Neonatal Pain and Developmental Outcomes in Children Born Preterm

Valeri, Beatriz Oliveira; Holsti, Liisa; Linhares, Maria Beatriz Martins

doi:10.1097/ajp.0000000000000114

Cited by 277 publications

(198 citation statements)

References 57 publications

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“…Insufficient use of analgesics has also been observed in other studies in NICUs (5)(6)(7) . The association between neonatal pain experiences in preterm infants and the implications of these children's development are the results of a systematic review that points to a negative impact on postnatal growth and brain development, in addition to negative effects on attention, and cognitive, emotional and motor development (8) .…”

Section: Introductionmentioning

confidence: 99%

Nurses' knowledge and practices regarding pain management in newborns

Costa

Rossato

Bueno

et al. 2017

Rev. esc. enferm. USP

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Objective:To analyze nurses' knowledge and practices regarding pain management of newborns admitted to Neonatal Intensive Care Units. Method: A descriptive and crosssectional study. Data were collected from 51 nurses based on an adapted questionnaire aimed at evaluating knowledge and practices regarding the management of neonatal pain in six hospitals in Curitiba and its Metropolitan Region. Results: For most nurses (86.0%), neonates feel pain. A total of 34.7% of the nurses reported never using pain assessment scales. Pain management was recorded by 84.3% of the nurses. Administered pharmacological measures were Paracetamol and Fentanyl (47.1%) and Morphine (17.6%); while non-pharmacological measures adopted were sweetened solution (68.6%), non-nutritive sucking (58.8%) and positioning (56.9%). Conclusion: Nurses considered neonatal pain a real event; however, they do not perform pain assessment or treatment of newborns in a systematized way. It is necessary to implement knowledge translation strategies in order to improve pain management in newborns.

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Section: Introductionmentioning

confidence: 99%

Nurses' knowledge and practices regarding pain management in newborns

Costa

Rossato

Bueno

et al. 2017

Rev. esc. enferm. USP

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“…i n critically ill neonates, pain-related stress affects developmental outcomes, so appropriate pain management is paramount (1). Opioid infusions, sometimes in combination with benzodiazepines, are commonly administered with the intent to decrease pain, agitation, and stress responses in neonates exposed to frequent procedures, during mechanical ventilation, or during therapeutic cooling for hypoxic-ischemic encephalopathy (HIE).…”

mentioning

confidence: 99%

Dexmedetomidine reduces cranial temperature in hypothermic neonatal rats

et al. 2015

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Background:The α2-adrenergic agonist dexmedetomidine (DEX) is increasingly used for prolonged sedation of critically ill neonates, but there are currently no data evaluating possible consequences of prolonged neonatal DEX exposure. We evaluated the pharmacokinetics and histological consequences of neonatal DEX exposure. Methods: DEX was administered (s.c.) to naive (uninjured) neonatal Lewis rats to provide acute (25 µg/kg, ×1) or prolonged (25 µg/kg three times daily, ×2 or ×4 d) exposure. Therapeutic hypothermia was simulated using a water-cooled blanket. Cranial temperatures were measured using an infrared thermometer. DEX concentrations were measured by LC-MS in plasma and homogenized brainstem tissue for pharmacokinetic analysis. Cortex, cerebellum, and brainstem were evaluated for evidence of inflammation or injury. results: Prolonged neonatal DEX exposure was not associated with renal or brain pathology or indices of gliosis, macrophage activation, or apoptosis in either hypothermic or control rats. Plasma and brain DEX concentrations were tightly correlated. DEX peaked within 15 min in brain and reduced cranial temperature from 32 to 30 °C within 30 min after injection in cooled rats. conclusion: Prolonged DEX treatment in neonatal rats was not associated with abnormal brain histology. These data provide reassuring preliminary results for using DEX with therapeutic hypothermia to treat near-term brain injury. i n critically ill neonates, pain-related stress affects developmental outcomes, so appropriate pain management is paramount (1). Opioid infusions, sometimes in combination with benzodiazepines, are commonly administered with the intent to decrease pain, agitation, and stress responses in neonates exposed to frequent procedures, during mechanical ventilation, or during therapeutic cooling for hypoxic-ischemic encephalopathy (HIE). However, opioid and benzodiazepine exposure may produce neuroapoptosis and neurodevelopmental abnormalities (2,3). To reduce opioid exposure, alternative pain medications are needed, but few of the analgesics used in adults have been tested in neonates. Dexmedetomidine (DEX) has recently become a popular analgesic used in adult critical care (4).A selective α-2 adrenoceptor agonist, DEX produces analgesic and sedative effects that can synergize with other analgesics (5,6). In randomized studies of adults, DEX lowers dosing requirements for adjunctive sedatives, shortens hospital stay, decreases psychosis, and may improve posthospitalization memory and cognitive function (7-9). It is recommended for short-term use only, less than 48 h. Minimal efficacy, pharmacokinetic, and safety data exist for neonates. Despite limited testing and without current Food and Drug Administration approval, the off-label use of DEX in pediatric and neonatal intensive care units is increasing (10-12). Since DEX can provide sedation and prevent shivering, it is a viable alternative to opioids for neonatal intensive care units patients undergoing therapeutic hypothermia as treatment for HIE. Con...

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“…Recently, there has been an investment in studies with prospective-longitudinal designs aiming to examine the impact of the exposure to neonatal pain-related stress on the development of the child. A systematic review of the literature showed that acute pain-related stress events experienced in the early neonatal phase have a negative impact on the development of the child, even when controlling for the clinical severity of illness of the preterm newborn samples (Valeri, Holsti, & Linhares, 2015). This review showed that in infants born extremely preterm greater numbers of painful procedures were associated with delayed postnatal growth, poor early neurodevelopment, high cortical activation and altered brain development.…”

Section: Impact Of Pain On Developmentmentioning

confidence: 99%

Non-pharmacological management of neonatal pain: Research and clinical practice in the Neonatal Intensive Care Unit

Linhares

Gaspardo

2017

Estud. psicol. (Campinas)

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According to the World Health Organization and the International Association for the Study of Pain, pain is a relevant worldwide problem in the healthcare field. The present study aimed to describe the definition of pediatric pain and the main characteristics, and to examine the findings regarding the impact of pain on the development of the child. The best clinical practices in Neonatal Intensive Care Units should include developmental care and specifically implement pain management, aiming to protect the health and development of the infants. The efficacious non-pharmacological management of neonatal pain includes breastfeeding, skin-to-skin, non-nutritive sucking, facilitated-tucking and swaddling. Sweet solutions also have pain relief effects. Psychologists could actively participate in the implementation of non-pharmacological interventions and in the whole process to sensitize and train the professional teams, to alert parents to protection against pain and to support policymakers in the implementation of pain guidelines in the hospital.

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Neonatal Pain and Developmental Outcomes in Children Born Preterm

Abstract: For infants born preterm, neonatal pain-related stress was associated with alterations in both early and in later developmental outcomes. Few longitudinal studies examined the impact of neonatal pain in the long-term development of children born preterm.

Cited by 277 publications

References 57 publications

Nurses' knowledge and practices regarding pain management in newborns

Nurses' knowledge and practices regarding pain management in newborns

Dexmedetomidine reduces cranial temperature in hypothermic neonatal rats

Non-pharmacological management of neonatal pain: Research and clinical practice in the Neonatal Intensive Care Unit

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