Premature Infant Pain Research Articles

The Effect of Grasp Reflex Stimulation on Pain During Vaccine Administration.

The administration of vaccination, being an invasive procedure, can induce considerable pain in preterm infants. This study was conducted to evaluate the effect of grasp reflex stimulation on pain and crying time during hepatitis B vaccine administration in infants. This parallel randomized controlled trial was conducted between November 1, 2022, and April 1, 2023, at the Neonatal Intensive Care Unit of a public hospital in Turkey. The study included preterm infants whose parents provided both verbal and written consent. The control group (n =31) underwent a routine vaccination procedure, while the experimental group (n =28) underwent grasp reflex stimulation in addition to the routine vaccination procedure. Data were collected through the infant information form, stopwatch, and Premature Infant Pain Profile Scale-Revised (PIPP-R) form. The mean PIPP-R score during the procedure was 11.67±2.05 in the experimental group and 15.51±1.36 in the control group (P ≤.001). After the procedure, the mean PIPP-R score was 10.89±2.06 in the experimental group and 14.67±1.55 in the control group (P ≤.001). The mean duration of crying was 19.57±6.17 in the experimental group and 27.12±6.19 in the control group (P ≤.001). The mean PIPP-R and crying time of the control group were higher. Grasp reflex stimulation applied to preterm infants during vaccine administration decreased pain and crying time during and after the procedure. Grasp reflex stimulation can be applied as a care approach for procedures that may cause pain in infants and may help calm infants as part of pain management in nursing. The results of this study provide new information to the literature regarding the impact of grasp reflex stimulation on pain and the duration of crying induced by the hepatitis B vaccine in preterm infants. To our knowledge, this is the first study to confirm the effectiveness and feasibility of grasping reflex stimulation in hepatitis B vaccine administration in preterm infants. This study may contribute to future evidence-based studies. Grasping reflex stimulation can be tried as a parent-provided intervention in younger or older infants or in those who are critically ill.

Efficacy of facilitated tucking position and Reiki given to preterm infants during orogastric tube insertion: A randomised controlled trial.

This research was conducted to evaluate the effects of Reiki and facilitated tucking position on pain, stress and physiologic parameters in preterm infants during orogastric tube (OGT) insertion. The study used a single-blind, parallel-group randomised controlled experimental design. It was carried out in the neonatal intensive care unit of a hospital in Niğde/Turkey between February 2022 and January 2023. A total of 45 preterm infants, who met the study criteria and whose sample size was determined according to power analysis, were randomly divided into three groups. As an intervention, the facilitated tucking position was applied to the first group, and Reiki was applied to the second group during OGT insertion. Routine application continued in the control group. The Infant Introductory Information Form, Physiological Parameter Follow-up Chart, Infant Stress Scale (ISS) and Premature Infant Pain Profile Scale-Revised (PIPP-R) were used for data collection. Significance was accepted as P < 0.05 in the statistical analysis. It was determined that the infants were homogeneously distributed between the experimental and control groups (P > 0.05). Infants who received the facilitated tucking position and Reiki intervention had better physiological stability compared to the control group (P < 0.05). The group with the lowest average stress (1.53 ± 0.99) and pain scores (4.06 ± 1.22) during OGT insertion was the facilitated tucking group (P < 0.001). After the procedure, stress and pain scores in both the facilitated tucking group and the Reiki group were found to be significantly lower than those in the control group (P < 0.001). The results of the study showed that the facilitated tucking position during OGT insertion was especially effective in reducing the pain and stress of infants. Both the facilitated tucking position and Reiki were determined to be effective interventions in reducing the pain and stress of infants more quickly after the procedure. The results of study contribute to the recommendation that NICU nurses should include non-pharmacological methods to decrease the pain of preterm infants during procedural pain.

Prospective, randomized, double-blind trial to validate the efficacy of an oral herbal gel on pain in the newborn during minor diagnostic-therapeutic procedures.

Term and preterm infants are frequently exposed to painful procedures and stimuli during hospitalization in the Neonatal Intensive Care Unit (NICU). Pain is widely recognized to cause short- and long-term effects in the newborn. In recent years there has been a growing medical interest and a strong demand from parents for phytotherapeutic drugs, but literature data are limited, and excellent methodological studies are necessary to evaluate the importance of phytotherapy in the neonatal period. We evaluated the use of an oral phytotherapeutic gel based on chamomile, angelica and oats in the management of full term and preterm infant pain caused by minor diagnostic or therapeutic procedures. We enrolled full term infants (>37 weeks gestational age [GA]) and preterm infants with higher GA than 28 weeks, weighing more than 1000 grams. Assessed painful procedures were minor diagnostic or therapeutic ones. Newborns were double-blind randomized into two groups (A and B) to orally receive the phytotherapeutic gel (solution A) and a gel of the same consistency and aroma (solution B) before the painful procedure. The group of newborns to whom solution A had been administered showed significantly lower scores in the Pain Scale (P<0.01) during painful procedure. This figure indicates that the herbal medicine has been effective in reducing pain experience in the population of examined newborns. To the best of our literature research, our work is the first scientific study highlighting the possibility of preventive beneficial effects of phytotherapeutic drugs on pain control.

Effects of endotracheal suctioning duration cerebral oxygenation in preterm infants.

This study evaluates the effects of endotracheal suctioning duration on cerebral oxygenation and physiological parameters in preterm infants in intensive care. Prospective and observational s tudy. In this study, 51 preterm infants born at 28-34 weeks of gestation in NICU were evaluated. Cerebral oxygenation was measured before, during, and after endotracheal suctioning with near-infrared spectroscopy. Pain levels of the infants were with N-PASS scale. A negative correlation was found between the lowest cerebral oxygenation value during endotracheal suctioning and the duration of endotracheal suctioning. Cerebral oxygenation levels during endotracheal suctioning were lower than pre- and post-endotracheal suctioning levels. Higher cerebral oxygenation was observed in infants whose endotracheal aspiration time was less than 13 s. The duration of endotracheal suctioning was positively correlated with pain and cerebral oxygenation stabilization time. Prolonged endotracheal suctioning duration negatively affects cerebral oxygenation in preterm infants. The study suggests an optimal endotracheal suctioning duration under 13 s. Properly executed endotracheal suctioning, with the correct technique and knowledge, can alleviate the adverse physiological effects observed in preterm infants and contribute to routine nursing care in intensive care units. This study has been reported in line with STROBE checklists. No patient or public contribution was required to design or undertake this research. Patients contributed only to the data collection. This study contributes to defining the ideal endotracheal aspiration duration, as there is not enough data so far. It showed the effect of prolonged endotracheal aspiration time on cerebral oxygenation, pain and physiological parameters in preterm infants.

Behavioral and physiological pain structures of PIPP-R and parental stress: structural equation modeling approach.

Although most non-acute pain assessment tools are multi-dimensional (behavioral and physiological measures) in their approach, the outputs of such tools are considered unidimensional. This study aimed to explore and determine the behavioral and physiological pain structures of Premature Infant Pain Profile-Revised (PIPP-R) for neonates and its association with parental stress. This cross-sectional study was conducted in 2022-2023 in Isfahan, Iran. We recruited 400 pre-term infants, i.e. with gestational age (GA) of less than 37weeks who were admitted to the NICU of educational hospitals. PIPP-R and Parental Stressor Scale: Neonatal Intensive Care Unit (PSS: NICU) were used for data gathering. The latent structures of pain and its association with parental stress were explored using latent variable modeling approach. A two-factor model, i.e. behavioral and physiological pain factors, was extracted, explaining 65% of the total variance. The results of confirmatory factor analysis showed that the identified structures in the exploratory factor analysis could be nearly replicated (CFI = 0.99، TLI = 0.98, RMSEA = 0.001). Behavioral pain structure, independent from gestational age had a significant direct association with parental stress score (β = 0.005, SE = 0.002, p = 0.026). The PIPP-R assesses both behavioral and physiological pain factors. We also found that behavioral pain factor was associated with parental stress. These results may provide a potential clue for physicians, nurses, and parents to manage the pain in preterm infant. The PIPP-R scores in preterm infants consist of "Behavioral and Physiological" pain factors. Single dependence on behavioral indicators (such as facial expression) has some limitations. Multidimensional tools may be the optimal method in detecting pain in preterm infants. Parental stress can affect behavioral pain structure in preterm infants. Intensive care nurses play an effective role in reducing the parental stress and pain severity of these preterm infants by including the help of mothers in procedures and providing them with psychological support.

Factors influencing nurses' practice of skin-to-skin contact as a pain management intervention for preterm infants

PurposeTo identify contextual as well as individual (personal and professional) factors influencing the practice of skin-to-skin contact (SSC) by nurses as a pain management intervention for preterm infants. SSC is among the most effective non-pharmacological interventions to manage procedural pain in preterm infants. MethodsIn this secondary analysis of a comparative international cross-sectional design study, 202 nurses were recruited and completed self-administered questionnaires. A mixed model was conducted. ResultsThe contextual factors correlated with the use of SSC for pain management included the country (p < 0.001) and work shift (p < 0.001). Individual nurse factors were level of education (p < 0.001), motherhood history (p < 0.001) as well as self-reported skin-to-skin practices [p < 0.001] (positive attitudes, education, and implementation). ConclusionMany factors may contribute to explain the differences in the use of SSC for pain management by nurses. These factors could be of relevant to consider when implanting SSC to manage procedural pain in preterm neonates.

The effect of music on pain, comfort, and physiological parameters during premature retinopathy examination

AimTo determine the effect of music applied during the ROP examination on pain, comfort, and physiological parameters in preterm infants. MethodsThe sample of this prospective randomized controlled double-blind experimental study consisted of 28 preterm infants who were examined for ROP of a tertiary hospital in the Neonatal Unit. Data were collected with a Questionnaire, Physiological Parameters Observation Form (PPOF), Revised-Premature Infant Pain Profile (PIPP-R), and Premature Infant Comfort Scale (PICS). ResultsThe results revealed that the crying times of the infants in the experimental group were shorter than the infants in the control group. The preterm infants in the experimental group had statistically lower PIPP-R scores during and after the procedure than the PIPP-R scores of the infants in the control group (p < 0.001) and the music applied to the preterm infants resulted in a mean decrease of 3.857 in the post-procedure and pre-procedure PIPP-R scores (p < 0.05). While there was no statistical difference between the pre-procedure and pre-procedural PICS scores of the preterm infants in the experimental and control groups (p = 0.599; p = 117), the post-procedure PICS values of the preterm infants in the experimental group were found to be lower than those of the control group (p < 0.001). It was found that the music applied to preterm infants during the ROP examination resulted in a mean decrease of 1.286 in PICS scores after the procedure and before the procedure (p < 0.05). ConclusionIt was determined that the music listened to during the ROP examination decreased the PIPP-R pain scores of preterm infants, had a positive effect on the PICS scores after the procedure, but did not affect the physiological parameters positively.Trial Registration: ClinicalTrials.gov Identifier: NCT05263973

The effects of white noise and swaddling methods on orogastric tube insertion-related pain in preterm infants: A randomized controlled trial.

This study aims to investigate the effects of the white noise, swaddling and white noise + swaddling methods on pain and physiological parameters associated with orogastric tube insertion procedure. This was a randomized controlled trial. A total of 132 preterm infants were randomly assigned to four groups as white noise group (n = 33), swaddling group (n = 33), white noise + swaddling group (n = 33) and control group (n = 33). Interventions were initiated 5 min before the orogastric tube insertion procedure and continued during and up to 5 min after the procedure. White noise intervention alone did not have a significant effect on reducing pain associated with orogastric tube insertion (p > 0.05). Compared with the control group, the preterm infants in the swaddling group experienced 0.587 times less pain, and those in the white noise + swaddling group experienced 0.473 times less pain. Findings indicate the swaddling and the combination of white noise + swaddling may be a useful intervention in reducing the invasive pain experienced by preterm infants during and after orogastric tube insertion and in improving the physiological parameters associated with pain.

Non-pharmacological methods to reduce pain in preterm infants: A systematic review

Objective: To systematically review the literature to determine whether non-pharmacological interventions reduce preterm infants' pain during invasive procedures in the neonatal intensive care unit. Methods: A systematic search was conducted according to the criteria of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for conducting and reporting systematic reviews. The search was performed in PubMed and Scopus from 2013 to 2023. Only studies in English were included. Results: In total, forty-four studies were included. Kangaroo Mother Care, massage, Yakson Touch, Gentle Human Touch, music therapy, mother’s voice, white noise, maternal heartbeat sounds, facilitated tucking, sucrose administration, olfactory stimulation, the use of "Calmer," environment modification, expressed breast milk, the mother scented simulated hand, and the combination of these methods proved to be effective in reducing pain in preterm infants undergoing various medical procedures. Conclusion: Healthcare professionals should consider using non-pharmacological methods for pain relief during minor invasive procedures.

Brain health in preterm infants: importance of early-life pain and analgesia exposure.

"Everyday" exposures in the neonatal period, such as pain, may impact brain health in preterm infants. Specifically, greater exposure to painful procedures in the initial weeks after birth have been related to abnormalities in brain maturation and growth and poorer neurodevelopmental outcomes in preterm infants. Despite an increasing focus on the importance of treating pain in preterm infants, there is a lack of consensus of optimal approaches to managing pain in this population. This may be due to recent findings suggesting that commonly used analgesic and sedative medications in preterm infants may also have adverse effects of brain maturation and neurodevelopmental outcomes. This review provides an overview of potential impacts of pain and analgesia exposure on preterm brain health while highlighting research areas in need of additional investigations for the development of optimal pain management strategies in this population.

The effect of maternal voice and non-nutritional sucking on repeated procedural pain of heel prick in neonates: a quasi-experimental study

BackgroundNeonates in the neonatal intensive care unit undergo frequent painful procedures. It is essential to reduce pain using safe and feasible methods.PurposeTo evaluate the effects of non-nutritional sucking, mother’s voice, or non-nutritional sucking combined with mother’s voice on repeated procedural pain in hospitalized neonates.MethodsA quasi-experimental study was conducted in which 141 neonates were selected in a hospital in Changsha, China. Newborns were divided into four groups: non-nutritional sucking (NNS) (n = 35), maternal voice (MV) (n = 35), NNS + MV (n = 34), and control (n = 37) groups. The Preterm Infant Pain Profile-Revised Scale (PIPP-R) was used to assess pain.ResultsDuring the heel prick, the heart rate value and blood oxygen saturation were significantly different between the groups (P < 0.05). Both non-nutritional sucking and maternal voice significantly reduced PIPP-R pain scores of hospitalized newborns (P < 0.05). The pain-relief effect was more robust in the combined group than in other groups.ConclusionsThis study showed that both non-nutritional sucking and the mother’s voice alleviated repeated procedural pain in neonates. Therefore, these interventions can be used as alternatives to reduce repeated procedural pain.

Translating evidence: pain treatment in newborns, infants, and toddlers during needle-related procedures : German version

Treatment of pain in preterm, sick, and healthy newborns and infants and toddlers (up to 2years of age) is consistently reported to be inadequate, and effective strategies are poorly implemented. To present existing evidence of effective pain treatment strategies during needle-related procedures and to highlight initiatives focused on translating evidence into practice. This Clinical Update focuses on the 2022 International Association for the Study of Pain Global Year for Translating Pain Knowledge to Practice in the specific population of newborns, infants, and toddlers. Best evidence is reviewed, and existing knowledge translation strategies and programs available to implement evidence into practice are presented. Effective strategies for newborn and young infants during frequently occurring needle procedures include small volumes of sweet solutions, breastfeeding, or skin-to-skin care when feasible and culturally acceptable. In addition, strategies such as nonnutritive sucking, positioning, swaddling, gentle touch, facilitated tucking, and secure holding can be used. For toddlers, the evidence is less robust, and discerning between pain and distress is challenging. However, strategies recommended for needlerelated procedures include upright secure comfort holding by parents/caregivers, age-appropriate distraction, and topical anesthetics. Translation of effective pain management needs to involve the family, who need to be supported and empowered to comfort their child during painful procedures. Organizational, nationwide, and global initiatives aimed at improving implementation of effective pain treatments exist. There is evidence of effective pain management strategies for newborns, infants, and toddlers, and agreat deal of effort is being made to translate knowledge into action.

Comparing the effect of aromatherapy with breast milk, Lavandula stoechas, and Rosa damascena on venipuncture pain in preterm infants.

Since preterm infants frequently undergo painful diagnostic and therapeutic procedures, pain management, especially through non-pharmacological methods, will be extremely beneficial. Accordingly, the present study aimed to compare the effects of aromatherapy with breast milk, Lavandula stoechas, and Rosa damascena on venipuncture pain in preterm infants. In this interventional study, preterm infants were randomly divided into four groups of aromatherapy with breast milk (25 infants), Lavandula stoechas (25 infants), Rosa damascena (25 infants), and sham (25 infants). One minute before, during, and two minutes after venipuncture, the Neonatal Infant Pain Scale (NIPS) as well as heart rate and SPO2 were measured. The results indicated that pain intensity was significantly lower during and after venipuncture in all the aromatherapy methods compared with the sham group (P<0.001). Breast milk odor decreased the pain more than the other two odors during and after venipuncture (P<0.001); however, there was no significant difference between Lavandula stoechas and Rosa damascena (P=0.94). SPO2 was significantly higher in infants in the Lavandula stoechas (P<0.001) and Rosa damascena (P=0.03) groups compared with the sham infants. All three aromatherapy methods were effective in decreasing preterm infants' venipuncture pain. Since no study on the effect of aromatherapy with Rosa damascena was found in this regard, the effectiveness of aromatherapy with Rosa damascena is of great importance, and future studies are recommended to analyze this topic in greater depth.

The effect of music on pain management in preterm infants during daily painful procedures: a systematic review and meta-analysis.

The present systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted to investigate the effects of music on pain management in preterm neonates during painful procedures. The PubMed, Embase, Web of Science, EBSCO and Cochrane Library databases were searched to identify relevant articles published from their inception to September 2023. The study search strategy and all other processes were implemented in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Four RCTs that satisfied the inclusion criteria were included in this meta-analysis. The music group had significantly lower Premature Infant Pain Profile (PIPP) scores during (RR = -1.21; 95% CI = -2.02--0.40, p = 0.0032) and after painful procedures (RR = -0.65; 95% CI = -1.06--0.23, p = 0.002). The music group showed fewer changes in PIPP scores after invasive operations than did the control group (RR = -2.06; 95% CI -3.16--0.96; p = 0.0002). Moreover, our results showed that music improved oxygen saturation during (RR = 3.04, 95% CI = 1.64-4.44, p < 0.0001) and after painful procedures (RR = 3.50, 95% CI = 2.11-4.90, p < 0.00001). However, the change in peak heart rate during and after painful procedures was not statistically significant (RR = -12.14; 95% CI = -29.70-5.41 p = 0.18; RR = -10.41; 95% CI = -22.72-1.90 p = 0.10). In conclusion, this systematic review demonstrated that music interventions are effective for relieving procedural pain in preterm infants. Our results indicate that music can reduce stress levels and improve blood oxygen saturation. Due to the current limitations, large-scale, prospective RCTs should be performed to validate the present results.

NON-pharmacological Approach Less Invasive Surfactant Administration (NONA-LISA) trial: protocol for a randomised controlled trial

IntroductionUsing pre-procedure analgesia with the risk of apnoea may complicate the Less Invasive Surfactant Administration (LISA) procedure or reduce the effect of LISA.MethodsThe NONA-LISA trial (ClinicalTrials.gov, NCT05609877) is a multicentre, blinded, randomised controlled trial aiming at including 324 infants born before 30 gestational weeks, meeting the criteria for surfactant treatment by LISA. Infants will be randomised to LISA after administration of fentanyl 0.5–1 mcg/kg intravenously (fentanyl group) or isotonic saline solution intravenously (saline group). All infants will receive standardised non-pharmacological comfort care before and during the LISA procedure. Additional analgesics will be provided at the clinician’s discretion. The primary outcome is the need for invasive ventilation, meaning mechanical or manual ventilation via an endotracheal tube, for at least 30 min (cumulated) within 24 h of the procedure. Secondary outcomes include the modified COMFORTneo score during the procedure, bronchopulmonary dysplasia at 36 weeks, and mortality at 36 weeks.DiscussionThe NONA-LISA trial has the potential to provide evidence for a standardised approach to relief from discomfort in preterm infants during LISA and to reduce invasive ventilation. The results may affect future clinical practice.ImpactPre-procedure analgesia is associated with apnoea and may complicate procedures that rely on regular spontaneous breathing, such as Less Invasive Surfactant Administration (LISA).This randomised controlled trial addresses the effect of analgesic premedication in LISA by comparing fentanyl with a placebo (isotonic saline) in infants undergoing the LISA procedure. All infants will receive standardised non-pharmacological comfort.The NONA-LISA trial has the potential to provide evidence for a standardised approach to relief from discomfort or pain in preterm infants during LISA and to reduce invasive ventilation. The results may affect future clinical practice regarding analgesic treatment associated with the LISA procedure.

Effect of non-pharmacological interventions on pain in preterm infants in the neonatal intensive care unit: a network meta-analysis of randomized controlled trials

ObjectiveTo evaluate the effectiveness of different non-pharmacological interventions for pain management in preterm infants and provide high-quality clinical evidence.MethodsRandomized controlled trials (RCTs) of various non-pharmacological interventions for pain management in preterm infants were searched from PubMed, Web of Science, Embase, and the Cochrane Library from 2000 to the present (updated March 2023). The primary outcome was pain score reported as standardized mean difference (SMD). The secondary outcomes were oxygen saturation and heart rate reported as the same form.ResultsThirty five RCTs of 2134 preterm infants were included in the meta-analysis, involving 6 interventions: olfactory stimulation, combined oral sucrose and non-nutritive sucking (OS + NNS), facilitated tucking, auditory intervention, tactile relief, and mixed intervention. Based on moderate-quality evidence, OS + NNS (OR: 3.92, 95% CI: 1.72, 6.15, SUCRA score: 0.73), facilitated tucking (OR: 2.51, 95% CI: 1.15, 3.90, SUCRA score: 0.29), auditory intervention (OR: 2.48, 95% CI: 0.91, 4.10, SUCRA score: 0.27), olfactory stimulation (OR: 1.80, 95% CI: 0.51, 3.14, SUCRA score: 0.25), and mixed intervention (OR: 2.26, 95% CI: 0.10, 4.38, SUCRA score: 0.14) were all superior to the control group for pain relief. For oxygen saturation, facilitated tucking (OR: 1.94, 95% CI: 0.66, 3.35, SUCRA score: 0.64) and auditory intervention (OR: 1.04, 95% CI: 0.22, 2.04, SUCRA score: 0.36) were superior to the control. For heart rate, none of the comparisons between the various interventions were statistically significant.ConclusionThis study showed that there are notable variations in the effectiveness of different non-pharmacological interventions in terms of pain scores and oxygen saturation. However, there was no evidence of any improvement in heart rate.

Ab. No. 101 A Conceptual Model of a Unified Wrist Sensor (UWS) for Non-Invasive Real-Time Preterm Infant Monitoring at NICU

Introduction: This study introduces a groundbreaking conceptual model for a Unified Wrist Sensor (UWS) designed to revolutionize non-invasive real-time monitoring of preterm infants in the Neonatal Intensive Care Unit (NICU). Current pain, sleep, and stress assessments in NICU settings are fraught with subjectivity and time constraints. The proposed UWS addresses these challenges by integrating multiple sensors into a single, non-restrictive wristband. Methods: The conceptual model employs a systematic approach, encompassing pre-processing, feature extraction, optimization, and learning models. Deep learning and machine learning techniques are harnessed to enhance accuracy in processing diverse physiological data. Standardization methods such as linear scaling, log scaling, or z-score are strategically applied to reduce variability, ensuring reliable outcomes across different individuals. Result: The discussion underscores the critical need for intelligent fusion structures that incorporate multiple sensor data and rich contextual information. The UWS aims to strike a balance between clinical utility and practicality, offering complementary, robust, and reliable multimodal sensor data. This approach provides a comprehensive understanding of pain, sleep, and stress patterns in preterm infants, paving the way for personalized treatment protocols. Conclusion: In conclusion, the proposed UWS emerges as a potential game-changer, appropriately reweighting data and enabling real-time monitoring of pain, stress, and sleep in NICU infants. The implications of this research are far-reaching, as the UWS can monitor physiological changes using multiple modalities, assess real-time patient outcomes, and dynamically adjust treatment protocols. Implication: This study contributes significantly to the field of neonatal care and introduces the prospect of seamlessly integrating advanced sensor technology into routine NICU practices.

Experience of early-life pain in premature infants is associated with atypical cerebellar development and later neurodevelopmental deficits

BackgroundInfants born very and extremely premature (V/EPT) are at a significantly elevated risk for neurodevelopmental disorders and delays even in the absence of structural brain injuries. These risks may be due to earlier-than-typical exposure to the extrauterine environment, and its bright lights, loud noises, and exposures to painful procedures. Given the relative underdeveloped pain modulatory responses in these infants, frequent pain exposures may confer risk for later deficits.MethodsResting-state fMRI scans were collected at term equivalent age from 148 (45% male) infants born V/EPT and 99 infants (56% male) born at term age. Functional connectivity analyses were performed between functional regions correlating connectivity to the number of painful skin break procedures in the NICU, including heel lances, venipunctures, and IV placements. Subsequently, preterm infants returned at 18 months, for neurodevelopmental follow-up and completed assessments for autism risk and general neurodevelopment.ResultsWe observed that V/EPT infants exhibit pronounced hyperconnectivity within the cerebellum and between the cerebellum and both limbic and paralimbic regions correlating with the number of skin break procedures. Moreover, skin breaks were strongly associated with autism risk, motor, and language scores at 18 months. Subsample analyses revealed that the same cerebellar connections strongly correlating with breaks at term age were associated with language dysfunction at 18 months.ConclusionsThese results have significant implications for the clinical care of preterm infants undergoing painful exposures during routine NICU care, which typically occurs without anesthesia. Repeated pain exposures appear to have an increasingly detrimental effect on brain development during a critical period, and effects continue to be seen even 18 months later.

Pharmacological pain and sedation interventions for the prevention of intraventricular hemorrhage in preterm infants on assisted ventilation - an overview of systematic reviews.

Pharmacological pain and sedation interventions for the prevention of intraventricular hemorrhage in preterm infants on assisted ventilation - an overview of systematic reviews.

Evaluation of Chronic Pain in Premature Infants on Invasive and Noninvasive Mechanical Ventilation

Amaç: İnvaziv ve noninvaziv mekanik ventilasyondaki prematüre bebeklerin kronik ağrısını değerlendirmek amacıyla yürütülen bu çalışma tanımlayıcı olarak yapılmıştır.&#x0D; Gereç ve Yöntem: Bu araştırmanın örneklemini Yenidoğan Yoğun Bakım Ünitesi’nde yatan, gestasyon yaşları ≥25 hafta ve ≤ 36 hafta olan 110 prematüre bebek oluşturmuştur. Veriler bebeklerin özelliklerini belirlemek amacıyla Tanımlayıcı Bilgi Formu ve Yenidoğan Ağrı ve Rahatsızlık Ölçeği (EDIN) ile Şubat 2018- Nisan 2019 tarihleri arasında toplanmıştır. Veriler normal dağılıma uygunluk durumuna uygun testler ile analiz edilmiş ve önemlilik düzeyi p6 puan) tespit edilmiştir. Mekanik ventilasyon uygulanan prematüre bebeklerin yatış süresi ve mekanik ventilasyon uygulama süresi arttıkça kronik ağrı puanlarının arttığı tespit edilmiştir (p