-attempts success in 48% of LPs in the lidocaine group and 42% of LPs in the control group) • Number of attempts per LP (mean 1.9 attempts, [standard error of the mean 0.2] in the lidocaine group, and mean 2.1 attempts [standard error of the mean 2.1] in the control group) • Episodes of bradycardia (0% of LPs in the lidocaine group and 4% of LPs in the control group) • Episodes of desaturation (0% of LPs in the lidocaine group and 8% of LPs in the control group) • Occurrence of apnea (RR 3.24, 95% CI 0.14 to 77.79; risk difference [RD] 0.02, 95% CI -0.03 to 0.08). Topical anesthetics compared to placebo may reduce pain assessed with the Neonatal Facial Coding System (NFCS) score (SMD -1.00 standard deviation (SD), 95% CI -1.47 to -0.53; I² = 98%; 2 RCTs, 112 infants; low-certainty evidence). No studies in this comparison reported total number of episodes of apnea. We identified three ongoing studies, which will assess the effects of EMLA, lidocaine, and fentanyl. Three studies are awaiting classification. The evidence is very uncertain about the effect of topical anesthetics (lidocaine) compared to no anesthesia on successful lumbar puncture on first attempt, the number of attempts per lumbar puncture, episodes of bradycardia, episodes of desaturation, and occurrence of apnea. Compared to placebo, topical anesthetics (lidocaine or EMLA) may reduce pain assessed with the NFCS score. One ongoing study will assess the effects of systemic treatment.

Development of locally relevant clinical guidelines for procedure-related neonatal analgesic practice in Kenya: a systematic review and meta-analysis

SummaryBackgroundIncreasing numbers of neonates are undergoing painful procedures in low-income and middle-income countries, with adequate analgesia seldom used. In collaboration with a multi-disciplinary team in Kenya, we aimed to establish the first evidence-based guidelines for the management of routine procedure-related neonatal pain that consider low-resource hospital settings.MethodsWe did a systematic review by searching MEDLINE, Embase, CINAHL, and CENTRAL databases for studies published from Jan 1, 1953, to March 31, 2019. We included data from randomised controlled trials using heart rate, oxygen saturation (SpO2), premature infant pain profile (PIPP) score, neonatal infant pain scale (NIPS) score, neonatal facial coding system score, and douleur aiguë du nouveau-né scale score as pain outcome measures. We excluded studies in which neonates were undergoing circumcision or were intubated, studies from which data were unextractable, or when pain was scored by non-trained individuals. We did a narrative synthesis of all studies, and meta-analysis when data were available from multiple studies comparing the same analgesics and controls and using the same outcome measures. 17 Kenyan health-care professionals formed our clinical guideline development panel, and we used the Grading of Recommendations, Assessment, Development and Evaluation framework and the panel's knowledge of the local health-care context to guide the guideline development process. This study is registered with PROSPERO, CRD42019126620.FindingsOf 2782 studies assessed for eligibility, data from 149 (5%) were analysed, with 80 (3%) of these further contributing to our meta-analysis. We found a high level of certainty for the superiority of breastfeeding over placebo or no intervention (standardised mean differences [SMDs] were −1·40 [95% CI −1·96 to −0·84] in PIPP score and −2·20 [–2·91 to −1·48] in NIPS score), and the superiority of oral sugar solutions over placebo or no intervention (SMDs were −0·38 [–0·61 to −0·16] in heart rate and 0·23 [0·04 to 0·42] in SpO2). We found a moderate level of certainty for the superiority for expressed breastmilk over placebo or no intervention (SMDs were −0·46 [95% CI −0·87 to −0·05] in heart rate and 0·48 [0·20 to 0·75] in SpO2). Therefore, the panel recommended that breastfeeding should be given as first-line analgesic treatment, initiated at least 2 min pre-procedure. Given contextual factors, for neonates who are unable to breastfeed, 1–2 mL of expressed breastmilk should be given as first-line analgesic, or 1–2 mL of oral sugar (≥10% concentration) as second-line analgesic. The panel also recommended parental presence during procedures with adjunctive provision of skin-to-skin care, or non-nutritive sucking when possible.InterpretationWe have generated Kenya's first neonatal analgesic guidelines for routine procedures, which have been adopted by the Kenyan Ministry of Health, and have shown a framework for clinical guideline development that is applicable to other low-income and middle-income health-care settings.FundingWellcome Trust Research Programme, and the Africa-Oxford Initiative.

Prenatal opioid exposure heightens sympathetic arousal and facial expressions of pain/distress in term neonates at 24–48 hours post birth

Purpose: The rising issue of opioid use during pregnancy poses an increased risk of fetal exposure to opioids in-utero and the development of neonatal abstinence syndrome (NAS). The cessation of exposure to opioids upon birth causes elevated levels of norepinephrine in the circulation enhancing sympathetic arousal. Skin conductance (SC) detects sympathetic-mediated sweating while the Neonatal Facial Coding System (NFCS) depicts facial expressions of stress and pain. We hypothesize that there will be a direct correlation between SC and NFCS scores, such that neonates with prenatal opioid exposure will have higher SC and facial responses to pain/stress as compared with healthy neonates without prenatal opioid exposure.Objective: This study evaluates the utility of SC and the NFCS in the objective assessment of early postnatal pain response in opioid-exposed and non-opioid exposed neonates.Methods: This prospective, single-center, pilot study enrolled opioid-exposed term neonates (>37 weeks) and healthy controls. Subjects were observed within 24–48 hours post-birth (and prior to opioid withdrawal) for pain at baseline, during, and post-heel lance/squeeze (HLS) with simultaneously measured SC and videotaped facial expressions. SC data included electro-dermal responses over time (EDR/second) and the average amplitude of responses (mean of peaks [MP]). Video data were scored using the NFCS by two trained coders with inter-rater agreement >85%.Results: SC and NFCS scores were significantly associated with both groups. The opioid-exposed neonates had significantly higher skin conductance indices, EDR/sec for the HLS phase, and MP for HLS and post phases as compared with controls (p < .05). Opioid-exposed neonates demonstrated higher NFCS at baseline (p = .003).Conclusions: Prenatal opioid exposure was associated with heightened sympathetic arousal during both pain and recovery phases and higher facial expressions of pain/distress at baseline only. A multimodal system of assessment may be useful in understanding the complexity and severity of opioid withdrawal associated with NAS.

A systematic review of YouTube videos on pain management during newborn blood tests

This study aims to: (1) conduct a systematic review of YouTube videos showing newborn infants undergoing blood tests and (2) ascertain the use of recommended pain treatment strategies and infant pain during the filmed blood test. The pain was assessed using: (1) Neonatal Facial Coding System (NFCS) scores before, during and following the procedure; (2) Cry duration before and during the procedure. A total of 55 videos showing 63 procedures were included. Over half the babies cried and most babies scored the highest NFCS score of 4 at time of the poke as well as 15 s after the poke. YouTube videos of newborn infants undergoing blood sampling showed that recommended effective pain management interventions were rarely used and most infants were distressed during and following the procedure.

A Randomized Trial to Evaluate the Effect of Two Topical Anesthetics on Pain Response During Frenotomy in Young Infants.

To examine the comparative effectiveness of two topical anesthetics in controlling the pain associated with tongue-tie release (frenotomy) in young infants. Randomized trial. A Pediatric Craniofacial Clinic. Forty-two infants who were referred for frenotomy were randomly allocated to receive the topical anesthetic gel 2% tetracaine or 20% benzocaine applied prior to frenotomy. Frenotomies were videotaped. The primary outcome measure was the Neonatal Facial Coding System (NFCS) score. Secondary outcome measures included cry duration and a visual analog scale (VAS) assessed by the parents. The two groups were comparable with regard to weight, age, gender, previous painful experience, and last feeding time. Median NFCS scores prior to frenotomy in the tetracaine and the benzocaine groups were 4.5 (IQR: 0.75–10.2) and 3.5 (IQR: 0–9.5), respectively (P = 0.89, 95% CI −3 to 4). During frenotomy, median NFCS score increased to 28 (IQR: 24.5–30.25) in the tetracaine group (P < 0.0001, median difference −22, 95% CI −24.5 to −19), and to 28 (IQR: 26–30) in the benzocaine group (P < 0.0001, median difference −23, 95% CI −27 to −17). Mean cry durations in the tetracaine and the benzocaine groups were 69.4 seconds and 63.9 seconds, respectively (P = 0.32, 95% CI −47 to 15), and mean VAS scores were 57.2 and 58.2, respectively (P = 0.89, 95% CI −15.2 to 13.4). These topical anesthetics seem ineffective in controlling the pain associated with frenotomy. Clinicians should continue to search for an effective treatment for this procedure.

Skin conductance and behavioral pain scales in newborn infants.

The purpose of the present study was to compare measurements of skin conductance activity for pain with behavioral pain assessment scales. Skin conductance activity, measured by the number of waves per second (NWps) and area under the curve (AUC), was recorded in 41 healthy term newborn infants and compared with scores on the Neonatal Facial Coding System (NFCS), Neonatal Infant Pain Scale (NIPS), and COMFORT behavior scale before, during, and after a heel prick. The NWps and AUC (p .001 and .03, respectively) and NFCS, NIPS, and COMFORT scale scores (all p .001) significantly increased during the heel prick. All of the measures were sensitive to the painful event, but no correlations were found between skin conductance activity and scores on these behavioral pain assessment scales. We conclude that skin conductance activity may be a useful and valid measure for acute pain diagnosis. Skin conductance activity can be recorded more quickly than the behavioral scales can be applied and may be helpful in emergency situations or neonates who do not cry, have no facial expressions, or do not present consistent motor activity.

PS-195 Sucrose Versus Breastfeeding For Venipuncture In Term Infants. A Randomised, Prospective, Controlled Study With Analysis Of The Specific Cortical Response

Background and aims Sucrose and breast milk during painful procedures are reported to decrease pain behavioural expression in neonates. Recent data showed a persistent cortical pain response while using the sucrose during a painful procedure. To compare the efficacy of sucrose versus breast milk for specific-pain brain activity relief during a painful procedure in neonates. Methods Randomised, prospective, controlled study. Each term newborn was randomly assigned to sucrose or breastfeeding group at day 3 during a systematic venipuncture. Change in the total haemoglobin concentration in the controlateral somatosensory cortex (Near Infra-red Spectroscoy, NIRS) was assessed 10 seconds before and after the venipuncture. Neonatal Facial Coding System (NFCS) was assessed 2 min before and at the time of the venipuncture. Groups were compared using Wilcoxon test for the variations in NIRS and Chi-square test for the NFCS scores. Results 113 newborns were included (sucrose: 56, breastfeeding: 57) with a mean (sd) of 39.3 weeks (0.9) for gestational age and 3370 g (478) for birth weight. 103 were analysed for the NIRS (sucrose: 55, breastfeeding: 48). Median (quartiles) of total haemoglobin concentration change was -8.5 µmol/L (-34.5; 12.5) for sucrose group and 12.3 µmol/L (-23.4; 39.3) for breastfeeding group with no statistical difference (p = 0.06). NFCS scores were significantly different with 46.8% with a painful score in the breastfeeding versus 26.8% in the sucrose (p = 0.03). Conclusions No difference were found between sucrose and breastfeeding on specific-pain brain activity during a venipuncture in term newborns. A discordance was revealed between NFCS scores and NIRS analysis.

Pain reactivity in preterm neonates: examining the sex differences.

Early and repeated experiences of pain may have long-term effects on vulnerable newborns hospitalized in the Neonatal Intensive Care Unit (NICU), and neonatal pain responses may be affected by a variety of factors that neonates encounter. We tested the hypothesis that male preterm neonates exhibited greater pain sensitivity than females by assessing biobehavioural pain reactivity and recovery patterns to painful procedure. Fifty-three infants born preterm and low birthweight who were admitted to NICU were observed during five phases (baseline, antisepsis, puncture, recovery-dressing and recovery-resting). Behavioural pain reactivity was measured using the Neonatal Facial Coding System (NFCS) and the Sleep-Wake States Scale (SWS). The heart rate (HR) was continuously recorded. All measures were assessed based on scores and magnitude of responses. We found that male and female preterm neonates had similar patterns of behavioural pain reactivity and recovery; there were no statistical differences between groups in NFCS and SWS scores. However, male preterm infants presented higher HR immediately in the first minute of the puncture phase and also higher change in maximum HR between the baseline and puncture phases, than female preterm infants. Although we found that male infants showed higher physiological reactivity to painful stimulus in some HR parameters than female infants, the evidences were not sufficient to confirm the influence of sex on biobehavioural response to pain in vulnerable neonates.

Heel-Lancing in Newborns: Behavioral and Spectral Analysis Assessment of Pain Control Methods

Pain experience can alter clinical outcome, brain development, and subsequent behavior in newborns, primarily in preterm infants. The aims of this study were (1) to evaluate several simple, commonly used methods for pain control in newborns and (2) to evaluate the concordance between behavioral and autonomic cardiac reactivity to pain in term neonates during heel-lancing. A prospective study was conducted of 180 term newborn infants who were undergoing heel-lancing for routine neonatal screening of phenylketonuria and hypothyroidism. Newborns were assigned to 6 groups: (1) control (no pain relief intervention); (2) nonnutritive sucking; (3) holding by mother; (4) oral glucose solution; (5) oral formula feeding; or (6) breastfeeding. Outcome measures included the Neonatal Facial Coding System score; cry duration; and autonomic variables obtained from spectral analysis of heart rate variability before, during, and after heel-lancing. Infants with no pain control showed the highest pain manifestation compared with newborns to whom pain control was provided. Infants who breastfed or received an oral formula showed the lowest increase in heart rate (21 and 23 beats per minute, respectively, vs 36; P < .01), lowest neonatal facial score (2.3 and 2.9, respectively, vs 7.1; P < .001), lowest cry duration (5 and 13 seconds, respectively, vs 49; P < .001), and lowest decrease in parasympathetic tone (-2 and -2.4, respectively, vs 1.2; P < .02) compared with the other groups. Any method of pain control is better than none. Feeding and breastfeeding during heel-lancing were found to be the most effective methods of pain relief.

Pain and distress reactivity and recovery as early predictors of temperament in toddlers born preterm

Background Pain reactivity may reflect underlying mechanisms of constitutional aspects of temperament. Aim To examine whether the neonatal biobehavioral reactivity and recovery responses from pain and distress, as well as the gestational age, the illness severity and the amount of painful procedures undergone the Neonatal Intensive Care Unit (NICU) stay, predict temperament later in toddlerhood, in vulnerable children born preterm. Study design Prospective-longitudinal study. Subjects Twenty-six preterm and very low birth weight infants followed from birth to toddlerhood. Outcome measures Illness severity was assessed with the Clinical Risk Index for Babies (CRIB) score. The medical charts were reviewed prospectively for obtaining the amount of pain exposure in NICU. For assessing the behavioral and cardiac reactivity and recovery from pain and distress, the neonates were evaluated during routine blood collection in the NICU in the first 10 days of life. Pain and distress reactivity and recovery was measured using the Neonatal Facial Coding System score, the duration of crying, and the magnitude of average heart rate. At toddlerhood, mothers answered the Early Childhood Behavior Questionnaire. Results Higher biobehavioral reactivity to pain and distress predicted higher temperamental Negative Affect, above and beyond gestational age, illness severity and amount of pain exposure in NICU. However, we did not find a predictive relation between gestational age, CRIB score and number of painful procedures undergone NICU and toddler's temperament. Conclusions The findings highlight the relevance of the neonatal individual characteristics of reactivity for identifying more vulnerable infants for future problems in biobehavioral regulation.

Pain reactivity and recovery in preterm neonates: latency, magnitude, and duration of behavioral responses

BackgroundStudies on acute-procedural pain in neonates have been based more on single behavioral scores than on response patterns. AimTo assess the individual reactivity and recovery pattern to the painful procedure of blood collection. Study designA cross-sectional, within-group comparison trial. SubjectsForty-eight preterm and very low birth weight neonates hospitalized in a Neonatal Intensive Care Unit. Outcome measuresThe assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was recorded by video, and sleep–wake state was recorded at the bedside. The facial activity of the neonates was analyzed according to Neonatal Facial Coding System (NFCS). The pain reactivity pattern was analyzed using the measures of latency, magnitude, and duration of behavioral responses and by comparison between the different phases. ResultsIn the Antisepsis phase, the neonates showed higher NFCS score and behavioral arousal than at Baseline. In the Puncture phase, the neonates showed higher NFCS score and behavioral activation than in Baseline and in Antisepsis. In Recovery-Dressing, 31% of neonates continued to show more behavioral activation than at Baseline. ConclusionTo better assess and manage pain in preterm neonates, it is relevant to analyze the individual patterns of changes, focusing on the reactivity and also the recovery, during painful stimuli.

Pain and tactile stimuli during arterial puncture in preterm neonates

The purpose of this study was to assess the behavioral and physiological reactivity of preterm neonates during different phases of a blood collection procedure involving arterial puncture. The sample consisted of 43 preterm and very low birth weight neonates with a postnatal age of 1 to 21 days who were hospitalized in the Neonatal Intensive Care Unit. The neonates were evaluated during the whole blood collection procedure. The assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was videotaped and analyzed using the Neonatal Facial Coding System (NFCS). The sleep-wake state and heart rate were registered at the bedside. There was a significant increase in NFCS score and heart rate, and more active behavior during phases A, P, and RD relative to BL. Regarding the tactile stimulation of the infant in pre-puncture (A) and post-puncture (RD), it was observed increased NFCS score, heart rate, and active behavior in comparison to the BL and RR phases. There was evidence of distress responses immediately before and after a painful event, quite apart from the pain reaction to the puncture procedure.

Neonatal Facial Coding System Scores and Spectral Characteristics of Infant Crying During Newborn Circumcision

To determine the relations between Neonatal Facial Coding System (NFCS) scores and measures of infant crying during newborn circumcision. Video and audio recordings were made of infant facial activity and cry sounds, respectively, during the lysis phase of circumcisions of 44 healthy term males (<3 d of age). All infants received topical analgesia before circumcision. NFCS scores were determined by blinded assistant from video recordings of facial activity. Measures of infant crying were determined via spectrum analysis of audio recordings by a blinded, independent researcher. Pearson product-moment correlations were used to examine relationship between NFCS scores and measures of crying. Principal component factor analysis detected dimensions underlying related measures of crying. Factor scores from a factor analysis were used in stepwise linear regression to predict NFCS scores. Higher NFCS scores correlated with lower peak fundamental frequency of crying (P<0.01) and with higher amplitudes of crying at peak fundamental frequency and dominant frequency and in overall cry sample (P<0.01). The factor analysis showed 3 significant orthogonal dimensions underlying measures of crying: Power and Velocity (amplitude and rapidity), Pitch of Crying (frequency characteristics), and Infant Arousal (turbulence and intensity) accounting for 42.3%, 17.8%, and 14.6% of variance, respectively. A regression analysis showed all 3 factor scores accounted for significant and separate portions of variance (P<0.001). The best predictor of NFCS score was Power and Velocity (P<0.002), followed by Infant Arousal (P<0.002), and Pitch of Crying (P<0.007). These data provide some of the first known evidence linking specific measures of infant crying with an independent, validated measure of pain.

Factors associated with infant pain response following an immunization injection

Objectives Specific potential determinants of infant pain response were assessed in the context of a 4- or 6-month immunization injection. The distal influences of gender, gestational and current age, temperament, and early nociceptive stimuli were considered, as well as the proximal influences of parental and nurse coping-promoting statements within the treatment room. Study design An observational study design was used. Pain responses in 93 infants receiving an immunization injection were videoed and coded using the Neonatal Facial Coding System (NFCS) and duration of crying was recorded. Parent and nurse vocalizations were coded using the Child–Adult Medical Procedure Interaction Scale-Revised. Results A multiple regression analysis evaluated the influence of the 5 distal and 2 proximal factors on NFCS scores, and found parental coping-promoting statements in the 30 s period before the injection to have the strongest effect on facial pain response ( p < 0.01). Parents made significantly more coping-promoting statements ( p < 0.05), and generally talked more ( p < 0.05), to female infants than male infants. Conclusions The findings suggest that parental behavior in the treatment room has a key role in influencing how infants respond to painful procedures.

Effect of foremilk and hindmilk on simple procedural pain in newborns

Infants are exposed to painful stimuli during routine medical care in the first few days of life. The aim of the present study was to compare the effect of foremilk; hindmilk, which has been known to have more fat content than foremilk; and sterile water in reducing pain in newborns undergoing minor painful procedures. Sixty-two healthy term infants requiring a heel prick blood sample for screening tests were randomly allocated to receive 2 mL of foremilk, hindmilk or sterile water. Median crying time, duration of the first cry, percent change in heart rate, maximum heart rate and neonatal facial coding system scores were recorded to assess the infants' response to pain. Statistically significant differences between the three groups were not found in terms of crying time, duration of the first cry, percent change in heart rate or maximum heart rate (P = 0.19, P = 0.08, P = 0.22 and P = 0.91, respectively). When the mean pain scores of the groups were compared at 0, 1, 2 and 3 min, there was no statistically significant difference between the three groups (P = 0.58, P = 0.55, P = 0.58 and P = 0.84 for 0, 1, 2 and 3 min, respectively). Although hindmilk has a minor superiority in terms of crying time, duration of the first cry and percent change in heart rate, it does not reach statistical significance. It is concluded that neither foremilk nor hindmilk is superior in relieving pain when compared to placebo.

Venepuncture is preferable to heel lance for blood sampling in term neonates

Background: The analgesic effect of oral sucrose in newborn infants undergoing painful procedures is generally accepted. For blood sampling, some studies have shown that venepuncture (VP) is less painful than...

Effet analgésique de la crème Emla ®, du saccharose et de leur association pour les injections sous-cutanées chez le nouveau-né prématuré : étude prospective de 265 injections

Objective. – To compare the analgesic effects of non nutritive pacifier sucking, oral administration of a 30% saccharose solution, local application of Emla ® and their association for subcutaneous injection of erythropoietin (EPO) in preterm infants. Methods. – Our study was a randomised, prospective study conducted over 5 months. Neonates with a gestational age below 33 weeks of gestation and older than 8 days of life were included if they were treated with EPO (three subcutaneous injections per week during 6 weeks). For each consecutive EPO injection, patients were randomised between four groups of intervention: non nutritive pacifier sucking (T), oral administration of 0.2–0.5 ml of a 30% saccharose solution with non nutritive pacifier sucking (S), local application of Emla ® with non nutritive pacifier sucking (E), and oral administration of 0.2–0.5 ml of a 30% saccharose solution with local application of Emla ® and with non nutritive pacifier sucking (S + E). Each child was its own control. Pain was assessed with the Newborn Acute Pain scale (DAN) and with the Neonatal Facial Coding System (NFCS). Results. – Thirty-three neonates were included, representing 265 injections. Distribution was: 41 in group T, 71 in group E, 86 in group S and 67 in group E + S. Mean DAN and NFCS scores were statistically different between groups T, E and S. Analgesic effect of saccharose (–1.05) was greater than Emla ® (–0.56). Used together, effects were adding up without potentialisation. Conclusion. – This study shows that the association of non nutritive pacifier sucking with oral administration of saccharose and local application of Emla ® has a better analgesic effect than each of these three interventions alone for subcutaneous injection of EPO.

Topical amethocaine gel for pain relief of heel prick blood sampling: a randomised double blind controlled trial

BACKGROUNDHeel prick blood sampling is a commonly performed and painful procedure in the newborn infant. Use of a topical local anaesthetic does not relieve this pain. A 4% w/w amethocaine...

Does topical amethocaine gel reduce the pain of venepuncture in newborn infants? A randomised double blind controlled trial

BACKGROUNDTopical amethocaine provides effective pain relief during venepuncture in children, and has been shown to have a local anaesthetic action in the newborn.AIMTo investigate the effect of topical amethocaine on...

Differences in pain expression between male and female newborn infants

The study of neonatal gender differences in pain expression is important since neonatal pain behavior occurs prior to any learned reaction pattern. The objective of this study was to verify the presence of gender differences in pain expression in preterm and term newborn infants. Sixty-five consecutive neonates (37 female and 28 male infants) with gestational age between 28 and 42 weeks and with 25–120 h of life were studied. Healthy term neonates required a capillary puncture for PKU screening and clinically stable premature infants needed a capillary puncture for glucose dosage. The Neonatal Facial Coding System (NFCS) and the Neonatal Infant Pain Scale (NIPS) were evaluated at bedside prior to the puncture, when patients were at rest, during foot heating; during capillary puncture; and at 1, 3, and 5 min after heel lancing. Results were analyzed by repeated-measures ANOVA followed by the Multiple Comparison Method of Bonferroni. A significant difference among the mean NFCS scores during the six study periods was noted for the whole group of neonates ( P<0.000001). Also, a significant interaction between the NFCS score profile in female and male neonates at the different study periods was observed ( P=0.025). Regarding NIPS, ANOVA showed only a significant difference among the mean NIPS scores during the six study periods for the whole group of neonates ( P<0.000001). No significant interactions between gestational age and time, nor between gestational age and gender were noted, for both NFCS and NIPS. In conclusion, recently born female neonates of all gestational ages expressed more facial features of pain than male infants, during the capillary puncture and 1 min afterwards. Maybe differences in pain processing and/or pain expression among genders may explain this finding.