1168 Contextual Factors Influencing Pain Response to Heel Stick Procedure in Preterm Infants: What Do We Know? a Systematic Review (original) (raw)
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Contextual factors associated with pain response of preterm infants to heel-stick procedures
European Journal of Pain, 2013
Background: Evidence indicates that medical and demographic contextual factors (cFs) impact pain responses in preterm neonates, but the existing evidence is very heterogeneous. Aim: To explore the effect of cFs on pain responses to heel-stick procedures of preterm infants. Methods: This study was a secondary analysis of data collected during a randomized controlled trial examining pain response to nonpharmacological 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. Results: 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. Conclusion: 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.
Parents as Pain killers in the Pain ManageMent of PreterM infants
The aim of this study was to develop a new pain management method called facilitated tucking by parents (FTP) to alleviate procedural pain in preterm infants in the Neonatal Intensive Care Unit (NICU). In two randomized controlled crossover trials, the effectiveness of FTP was compared to a non-pharmacological evidence-based practice (oral glucose), a pharmacological method (intravenous oxycodone) and a placebo (oral water) or control care in the context of heel lance and endotracheal or pharyngeal suctioning. In addition, the short-term adverse effects (desaturation, bradycardia) and the prolonged effects of pain management on sleep were measured. The gestational age of the infants was a median of 28 weeks (n=20) in Study I and a mean of 28 1/7 (n=20) in Study II. The primary outcome measure for procedural pain was the Premature infant pain profile (PIPP). After interventions, sleep structure was analysed from 13-hour polysomnographic recordings. In the third study, the mothers (n = 23) who had used FTP from 2-4 weeks in the NICU were interviewed using the Clinical interview for parents of high-risk infants with additional questions related to the infants' pain care.
Factors Explaining Lack of Response to Heel Stick in Preterm Newborns
Journal of Obstetric, Gynecologic, <html_ent glyph="@amp;" ascii="&"/> Neonatal Nursing, 1999
Objective: To determine factors explaining lack of response by preterm newborns to heel stick for blood sampling. Design: A cross-sectional design based on secondary analysis of the control session of a randomized crossover design. Setting: Four Level 111 neonatal intensive-care units of university teaching hospitals.
International journal of nursing studies, 2012
Preterm infants' repeated exposure to painful procedures may contribute to negative consequences. Thus, improving preterm infants' neurodevelopmental outcomes requires prioritising their pain management. To compare the effectiveness of two non-pharmacological pain-relief strategies (non-nutritive sucking and facilitated tucking) with routine care on preterm infants' pain, behavioural, and physiological responses before, during, and after heel-stick procedures. Prospective, randomised controlled crossover trial. Level III Neonatal Intensive Care Unit in Taipei. Thirty-four preterm infants (gestational age 29-37 weeks) needing three procedural heel sticks were recruited by convenience sampling and randomly assigned to a sequence of three treatments (two pain-relief interventions and the control condition): (1) routine care, non-nutritive sucking, facilitated tucking, (2) non-nutritive sucking, facilitated tucking, routine care, and (3) facilitated tucking, routine care, no...
Parents’ perceptions of their infant's pain experience in the NICU
International Journal of Nursing Studies, 2004
Despite numerous advances in the recognition, assessment, and management of pain in neonates over the past two decades, there has been limited improvement in the knowledge base regarding parental responses to their infant's pain. This study examined parents' views of their experiences observing and coping with their infant's pain in the neonatal intensive care unit (NICU). Twelve participants were recruited using purposive sampling from two groups: (a) parents who had infants currently receiving care in the NICU (n ¼ 6); and (b) parents whose infants had been discharged from the NICU and were enrolled in the outpatient follow-up clinic at each hospital (n ¼ 6). An exploratory, semi-structured format was used to interview parents individually (n ¼ 5) or in focus groups (n ¼ 7) regarding their infant's clinical course, infant pain experiences, and the parenting experience during and after the NICU stay. Thematic content analysis was used to develop conceptual categories. Two broad themes were identified: (a) infant pain as a source of parental distress and (b) relief of parental distress due to infant's pain. r
European Journal of Pain, 2011
Major efforts to develop objective measurement tools for neonatal pain assessment have been made. However, the challenge of measuring pain in neonates remains suggesting that contextual factors (cFs) might alter their responses to pain. Although the role of cFs is increasingly discussed as crucial for pain assessment, they are not well described in the literature and are rarely considered in the clinical setting despite their importance. Aim: To systematically examine studies investigating the impact of cFs on pain response in preterm infants. Method: A literature search was undertaken for the period from 1990 to 2009. Studies reporting the relation between one or more cFs and pain response in preterm infants during a heelstick procedure were considered for inclusion. Results: Twenty-three studies satisfied inclusion criteria. The studies varied relative to their design, sample, analysis procedures, and variables examined. Six categories of cFs emerged: age, pain exposure, health status, therapeutic interventions, behavioral status, and demographic factors. The examined cFs varied in the strength of their association with pain response, although none were invariably related, as evidenced by contradictory findings. In some cases the inconsistencies appeared attributable to methodological limitations in studies. Behavioral and physiological pain responses were not always in agreement as would be expected. Conclusion: This review supports the influence of some cFs on pain response. However, the results remain inconclusive which may be, in part, related to the heterogeneity of the studies. Contextual factors need further investigation for a better understanding of the magnitude of their effect on pain response.
Neonatal Nurse and Midwife Competence Regarding Pain Management in Neonates
Advances in Neonatal Care, 2021
Background: Neonates in need of intensive care are often subjected to numerous painful procedures. Despite the growing scientific research, hospitalized neonates continue to experience unrelieved pain. Enhancing the competence of neonatal intensive care nurses is an integral component of effective pain management. Purpose: The purpose of this article is to identify and synthesize the existing evidence on nurses' and midwives' competence regarding neonatal pain management internationally. Methods/Search Strategy: The review was guided by Whittemore & Knafl's five-stage framework, with 8 databases searched in June 2020 including PubMed, CINAHL Complete (via EBSCOhost), MEDLINE (via EBSCOhost), PsycINFO (via Ovid), EMBASE, Scopus, Cochrane Library, and Google scholar. Reference lists of selected articles were also handsearched. Studies were reviewed independently for methodology and inclusion and exclusion criteria. The initial search yielded 3037 articles; 19 met the inclusion criteria and were included for analysis: qualitative (n = 5) and quantitative (n = 14). Findings/Results: Nurses' and midwives' competence regarding neonatal pain management in the neonatal intensive care unit is discussed in relation to knowledge, attitudes, behaviours, and perceptions of competence by most studies. The barriers to effective neonatal pain management were found to relate to nurses' and midwives' factors, underutilized pain assessment tools and organizational factors. Potential facilitators to effective neonatal pain management included clear evidence-based guidelines/protocols, adequate training, and the use of appropriate and accurate pain assessment tools. Parent involvement and a team approach to neonatal pain management were also identified.
Pain perception in NICU: a pilot questionnaire
The Journal of Maternal-Fetal & Neonatal Medicine, 2017
Pain perception in NICU: a pilot questionnaire Purpose: Neonatal pain management has made a great step forward over the last several years. Despite the drafting of International guidelines, an under-treatment of neonatal pain is still reported. Materials and methods: Medical and paramedical personnel working in 5 Italian NICUs were asked to complete a questionnaire about pain management. The questionnaire was comprised of three sections: (i) brief explanation of the purpose; (ii) demographic information, including age, profession, religious beliefs, and hospital level; (iii) questionnaire about pain management and prevention. Results: One-hundred and forty caregivers participated in this study. Non-pharmacological analgesia during heel prick or venipuncture was used by 64% and 60% of them, respectively; topical analgesia was performed in 13% of venipunctures; no analgesia was used in 30% of cases for both heel prick and venipuncture. In the case of lumbar puncture, 35% of participants used topical analgesia, 15% non-pharmacological approach, 10% opioids and 6% intravenuous paracetamol. While 65% of participants gave a score of 4 out of 5 about the importance of pain treatment, 39% of them reported that in their department no pain scales were used. Conclusions: Pain treatment in these NICUs is still far to be optimal. This nonetheless reflects a worldwide trend, which requires more attention on pain prevention, assessment and treatment.
Evidence Based Care, 2018
Background: Neonates are more sensitive to pain and likely to suffer from its long-term complications. Therefore, various methods including non-nutritive sucking, sensory stimulations, and various supportive interventions are employed to relieve pain in newborns. Aim: This study aimed to compare the effects of Yakson therapeutic touch and heel warming on pain caused by heel stick procedure, vital signs, and cry duration in full-term neonates. Method: This randomized clinical trial was conducted among 78 full-term newborns referred to healthcare centers in Mashhad, Iran, 2017. They were assigned into three groups of Yakson theraputic touch, heel warming using a hot-water bottle with the temperature of 40°C, and control receiving routine care, through randomized block method. Then, vital signs before and after and pain intensity after heel-stick procedure were measured using Neonatal Infant Pain Scale (NIPS). Data analysis was performed using Kruskal-Wallis and Wilcoxon tests in SPSS ...