Efficacy and safety of non-pharmacological interventions for neonatal pain: an overview of systematic reviews

Abstract

ObjectivesTo synthesise current evidence from systematic reviews (SRs) regarding the efficacy and safety of non-pharmacological interventions to prevent and treat pain in newborn infants.DesignOverview of SRs.Data sourcesWe searched PubMed, Embase, Cochrane Library, Web of Science, CINAHL, Chinese National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Wanfang Database, Chinese Science and Technology Periodical Database (VIP) and Google Scholar to identify all relevant SRs published in the last 5 years.Eligibility criteria for selecting studiesWe included SRs that evaluated the efficacy and safety of non-pharmacological interventions for neonatal pain.Data extraction and synthesisTwo reviewers independently extracted the data, assessed the methodological quality using a Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 and graded the evidence quality with the Grading of Recommendations Assessment, Development and Evaluation (GRADE).ResultsA total of 29 SRs were included in this overview, of which 28 focused on procedural pain and only 1 focused on postoperative pain. Based on AMSTAR 2, seven reviews were found to be of ‘high quality‘, eight of ‘moderate quality’, five of ‘low quality’ and nine of ‘critically low quality’. The GRADE results suggested that facilitated tucking, kangaroo care, sweet solutions, familiar odour or combined non-pharmacological interventions, such as a combination of sucrose and non-nutritive sucking, were effective and safe in reducing pain from medical procedures in neonates. However, sucrose alone was less effective than local anaesthesia or a combination of the two during circumcision.ConclusionsFacilitated tucking, small volumes of sweet solutions, kangaroo care and familiar odour were recommended. Scientific implementation strategies should be developed to promote the clinical use of these effective non-pharmacological interventions. Meanwhile, further rigorous trials and SRs are needed to identify the best non-pharmacological approaches for pain from common surgery and illnesses in neonates.PROSPERO registration numberCRD42021292583.

Dexmedetomidine: An Alternative to Pain Treatment in Neonatology

“…Non-pharmacological pain management are recommended as first line treatment of pain in this population. As some authors have published before, regarding ethical considerations, they are preferred because their minimal risk and great benefit [ 24 , 25 ].…”

“…Behavioral strategies: these strategies consist of directly or indirectly manipulate the neonate to block the transmission of nociception or directly activate inhibitory pathways [ 24 ]. More than fifteen strategies have demonstrated their benefits to relief the pain [ 27 ]: skin to skin contact (Kangaroo care), facilitated tucking (hand-hugging), non-nutritive sucking and other sucking strategies (finger or pacifier), swaddle methods, rocking, breastfeeding, co-bedding (placing twins together in the same incubator) [ 25 ] sweet solutions, touch-massage therapies, simulated mother’s voice, parents presence, familiar odor, nonfamiliar odor (such as vanilla, lavender or other pleasant smells) [ 28 ], warming the neonate’s heel before a heel lance procedure, music therapy or even touching crochet toys (such as octopus) during painful procedures among others [ 29 ].…”

“…Classically, the most studied molecule and the one that has shown the most effectiveness has been sucrose. The concentration, timing and route of administration differs from the different published articles [ 24 ].…”

Anesthesia or Sedation of Newborns in Intensive Care: How to Determine the Optimal Way?

“…Було виявлено, що немовлята, які отримують грудне вигодовування під час болісної процедури, демонструють значно меншу частоту серцевих скорочень, менший плач, і нижчі оцінки болю в порівнянні з іншими нефармакологічними втручаннями, такими як сповивання, контакт «шкіра до шкіри» та непоживне смоктання. Поєднання кількох методів немедикаментозної терапії за допомогою мультисенсорної стимуляції виявилося найефективнішим у забезпеченні знеболюючого ефекту [11].…”

Musicoterapia Na Assistência Ao Prematuro Internado Na Unidade De Terapia Intensiva Neonatal: Uma Revisão Integrativa

“…Ocorreram avanços nas últimas décadas em relação às intervenções empregadas em prematuros, em que as abordagens não farmacológicas são indicadas como tratamento de primeira linha conforme as diretrizes de controle da dor neonatal (CAPARROS-GONZALEZ et al, 2018;KEHL et al, 2021;SHEN et al, 2022). Tratamentos para diminuir o estresse e estabilizar o neonato são essenciais para prevenir e/ou atenuar os danos ao cérebro em desenvolvimento .…”