Pain Response In Neonates Research Articles

Study of pain response in neonates during venipuncture with a view to analyse utility of topical anaesthetic agent for alleviating pain

BackgroundNeonates being nonverbal are unable to express their pain leading to underestimation of their pain and hence insufficient pain relief. Neonatal pain is assessed by pain scales based on the behavioural and physiological changes that occur in response to painful stimuli. This cross sectional study was conducted at a tertiary care centre using Premature Infant Pain Profile (PIPP) score with 4% lidocaine as local anaesthetic agent to produce surface anaesthesia of skin prior to intravenous cannulation. MethodsSample size was collected by simple randomisation method. Our study groups included 50 term and 50 preterm neonates with POG of 28–40 weeks requiring IV cannulation. Heart rate (HR), SpO2, facial expressions and behavioural state were noted before venipuncture and after venipuncture using PIPP scale. Same cohort of patients was assessed for pain response after applying 4% lidocaine cream during future venipuncture with help of PIPP score. ResultsThe PIPP score in preterm group before and after anesthesia was 11.28±3.72 and 9.58±3.39. PIPP score in term group before and after anesthesia was 11.54±2.84 and 9.04±2.97. There was reduction in mean PIPP score after using topical anesthetic agent in both study groups and the results were statistically significant. ConclusionThis study found that topical anesthetic agents were effective in reducing pain during venipuncture. Based on the facts of the study, it is recommended that pain scoring should be a part of routine monitoring in neonatal intensive care units and appropriate measures should be used to reduce pain.

Olfactive stimulation interventions for managing procedural pain in preterm and full-term neonates: a systematic review protocol

BackgroundWhile hospitalized in the NICU, preterm neonates undergo many painful procedures. This may be the same for full-term neonates when longer hospitalization is required. Untreated and repeated pain has short-term as well as long-term consequences for these neonates. Pharmacological pain management methods have many limitations in their applications for both preterm and full-term neonates. A combination of different non-pharmacological methods is recommended for pain management. The effect of olfactive stimulation as a non-pharmacological pain management method was investigated by a few studies in the past years with premature and term neonates, but no systematic review has been conducted. The objective of this systematic review is to evaluate the effect of olfactive stimulation intervention on the pain response of preterm and full-term neonates during painful procedures.MethodsAn electronic search will be conducted in various databases such as PubMed (1946 to date), MEDLINE (1946 to date), CINAHL (1981 to date), Embase (1947 to date), PsycINFO (1806 to date), Web of Science (1945 to date), CENTRAL and Scopus (1960 to date), and Proquest, without restriction for the year of publication. Only studies published in English or French will be included. The search will be conducted using the following three concepts: pain, odors, and neonates. Selection of articles, data extraction, and assessment of risk of bias will be conducted by two independent researchers. A third researcher will intervene in case of disagreement. According to the availability of studies and data homogeneity, the results will be combined to perform a meta-analysis, or they will be described by a narrative synthesis.DiscussionThis systematic review will provide light on the current state of knowledge on the effectiveness of olfactive stimulation interventions for managing pain in preterm and full-term neonates. This review will guide clinical practice as well as research to improve preterm and full-term neonates’ pain management and prevent short-term and long-term complications caused by pain.Systematic review registrationPROSPERO CRD42017058021

Individual contextual factors in the validation of the Bernese pain scale for neonates: protocol for a prospective observational study

BackgroundThe Bernese Pain Scale for Neonates (BPSN) is a multidimensional pain assessment tool that is already widely used in clinical settings in the German speaking areas of Europe. Recent findings indicate that pain responses in preterm neonates are influenced by individual contextual factors, such as gestational age (GA), gender and the number of painful procedures experienced. Currently, the BPSN does not consider individual contextual factors. Therefore, the aim of this study is the validation of the BPSN using a large sample of neonates with different GAs. Furthermore, the influence of individual contextual factors on the variability in pain reactions across GA groups will be explored. The results will be used for a modification of the BPSN to account for individual contextual factors in future clinical pain assessment in neonates.Methods and designThis prospective multisite validation study with a repeated measures design will take place in three university hospital neonatal intensive care units (NICUs) in Switzerland (Bern, Basel and Zurich). To examine the impact of GA on pain responses and their variability, the infants will be stratified into six GA groups ranging from 24 0/7 to 42 0/7. Among preterm infants, 2–5 routine capillary heel sticks within the first 14 days of life, and among full-term infants, two heel sticks during the first days of life will be documented. For each heel stick, measurements will be video recorded for each of three phases: baseline, heel stick, and recovery. The infants’ pain responses will be rated according to the BPSN by five nurses who are blinded as to the number of each heel stick and as to the measurement phases. Individual contextual factors of interest will be extracted from patient charts.DiscussionUnderstanding and considering the influence of individual contextual factors on pain responses in a revised version of the BPSN will help the clinical staff to more appropriately assess pain in neonates, particularly preterm neonates hospitalized in NICUs. Pain assessment is a first step toward appropriate and efficient pain management, which itself is an important factor in later motor and cognitive development in this vulnerable patient population.Trial registrationThe study is registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461. Registration date: 12 April 2016.

Studi Komparatif Pemberian Air Susu Ibu (ASI) dan Glukosa 30% terhadap Respon Nyeri Neonatus yang Dilakukan Tindakan Invasif di Rumah Sakit Abdul Moeloek Provinsi Lampung

Neonates that were hospitalized, often got invasive procedure that causes pain. Invasive procedures in 54 neonates that were in the NICU, there were occur 3283 times acts that cause pain during treatment. Pain is an unpleasant experience due to tissue damage, that have subjective nature can be assessed from facial expressions, body movements, crying and break. The pain scale were using the Neonatal Infant Pain Scale (NIPS). This study was to compare the combination of breast feeding and NNS to combination glucose 30% and NNS, for neonatal pain response during applying infusion or taking blood specimen, in A hospital of Lampung Province. It was a quasi experiment with comparison group design (static group comparism). Sample were neonates aged 0-28 which was applied infusion or taken blood specimen, consist of 16 respondents as group of NNS combination with breast feeding and 16 respondents as group of NNS intervention combination with glucose 30%. Differences of pain response during infusion or taking blood specimen were analyzed by independent sample t-test. The results showed that there was no significant difference between the combination group of NNS with breast feeding and the group of NNS combination with glucose 30% (p=0.076). Based on this study, it was recommended that NNS with breast feeding and NNS with glucose 30%, both can be used as a non-pharmacological therapy management in neonates while applying infusion or taking blood specimen.

Decreased neonatal pain response after vaginal-operative delivery with Kiwi OmniCup versus metal ventouse

BackgroundVaginal delivery, especially operative assisted vaginal delivery, seems to be a major stressor for the neonate. The objective of this study was to evaluate the stress response after metal cup versus Kiwi Omnicup® ventouse delivery.MethodsThe study was a secondary observational analysis of data from a former prospective randomised placebo controlled multicentre study on the analgesic effect of acetaminophen in neonates after operative vaginal delivery and took place at three Swiss tertiary hospitals. Healthy pregnant women ≥35 weeks of gestation with an estimated fetal birth weight above 2000 g were recruited after admission to the labour ward. Pain reaction was analysed by pain expression score EDIN scale (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) directly after delivery. For measurement of the biochemical stress response, salivary cortisol as well as the Bernese Pain Scale of Newborns (BPSN) were evaluated before and after an acute pain stimulus (the standard heel prick for metabolic testing (Guthrie test)) at 48–72 h.ResultsInfants born by vaginal operative delivery displayed a lower pain response after plastic cup than metal cup ventouse delivery (p < 0.001), but the pain response was generally lower than expected and they recovered fully within 72 h.ConclusionsNeonatal pain response is slightly reduced after use of Kiwi OmniCup® versus metal cup ventouse.Trial registrationTrial was registered under under NCT00488540 on 19th June 2007.

Effect of combined music and touch intervention on pain response and \u03b2-endorphin and cortisol concentrations in late preterm infants

BackgroundPreterm neonates undergo many painful procedures as part of their standard care in the neonatal intensive care unit. However, pain treatment is inadequate in many of these routine procedures. In the present study, we investigated the impact and mechanism of combined music and touch intervention (CMT) on the pain response in premature infants.MethodsSixty-two preterm neonates (gestational age of <37 weeks) were randomly assigned to either the experimental or control group. Infants in the experimental group underwent painful procedures with CMT, and those in the control group underwent painful procedures without CMT. Blood samples were collected from all infants at the beginning of hospitalization and 2 weeks later to assess the cortisol and β-endorphin concentrations. Differences in the levels of cortisol and β-endorphin between two groups were examined using analysis of covariance (ANCOVA).ResultsIn total, 3707 painful procedures were performed on 62 neonates during their hospitalization. The average number of painful procedures in the control group (n = 35.5) was higher than that in the experimental group (n = 29.0) during hospitalization, although no significant difference was reached (P > 0.05). After 2 weeks, the Premature Infant Pain Profile scores were significantly higher in the control group than experimental group (13.000 ± 0.461 vs 10.500 ± 0.850, respectively; P < 0.05). The cortisol concentration was not significantly different between the control and experimental groups either at the beginning of hospitalization (131.000 ± 18.190 vs 237.200 ± 43.860, respectively; P > 0.05) or 2 weeks later (162.400 ± 23.580 vs 184.600 ± 21.170, respectively; P > 0.05). However, the serum β-endorphin concentration was higher in the experimental group than in the control group both at the beginning of hospitalization (1.640 ± 0.390 vs 1.179 ± 0.090, respectively; P < 0.05) and 2 weeks later (2.290 ± 0.740 vs 1.390 ± 0.410, respectively; P < 0.05).ConclusionsCMT might decrease the pain response of preterm neonates by significantly improving the β-endorphin concentration, but not the blood cortisol concentration.Trial registrationCurrent Controlled Trials ISRCTN14131492. Registered on 01 Aug 2016.

Neonatal inflammatory pain and systemic inflammatory responses as possible environmental factors in the development of autism spectrum disorder of juvenile rats.

BackgroundAutism spectrum disorder (ASD) affects many children and juveniles. The pathogenesis of ASD is not well understood. Environmental factors may play important roles in the development of ASD. We examined a possible relationship of inflammatory pain in neonates and the development of ASD in juveniles.MethodsAcute inflammation pain was induced by 5 % formalin (5 μl/day) subcutaneous injection into two hindpaws of postnatal day 3 to 5 (P3–P5) rat pups. Western blot, immunohistochemical, and behavioral examinations were performed at different time points after the insult.ResultsFormalin injection caused acute and chronic inflammatory responses including transient local edema, increased levels of inflammatory cytokines, TNF-α, and IL-1β in the blood as well as in the brain, and increased microglia in the brain. One day after the pain insult, there was significant cell death in the cortex and hippocampus. Two weeks later, although the hindpaw local reaction subsided, impaired axonal growth and demyelization were seen in the brain of P21 juvenile rats. The number of bromodeoxyuridine (BrdU) and doublecortin (DCX) double-positive cells in the hippocampal dentate gyrus of P21 rats was significantly lower than that in controls, indicating reduced neurogenesis. In the P21 rat’s brain of the formalin group, the expression of autism-related gene neurexin 1 (NRXN1), fragile X mental retardation 1 (FMR1), and oxytocin was significantly downregulated, consistent with the gene alteration in ASD. Juvenile rats in the formalin group showed hyperalgesia, repetitive behaviors, abnormal locomotion, sleep disorder, and distinct deficits in social memory and social activities. These alterations in neuroinflammatory reactions, gene expression, and behaviors were more evident in male than in female rats. Importantly, an anti-inflammation treatment using indomethacin (10 mg/kg, i.p.) at the time of formalin injections suppressed inflammatory responses and neuronal cell death and prevented alterations in ASD-related genes and the development of abnormal behaviors.ConclusionsThese novel observations indicate that severe inflammatory pain in neonates and persistent inflammatory reactions may predispose premature infants to development delays and psychiatric disorders including ASD. The prevention of pain stimuli and prompt treatments of inflammation during development appear vitally important in disrupting possible evolution of ASD syndromes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12974-016-0575-x) contains supplementary material, which is available to authorized users.

Randomized placebo-controlled trial of sucrose analgesia on neonatal skin blood flow and pain response during heel lance.

To evaluate the effect of oral sucrose on skin blood flow (SBF; perfusion units; PU) measured by Laser Doppler Imager (LDI) in term newborns and pain response (Neonatal Infant Pain Scale score; NIPS score) during heel lance; (2) determine SBF changes during heel lance; and (3) the relationship between SBF and NIPS. Term infants ≤7 days old (n=56) undergoing routine heel lance were randomized to pretreatment with 2.0 mL oral 24% sucrose (n=29) or sterile water (n=27) in a double-blinded, placebo-controlled trial. SBF was assessed by LDI scans and NIPS scores at 10 minutes before lance, immediately after lancing, and 5 minutes after blood extraction. Mean SBF and median NIPS scores were compared between groups using General Linear Model or Kruskal-Wallis. Regressions examined the relationship between SBF immediately after heel lance and NIPS score. Mean SBF and median NIPS scores immediately after heel lance were lower in sucrose-treated infants (167.9±15.5 vs. 205.4±16.0 PU, P=0.09; NIPS 1 [interquartile range 0 to 4] vs. NIPS 3 [interquartile range 0 to 6], P=0.02), although no significant difference in mean SBF. During heel lance NIPS score was predictive of SBF. An increase of 1 in NIPS score was associated with 11 PU increase in SBF (R=0.21; P=0.09) for sucrose, and 16 PU increase for placebo-treated infants (R=0.20; P=0.014). Increased SBF assessed by LDI is a pain response among term neonates after routine heel lance, which was not completely attenuated by oral sucrose administration. Increased SBF is associated with NIPS scores. Sucrose analgesic efficacy evidenced by decreased NIPS scores for the sucrose group. Association of SBF with NIPS scores suggests that LDI is potentially useful for assessing newborn procedural pain.

Respon Nyeri pada Neonatus Paska Pengambilan Darah Setelah Dibedong di Ruang Neonatus RSUD Ngudi Waluyo Wlingi

Newborns in hospitals often have a variety of invasive procedures, so that the baby is experiencing pain. Baby’s sense of discomfort and fear which will result from the pain can be observed through the tears. While wrapping the newborn to fit in a blanket (swaddling) can soothe a fussy baby or cry. The purpose of this study was to identify the effect of swaddling on pain response in neonates after venous blood sampling procedures in hospitals Ngudi Waluyo Wlingi. This study was descriptive. Samples taken by accidental sampling technique with a sample of 35 neonates. The results showed that swaddled neonates after venous blood sampling procedure was 80% (28 respondents) pulse between 120–160 times per minute, 100% (35 respondents) respiration between 30–60 times per minute and 51.4% (18 respondents) SaO2 is greater than 92%. Behavioral responses such as shrill and loud cry was 8.4% (24 respondents), stretching in some facial muscles and facial muscles stretching along each was 4.2% (12 respondents), a strong move is 5.95% (17 respondents ), and increased muscle tone face with flexion of the fingers and toes was 7.7% (22 respondents).Use of swaddling post venous blood sampling procedures in neonates can be used as a way of making neonates feel comfortable and calm.

To study the effect of Kangaroo Mother Care on pain response in preterm neonates and to determine the behavioral and physiological responses to painful stimuli in preterm neonates: a study from western Rajasthan

Aims: To study the effect of Kangaroo Mother Care (KMC) on pain response in preterm neonates and to determine the behavioral and physiological responses to painful stimuli in preterm neonates.Materials and methods: This was a single-blind cross over study in which total 140 neonates were enrolled. Pain stimulus was given in the form of heel-lance before and after giving KMC and data were recorded.Results: The effect of KMC on heart rate variability was statistically significant in preterm (30–34 wks) and very low birth weight (1.0–1.5 kg) neonates. The mean fall in SpO2 from base line was less in KMC group as compared to without KMC group at 60 s (1.63% versus 2.22%) and 120 s (0.45% versus 2.22%). The mean duration of cry was less in the KMC group (15.05 s) as compared to without KMC group (24.82 s) and the difference was statistically significant (p < 0.05). The mean duration of cry was reduced by 36% in KMC group as compared to the without KMC group. The effect of KMC on pain scores (premature infant pain profile (PIPP)) were significantly lower after heel-lance in KMC at 60 s (p < 0.01).Conclusion: KMC is a most physiological, non-pharmacological and easy intervention that involves parents: to manage procedural pain that can be implemented for physiological or behavioral stability in their premature infants.

Pain relief effect of breast feeding and music therapy during heel lance for healthy-term neonates in China: A randomized controlled trial

Objectivesto test the effectiveness of breast feeding (BF), music therapy (MT), and combined breast feeding and music therapy (BF+MT) on pain relief in healthy-term neonates during heel lance. Designrandomised controlled trial. Settingin the postpartum unit of one university-affiliated hospital in China from August 2013 to February 2014. Participantsamong 288 healthy-term neonates recruited, 250 completed the trial. All neonates were undergoing heel lancing for metabolic screening, were breast fed, and had not been fed for the previous 30 minutes. Interventionsall participants were randomly assigned into four groups – BF, MT, BF+MT, and no intervention – with 72 neonates in each group. Neonates in the control group received routine care. Neonates in the other three intervention groups received corresponding interventions five minutes before the heel lancing and throughout the whole procedure. MeasurementsNeonatal Infant Pain Scale (NIPS), latency to first cry, and duration of first crying. Findingsmean changes in NIPS scores from baseline over time was dependent on the interventions given. Neonates in the BF and combined BF+MT groups had significantly longer latency to first cry, shorter duration of first crying, and lower pain mean score during and one minute after heel lance, compared to the other two groups. No significant difference in pain response was found between BF groups with or without music therapy. The MT group did not achieve a significantly reduced pain response in all outcome measures. ConclusionsBF could significantly reduce pain response in healthy-term neonates during heel lance. MT did not enhance the effect of pain relief of BF. Implications for practicehealthy-term neonates should be breast fed to alleviate pain during heel lance. There is no need for the additional input of classical music on breast feeding in clinic to relieve procedural pain. Nurses should encourage breast feeding to relieve pain during heel lance.

PO-0725b Flacc Is A Valid And Reliable Tool As Compared To The Pipp For Assessment Of Neonatal Pain

Background Neonates are able to detect and process painful stimuli but are unable to mount a complete response, posing a clinical challenge. Repeated exposure to pain may result in long-term neurodevelopmental sequelae. There is no uniformly agreed method of assessing neonatal pain. Although the “Premature Infants Pain Profile” (PIPP) score is the commonest used worldwide, the “Face, Legs, Activity, Cry and Consolability” (FLACC) score is also often utilised. However, FLACC score has not been validated for infants younger than 2 months old. Aim To assess validity and reliability of FLACC score in the assessment of neonatal pain responses and collect user feedback. Method A prospective observational study of infants receiving neonatal care in Singapore General Hospital was performed. Painful responses to common procedures were evaluated. Infants were assessed 5 min before, during and 5 min after the procedure by 2 independent observers (researcher and nurse), who simultaneously scored the infant using both FLACC and PIPP. User feedback was collected. Results A total of 53 observations of 30 infants were obtained. FLACC meets criterion validity with a correlation coefficient of 0.641 (p-value Conclusion FLACC is a valid and reliable tool as compared to the PIPP. FLACC received greater clinical acceptance from the nurses, being less cumbersome and not requiring continuous physiologic parameter monitoring.

Pain reactivity in preterm neonates: examining the sex differences.

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

Efficacy of swaddling and heel warming on pain response to heel stick in neonates: a randomised control trial

To determine the efficacy of swaddling and heel warming on pain response in neonates following heel stick. Swaddling has been suggested to reduce pain response in neonates during heel stick. Heel warming is also often performed for drawing blood easily before heel stick. However, the efficacy of both on pain response is unclear. A randomised controlled study was used. Twenty-five neonates were randomly assigned to each of the control, swaddling and heel-warming groups. Heart rate, oxygen saturation Neonatal Infant Pain Scale and duration of crying were used to assess pain reactivity and pain recovery. A greater heart rate and Neonatal Infant Pain Scale increase, or oxygen saturation decrease, indicated higher pain reactivity. A longer duration of heart rate and oxygen saturation changes after heel stick back to baseline indicated a longer pain recovery. The decrease in oxygen saturation in swaddling group was significantly greater than that in heel-warming group. The increase in the Neonatal Infant Pain Scale in control group was significantly higher than that in swaddling group. The heart rate recovery time in control group and swaddling group was significantly longer than that in heel-warming group. The oxygen saturation recovery time in control group was significantly longer than that in heel-warming group. The duration of crying in control group was significantly longer than those in swaddling group and heel-warming group. Both swaddling and heel warming decreased the pain response of neonates during heel stick. Heel warming resulted in a lower pain response than did swaddling for neonates, particularly in terms of pain recovery. Heel warming could become a routine practice to decrease the pain response of neonates during heel stick.

Neonatal pain: What's age got to do with it?

Background:The neurobiology of neonatal pain processing, especially in preterm infants, differs significantly from older infants, children, adolescence, and adults. Research suggests that strong painful procedures or repeated mild procedures may permanently modify individual pain processing. Acute injuries at critical developmental periods are risk factors for persistent altered neurodevelopment. The purpose of this narrative review is to present the seminal and current literature describing the unique physiological aspects of neonatal pain processing.Methods:Articles describing the structures and physiological processes that influence neonatal pain were identified from electronic databases Medline, PubMed, and CINAHL.Results:The representation of neonatal pain physiology is described in three processes: Local peripheral nervous system processes, referred to as transduction; spinal cord processing, referred to as transmission and modulation; and supraspinal processing and integration or perception of pain. The consequences of undermanaged pain in preterm infants and neonates are discussed.Conclusion:Although the process and pain responses in neonates bear some similarity to processes and pain responses in older infants, children, adolescence, and adults; there are some pain processes and responses that are unique to neonates rendering them at risk for inadequate pain treatment. Moreover, exposure to repeated painful stimuli contributes to adverse long-term physiologic and behavioral sequelae. With the emergence of studies showing that painful experiences are capable of rewiring the adult brain, it is imperative that we treat neonatal pain effectively.

Trial of Repeated Analgesia with Kangaroo Mother Care (TRAKC Trial)

BackgroundSkin-to-skin contact (SSC) between mother and infant, commonly referred to as Kangaroo Mother Care (KMC), is recommended as an intervention for procedural pain. Evidence demonstrates its consistent efficacy in reducing pain for a single painful procedure. The purpose of this study is to examine the sustained efficacy of KMC, provided during all routine painful procedures for the duration of Neonatal Intensive Care Unit (NICU) hospitalization, in diminishing behavioral pain response in preterm neonates. The efficacy of KMC alone will be compared to standard care of 24% oral sucrose, as well as the combination of KMC and 24% oral sucrose.Methods/designInfants admitted to the NICU who are less than 36 6/7 weeks gestational age (according to early ultrasound), that are stable enough to be held in KMC, will be considered eligible (N = 258). Using a single-blinded randomized parallel group design, participants will be assigned to one of three possible interventions: 1) KMC, 2) combined KMC and sucrose, and 3) sucrose alone, when they undergo any routine painful procedure (heel lance, venipuncture, intravenous, oro/nasogastric insertion). The primary outcome is infant’s pain intensity, which will be assessed using the Premature Infant Pain Profile (PIPP). The secondary outcome will be maturity of neurobehavioral functioning, as measured by the Neurobehavioral Assessment of the Preterm Infant (NAPI). Gestational age, cumulative exposure to KMC provided during non-pain contexts, and maternal cortisol levels will be considered in the analysis. Clinical feasibility will be accounted for from nurse and maternal questionnaires.DiscussionThis will be the first study to examine the repeated use of KMC for managing procedural pain in preterm neonates. It is also the first to compare KMC to sucrose, or the interventions in combination, across time. Based on the theoretical framework of the brain opioid theory of attachment, it is expected that KMC will be a preferred standard of care. However, current pain management guidelines are based on minimal data on repeated use of either intervention. Therefore, regardless of the outcomes of this study, results will have important implications for guidelines and practices related to management of procedural pain in preterm infants.Trial registrationClinicalTrials.gov Identifier: NCT01561547.

Effect of non-nutritive sucking and leg massage on physiological and behavioral indicators of pain following heel blood sampling in term neonates

Background: Pain management is especially important for neonates who are not able to verbally express their pain. Non-pharmacological pain management method as an alternative to pharmacological pain medication has increased nowadays. Objectives: The purpose of this study was to test the effect of leg massage and non-nutritive sucking (NNS) on reducing the pain that neonates experience when undergoing the heel stick procedure for blood testing. Methods: This investigation was a random controlled clinical trial study on ninety neonates who were selected randomly among admitted neonates to NICU in Alavi hospital at Ardabil. The subjects were randomly classified in two case and one control groups. The neonates received leg massage (n=30), NNS (n=30), and no intervention (n=30) respectively. Measurements of HR and SaO2 were taken twice: once before and then again after intervention. Pain response was measured by the PIPP scale. Results: The study showed that the HR of the three groups significantly increased after heel stick compared to before heel stick. The change of SaO2 levels in NNS groups was lower than the control and massage groups. The change of PIPP scores in massage and NNS groups was lower than that of the control group; however, there was not statistically significant differences between NNS &amp; massage groups(p=0.91) Conclusion: pain management and pain relief in the infant is an important issue in neonatal health care. It is suggested that the single or combined use of massage and a pacifier is effective in reducing pain responses in neonates undergoing heel stick.

O720 METAL CUPS FOR VACUUM-ASSISTED VAGINAL DELIVERY INCREASE NEONATAL PAIN RESPONSE

International Journal of Gynecology & ObstetricsVolume 119, Issue S3 p. S514-S514 Free communication (oral) presentations O720 METAL CUPS FOR VACUUM-ASSISTED VAGINAL DELIVERY INCREASE NEONATAL PAIN RESPONSE E. Visca, E. ViscaSearch for more papers by this authorC. Voekt, C. VoektSearch for more papers by this authorE.-M. Tinner, E.-M. TinnerSearch for more papers by this authorT. Burkhardt, T. BurkhardtSearch for more papers by this authorA. Krafft, A. KrafftSearch for more papers by this authorD. Surbek, D. SurbekSearch for more papers by this authorS. von Felten, S. von FeltenSearch for more papers by this authorI. Hoesli, I. HoesliSearch for more papers by this author E. Visca, E. ViscaSearch for more papers by this authorC. Voekt, C. VoektSearch for more papers by this authorE.-M. Tinner, E.-M. TinnerSearch for more papers by this authorT. Burkhardt, T. BurkhardtSearch for more papers by this authorA. Krafft, A. KrafftSearch for more papers by this authorD. Surbek, D. SurbekSearch for more papers by this authorS. von Felten, S. von FeltenSearch for more papers by this authorI. Hoesli, I. HoesliSearch for more papers by this author First published: 22 October 2012 https://doi.org/10.1016/S0020-7292(12)61150-3Citations: 2AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume119, IssueS3Abstracts of XX FIGO World Congress of Gynecology and ObstetricsOctober 2012Pages S514-S514 RelatedInformation

Stress and pain response of neonates after spontaneous birth and vacuum-assisted and cesarean delivery

The objective of the study was to compare the stress response and pain expression of newborns (NBs) in the early postpartum period. This was a prospective study with 280 NBs enclosed at 3 Swiss university hospitals. Stress response and pain reaction were analyzed according to the mode of delivery: elective cesarean section (ELCS), spontaneous vaginal delivery, and assisted vaginal delivery by vacuum extraction (VE). Saliva cortisol and clinical pain expression were evaluated after delivery and before and after heel prick for metabolic screening. Significant differences were evident during the first 72 hours postpartum with highest nominations in the VE group. Meconium-stained amniotic fluid was the only intrapartum stress factor with an impact on clinical pain expression. NBs delivered vaginally show a higher incidence of stress response and pain expression than infants of the ELCS group. The long-term impact of these findings remains to be determined.

Contextual factors associated with pain response of preterm infants to heel‐stick procedures

Evidence indicates that medical and demographic contextual factors (cFs) impact pain responses in preterm neonates, but the existing evidence is very heterogeneous. To explore the effect of cFs on pain responses to heel-stick procedures of preterm infants. This study was a secondary analysis of data collected during a randomized controlled trial examining pain response to non-pharmacological interventions across repeated heel sticks. Five heel sticks across the first 14 days of life were videotaped. Pain response was rated with the Bernese Pain Scale for Neonates (BPSN) by four raters blinded to the heel-stick phases (baseline, heel stick, recovery). Demographic and medical cFs were extracted from medical charts. Mixed single and multiple regression analyses were performed controlling for the intervention group, site and heel-stick phase. Apgar scores at 1 min were negatively associated with behavioural (p = 0.002) BPSN scores, while Apgar scores at 5 min after birth were positively associated with behavioural (p = 0.006) scores. Accumulated number of painful procedures (p = 0.002) and gender (p = 0.02) were positively associated with physiological scores while continuous positive airway pressure CPAP (p = 0.009) and mechanical ventilation (p = 0.005) were negatively associated. Higher exposure to painful procedures, male infants and having CPAP or mechanical ventilation were cFs associated with physiological response. The only variables significantly associated with behavioural BPSN scores were Apgar scores but these relationships were inconsistent.