Due to time constraints, clinicians are rarely able to carry out neurobehavioral assessments that use the Naturalistic Observation of Newborn Behavior Instrument. The content validity, interrater reliability, and criterion-related validity for a less time-consuming instrument, the Modified Infant Behavioral Observation Record (MIBOR) for developmental care was evaluated in this study. Eight developmental care specialists evaluated the MIBOR for content validity. Fifteen infants (birth weight < 1,500 g) were observed to determine interrater reliability, and three were observed to evaluate criterion-related validity. The content validity of the MIBOR, as determined by average congruence, was 96.9%. Interrater reliability for each developmental care subsystem ranged from 67% to 98%. Three of the four subsystems on the MIBOR achieved criterion-related validity, achieving an agreement of r = .60.
BackgroundDespite the availability of evidence-based analgesic strategies, neonatal pain management continues to be suboptimal. Intranasal (IN) fentanyl is an alternative pharmacotherapy for procedural pain in neonatal units. The objective was to evaluate the effectiveness and safety of IN fentanyl for procedural pain in preterm infants.MethodsA retrospective cohort study was conducted in infants who received IN fentanyl between May 2019 and December 2020 at an academic neonatal intensive care unit. Main outcome measures were pain responses, physiological parameters before and up to 60 min after IN fentanyl administration, and adverse events. Paired t-test and analysis of variance were used to compare pain scores and physiological parameters, respectively.ResultsThirteen infants received IN fentanyl on 22 occasions. Median (interquartile range [IQR]) gestational age and birthweight were 27 (25, 27.6) weeks and 850 (530, 1,030) grams, while median (IQR) post-menstrual age and weight were 30.9 (28.9, 32.9) weeks and 1,280 (945, 1,623) grams at the time of IN fentanyl administration. IN fentanyl was most used for lumbar puncture (55%) followed by insertion of epicutaneo-caval catheters (27%). There was a difference between the mean pre- and post-procedure Premature Infant Pain Profile scores of 1.3 (95% CI = 0.07, 2.5; p = 0.04). Physiological parameters did not differ before and up to 60 min post IN fentanyl administration (p > 0.05). Two adverse events (one apnea and one desaturation) were noted.ConclusionIn our limited experience, IN fentanyl appears to be an alternative pharmacotherapy for procedural pain management in the absence of intravenous access in preterm infants.
TreatmentHigh frequency oscillatory ventilation was not more effective than conventional ventilation in preterm infants Johnson AH, Peacock JL, Greenough A, et al,
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