Perception of pain and distress in intubated and mechanically ventilated newborn infants by parents and health professionals

Abstract

BackgroundAn understanding of perceptions of parents and health caregivers who assist critically ill neonates is necessary to comprehend their actions and demands. Therefore this study aim to analyze the agreement among parents, nurse technicians and pediatricians regarding the presence and intensity of pain and distress in mechanically ventilated and intubated newborn infants.MethodsCross-sectional study comprising 52 infants and 52 trios of adults composed of one parent, one nurse technician, and one pediatrician who all observed the same infant. All infants were intubated and under mechanical ventilation and were not handled during the observations. Each newborn was simultaneously observed by the trio of adults for 1 minute to evaluate the presence of pain and distress. The intensity of pain and distress that the adults believed was felt by the infants was marked in a visual analogical scale. Adults’ agreement about the simultaneous presence of pain and distress in each infant was analyzed by marginal homogeneity and Cochran tests. The agreement about the intensity of pain and distress in each infant was studied by Bland-Altman plot and intraclass correlation coefficient (ICC).ResultsThe assessments of pain and distress were heterogeneous in all three investigated groups of adults as determined by the results of a Bland-Altman plot. The presence of distress was more frequently reported compared with pain (marginal heterogeneity, p < 0.01). The pain and distress scores in each adult group were not correlated as shown by ICC [parents, 0.36 (95% CI: 0.01-0.63); nurses 0.47 (0.23-0.66); pediatricians, 0.46 (0.22-0.65)].ConclusionsAdults systematically underscore pain in comparison to distress in mechanically ventilated newborns, without recognizing the association between them.

Parent-led neonatal pain management—a narrative review and update of research and practices

“…Parents who are able to be present with their infant at the hospital can identify signs of pain and discomfort ( 7 – 9 ). However, parents may underestimate their infant's pain, compared to the assessment of health care professionals ( 10 , 11 ). As such, it is important that parents receive education and support from health care professionals to enable them to perform a valid and reliable pain assessment ( 12 ).…”

Assessment and Management of Pain in Preterm Infants: A Practice Update

“…Modern neonatal care is family-centered and supports parental presence in the neonatal unit and parental involvement in care procedures, including pain management, with proper counselling and information [ 171 , 172 , 173 , 174 ] Historically, the parent’s role in pain care has been significantly underutilized, and there has been a lack of focus on ensuring families have the resources they need to best help manage their infant’s pain. Studies show that parents can recognize their infant’s pain but tend to underestimate it compared to healthcare professionals [ 175 , 176 ]. A parent who can be with their newborn infant continuously will be able to learn its signs of comfort and discomfort and should be involved in pain assessment in collaboration with the staff [ 177 ].…”