Assessment Of Pain In Newborns Research Articles

The effects of different procedures on pain levels in preterm and term infants in neonatal intensive care unit: a cross-sectional survey of pain assessment in newborns.

Newborns show a series of behavioral and physiological reactions to painful stimuli. The current study aimed to determine the effect of different procedures on the pain levels of newborns in the Neonatal Intensive Care Unit (NICU). One hundred ninety-six newborns with gestational age (GA) of 23-40weeks, birth weight (BW) between 2235 ± 911g were included. Painful procedure (PP) (vascular access (VA), heel prick (HP), umbilical catheter (UC), orogastric catheter (OC), and intubation (I)) were recorded. Pain during the PP was evaluated with Neonatal Infant Pain Scale (NIPS). Pulse and O2 saturation were recorded before (BP), during (DP) and after (AP) procedure. NIPS total scores were found to be significantly higher with term infants (p < 0.05). When NIPS total scores were compared according to the type of PP, significant difference was observed between groups (p = 0.000). Positive correlation was found between birth week (p = 0.000, r = 0.364), BW of infants and NIPS total score (p = 0.000, r = 0.371), pulse values of DP and NIPS total score (p = 0.000, r = 0.386). Negative correlation was found between O2 saturation values DP and the NIPS total scores (p = 0.000, r = -0.405). It is concluded that as GA and BW increase, so do the pain responses of the infant, which showed that the pain thresholds of term-preterm infants are different, and decrease as GA and BW increase.

Evaluación del dolor neonatal y opinión de los profesionales sobre el uso de un sistema automático para su valoración

Objective: to understand the characteristics of the evaluation of neonatal pain in Neonatal Intensive Care Units (NICUs) and the opinion of professionals about the use of an automatic assessment system. Method: a cross-sectional study (2017). Population: NICU nurses and doctors from Spanish hospitals. Data collection through online questionnaire which included variables of the professional profile, frequency of pain assessment, evaluation scale used, training received, difficulties perceived to assess pain, opinion about pain evaluation and about the use of an automatic assessment system. Descriptive statistical analysis; Jamovi 1.2.7® program.Results: there were 133 answers: 83.5% were women, with a mean age of 40 (9.43) years. 88% from tertiary level hospitals; 44.1% were Nursing professionals, and 72% with >6 years’ experience at the NICU. Of these respondents, 66.9% assessed pain according to the status of the newborn, 29.3% with a scale specific to the unit, 72.6% considered that there was a subjective component in the assessment, 48.1% did not receive any training to assess pain. An automatic system was regarded as useful by 93.2%, but for 36.1% it would not be reliable, and 23.3% reckoned that an automatic system could not replace human perception. Conclusions: no protocol by consensus was applied for pain assessment in newborns, there was variability, sometimes it was not measured due to lack of time, and when it was measured, data could be subjective. The majority considered that the use of an automatic pain assessment system could be useful, although some doubted its reliability due to lack of knowledge of the technology currently applied.

Usefulness of two types of pain monitors in newborns treated in NICU, in the opinion of experts: Results of the survey.

Pain experienced in the neonatal period has been shown to have serious short- and long-term consequences. It is also known that painkillers have side effects and should not be abused. The basis of proper pain management is assessment of pain, which in newborns is very difficult due to the lack of verbal communication. In these patients, behavioural scales are used to assess pain, but they have numerous shortcomings. For this reason, many newborns treated in the ICU are at risk of pain, so instrumental methods of detecting and assessing the severity of pain are being sought.During three months, seven Polish NICUs conducted research with the use of NIPE and SCA monitors. After this time, the heads of these departments filled in questionnaires regarding their individual opinions on the usefulness of these devices.All respondents found pain monitors useful in the NICU. The NIPE monitor was rated slightly higher, as its usefulness in assessing the effectiveness of analgosedation and in the management of patients in the postoperative period was better rated. The high acceptance of both devices by legal guardians of newborns is noteworthy.It should be stated that in newborns, any way to improve pain monitoring is valuable. In the opinion of Polish experts, pain monitors are useful in NICU. The NIPE monitor was assessed a little higher and was considered useful in the assessment of analgosedation and in postoperative treatment. Pain monitors can provide valuable support for pain assessment in newborns treated in the NICU.

Available Instruments to Assess Pain in Infants

Pain assessment in newborns and infants is challenging for clinicians. Although behavioral and behavioral-physiological scales are validated pain assessment instruments, their use in this age group has significant limitations. In this review, we summarize the methods currently available for assessing pain in neonates and infants. It is possible that these pain detection methods are also useful for assessing the quality of anesthesia and analgosedation in these populations. Further research should be aimed at confirming the usefulness of these tools in infants and identifying additional pain assessment options for clinical practice.

Clinical assessment of pain in newborns

Theе article describes the key points of pain assessment in newborns, its prognostic value, and tools to assess the pain severity in a child unable to inform about the problem. The latter is of special interest, since the results of existing scientific research in the neonatal practice are not completely universal and clear. The review contains data on pain in newborns available in open sources. The authors devoted special attention to clinical methods of pain severity determination, especially to the most widely used scales. They compared the clinical methods for objectifying the pain severity in newborns frequently used in neonatal practice.

The effect of video-assisted training given to midwifery and nursing students about pain and its management in newborns on students' level of knowledge

Context: In Turkey, pain and its management in newborns is within the curriculum of midwifery and nursing education. It is important for midwifery and nursing students to have sufficient knowledge and skills for practice about pain and its management in newborns. Aims: The present study aimed to find the effect of video-assisted training given to midwifery and nursing students about pain and its management in newborns on the knowledge level of students. Setting and Design: This study employed a quasi-experimental pretest–posttest design in Ondokuz Mayis University Health Sciences Faculty between 26 and 27 February 2018. Materials and Methods: Midwifery and Nursing students (n = 182) enrolled by census sampling. In addition to students' sociodemographic data and information about the state of observing and applying a painful procedure on newborns, the data were collected through a questionnaire form prepared by the researcher which included pain characteristics, symptoms of the newborn, scales, and management. The questionnaire form filled in before the training was repeated following the video-assisted training given. Statistical Analysis Used: Data were analyzed using descriptive statistics, Chi-square test, and McNemar's test. Results: It was found that 74.7% of the students who participated in the study observed a painful intervention to newborn and 23.1% performed a painful intervention on newborn. It was found that students' posttraining states of knowing about newborns' pain characteristics, behavioral and physiological symptoms, scales used in the assessment of pain in newborns, and characteristics about nonpharmacological and pharmacological treatments used in pain treatment increased when compared with pretraining (P Conclusion: It was found that students' states of knowing about newborns' pain increased after the training given when compared with before training. It is recommended that the content of the subject of pain and its management in newborn period within the curriculum of midwifery and nursing schools should be reviewed and improved by new educational methods.

Objective assessment of induced acute pain in neonatology with the Newborn Infant Parasympathetic Evaluation index.

Objective tools are needed to improve pain assessment in newborns. The aim of this study was to assess the correlation between the Newborn Infant Parasympathetic Evaluation (NIPE) index and two pain scales during a painful procedure in premature infants. Each baby born at least at 26weeks of gestational age (GA) undergoing a planned painful procedure in the Neonatal Intensive Care Unit (NICU) was eligible. NIPE index, heart rate variability (HRV) indices and Neonatal Acute Pain scale (DAN) were recorded across three periods: the first at rest 5min before the painful procedure (T1), the second during it (T2) and the third 3min after the end of it (T3). The Premature Infant Pain Profile-Revised (PIPP-R) pain scale was recorded at T2. Sixty-four recordings were performed in 29 preterm infants (mean GA=29.9±4.2weeks). Twenty-eight tachograms were coupled to NIPE for analysis. We did not find a correlation between the NIPE index and DAN and PIPP-R at the pain time T2. Between T1 and T2, heart rate was higher (159±16 vs. 169±12, p<0.001). Considering the linear HRV indices, we did not observe a modification in parasympathetic or sympathetic activity, while for the nonlinear HRV indices (H exponent, Approximate and conditional Entropy), a significant change towards a loss of physiological chaotic cardiac behaviour was detected. The NIPE index seems to be not reliable to assess acute pain in the preterm infant, but other HRV indices could be explored as additional tools next to pain scales in NICUs. The NIPE monitor was developed for objective pain assessment in neonates based on HFnu variations, but it does not seem reliable enough for assessing acute pain in real time in preterm neonates. Pain assessment in preterm babies still relies on pain scales.

Pain Assessment in Newborns, Infants, and Children.

Pain in children is underestimated and undertreated because of lack of pain assessment tools. Pain assessment depends on the cognitive development of the child being tested, clinical context, and pain typology. For children older than age 6 years, pain assessment is based on a self-report. For children younger than age 6 years, behavioral pain scales are needed to assess pain. Numerous pain scales exist. Many are reliable and some are recommended, but all have specific conditions for their use. In this article, we review the available pain scales for children from birth to adolescence. We provide the validity criteria of each pain scale to help caregivers use the adapted tools. We then propose a synthesis of the reliable tools to use based on the pain context. [Pediatr Ann. 2017;46(10):e387-e395.].

Assessment of pain in newborns during immunization by using a scoring system

Introduction: The inability of the newborn to independently express words of my pain significantly contributes to the lack of recognition of presence and inadequate treatment of pain. Aim: To determine the presence and intensity of pain during immunization depending. Objective and hypothesis: To determine the presence and intensity of pain during immunization depending on gender and age; assessment of analgesia using the oral solution of 12% sucrose and breast milk selected pain scales (DAN, PIPP). Materials and methods: A prospective transversal study conducted at the Department of Neonatology OB ,,Sveti Luka 'Smederevo in the period March to July 2014. Results: 150 infants, mean gestational age of 39,291 + 1,411 GN. Values DAN and PIPP at the time of maximum response (T1) compared to the beginning of the procedure (T0) were statistically significantly higher (p = 0.00), and compared to the end of the procedure (T2) statistically significantly lower (p = 0, 00). There were no statistically significant changes in value of DAN and PIPP lost between the observed groups of patients according to age and gender. Depending on the non-pharmacological analgesia solution of 12% sucrose and breast milk are DAN and PIPP in all applications observations (T0, T1, T2) were significantly lower than in the control group (p = 0.000). Conclusions: Immunization of infants is painful. The use of oral sucrose solution and breast milk significantly influence the presence and extent of pain in the newborn. The use of breast milk has a slightly better analgesic effects in a newborn during immunization in relation to the use of oral sucrose solution.

PO-0900 Translation Comfortneo – A Pain Assessment Tool

Background COMFORTneo scale is a pain assessment tool designed to assess the degree of pain for neonates. The scale is designed to assess the short term or long term pain. Centre for Clinical guidelines recommend the use of COMFORTneo systematic assessment of pain in newborns in Denmark. The instrument was originally developed in the Netherlands, but are published in an English edition. Purpose The purpose of this poster is to describe how the pain assessment tool COMFORTneo has been translated into Danish and adapted to Danish conditions. Method We have followed the principles recognised as good practice for the translation and cultural adaptation of an instrument from the source language into another language. This translation process involves eight steps: 1) Preparation 2) Forward translation 3) Comparison and critical review of the translations 4) Back Translation 5) Review of back translation 6) Adjustment of COMFORTneo to Danish conditions 7) Pilot Testing and 8) Proof and final adoption. Results Translation and adaptation of COMFORTneo has been a fruitful process. Immediately, the applicability of COMFORTneo was confirmed through involvement of many nurses in the translation process. Involvement of nurses has been important and theese comments have contributed to the establishment of a Danish version of COMFORTneo that makes sense for Danish nurses. Perspectives Following good practice for the translation and cultural adaptation, an instrument COMFORTneo is ready for implementation. This is of great importance as instruments of pain scoring of premature and sick newborns and are called for by many Danish neonatal departments.

Salivary biomarkers are not suitable for pain assessment in newborns

Background and aimsNewborns admitted to the neonatal intensive care unit are repeatedly subjected to painful or stressful procedures; therefore, objective assessment of their pain is essential. An increasing number of scales for neonatal pain assessment have been developed, many of which are based on physiological and behavioral factors. Recently, salivary biomarkers have been used to assess stress in adults and older infants. This study aimed to determine whether salivary biomarkers can be useful objective indices for assessing newborn pain. Study designA total of 47 healthy newborns were enrolled 3–4days after birth. Heel lancing was performed to collect blood for a newborn screening test. Before and after heel lancing, saliva was collected to analyze hormone levels, a video was recorded for behavioral observations, and heart rate was recorded. Two investigators independently assessed newborn pain from the video observations using the Neonatal Infant Pain Scale (NIPS). Salivary chromogranin (sCgA) and salivary amylase (sAA) levels were measured using an enzyme-linked immunosorbent assay kit and a dry chemistry system, respectively. ResultsNo definite changes in salivary biomarkers (sCgA or sAA) were detected before and after heel lancing. However, newborn sCgA levels were markedly higher than reported adult levels, with large inter- and intra-subject variability, whereas newborn sAA levels were lower than adult levels. NIPS score and heart rate were dramatically increased after heel lancing. ConclusionsNIPS score (behavioral assessment) and heart rate are useful stress markers in newborns. However, neither sCgA nor sAA is suitable for assessing newborn pain.

Analysis of behavioural and physiological parameters for the assessment of postoperative analgesic demand in newborns, infants and young children: a comprehensive report on seven consecutive studies.

Many different systems for the assessment of pain in newborns and infants have been tested for validity, rarely for reliability but never for sensitivity or specificity. We aimed to determine whether the assessment of an analgesic demand in the lower age group during the postoperative period is possible by observational methods only. In an repetitive and sequential prospective process for identifying observationable behaviour and measurable physiological parameters as indicators of a postoperative analgesic demand, 584 newborns, infants and young children were studied (7 prospective studies, 4238 observations). Twenty-six items were selected as suggested by current literature and for reasons of economy and practicability. The factor analyses resulted in a two-factorial solution with the behavioural items loading on one factor and the physiological parameters on the other (principal component analyses). The physiological parameters blood pressure, respiratory rate and heart rate were found to be unreliable and had no discriminant power to detect an analgesic demand during the postoperative period (discriminant analyses, ROC-curves). In newborns and infants, nine observational items were identified as equally selective, reliable, sensitive and specific to the assessment of postoperative analgesic demand, whereas in young children only five items could be identified (discriminant analyses, ROC-curves). For economic reasons, these five items (crying, facial expression, posture of the trunk, posture of the legs, motor restlessness) were chosen as the basis of an additional pain scale ranging from 0=no pain to 10=maximal (Children's and Infants' Postoperative Pain Scale, CHIPPS). Its internal consistency yielded values for Cronbachs' alpha with 0.92 for toddlers and 0.96 for infants. The coefficient for interrater reliability was 0.93. The scale was validated constructively by the intravenous administration of metamizol, tramadol, nalbuphine, piritramide and ketamine (repeated measures analysis of variance). The Toddler-Preschooler Postoperative Pain Scale and CHIPPS equally identified painfree situations or analgesic demand in 87.4%. In cases with definite pain, the score of CHIPPS was never below 4 points. Seventy-one toddlers gave verbal comments on their pain intensity: in 29 painfree situations the CHIPPS score was 3.0 and in 29 painful situations it was 5.7. The values for sensitivity and specificity of CHIPPS were calculated to be 0.92-0.96 and 0.74-0.95, respectively (discriminant analyses). We conclude that it is possible to determine postoperative analgesic demand in the low age group of children by using an observational system such as CHIPPS alone.

Pain assessment in newborns

Pain assessment in newborns