Pain and distress outcomes in infants and children: a systematic review

The aim of the present study was to systematically review the recent literature about pain and distress outcomes in children and critically analyze the methodological quality of the reports. The systematic review was based on the PRISMA statement and performed by selecting articles that are indexed in scientific databases. The methodological quality of reports was examined using STROBE statement, for observational studies, and CONSORT statement, for randomized controlled trials. The PedIMMPACT consensus was used to evaluate the psychometric quality of pain instruments. We analyzed 23 empirical studies, including 14 randomized controlled trials, seven cross-sectional studies, and two studies with cohort designs. Fourteen studies included preschool- and schoolchildren, and nine studies included infants. Regarding studies with infants, pain responses were evaluated by heart rate, crying and behavioral observation scales, and distress was evaluated only by salivary cortisol. Four-handed care and sensorial saturation interventions were used to evaluate efficacy to reduce pain and distress responses. Concerning studies with children, both pain and distress responses were evaluated by self- and hetero-reports, behavioral observation and/or physiological measures. Distraction was effective for reducing pain and distress during burn dressing changes and needle procedures, and healing touch intervention reduced distress and pain in chronic patients. All of the studies scored at least 60% in the methodological quality assessment. The pain outcomes included measures of validity that were classified as well-established by the PedIMMPACT. This systematic review gathers scientific evidence of distress-associated pain in children. Pain and distress were measured as distinct constructs, and their associations were poorly analyzed.

Examining the side effects of sucrose for pain relief in preterm infants: a case-control study

Sucrose solution is recommended as relevant pain relief management in neonates during acute painful procedures; however, only a few studies have analyzed the potentially adverse effects of sucrose administration to preterm neonates. The goal of this study was to examine the potential side effects of sucrose for pain relief in preterm infants, assessing feeding and weight gain during hospitalization and their feeding patterns postdischarge. The study sample consisted of 43 preterm neonates divided into two groups: a sucrose group (SG, n=18) and a control group (CG, n=25) in which no sucrose was administered. The SG received 0.5 mL/kg 25% oral sucrose for 2 min prior to all acute painful procedures during three consecutive days. A prospective review of medical charts was performed for all samples. The study was done prior to implementation of the institutional sucrose guidelines as a routine service, and followed all ethical requirements. There were no statistically significant differences between groups in terms of weight gain, length of stay with orogastric tubes, and parenteral feeding. Postdischarge, infant nutritional intake included feeding human milk to 67% of the SG and 74% of the CG. There were no statistically significant differences between groups regarding human milk feeding patterns postdischarge. Neonate feeding patterns and weight gain were unaffected following the short-term use of sucrose for pain relief.

Pediatric pain: prevalence, assessment, and management in a teaching hospital

The goal of this study was to examine the prevalence, assessment and management of pediatric pain in a public teaching hospital. The study sample consisted of 121 inpatients (70 infants, 36 children, and 15 adolescents), their families, 40 physicians, and 43 nurses. All participants were interviewed except infants and children who could not communicate due to their clinical status. The interview included open-ended questions concerning the inpatients’ pain symptoms during the 24 h preceding data collection, as well as pain assessment and pharmacological/non-pharmacological management of pain. The data were obtained from 100% of the eligible inpatients. Thirty-four children/adolescents (28%) answered the questionnaire and for the other 72% (unable to communicate), the family/health professional caregivers reported pain. Among these 34 persons, 20 children/adolescents reported pain, 68% of whom reported that they received pharmacological intervention for pain relief. Eighty-two family caregivers were available on the day of data collection. Of these, 40 family caregivers (49%) had observed their child’s pain response. In addition, 74% reported that the inpatients received pharmacological management. Physicians reported that only 38% of the inpatients exhibited pain signs, which were predominantly acute pain detected during clinical procedures. They reported that 66% of patients received pharmacological intervention. The nurses reported pain signs in 50% of the inpatients, which were detected during clinical procedures. The nurses reported that pain was managed in 78% of inpatients by using pharmacological and/or non-pharmacological interventions. The findings provide evidence of the high prevalence of pain in pediatric inpatients and the under-recognition of pain by health professionals.

Avaliação das variáveis clínicas e neurocomportamentais de recém-nascidos pré-termo / Assessment of the clinical and neurobehavioral variables of preterm newborns

OBJETIVOS: Avaliar as variáveis clínicas e neurocomportamentais do desenvolvimento de recém-nascidos pré-termo. MÉTODO: Estudo transversal com amostra de 21 recém-nascidos, com idade gestacional média de 32 semanas (± 1,7) e idade cronológica média de 27 dias (±15,2), de ambos os sexos, avaliados na internação hospitalar. Foi utilizado roteiro de anamnese para a coleta dos dados sobre a gestação, parto, complicações desenvolvidas e Neonatal Medical Index (NMI). Os recém-nascidos foram avaliados pela Neurobehavioral Assessment of the Preterm Infant (NAPI) em sete categorias: sinal de cachecol, desenvolvimento motor e vigor, ângulo poplíteo, alerta e orientação, irritabilidade, choro e percentual de sono. Os dados foram analisados no programa SPSS® com base na estatística descritiva (freqüências, médias e desvios-padrões), teste t de Student para comparação de grupos (amostra do estudo com amostra normativa NAPI) e teste de correlação de Spearman (variáveis clínicas e categorias da NAPI). RESULTADOS: O desempenho dos recém-nascidos pré-termo apresentou diferença estatisticamente significativa em relação ao do grupo normativo NAPI nas varáveis sinal de cachecol, desenvolvimento motor/vigor e choro. O NMI correlacionou-se negativamente com o sinal cachecol (r= -0,60), o estado comportamental alerta inativo correlacionou-se positivamente com o desenvolvimento motor e vigor (r= 0,59) e com a qualidade do choro (r= 0,71). As complicações maternas mais freqüentes foram infecção genitourinária (47 por cento) e hipertensão arterial gestacional (24 por cento), e as neonatais foram síndrome da membrana hialina (86 por cento), infecção neonatal (57 por cento) e hiperbilirrubinemia (47 por cento). CONCLUSÃO: A avaliação neurocomportamental e os dados clínicos são variáveis que devem ser estudadas quando se trabalha com recém-nascidos em risco para atraso no desenvolvimento.

OBJECTIVE: To assess the clinical and neurobehavioral variables for the development of preterm newborns. METHOD: This was a cross-sectional study with a sample of twenty-one preterm newborns of both genders and mean gestational and chronological ages of 32 weeks (± 1.7) and 27 days (± 15.2), respectively, who were assessed while still in hospital. The medical files were used to collect data on the gestation, delivery, complications developed and on the Neonatal Medical Index (NMI). The newborns were evaluated using the Neurobehavioral Assessment of the Preterm Infant (NAPI) in seven categories: scarf sign, motor development and vigor, popliteal angle, alertness and orientation, irritability, cry quality and percent asleep. The data were analyzed using SPSS® statistical software based on descriptive statistics (frequencies, means and standard deviations), Student's t test for comparison of groups (study sample versus normative NAPI sample) and Spearman's correlation test (clinical variables and NAPI categories). RESULTS: The preterm newborns' performance was statistically significantly different from the normative NAPI group in relation to the variables of scarf sign, motor development and vigor and cry quality. The NMI correlated negatively with scarf sign (r= -0.60). Alert behavioral state during inactivity correlated positively with motor development and vigor (r= 0.59) and with cry quality (r= 0.71). The most frequent maternal complications were genitourinary tract infection (47 percent) and gestational arterial hypertension (24 percent), and the neonatal complications were hyaline membrane syndrome (86 percent), neonatal infection (57 percent) and hyperbilirubinemia (47 percent). CONCLUSION: Neurobehavioral assessment and clinical data are variables that must be considered when working with newborns at risk of delayed development.