Neonatal Infant Pain Scale Scores Research Articles

Reduction of Environmental Noise Impact on Preterm Babies in NICU by Using Ear Plugs

Objective − To determine if using ear plugs reduce the impact of noise on preterm babies admitted to neonatal intensive care units in terms of changes in their vital parameters and their discomfort level, assessed using the Neonatal Infant Pain Scale (NIPS) score.Materials and Methods − This is an interventional study conducted in a tertiary level neonatal intensive care unit (NICU) (Bangalore, India) over a period of 3 months, ranging from June 2022 to September 2022. This study included 20 preterm babies with different gestational ages and birth weights who were admitted to the NICU during that period. The babies’ response to noise, in terms of changes in heart rate, respiratory rate, blood pressure, oxygen saturation and discomfort level, were assessed with ear plugs and without ear plugs on alternate days and the results were recorded. Descriptive statistics were used for statistical analysis. Results − On days 1 and 3, mean heart rate and systolic blood pressure were lower in babies wearing ear plugs (141.55±2.42 SD and 60.1±11.58, respectively) than in the same babies without ear plugs (157.55±2.52 SD and 61.85±1.6 SD, respectively) on days 2 and 4. The mean oxygen saturation was higher in babies wearing ear plugs (96.7%±0.80 SD) than in the same babies without the intervention (93.75%±1.29 SD). The mean NIPS score was lower with the intervention (2.05±0.22) than without ear plugs (5.05±0.22 SD).Conclusion – Ear plugs were an effective alternative in situations where noise in the NICU cannot be consistently maintained at a lower level than the standard recommendation by the AAP of 45 decibels.

Evaluation of procedural pain for neonates in a neonatal intensive care unit: a single-centre study

BackgroundTo evaluate the procedural pain experienced by neonates in a neonatal intensive care unit (NICU) setting and determine the corresponding pain grades.MethodsTwo experienced nurses independently used the Neonatal Infant Pain...

Comparing Opioid with Opioid-free Anesthesia Technique in Neonates Undergoing Tracheoesophageal Fistula Repair.

Tracheoesophageal fistula (TEF) is a congenital disorder that presents as a surgical emergency in neonates. In regions where neonatal intensive care unit facilities and resources are inadequate and skilled personnel are scarce, not extubating neonates on table, contributes to mortality. Our aim was to assess and compare the on-table extubation rate, extubation time, and postoperative pain scores between opioid and opioid-free anesthesia techniques in neonates undergoing surgical repair of TEF. We conducted a prospective, single-blind, randomized trial over 18 months between January 2021 and June 2022 in Safdarjung Hospital, New Delhi on 60 full-term neonates scheduled for TEF surgeries randomly allocated to two groups according to the mode of analgesia administered. Group O were given fentanyl injection 1 µg/kg intravenous (IV) loading dose with IV injection. acetaminophen at 7.5 mg/kg and top-up of 0.25 µg/kg fentanyl IV si opus sit. Group NO were given pre-surgical local infiltration and intercostal block with 0.25% and 0.5% bupivacaine, respectively, with IV acetaminophen at 7.5 mg/kg. Mean age in days, gender distribution, and weight in both groups were statistically comparable. The difference in the number of neonates extubated on table was statistically significant (p =0.002) in group NO compared to group O. Lower mean extubation time was seen in group NO (9.0 min 40.0 secs±3.0 min 3.0 secs) compared to group O (16.0 min 45.0 secs±8.0 min 5.0 secs) (p < 0.001). There was a statistically significant (p =0.010) lower Neonatal Infant Pain Scale score in group NO with mean and SD as 1.8±0.8 compared with group O, 2.5±1.1 at 90 min. In neonates undergoing TEF repair, opioid-free anesthesia is a safe and effective method, providing a better extubation rate, faster time to extubation, and better postoperative pain control.

The effect of postpartum skin-to-skin contact on the pain of the first intramuscular injection to the Newborn: A randomized controlled trial

BackgroundNewborns are exposed to painful interventions during medical procedures. AimThis study was conducted to evaluate the effect of postpartum skin-to-skin contact (SSC) on the pain of the first intramuscular (IM) injection in the newborn. DesignA randomized controlled trial with four measurement points (5 min following pre-intervention, pre-injection and post-injection, 10 min following post-injection). ParticipantsTerm newborns delivered vaginally. MethodThe women were randomly divided into control (n = 30) and experimental (n = 30) groups. SSC was performed to the experimental group 5 min before and after injection while the control group did not receive SSC. The pain response of newborns was evaluated by Neonatal Infant Pain Scale (NIPS), crying time, oxygen saturation (SpO2) and heart rate (HR). ResultsPre- and post-injection NIPS scores of the newborns in the experimental group were significantly lower than the control group (p < 0.01). The crying time of the newborns in the experimental group at 5 min after the injection was found to be significantly lower than the control group (p < 0.01). The newborns in the experimental group had significantly higher SpO2 at 5 min before and after the injection compared to the control group (p < 0.05). The mean HR of the newborns in the experimental group at 5 min before and after, and at 10 min after the injection was found to be significantly lower than that of the control group (p < 0.05). ConclusionIt has been determined that performing SSC to newborns is an effective method in reducing the pain of the first IM injection.

The effects of Yakson touch and gentle human touch on preterm infants: A systematic review and meta-analysis.

We aim to collect the evidence of efficacy of Gentle Guman Touch (GHT) and Yakson Touch in preterm neonates as pain relief, heart rate, oxygen saturation, and urine cortisol level. We made our search through PubMed, Web of Science, Scopus, and Cochrane by the mid of March 2023. Randomized control trials (RCTs) were included, and the Cochrane risk of bias tool was utilized to assess their quality. Using Review Manager software, a meta-analysis was conducted. We computed the mean difference (MD) with a 95% confidence interval (CI) for the continuous data. During the examination, the Neonatal Infant Pain Scale (NIPS) was significantly reduced in the touch group compared to the control group (MD = -3.40, 95% CI [-4.15 to -2.64], P-value= 0.00001). After the examination, the NIPS score was also reduced by both Yakson touch and GHT compared to the control (MD = -2.14, 95% CI [-3.42 to -0.85], P-value <0.00001). Yakson touch and GHT are non-pharmacological, easy, and safe methods that can be used for painful interventions to reduce the pain experience of preterm infants from variable interventions. Both methods improved infant sleep and behavior. Preterm infants' heart rates and oxygen saturation were unaffected by Yakson touch or GHT.

The effect of using maternal voice, white noise, and holding combination interventions on the heel stick sampling

BackgroundHeel stick sampling, a common procedure in newborns, causes acute pain. AimsThis study aims to measure the outcome of five various non-pharmacologic pain relief groups; maternal voice, white noise, holding, maternal voice+holding, and white noise+holding. MethodsThe study is an open label, randomized controlled trial. A total of 178 newborns were included in this study. Newborns were randomly allocated to each group; white noise (n = 31), maternal voice (n = 31), holding (n = 30), white noise+holding (n = 29), maternal voice+holding (n = 28), and control (n = 29) interventions. Newborns' pain responses were evaluated using the Neonatal Infant Pain Scale (NIPS), and the Premature Infant Pain Profile (PIPP). The primary measured outcomes were the newborns' pain levels, while the secondary outcomes were the heart rate and changes in oxygen saturation. The mean values of pain in neonates between groups were evaluated one minute before (Phase1), during (Phase2), and one minute after (Phase3) the procedure. ResultsThe research results are given with comparisons in three time periods (Phase1, Phase2 and Phase3). White noise and white noise+holding were found to have the lowest mean NIPS and PIPP score (p < 0.001). The mean heart rate was found to be the lowest in the white noise+holding group (p < 0.001). There was no significant difference between the groups in terms of oxygen saturation score (p = 0.453). ConclusionThe white noise+holding applied to newborns during heel stick sampling were effective in pain reduction. Nurses and midwives can use white noise+holding method. Implications to practiceThese results contribute to the pain management of newborns.

Timing for maximum anaesthetic effect of topical cream during early infant circumcision (EIC) in Rakai, Uganda.

The objective of this study is to determine the optimal timing for device-based infant circumcision under topical anaesthesia. We include infants aged 1-60 days who were enrolled in a field study of the no-flip ShangRing device at four hospitals in the Rakai region of south-central Uganda, between 5 February 2020 and 27 October 2020. Two hundred infants, aged 0-60 days, were enrolled, and EMLA cream was applied on the foreskin and entire penile shaft. The anaesthetic effect was assessed every 5 min by gentle application of artery forceps at the tip of the foreskin, starting at 10 min post-application until 60 min, the recommended time to start circumcision. The response was measured using the Neonatal Infant Pain Scale (NIPS). We determined the onset and duration of anaesthesia (defined as <20% of infants with NIPS score >4) and maximum anaesthesia (defined as <20% of infants with NIPS score >2). Overall, NIPS scores decreased to a minimum and reversed before the recommended 60 min. Baseline response varied with age, with minimal response among infants aged 40 days. Overall, anaesthesia was achieved after at least 25 min and lasted 20-30 min. Maximum anaesthesia was achieved after at least 30 min (except among those aged >45 days where it was not achieved) and lasted up to 10 min. The optimal timing for maximum topical anaesthesia occurred before the recommended 60 min of waiting time. A shorter waiting time and speed may be efficient for mass device-based circumcision.

A Randomized Comparative Effectiveness Study of Reflexology, Sucrose, and Other Treatments for Needle Procedures in Newborns

BackgroundApproximately 10 to 14 painful procedures per day are performed in infants during the hospital stay. We aimed to determine the effect of reflexology applied to the sole during painful procedures on pain perception in newborns compared with other nonpharmacologic methods. MethodsOur study was planned as a randomized controlled trial in term infants being followed up in the neonatal intensive care unit and maternity ward. To reduce pain during collection of venous blood or heel lance reflexology on the soles of the foot, 24% sucrose solution, kangaroo care, and classical music listening were applied to the infants. The Neonatal Infant Pain Scale (NIPS) was used to assess newborns during acute pain. ResultsA total of 300 patients were enrolled in the study. Higher pain scores and crying times were observed during heel blood collection. All analgesic methods significantly reduced NIPS scores during heel blood collection. Sucrose was the most effective method, followed by reflexology. The best method that significantly shortened the crying time was again sucrose solution followed by reflexology, kangaroo care, and classical music, during heel blood collection. However, none of the nonpharmacologic methods was effective during venous blood collection. ConclusionsAlthough sucrose was the most effective method, reflexology has significant positive effects, especially on average heartbeat, reducing pain, and shortening crying times during heel blood sampling. Reflexology might be considered among the nonpharmacologic methods to be applied before routine interventions, but still, there is a need for further studies to investigate the efficiency.

Assessment of salivary cortisol concentrations for procedural pain monitoring in newborns.

The study aimed to evaluate the usefulness of salivary cortisol (SC) for the assessment of procedural pain intensity in preterm and term newborns. Three groups of neonates (term, 370-416 weeks; moderate to late preterm, 320-366; and very preterm, <320) hospitalized in neonatal intensive care unit were assessed for the study. Response to nappy change, lung ultrasound (LUS), and blood sampling was analyzed. The intensity of pain was evaluated using continuous heart rate and blood oxygen saturation (SpO2) monitoring, Neonatal Infant Pain Scale (NIPS), and SC concentrations. Saliva samples were collected before and 20min after the procedure's end. Seventy-one infants were examined: 30 term, 21 moderate to late preterm, and 20 very preterm. SC has increased significantly in response to nappy change only in very preterm newborns (2.13ng/mL [1.55-3.68] vs. 2.84ng/mL [1.93-9.06], p=0.01). LUS did not affect concentrations of SC in any group. Significant increase in SC was observed after blood sampling in term and very preterm infants (2.2ng/mL [1.45-2.92] vs. 4.29ng/mL [3.88-5.73], p=0.002, and 1.88ng/mL [1.47-4.13] vs. 5.3ng/mL [3.42-8.02], p=0.002, respectively). A significant correlation between values of SC increase and NIPS scores was found (Spearman's rank correlation coefficient [rs]=0.31, p=0.001). We observed the increase in SC concentrations in response to painful stimulus. The presence of a correlation between NIPS scores and SC increase suggests that SC can be used as an objective parameter to assess pain in neonates.

ShangRing versus Mogen clamp for early infant male circumcision in eastern sub-Saharan Africa: a multicentre, non-inferiority, adaptive, randomised controlled trial

Use of medical devices represents a unique opportunity to facilitate scale-up of early infant male circumcision (EIMC) across sub-Saharan Africa. The ShangRing, a circumcision device prequalified by WHO, is approved for use in adults and adolescents and requires topical anaesthesia only. We aimed to investigate the safety and efficacy of the ShangRing versus the Mogen clamp for EIMC in infants across eastern sub-Saharan Africa. In this multicentre, non-inferiority, open-label, randomised controlled trial, we enrolled healthy male infants (aged <60 days), with a gestational age of at least 37 weeks and a birthweight of at least 2·5 kg, from 11 community and referral centres in Kenya, Tanzania, and Uganda. Infants were randomly assigned (1:1) by a computer-generated text message service to undergo EIMC by either the ShangRing or the Mogen clamp. The primary endpoint was safety, defined as the number and severity of adverse events (AEs), analysed in the intention-to-treat population (all infants who underwent an EIMC procedure) with a non-inferiority margin of 2% for the difference in moderate and severe AEs. This trial is registered with Clinical. gov, NCT03338699, and is complete. Between Sept 17, 2018, and Dec 20, 2019, a total of 1420 infants were assessed for eligibility, of whom 1378 (97·0%) were enrolled. 689 (50·0%) infants were randomly assigned to undergo EIMC by ShangRing and 689 (50·0%) by Mogen clamp. 43 (6·2%) adverse events were observed in the ShangRing group and 61 (8·9%) in the Mogen clamp group (p=0·078). The most common treatment-related AE was intraoperative pain (Neonatal Infant Pain Scale score ≥5), with 19 (2·8%) events in the ShangRing and 23 (3·3%) in the Mogel clamp group. Rates of moderate and severe AEs were similar between both groups (29 [4·2%] in the ShangRing group vs 30 [4·4%] in the Mogen clamp group; difference -0·1%; one-sided 95% CI upper limit of 1·7%; p=0·89). No treatment-related deaths were reported. Use of the ShangRing device for EIMC showed safety, achieved high caregiver satisfaction, and did not differ from the Mogen clamp in other key measures. The ShangRing could be used by health systems and international organisations to further scale up EIMC across sub-Saharan Africa. Bill & Melinda Gates Foundation.

Nonpharmacological pain management in vaccination. Perception of paediatricians, patients and guardians

IntroductionThe use of nonpharmacological measures to reduce pain during vaccination has been studied extensively in infants, but there are fewer studies on its effectiveness in older children and on the parental perception of pain in children. MethodsWe conducted a multicentre, quasi-experimental interventional study with a control group. Patients: infants aged 2–11 months and children aged 4 years that attended routine vaccination appointments. Setting: Primary care. Intervention during vaccination: infants were breastfed and 4-year-old children blew a party horn. Control: vaccination performed following routine practice. Measurement: NIPS (Neonatal Infant Pain Scale) and duration of crying in infants, Wong-Baker FACES pain rating scale in older children and parents. ResultsThe study included 125 children (intervention: 60; control: 65). There was a significant decrease in perceived pain in the intervention groups: NIPS score in infants, 3.8 ± 1.1 compared to 5.2 ± 0.7 (P < .001); Wong-Baker FACES score at 4 years of 3.3 ± 1.7 compared to 4.2 ± 1.6 (P = .042). These same differences in support of the intervention were reflected in the parental assessments (3.4 ± 1.3 vs 4.5 ± 1.5; P < .001). The correlation between child and parent scores was strongly positive: 0.7 (95% CI, 0.59−0.78). However, the duration of crying was longer in the intervention group. ConclusionThe use of distraction techniques reduces pain in children and the pain perceived by parents in their children, thus increasing their satisfaction with the procedure.

Efficacy of Skin-to-Skin Care versus Swaddling for Pain Control Associated with Vitamin K Administration in Full-Term Neonates: A Randomized Controlled Trial.

The objective of the study was to assess the efficacy of immediate skin-to-skin care (SSC) versus swaddling in pain response to intramuscular injection of vitamin K at 30 min of birth in neonates. Healthy full-term newborns were enrolled immediately after normal vaginal delivery and randomized in two groups, SSC and swaddling. Neonatal Infant Pain Scale (NIPS) was measured before, immediately after and at 2 min after the injection. Total 100 newborns were enrolled in the study (50 in each group). The mean (SD) birth weight of newborns in the SSC and swaddling group was 2668 (256) and 2730 (348) g, respectively. NIPS was comparable between the SSC and swaddling at before [1.78 (0.58) vs. 1.96 (0.83), p = 0.21], and immediately after the injection [4.82 (0.72) vs. 5.08 (0.75), p = 0.08]. NIPS at 2 min after the injection was significantly low in the SSC group compared to the swaddling group [1.38 (0.70) vs. 2.88 (1.00), p < 0.001]. At 2 min after injection, the NIPS score was significantly lower than baseline in the SSC group (p = 0.002), while it was significantly higher in the swaddling group (p < 0.001). A significantly higher proportion of newborns had a NIPS score of more than three at 2 min after injection in the swaddling group as compared to the SSC group (22% vs. 2%, p < 0.001). Immediate SSC was more efficacious as compared to swaddling as a pain control intervention while giving vitamin K injection. The trial is registered with the Clinical Trial Registry of India with Registration number: CTRI/2020/01/022984.

MP30-19 THE RAKAI SCORE: A NOVEL TOOL FOR PAIN MEASUREMENT DURING EARLY INFANT MALE CIRCUMCISION WITH THE SHANGRING

You have accessJournal of UrologyCME1 May 2022MP30-19 THE RAKAI SCORE: A NOVEL TOOL FOR PAIN MEASUREMENT DURING EARLY INFANT MALE CIRCUMCISION WITH THE SHANGRING Aaron Brant, Christina Sze, Jeffrey Johnson, Spyridon Basourakos, Quincy Nang, Stephen Kiboneka, Joseph Kagayi, Alice Christensen, Mark Barone, Marc Goldstein, Kaylee Ho, Karla Ballman, Philip Li, Godfrey Kigozi, and Richard Lee Aaron BrantAaron Brant More articles by this author , Christina SzeChristina Sze More articles by this author , Jeffrey JohnsonJeffrey Johnson More articles by this author , Spyridon BasourakosSpyridon Basourakos More articles by this author , Quincy NangQuincy Nang More articles by this author , Stephen KibonekaStephen Kiboneka More articles by this author , Joseph KagayiJoseph Kagayi More articles by this author , Alice ChristensenAlice Christensen More articles by this author , Mark BaroneMark Barone More articles by this author , Marc GoldsteinMarc Goldstein More articles by this author , Kaylee HoKaylee Ho More articles by this author , Karla BallmanKarla Ballman More articles by this author , Philip LiPhilip Li More articles by this author , Godfrey KigoziGodfrey Kigozi More articles by this author , and Richard LeeRichard Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002573.19AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Measurement of pain in infants can be challenging due to an inability to communicate level of discomfort directly. Therefore, providers are forced to rely on secondary proxies for discomfort, resulting in a nonspecific or inaccurate measurement. In this study, we present the use of the novel Rakai scale for the measurement of pain during early infant circumcision (EIMC) using ShangRing (SR) in our recent clinical trials in Uganda, Tanzania, and Kenya. METHODS: Male infants aged 0 – 60 days were brought to 14 sites in Kenya, Tanzania, and Uganda by a parent or legally appointed representative for SR EIMC from February to December 2020. Infants with congenital genitourinary anomalies, bleeding diatheses, or allergy to local anesthetics were excluded. Topical anesthesia was administered, with additional local injectable anesthesia given if needed. Infants were scored on both the nine-point Rakai scale during SR placement (Table 1) as well as the seven-point Neonatal Infant Pain Scale (NIPS) post-operatively. RESULTS: Rakai and NIPS scores were completed for 1,690 of 1,691 infants (99.9%) who underwent SR placement. The mean procedure time was 10.1 minutes (standard deviation (STD): 5.3). Additional injectable anesthesia was needed for 44 infants (2.6%). Mean Rakai Score was 3.6 of 9 (STD: 2.6). The highest scored portion of the procedure was “skin adjustment with the ring in place” (mean 0.52 of 1), and the lowest scored portion was “placement of hemostats” (mean 0.24 of 1). Severe Rakai Score (>6 of 9) was recorded in 303 infants (17.9%). Mean NIPS Score was 0.3 of 7 (STD: 0.8), with “flexed or extended arms” the highest scored portion (mean 0.06 of 1). A severe NIPS score (≥5 of 7) was recorded in 8 infants (0.5%). CONCLUSIONS: In a large prospective study of male newborn infants undergoing SR placement, the Rakai Score captured infant pain at each step of the procedure with a higher rate of severe pain detection than the NIPS score administered post-operatively. Thus, the Rakai score may be superior to pre-existing tools such as the NIPS score for pain measurement during SR EIMC due to its detection of intraprocedural pain with more significant detection of severe pain. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e486 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Brant More articles by this author Christina Sze More articles by this author Jeffrey Johnson More articles by this author Spyridon Basourakos More articles by this author Quincy Nang More articles by this author Stephen Kiboneka More articles by this author Joseph Kagayi More articles by this author Alice Christensen More articles by this author Mark Barone More articles by this author Marc Goldstein More articles by this author Kaylee Ho More articles by this author Karla Ballman More articles by this author Philip Li More articles by this author Godfrey Kigozi More articles by this author Richard Lee More articles by this author Expand All Advertisement PDF DownloadLoading ...

A comparison of anesthetic efficacy between dorsal penile nerve block (DPNB) with lidocaine and eutectic mixture of local anesthetics (EMLA) cream during neonatal circumcision.

Circumcision is often performed in neonates and is associated with significant pain. This study was conducted to compare the anesthetic efficacy of two methods of local anaesthesia for neonatal circumcision: topical eutectic mixture of local anesthetics (EMLA) cream and dorsal penile nerve block (DPNB) with lidocaine. Male neonates who presented for circumcision and met the eligibility criteria were recruited for the study and were randomly assigned to one of the two methods of anesthesia before the procedure. Anesthetic efficacy was compared by pain assessment during four standardized steps of the procedure (clamping, crushing, tying, and cutting of the foreskin, respectively) using the modified Neonatal Infant Pain Scale (NIPS), changes in transcutaneous oxygen saturation (SpO2), heart rate (HR), and preoperative and postoperative salivary cortisol levels. Patients also were evaluated after 24 hours to assess for complications. Totally, 138 babies were recruited. Significantly higher NIPS scores were observed among babies who had EMLA cream during tying (p=0.019) and cutting (p=0.043). The rise in mean HR from baseline was statistically significant throughout the procedure in the EMLA group. In the DPNB group, there was no significant rise in mean HR during crushing (p=0.919) and cutting (p=0.197). There was a significant decrease in mean SpO2 from baseline in both groups. Salivary cortisol showed significant increase in mean levels in both groups. No significant untoward effects were observed. DPNB with lidocaine has a better pain control compared with EMLA cream during neonatal circumcision. Both methods are safe in neonates.

Analgesic effect of inhaled lavender essential oil for frenotomy in healthy neonates: a randomized clinical trial.

BackgroundNeonatal pain may affect long-term neurodevelopment and must be treated. Frenotomy is a painful procedure wherein a common strategy to relieve pain (sucking) cannot be used because the technique is performed on the tongue. Lavender essential oil (LEO) has sedative and antispasmodic properties and has been successfully used to treat pain during heel puncture and vaccination. Our aim was to demonstrate if the use of inhaled LEO is effective in reducing pain during frenotomy in healthy, full-term neonates.MethodsWe conducted a randomized clinical trial in neonates who underwent a frenotomy between August 2020 and April 2021. We assessed pain using pre and post-procedure heart rate and oxygen saturation, crying time and Neonatal Infant Pain Scale (NIPS) score. Patients with type 3 tongue tie were randomized into the “experimental group” and “control group”. In both groups, we performed swaddling, administered oral sucrose, and let the newborn suck for two minutes. In the experimental group, we also placed a gauze pad with one drop of LEO under the neonate’s nose for two minutes prior to and during the frenotomy.ResultsWe enrolled 142 patients (71 per group). The experimental group showed significantly lower NIPS scores (1.88 vs 2.92) and cried almost half the amount of time (14.8 vs. 24.6 seconds, P = 0.006). Comparing with the control group, we observed no side effects in either of the groups.ConclusionsWe observed a significant decrease in crying time and lower NIPS scores in the neonates who received inhaled LEO and underwent a frenotomy for type 3 tongue-ties. Thus, we recommend using inhaled LEO during neonatal frenotomies.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12519-022-00531-7.

Agreement of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) With NICU Nurses' Assessments.

Objective assessment tools should standardize and reflect nurses' expert assessments. The Neonatal Pain, Agitation, and Sedation Scale (N-PASS) and the Neonatal Infant Pain Scale (NIPS) are valid measures of pain. The N-PASS also provides a sedation subscale. The objective of this study was to determine N-PASS clinical validity and utility by evaluating agreement of N-PASS scores with bedside nurses' assessments of pain/agitation and sedation in a 64-bed tertiary neonatal intensive care unit. Fifteen bedside nurses trained to use the N-PASS and the NIPS prospectively completed 202 pain/agitation and sedation assessments from a convenience sample of 88 infants, including chronically ventilated, medically fragile infants. N-PASS and NIPS scores were obtained simultaneously but independently of nurse investigators. Bedside nurses also made recommendations about infants' pain and sedation management. There was moderate agreement between N-PASS pain scores and nurses' recommendations (κ= 0.52), very strong agreement between N-PASS sedation scores and nurses' recommendations (κ= 0.99), and very strong associations between N-PASS pain and NIPS scores ( P < .001). Bedside nurse and independent investigator interrater reliability was good for N-PASS pain and NIPS scores (intraclass correlation coefficient [ICC] = 0.83, ICC = 0.85) and excellent for N-PASS sedation (ICC = 0.94). During 93% of assessments, bedside nurses reported that the N-PASS reflected the level of infant sedation well or very well. The N-PASS provides an easy-to-use, valid, and reliable objective measure of pain and sedation that reflects nurses' assessments. Additional studies using the N-PASS are needed to verify results and the influence of the N-PASS on pain and sedation management for medically fragile infants with chronic medical conditions.

Effect of Positioning on the Pain Response of Infants Vaccinated with Inactivated Polio and Pentavalent (dtwp-hepatitis B-hemophilus Influenza B) Vaccines

Objective – To compare the acute pain response to sequential vaccination in two different positions: holding the baby on the parent’s lap during vaccination injections (cuddle position) and making infants lie supine on the bed during vaccination procedure (bed position) after administration of IPV and pentavalent vaccines. Material and Methods − A total of 68 infants 34 each in cuddle and bed positions were included in the study. The procedure of injection was video recorded and later analysed by two resident interns for the pain response before and after the procedure using the neonatal infant pain scale (NIPS). Results − The baseline NIPS scores, median (IQR) was 0 (0-1) in the cuddle position and 0 (0-2) in the bed position. The pain response in both cuddle and bed positions was similar with a final NIPS score, median (IQR), of 7 (7-7). Conclusion − The parent held ‘cuddle position’ did not benefit the infants in terms of reducing acute pain response to vaccine injections compared to the supine (bed) position on the table.

Sağlam Çocuk Polikliniğinde ve Yenidoğan Yoğun Bakım Ünitesinde Farmakolojik Olmayan Ağrı Giderme Yöntemlerinden Emzik Verme ve Anne Kucağının Yenidoğan Ağrısı Üzerine Etkisinin İncelenmesi

Introduction: The most important purpose in neonatal pain management is to minimize the pain felt by newborns and to help the newborn cope with pain. This study planned to examine the effects of two non-pharmacological methods, using pacifiers or maternal holding, on neonates’ pain admitted to the outpatient clinic (OC) and hospitalized in the Neonatal Intensive Care Unit (NICU). Material and Methods: Ninety newborns (30 used pacifiers, 30 maternal holding,30 control) who applied to the OC and 60 newborns (30 used pacifiers, 30 control) admitted to the NICU were prospectively included in this study. The Neonatal Infant Pain Scale (NIPS) was used to evaluate behavioral responses to pain perception. Physiological parameters of newborns and their durations of crying were also evaluated. Results: When the NIPS scores were analyzed in OC group during and after the procedure, the lowest score was found in the group using pacifiers (p&amp;lt;0.001). As for the NICU patients, both during and after the procedure, NIPS scores were found to be significantly lower in the pacifier users (p&amp;lt;0.001). It was observed that giving pacifiers and mathernal holding had positive effects on physiological parameters and duration of crying in OC patients (p&amp;lt;0.05). No significant difference in the NIPS score was found between OC and NICU group. Conclusion: This study showed that giving pacifiers and maternal holding during the procedure of blood sampling decreased the NIPS score, restored the changes in physiological parameters and decreased the duration of crying.

The effect of foot reflexology applied to neonates before oro/nasopharyngeal suctioning on procedural pain and comfort in the neonatal intensive care unit

Introduction and aim. This study was performed to examine the effect of foot reflexology applied to the neonates on the level of pain and discomfort developed due to suctioning procedure. Material and methods. The study was conducted experimentally by taking pretest and repeated measurements on reflexology and control groups determined by simple randomization. The study was carried out with 66 neonates (reflexology applied: 33 and control group: 33). Neonatal Information Form, Neonatal Infant Pain Scale (NIPS) and Newborn Comfort Behavior Scale (NCBS) were used as the data collection tools. Results. The during (p&lt;0.001) and after suctioning (p&lt;0.001), the NIPS scores of the neonates in the intervention group was statistically lower than the control group. The NCBS scores of the neonates in the intervention group during (p&lt;0.001), and after suctioning (p&lt;0.001), were statistically significantly lower than the control group. Conclusion. It was concluded that foot reflexology applied to neonates was effective both in reducing pain during and after the suctioning and in increasing comfort during and after the suctioning.

Analgesia no farmacológica en la vacunación. Valoración de pediatras, pacientes y tutores

IntroductionThe use of nonpharmacological measures to reduce pain during vaccination has been studied extensively in infants, but there are fewer studies on its effectiveness in older children and on the parental perception of pain in children. MethodsWe conducted a multicentre, quasi-experimental interventional study with a control group. Patients: Infants aged 2 and 11 months and children aged 4 years that attended routine vaccination appointments. Setting: Primary care. Intervention during vaccination: infants were breastfed and 4-year-old children blew a party horn. Control: vaccination performed following routine practice. Measurement: NIPS (Neonatal Infant Pain Scale) and duration of crying in infants, Wong−Baker FACES pain rating scale in older children and parents. ResultsThe study included 125 children (intervention: 60; control: 65). There was a significant decrease in perceived pain in the intervention groups: NIPS score in infants, 3.8±1.1 compared to 5.2±0.7 (P<.001); Wong−Baker FACES score at 4 years of 3.3±1.7 compared to 4.2±1.6 (P=.042). These same differences in support of the intervention were reflected in the parental assessments (3.4±1.3 vs 4.5±1.5; P<.001). The correlation between child and parent scores was strongly positive: 0.7 (95% CI, 0.59–0.78). However, the duration of crying was longer in the intervention group. ConclusionsThe use of distraction techniques reduces pain in children and the pain perceived by parents in their children, thus increasing their satisfaction with the procedure.