Kangaroo Care Is Effective in Diminishing Pain Response in Preterm Neonates

Johnston, Céleste; Stevens, Bonnie; Pinelli, Janet; Gibbins, Sharyn; Filion, Françoise; Jack, Anne; Steele, Susan M.; Boyer, Kristina; Veilleux, Alain

doi:10.1001/archpedi.157.11.1084

Cited by 263 publications

(210 citation statements)

References 53 publications

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“…For example, skin-to-skin holding reduces effectively behavioral manifestations of pain, but has little effect on heart rate or on oxygen saturations (Johnston et al, 2003). Similarly, although sucrose reduces pain behavior, varying effects on different physiologic indices have been found (e.g.…”

Section: Discussionmentioning

confidence: 99%

Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

Holsti

Grunau²

2007

Pain

155

117

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Accurate pain assessment in preterm infants in the neonatal intensive care unit (NICU) is complex. Infants who are born at early gestational ages (GA), and who have had greater early pain exposure, have dampened facial responses which may lead to under-treatment. Since behavioral and physiological responses to pain in infants are often dissociated, using multidimensional scales which combine these indicators into a single score may limit our ability to determine the effects of interventions on each system. Our aim was to design a unidimensional scale which would combine the relatively most specific, individual, behavioral indicators for assessing acute pain in this population.The Behavioral Indicators of Infant Pain (BIIP) combines sleep/wake states, 5 facial actions and 2 hand actions. Ninety two infants born between 23-32 weeks GA were assessed during 3, one minute Phases of blood collection. Outcome measures included changes in BIIP and in Neonatal Infant Pain Scale (NIPS) scores coded in real time from continuous bedside video recordings; changes in heart rate (HR) were obtained using custom physiological processing software.Scores on the BIIP changed significantly across Phases of blood collection (p < 0.01). Internal consistency (0.82) and inter-rater reliability (0.80-0.92) were high. Correlations between the BIIP and NIPS were modest (r = 0.64, p < 0.01) as were correlations between the BIIP and mean heart rate (r = 0.45, p < 0.01). In this initial study, the BIIP has been shown to be a reliable, valid scale for assessing acute pain in preterm infants in the NICU. Keywordspremature; infant; pain; assessment IntroductionPreterm infants undergo repeatedly painful diagnostic and therapeutic procedures to ensure their survival. In order to provide appropriate pain management in this population, accurate assessment of pain is necessary (Anand et al., 2005), yet complex because we are limited to indirect measures of pain responses. And although infant pain responses have both behavioralCorresponding author: Dr. Liisa Holsti, Centre for Community Child Health Research, F611, 4480 Oak Street, Vancouver, British Columbia, V6H 3V4. Canada, Phone: 604-875-2000, local 5200, Fax: 604-875-2384, E-mail address: lholsti@cw.bc.ca. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. and physiological components, dissociations between behavioral and physiological pain responses are common (Barr, 1998;Morison et al., 2001). Furthermore, facial actions are the relatively most specific behavioral pain indicators in preterm infants, yet these responses may be dampened. Grunau et al...

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Section: Discussionmentioning

confidence: 99%

Initial validation of the Behavioral Indicators of Infant Pain (BIIP)

Holsti

Grunau²

2007

Pain

155

117

View full text Add to dashboard Cite

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“…55 Such an approach might include reducing the number of bedside disruptions in care. 55,60,61 Other strategies might include bundling interventions, eliminating unnecessary laboratory or radiographic procedures, using transcutaneous measurements when possible, and minimizing the number of repeat procedures performed after failed attempts. 58…”

Section: Reducing Pain From Bedside Care Proceduresmentioning

confidence: 99%

Prevention and Management of Pain in the Neonate: An Update

2006

Pediatrics

414

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The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures. INTRODUCTION ObjectivesThis updated statement is intended for health care professionals who care for neonates (preterm to 1 month of age). The objectives are to:1. emphasize that despite increased awareness of the importance of pain prevention, neonates in the NICU continue to be exposed to numerous painful minor procedures daily as part of their routine care;2. present objective means of assessing neonatal pain by health care professionals;3. describe effective strategies to prevent and treat pain associated with routine minor procedures; and 4. review appropriate methods to prevent and treat pain associated with surgery and other major procedures. BackgroundThe prevention of pain in neonates is an expectation of parents. 1 However, there are major gaps in our knowledge regarding the most effective way to accomplish this. Although it may not be possible to completely eliminate pain in neonates, much can be done to reduce the amount and intensity of pain. The prevention of www.pediatrics.org/cgi

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“…(18) Additionally, the maternal contact promotes cortical pain center activation. However, according to Johnston et al, (13) in extremely PN, endogenous mechanism activation is not as fast and potent as in older babies or adults.…”

Section: Kangaroo Care As a Non-pharmacological Pain Relief Proceduresmentioning

confidence: 97%

“…(14) Therefore, perceiving the mother's scent appears to be related to pain control in PN. (13) Other non-pharmacological pain-relief methods Freire, Garcia & Lamy (12) show that the use of glucose solution can also be considered as an effective non-pharmacological method, as its administration was shown to reduce behavioral indicators when compared to the control group patients, who were maintained in the incubator.…”

Section: Kangaroo Care As a Non-pharmacological Pain Relief Proceduresmentioning

confidence: 99%