Systematic review and meta‐analysis suggest that varying prevalence of non‐acute pain in critically ill infants may be due to different definitions

İlhan, Emre; Pacey, Verity; Brown, Laura S.; Spence, Kenneth W.; Trivedi, Amit; Hush, Julia M.

doi:10.1111/apa.14956

Cited by 4 publications

(3 citation statements)

References 37 publications

(67 reference statements)

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“…Infants in the neonatal intensive care unit (NICU) are capable of experiencing chronic pain (Debillon, Zupan, Ravault, Magny, & Dehan, 2001; Ilhan et al., 2019; Pillai Riddell et al., 2009), but little is known about its development (Anand, 2017; Ilhan et al., 2019), definition (van Ganzewinkel & Andriessen, 2017), treatment or prevention (Anand, 2017; Boyle, Bradshaw, & Blake, 2018). Chronic pain in older populations (Friedrichsdorf et al., 2016; Treede et al., 2015), defined as pain lasting longer than 3 months, has obvious limitations when applied to infants.…”

Section: Introductionmentioning

confidence: 99%

Trajectories of post‐surgical pain in infants admitted to neonatal intensive care

İlhan

Galea

Pacey

et al. 2020

European Journal of Pain

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Background The aim of this study was (a) to statistically identify distinct trajectories of pain following surgery in infants less than 6 months of age, and (b) to compare these trajectories to descriptions of chronic pain in infants in the neonatal intensive care unit (NICU). Methods This was a retrospective medical record review of infants admitted to a NICU between 2008 and 2018 following surgery. All infants who underwent one major procedure to the abdomen or thorax and returned to the NICU following surgery were included. Pain was assessed regularly using a validated Pain Assessment Tool. Group‐based trajectory analysis was used to determine the trajectory of recovery from pain following surgery. Results A total of 726 infants were included in the study. A two‐group trajectory model, defined as typical and atypical pain trajectories, was selected. The typical group (n = 467) consisted of infants who had significantly fewer days (1.5 ± 2.3 vs 5.3 ± 5.5, p < .001) and recorded instances of pain (2.0 ± 3.4 vs 9.7 ± 10.5, p < .001) compared to infants in the atypical group (n = 259). The incidence of iatrogenic neonatal abstinence syndrome was greater in the atypical than the typical group (11% vs 5%, p = .001). Conclusions This study has revealed two distinct pain trajectories in infants after surgery. While recovery from pain occurs within days in the typical group, the atypical group demonstrates pain for a significantly longer period, often weeks and months following surgery. This latter group adheres closely to current descriptions of chronic pain in infants.

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Section: Introductionmentioning

confidence: 99%

Trajectories of post‐surgical pain in infants admitted to neonatal intensive care

İlhan

Galea

Pacey

et al. 2020

European Journal of Pain

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“…Additionally, given that consensus on the constructs of chronic pain and acute episodic pain has been reached, researchers, clinicians and families are able to communicate about these more clearly. Because there is a lack of validated pain assessment scales for chronic pain, 23 we recommend that future studies should first aim to develop procedures and assessment techniques to accurately detect chronic pain in critically ill neonates and infants, then to focus on the development and evaluation of the efficacy and safety of pharmacological and non-pharmacological strategies to alleviate it. It should be emphasised, however, that due to the lack of safety studies for chronic pain medications in this population, we do not recommend their use in neonates and infants, particularly as animal studies 24 imply that infants may not develop chronic pain similarly to adults.…”

Section: Implications For Practice and Future Researchmentioning

confidence: 99%

What is the definition of acute episodic and chronic pain in critically ill neonates and infants? A global, four-stage consensus and validation study

et al. 2022

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ObjectivesTo define and validate types of pain in critically ill neonates and infants by researchers and clinicians working in the neonatal intensive care unit (NICU) and high dependency unit (HDU).DesignA qualitative descriptive mixed-methods design.Procedure/sEach stage of the study was built on and confirmed the previous stages. Stage 1 was an expert panel to develop definitions; stage 2 was a different expert panel made up of neonatal clinicians to propose clinical characteristics associated with the definitions from stage 1; stage 3 was a focus group of neonatal clinicians to provide clinical case scenarios associated with each definition and clinical characteristics; and stage 4 was a survey administered to neonatal clinicians internationally to test the validity of the definitions using the clinical case scenarios.ResultsIn stage 1, the panel (n=10) developed consensus definitions for acute episodic pain and chronic pain in neonates and infants. In stage 2, a panel (n=8) established clinical characteristics that may be associated with each definition. In stage 3, a focus group (n=11) created clinical case scenarios of neonates and infants with acute episodic pain, chronic pain and no pain using the definitions and clinical characteristics. In stage 4, the survey (n=182) revealed that the definitions allowed an excellent level of discrimination between case scenarios that described neonates and infants with acute episodic pain and chronic pain (area under the receiver operating characteristic=0.87 and 0.89, respectively).ConclusionsThis four-stage study enabled the development of consensus-based and clinically valid definitions of acute episodic pain and chronic pain. There is a need to define and validate other pain types to inform a taxonomy of pain experienced by neonates and infants in the NICU and HDU.

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“…In the published article of Ilhan et al, 1 the funding statement was missing and should have been added to the article.…”

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confidence: 99%

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2020

Acta Paediatrica

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Systematic review and meta‐analysis suggest that varying prevalence of non‐acute pain in critically ill infants may be due to different definitions

Cited by 4 publications

References 37 publications

Trajectories of post‐surgical pain in infants admitted to neonatal intensive care

Trajectories of post‐surgical pain in infants admitted to neonatal intensive care

What is the definition of acute episodic and chronic pain in critically ill neonates and infants? A global, four-stage consensus and validation study

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