Neonatal Infant Research Articles

Inflammatory mediators of stress exposure and neurodevelopment in very preterm infants: Protocol for the stress neuro-immune study.

(a) Determine relationships among stress exposure, inflammation, and neurodevelopment in very preterm infants and determine the mediated effect of inflammation on the relationship between stress exposure and neurodevelopment; (b) describe cytokine trajectories following birth and determine the effect of stress exposure on these trajectories; and (c) examine relationships between stress exposure and chronic stress responses in very preterm infants. Non-experimental, repeated measures. Very preterm infants born 28-31weeks post menstrual age will be enrolled. Cumulative stress exposure over the first 14days of life will be measured using the Neonatal Infant Stressor Scale. Blood will be collected weekly for the quantification of cytokines. Neurodevelopment will be assessed using the Neurobehavioral Assessment of the Preterm Infant and hair for quantification of hair cortisol will be collected at 35weeks post menstrual age. Multiple linear regression and conditional process analysis will be used to analyse the relationships among stress exposure, inflammation and neurodevelopment. Linear mixed models will be used to determine inflammatory trajectories over time. IRB approval for the study was received May 2017, and funding from the National Institute of Nursing Research was awarded July 2017. This study will determine the extent to which inflammation mediates the relationship between stress exposure and neurodevelopment. Interventions to attenuate inflammation in preterm infants may improve outcomes. Determining the potentially modifiable mediators of stress exposure and neurodevelopment in preterm infants is critical to improving long-term outcomes.

Effect of breast milk and sucrose on pain and perfusion index during examination for retinopathy of prematurity

Objective The objective of this study is to investigate the effect of breast milk and sucrose on pain scores and perfusion index (PI) and to evaluate the alteration in pain and PI during retinopathy of prematurity (ROP) examination. Methods This prospective randomized controlled study was conducted with preterm infants who were born in our hospital, hospitalized in the neonatal intensive care unit and whose gestational week was <32 weeks and birth weight was <1500 g. The preterm infants who would undergo ROP examination were allocated to three groups according to simple randomization method as follows: group 1: only local anesthetic eye drops, proparacaine HCl ophthalmic solution 0.5%, group 2: proparacaine HCl ophthalmic solution 0.5% plus breast milk, and group 3: proparacaine HCl ophthalmic solution 0.5% plus sucrose 24%. Postductal PI, transcutaneous oxygen saturation and heart rate (HR) values were measured before the eye examination (0), at the 30th, 60th, and 90th seconds (s) of the eye examination and 30 s after lasting of the examination in all infants. Pain was evaluated using Neonatal Infant Pain Scale (NIPS) during the examination. Results Fifty-one preterm neonates were prospectively enrolled into the study. The HR was higher during and after the examination in all infants according to before the examination (p < .001). Transcutaneous oxygen saturation values significantly decreased during the examination in breast milk and sucrose groups (p = .001 and <.001, respectively). While PI was found to be lower at the 60th s compared to the 30th s of the examination in the proparacaine HCl group, no difference was found between the values before and after the examination. Perfusion index was found to significantly decrease during and after the examination compared to the values before the examination in the breast milk group. Perfusion index values were determined to significantly decrease at the 30th and 60th s of the examination in the sucrose group. The NIPS scores during the examination were determined to be higher compared to the NIPS scores before the examination in all groups (p< .001). In the intergroup comparisons, the NIPS scores were found to be higher in the sucrose group compared to the proparacaine HCl group at the 60th s of the examination and higher than that in the breast milk group at the 90th s of the examination (p = .02 and p = .01, respectively). Conclusions The present study indicates that alterations may be seen in PI during the ROP examination; in other words, peripheral tissue perfusion could be affected. We consider that eye examination is a very painful procedure, and administering breast milk, sucrose or local anesthetic is not sufficient for reducing pain.

Effects of Early Initiation of Breastfeeding on Exclusive Breastfeeding Practices of Mothers in Rural Haiti

Rates and relationships of early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) of mothers in rural Haiti were examined. Prelacteal and complementary feedings were identified. With a cross-sectional descriptive design, survey data from mothers (N = 195) were collected at three intervals after birth. Data were analyzed for indicators of EIBF, EBF, and complementary feedings. Overall, 148 (75.9%) mothers reported EIBF, and 75 (38.5%) reported EBF. EIBF was associated with EBF, with an adjusted relative risk 1.35 (95% confidence interval = [0.84, 2.18]). Several nutritive and nonnutritive substances interrupted EBF during the first 6 months of life. Haiti has an under-five mortality rate of 67.0/1,000 live births, exceeding the mean of 46.5/1,000 live births for developing regions. Both EIBF and EBF are associated with decreased neonatal and early infant mortality. Country-specific data are needed to inform and develop breastfeeding initiatives and community-level campaigns to improve the prevalence of EIBF and EBF in Haiti.

Expressão de dor após atendimento de fisioterapia em recém-nascidos prematuros: estudo observacional

INTRODUÇÃO: Atendimento fisioterapêutico a neonatos prematuros é rotina nas unidades de terapia intensiva neonatais. O questionamento se o manuseio em prematuros extremos e moderados provoca dor é norteador deste estudo. OBJETIVO: Avaliar a presença de dor em recém-nascidos prematuros após a realização de manobras fisioterapêuticas. MÉTODO: Estudo observacional realizado em recém-nascidos prematuros extremos e moderados durante a primeira semana de vida, com necessidade clínica de fisioterapia respiratória. Os recém-nascidos recebiam as manobras posicionados no ninho feito com cueiros dobrados. Imediatamente após as manobras de desobstrução pulmonar e antes da aspiração das vias aéreas foram aplicadas as escalas Neonatal Infant Pain Scale (NIPS) e Premature Infant Pain Profile (PIPP) e anotados os dados vitais. Trabalho aprovado pelo comitê de ética da instituição sob o número 706.623. RESULTADOS: Foram avaliados 50 atendimentos fisioterapêuticos em 22 recém-nascidos na primeira semana de vida. Estavam em ventilação mecânica invasiva 18 (36%), em Continuous Positive Airway Pressure (CPAP) 24 (48%), Cateter nasal 6 (12%) e sem suporte de oxigênio 2 (4%). Os mesmos mantiveram os dados vitais dentro dos limites de normalidade e somente dois prematuros cursaram com escore positivo para dor. CONCLUSÃO: Manobras de fisioterapia respiratória são suaves para não causarem dor. Porém é importante estar sempre atento aos sinais e oferecer atendimento humanizado ao prematuro para minimizar efeitos nocivos do internamento.

Role of Health Education in Raising Tetanus Toxoid Vaccination Coverage among Pregnant Women and Mothers with Newborns in Khartoum North-Sudan, 2019

&lt;p&gt;&lt;em&gt;Tetanus is an acute disease caused by the toxin of a bacterium called C&lt;/em&gt;&lt;em&gt;lostridium tetani which is often found in soil. It is a life-threatening bacterial disease, which causes severe mortality among maternal, neonatal, and young infant. It is so serious even it can waste pregnancy, harm her baby during pregnancy or after delivery. A quasi experimental community based study was conducted among pregnant women and mothers with newborns in Khartoum North Locality from 2015-2019 with the aim to assess the effectiveness of health education intervening in raising tetanus toxoid vaccination coverage among pregnant women and mothers with new born. 266 participants were selected by using a systematic random sampling technique. The intervention that continued for six months includes; health talks, home visits, video show, presentations with power points, focus groups discussion, exhibitions, distribution of printed materials, pamphlets, brochures and posters. The data was statistically analyzed by using the (SPSS) and significant t and &lt;/em&gt;&lt;em&gt;c&lt;/em&gt;&lt;em&gt;2 - tests. The result showed a significant increase in the participants’ knowledge after the intervention towards tetanus toxoid at P value 0.00, the mode of infection with tetanus at P value 0.00, vulnerable group to tetanus at p value is 0.00, the seriousness of the tetanus at P value 0.00, neonatal tetanus at P value 0.00. There was a significant positive modification of the participants’ attitudes towards the easiness to communicate with the health workers at P value 0.00. The result showed a significant change in the participants’ practices towards vaccination against tetanus toxic at P value 0.00 and significant change towards taking vaccine dose regularly at P value 0.00. The study recommended that Federal Ministry of Health has to conduct many health education interventions to raise the tetanus toxoid vaccination coverage. &lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;

Pierre Robin sequence in association with tracheoesophageal fistula and esophageal atresia

The first symptom of esophageal atresia and tracheoesophageal fistula is the inability to eat and respiratory distress after feeding. The coexistence of Pierre Robin Sequence (PRS) with esophageal atresia and tracheoesophageal fistula is a rare clinical condition. In infants with PRS, evaluation of respiratory and nutritional problems is important. The coexistence of esophageal atresia and tracheoesophageal fistula leads to increased nutritional and respiratory problems. Problems that may occur in the airways may occur late. In this case report, we aimed to present a case of neonatal infant with rare esophageal atresia, tracheoesophageal fistula, and PRS.

Effects of breastfeeding and heel warming on pain levels during heel stick in neonates.

To determine the effects of two different methods, breastfeeding and heel warming, during heel stick procedures on pain levels in healthy term neonates. This study was a prospective, randomized controlled trial. The sample of the study consisted of 150 healthy newborns who matched the case selection criteria and were brought to the nursery for the heel stick procedure. Fifty neonates were randomly assigned to each group: breastfeeding (n = 50), heel warming (n = 50), and control (n = 50), using computer-based randomization. The study data were obtained using an Information Form and the Neonatal Infant Pain Scale (NIPS). The pre-procedural pain scores of the breastfeeding group (mean 4.44 SD 1.21seconds) were lower than in the heel warming (mean 6.10 SD 1.07seconds) and the control group (mean 6.42 SD 0.91seconds) (P<0.01). Both the total crying time and the first calming time of the breastfeeding group were shorter than the heel warming and control group. The first calming time of the heel warming group was shorter than in the control group. Both breastfeeding and heel warming are effective in reducing the calming time during heel stick procedures. However, breastfeeding is more effective than heel warming in reducing pain during heel stick and should be preferred as the first choice.

SAT-270 Outcomes of a Quality Improvement Project Integrating Continuous Glucose Monitoring Systems into rhe Routine Management of Neonatal Hypoglycaemia

Introduction Continuous glucose monitoring systems (CGMS) are safe and can optimize neonatal hypoglycaemia management. However, they need to be tested within resource-limited clinical practice. CGMS was piloted in our Neonatal Intensive Care Unit (NICU) in June 2017. Five barriers to its effective implementation were identified: 1) Lack of staff confidence in device usage 2) Infant discomfort during device removal 3) Calibration errors 4) Wireless connection disruptions 5) Bruising after device removal. We designed a quality improvement project that aimed to reduce the number of problems per patient associated with CGMS use in our NICU from 5 to 0 over a 1 month period. Methods This study was conducted in July 2017. Eligible for inclusion were term neonates >1.5kg who were admitted for hypoglycaemia (<2.6mmol/L) <48 hours old. A New Generation EnliteTM Sensor (Medtronic, California) was inserted into five consecutive babies admitted with hypoglycaemia and removed when normoglycaemia was achieved. The sensor transmitted interstitial glucose readings to a MinimedR REAL-Time Transmitter and displayed values on a MiniMedR 530G System (both Medtronic, California). Five "Plan-Do-Study-Act" (PDSA) cycles tested the change intervention. Results The first two cycles tested CGMS acceptability and practicality of the device using qualitative feedback from staff and families, and quantitative data from the Neonatal Infant Pain Scale (NIPS). Subsequent cycles optimised the insertion process, trouble-shooting calibration errors and promoting NICU staff confidence in device usage. Key recommendations included manually inserting the device on small babies, using Duoderm® to reduce subcutaneous bruising, timely insertion of calibration readings to avoid sensor errors, adaption of nursing cares to avoid signal loss, and using near-peer teaching techniques to educate staff on CGMS usage. Bland-Altman analysis comparing point-of-care and sensor glucose readings showed no significant proportional bias Conclusions PDSA cycles revealed aspects of CGMS use that need to be adapted for its successful implementation in clinical practice. Further studies should assess the potential of CGMS as a decision-making tool in hypoglycaemia management.

Hearing loss-related knowledge and attitude toward neonatal hearing screening among Egyptian parents

BackgroundHearing loss is considered one of the most prevalent global health concerns. In Egypt, the accurate estimation of hearing loss among children is difficult to be determined owing to the absence of a national hearing screening program until now. The parents play an important role in the process of hearing screening and intervention. Their knowledge and attitude certainly influence their decisions. Their decisions toward early identification and intervention of hearing loss may have lifelong effects on the infant’s life.AimTo assess the knowledge and attitude of Egyptian parents toward risk factors of infant hearing loss and its neonatal screening and treatment.MethodsA cross-sectional study was conducted among 384 Egyptian parents through convenience sampling technique using an online questionnaire over a period of 3 months (from August 2018 to November 2018).ResultsOverall, 51.6% of the parents who participated in the study had a good knowledge about hearing loss, and 99.5% had a good attitude toward neonatal hearing screening. There was no significant association between knowledge, attitude, and sociodemographic characteristics except between the attitude toward child wearing of hearing aid and age of the parents.Conclusion and recommendationIn spite of good positive attitude toward neonatal hearing screening and infant wearing of hearing aids among the studied parents only half of them showed a good level of knowledge about hearing loss. Accordingly, the application of a national newborn hearing screening program is highly recommended.

Effect of Eye Shield versus Massage on Preterm Infants’ Pain Response during Venipuncture

Background: Evidence demonstrates that controlling pain in the preterm infants during the neonatal periods is improving physiological, behavioral and hormonal outcomes. Eye shield and massage may play an important role as a non-pharmacological pain management during venipuncture. Aim: Is to investigate effect of eye shield and massage on preterm infants’ pain response during venipuncture. Patients and Methods: Time seriesquasi experimental research design was carried out on a randomized sample of 100 newborn infants attending the Neonatal Intensive Care Unit (NICU) of El Manial University Hospital (Kasr Al Ainy), (30control group,30 eye shield group and 30 massage group). Neonatal assessment tool and Preterm Infant Pain Profile (PIPP) were utilized for data collection. Results: There was a significant mean difference between control, eye shield and massage groups regarding PIPP pain assessment scores in three time frames (before venipuncture T0, during T1 and after T2) at P? 0.00 but there wasn’t a significant mean differences after 5 min (T3). Massage group had the fewest mean PIPP score during four time frames (3.50±0.97 before venipuncture, 8.16±1.91 during venipuncture, 4.30±4.30 after venipuncture and 3.22±0.81 after 5 minutes of venipuncture). Conclusion: ANOVA indicated that massage and eye shield groups showed a significant reduction in preterm infant’s pain response than control group during venipuncture but massage was more effective than eye shield. Recommendations: Further studies needed to evaluate the effect of massage in combination with eye shield on preterm infant pain response.

Is my baby normal? A review of seemingly worrisome but normal newborn signs, symptoms and behaviors

Infant patients are a unique challenge to emergency department (ED) physicians as the spectrum of normal infant signs, symptoms and behaviors are often difficult to differentiate from abnormal and potentially life-threatening conditions. In this article, we address some common chief complaints of neonates and young infants presenting to the ED, and contrast reassuring neonatal and young infant signs and symptoms against those that need further workup and intervention.

The Effect of Aromatherapy by Lavender Oil on Infant Vaccination Pain: a Double Blind Randomized Controlled Trial.

Introduction: Exposure to noxious stimuli can cause pain in infants. This study was conducted to evaluate the effects of the lavender oil inhalation on the pain resulting from the pentavalent vaccination.Methods: This clinical trial consisted of two groups: the lavender oil group with 42 infants and the placebo group with 57 infants. The healthy infants without congenital abnormalities in need of pentavalent vaccine also participated in our study. The infants started the lavender oil or placebo aromatherapy one minute before injection. The pain was assessed three times, using the Neonatal Infant pain Scale (NIPS): before vaccination, 15 s, and 5 min after vaccination. Also, the duration of crying was measured in both groups.Results: At baseline, the two groups were similar in relation to the NIPS scores. While, after 5 minutes, the NIPS score was significantly lower in the lavender group. Based on the repeated measures analysis, the NIPS score changed over time totally. However, the two groups were significantly different in relation to the NIPS score over time. The duration of crying was 75.47 (60.675) second in the lavender group and 105.22 (75.739) s in the control group. The statistical test showed a significant difference between the two groups.Conclusion: A low concentration of the lavender oil inhalation can reduce the pain and improve soothing in the infants with the pentavalent vaccine injection.

COMPARISON OF THE ANALGESIC EFFICACY OF EXPRESSED BREAST MILK AND 25% DEXTROSE DURING THE FIRST HEPATITIS B VACCINATION

Background: Injectable vaccines are a common source of pain and distress for newborn babies. Sweet-tasting solutions such assucrose and 25% dextrose (25D) are described as effective strategies for pain relief in newborns. Objective: This study was doneto compare the analgesic efficacy of expressed breast milk (EBM) and 25D solution during vaccination with hepatitis B (Hep B)vaccine at birth. Materials and Methods: This study was conducted at the vaccination clinic in the pediatrics department of atertiary care hospital in southern India. The participants included healthy term babies and late preterm babies at the clinic duringtheir routine dose of Hep B at birth, during the study period from June 2017 to December 2017. A total of 70 consecutive neonateswere randomly allocated into two groups. 2 ml of either EBM or 2 ml of 25D solution was given 1 min before the injection. Theoutcome variables recorded were the duration of cry after injection and Neonatal Infant Pain Scale (NIPS) scores for both thegroups. Results: The duration of cry was found to be slightly higher in the group receiving EBM than those receiving 25D, althoughit was not found to be statistically significant. The neonates in the 25D group had lower NIPS scores than those in the EBM group.Conclusions: 25D appears to be a slightly better analgesic when compared to EBM during Hep B injection at birth.

Preclinical modeling of exposure to a global marine bio-contaminant: Effects of in utero Domoic acid exposure on neonatal behavior and infant memory

Domoic Acid (DA) is a naturally-occurring marine neurotoxin that is increasingly recognized as an important public health issue. Prenatal DA exposure occurs through the maternal consumption of contaminated shellfish/finfish. To better understand the fetal risks associated with DA, we initiated a longitudinal, preclinical study focused on the reproductive and developmental effects of chronic, low-dose oral DA exposure. To this end, 32 adult female Macaca fascicularis monkeys were orally dosed with 0, 0.075 or 0.15 mg/kg/day DA on a daily basis prior to breeding and throughout breeding and pregnancy. The doses included the proposed human Tolerable Daily Intake (TDI) (0.075 mg/kg/day) for DA. Adult females were bred to nonexposed males. To evaluate development during early infancy, offspring were administered a Neonatal Assessment modeled after the human Neonatal Behavior Assessment Scale and a series of Visual Recognition Memory problems using the novelty paradigm. Results indicated that prenatal DA exposure did not impact early survival reflexes or responsivity to the environment. Findings from the recognition memory assessment, given between 1 and 2 months of age, showed that exposed and control infants demonstrated robust novelty scores when test problems were relatively easy to solve. Performance was not diminished by the introduction of delay periods. However, when more difficult recognition problems were introduced, the looking behavior of the 0.15 mg/kg DA group was random and infants failed to show differential visual attention to novel test stimuli. This finding suggests subtle but significant impairment in recognition memory and demonstrates that chronic fetal exposure to DA may impact developing cognitive processes.

Legal and ethical considerations for midwives performing the neonatal infant physical examination

The newborn and infant physical examination (NIPE) is part of a national screening programme in the UK that involves the first full physical assessment of the newborn. The examination aims to identify conditions and diseases early in order for prompt intervention and treatment to be arranged. Historically, the examination has lain solely in the paediatrician's remit; however, the more recent shift in midwifery care provision has led to a focus on midwifery-led care, continuity of carer and seamless care, which has brought the NIPE into the midwife's sphere of practice. There has been increasing evidence demonstrating that the midwife is the most suitable practitioner to conduct the NIPE following appropriate training; however, this has not been evaluated in recent years. Midwives are supported professionally, legally and ethically to conduct this examination, provided that they work within their sphere of practice and professional guidelines.

THE INFLUENCE OF MATERNAL AND CHILD HEALTH SERVICES ON NEONATAL DEATH OF LOW BIRTH WEIGHT NEONATES IN ACEH PROVINCE

Low birth weight (LBW) is one of the most crucial problem related to neonatal mortality and infant mortality. The LBW is defined as babies born with a birth weight less than 2500 grams. LBW does not only contribute to neonatal morbidity, but may lead to neonatal mortality. This study aim to determine the influence of maternal and child health services (MCH) services to neonatal death among LBW babies in Aceh province, Indonesia.This study is observational study with mix method, using quantitative (Unmatched case control study) and qualitative (case study). The study was conducted between 2011-2015 in 8 district/municipality in Aceh Province, Indonesia. Total sample for quantitative study was 500 neonates (1:1), 250 neonates who died in neonatal period (case) and 250 LBW neonates who survived in the neonatal period (control group). Meanwhile, the total sample for qualitative study was 22, there were 12 (mother) and 10 (midwife).The result of A simple logistic regression analysis for MCH factors found that 4 of 7 variable were significant association with neonatal death among LBW (P value &lt; 0.05), these variables include: Antenatal care (ANC), place of delivery, level of health facilities and neonatal visit. Multiple logistic regression found the ANC has a strongest influence on neonatal death among LBW babies in Aceh Province (OR=3.6; 95% CI: 2.3-5.7). The LBW neonates who were born to mothers who received number of ANC equal to or less than 3 times had a 3.6 times higher risk of death, than neonates who were born to mothers who received ANC ≥ 4 times. The appropriate of health services in health facilities are needed to reduce the NMR and improve the health of neonate.

Comparison of the efficacy of eutectic mixture of local anesthetics (EMLA) and dorsal penile nerve block (DPNB) in neonatal circumcision.

Neonates feel pain. There is a concern among practitioners that pain of injecting analgesics to neonates prior to circumcision could as well be the same as the pain of the procedure. This has made many reluctant to offer effective analgesia for circumcision. If eutectic mixture of local anesthetics (EMLA) provides analgesia comparable to dorsal penile nerve block (DPNB), it will obviate needle prick and encourage analgesia use in neonatal circumcision. To determine how the analgesic efficacy of EMLA compares with that of DPNB in neonatal plastibell circumcision. A prospective study of 110 male neonates for plastibell circumcision randomized into two groups: A and B, of 55 each, received EMLA or DPNB as analgesia prior to circumcision, respectively. The pulse rates and SpO2 were recorded with pulse oximeter pre-procedural and at four stages of the procedure (adhesiolysis, dorsal slit, tying, and excision) for each neonate. Also the modification of neonatal infant pain scale (NIPS) was recorded during the procedure. There were differential changes in SpO2 (lower absolute mean values) and pulse rate (higher absolute mean values) for neonates who received EMLA when compared with DPNB before the procedure. These differences were significant with SpO2 at adhesiolysis (91.0% and 95.0%), dorsal slitting (90.9% and 94.7%), and excision stages (93.4% and 95.3), respectively (P < 0.05). They were also significant with the pulse rates at adhesiolysis (167.9 and 158.6), dorsal slitting (174.3 and 161.7), and tying stages (182.2 and 169.0), respectively (P values = 0.013, 0.015, and 0.044, respectively). This shows DPNB is better than EMLA. However, the difference was not significant at the tying stage with SpO2 and at excision stage with PR (P > 0.05). EMLA produces analgesic effect. However, it does not provide effective analgesia for plastibell circumcision in neonates. DPNB provides a better analgesia than EMLA for neonatal plastibell circumcision.

Oral 24% sucrose associated with nonnutritive sucking for pain control in healthy term newborns receiving venipuncture beyond the first week of life.

ObjectiveTo test the hypothesis that oral administration of 24% sucrose associated with nonnutritive sucking in healthy newborns receiving venipuncture beyond the first week of life controls pain and pain-related variation in heart rate (HR) and noninvasive oxygen saturation (SpO2).MethodsA total of 66 term newborns were enrolled between February and September 2017 in the Neonatology Department of AORN Santobono-Pausilipon, Naples. They were randomly assigned to receive oral 1 mL 24% sucrose (treated group [TG], n=33; gestational age 38.53±1.49 weeks; body weight 3,035±55 g; age 22.40±6.82 weeks) or oral 1 mL 10% glucose (control group [CG], n=33; gestational age 38.91±1.45 weeks; body weight 3,203±65 g; age 23.36±7.02 weeks) 1 minute before and during venipuncture. Evaluations were carried out between 8 and 9 am in all newborns. The Neonatal Infant Pain Scale (NIPS) was used to assess pain in newborns. Outcome measurements (HR, SpO2) were obtained before (T0), during (T1), and 1 minute after (T2) venipuncture using a Nellcor bedside SpO2 patient-monitoring system. NIPS scores were recorded throughout the procedure. Statistical analysis was performed using SPSS version 20.0. Changes in HR and SpO2 were assessed by mixed ANOVA for repeated measures. NIPS scores were evaluated by Mann–Whitney U test.ResultsThere were no statistically significant differences in HR or SpO2 between TG and CG at T0. HR was significantly lower in TG than CG at both T1 and T2 (P<0.05), whereas SpO2 was significantly higher in TG than CG at both T1 and T2 (P<0.05). NIPS scores were significantly lower in TG (median 0) than CG (median 6) during the entire procedure (P<0.05).ConclusionOral administration of 24% sucrose associated with nonnutritive sucking prior to and during a painful procedure has a strong impact on pain response in term newborns, reducing NIPS scores and influencing pain-associated variations in HR and SpO2. Complete analgesia during painful procedures in term newborns might prevent pain reactivity and its behavioral and neurodevelopmental consequences. Replication of this study is needed before widespread application of findings.

Efficacy of Vein Visualization Devices for Peripheral Intravenous Catheter Placement in Preterm Infants: A Randomized Clinical Trial.

The aim of this randomized controlled trial was to examine the efficacy of vein visualization devices and the routine method for insertion of peripheral intravenous catheters (PIVCs) in preterm infants. The study was conducted between June 2016 and April 2017 in the neonatal intensive care unit of Bakırköy Dr Sadi Konuk Education and Research Hospital. Participants (N = 90) were randomly assigned to the infrared group (n = 30), the transilluminator group (n = 30), or the control group (n = 30). Time to successful cannulation was significantly lower for the infrared group (8.70 ± 2.56 seconds) than for the transilluminator group (45.27 ± 30.83 seconds) and the control group (17.30 ± 8.40 seconds) (P ≤ .001). Success of the first attempt was significantly higher in the infrared and transilluminator groups than in the control group (P ≤ .05). Dwell time of the PIVC in place was significantly higher in the infrared group than in the transilluminator and control groups (P ≤ .05). Neonatal Infant Pain Scale scores were significantly higher in the transilluminator group (0.60 ± 0.855) than in the infrared (0.33 ± 0.182) and control groups (0.33 ± 0.182) while seeking an appropriate vein (P ≤ .001). The use of an infrared device provides efficacy in time to successful cannulation, success of the first attempt, length of the time the catheter is in place, and technique-related pain.

A Comprehensive analysis of Neonatal pain and measures to reduce pain

Pain management of neonates is much debated topic in the medical field. Pain and particularly chronic pain may affect the development of the brain and cause permanent injuries. Neonates being non-verbal are unable to express their pain and thus are exposed to various painful procedures without adequate pain relief. This lack of self-report, inadequate pain assessment tool, lack of awareness and concern amongst the care providers and non-availability of standard protocols lead to inadequate pain relief in neonates. The communication of infant pain is identified through validated tools such as: Premature Infant Pain Profile (PIPP), Neonatal Facial Coding System (NFCS), and the Neonatal Infant Pain Scale (NIPS). The most popular means of reducing minor procedural pain is oral glucose solution, music therapy, cuddling the neonates, breast feeding and use of topical anaesthetic agents. Topical anaesthetic agents that are commonly used like EMLA are not far from side effects. EMLA is known to cause methemoglobinemia in preterm babies. Recently a study has been conducted using 4% Liposomal Lidocaine at a tertiary care centre in India by Kaur et al which has found this agent to be useful to relieve minor procedural pain like Venepuncture and found it to be free from side effects of methaemoglobinaemia.[18] In nutshell, effective management of pain is an ethicals well as a scientific issue. Is it not humane to think about providing adequate pain relief to such tiny non-verbal human beings? Effective pain assessment and management in infants correlates with the quality of healthcare provided and the professionalism shown by healthcare providers. As part of comprehensive pain prevention program, each neonatal unit should develop strategies to provide effective pain relief for all procedures.