Pain and Physiological Stress During Minimally Invasive Surfactant Therapy (MIST) in Very Preterm Infants

Objectives: To evaluate the pain or physiological stress caused during minimally invasive surfactant therapy (MIST) to very preterm neonates. Methods: In this prospective observational study conducted in a tertiary NICU, very preterm neonates were assessed for pain using Premature Infant Pain Profile-Revised (PIPP-R) score before, during and after MIST. Changes in the heart rate and oxygen saturation were also recorded during the procedure. Results: 23 neonates who received MIST were assessed for pain using PIPP-R. Mean (SD) PIPP-R score during MIST was 3.87(1.3), before; 12.83 (1.9), during; and 6.26 (1.0), after the procedure, respectively (all P<0.001). Heart rate and oxygen saturation were also significantly reduced during MIST (P<0.001). Conclusion: The high PIPP-R scores during surfactant administration suggest that MIST can cause moderate to severe pain/discomfort and significant physiological stress in very preterm infants.

Assisted Physical Exercise and Stress in Preterm Neonates

Objective: To evaluate the markers of stress before and after a session of assisted physicalexercise in infants born before 35 weeks’ gestation. Methods: 25 infants born at 280/7 to 346/7weeks were subjected to assisted physical exercise daily for about 10-15 min at one week ofpostnatal age or 33 weeks of post menstrual age, whichever was later. Primary outcome wassalivary cortisol and secondary outcome was Premature infant pain profile (PIPP) score.Outcomes were measured, on day 5 (±1) of exercise. Results: There was no difference insalivary cortisol between baseline and immediately after (P=0.16), at 90 min (P=0.6) or 120min (P=0.7) after exercise. Salivary cortisol was lower at 30 min after exercise as compared tobaseline (mean difference -0.08 ?g/dL; 95% CI -0.16 to -0.002; P=0.04). The median (IQR)PIPP score was significantly higher at 5 min into exercise (4 (3-6) vs 4 (3-5); P=0.04) and atcompletion of exercise 6 (4-8) vs 4 (3-5); P<0.01), as compared to baseline. Conclusion:Assisted physical exercise does not seem to result in stress in premature infants

Expressed Breast Milk vs 25% Dextrose in Procedural Pain in Neonates: A Double Blind Randomized Controlled Trial.

Objective: To compare the effect of expressed breast milk (EBM), 25% dextrose (25 D) and sterile water (SW) on procedural pain in neonates as assessed by the premature infant pain profile (PIPP), changes in heart rate (HR), oxygen saturation (SpO2) and duration of crying. Design: Prospective, double blind, randomized controlled trial. Setting: Postnatal ward of a tertiary-care hospital. Participants: 210 babies who required venipuncture for blood sampling and who were on oral feeds were recruited into the study after parental informed consent. Methods: The enrolled babies were randomized into intervention groups (EBM, 25% dextrose) and control group (sterile water). Two ml of test solution was given to baby by paladay (a traditional cup with a spout) 2 min before venipuncture. The face and crying of baby were video graphed by an independent, blinded observer. The facial response to pain (brow bulge, eye squeeze, nasolabial furrow) was analysed from the video. Maximum HR and minimum SpO2 were recorded during, and 1, 3 and 5 min after venipuncture by another blinded observer. Outcome variable: :PIPP score, HR, SpO2 and crying time at 0/ 1/3/5 min after sampling. Results: 160 babies were considered for final analysis with 50 in 25 D, 62 in EBM and 48 in SW group. The mean PIPP score in the 3 groups were 5.22, 6.84 and 11.22 at 0-30 sec after venipuncture; 4.52, 6.34, and 10.88 at 1-1 ½ min; 3.96, 6.15 and 9.35 at 3-3 ½ min; and 3.12, 4.68 and 7.83 at 5-5 ½ min; respectively (P< 0.001). The median crying time was 10 ,37.5 and 162 seconds in 25 D, EBM and SW groups, respectively (P< 0.001). Conclusions: EBM significantly reduces procedural pain in neonates though to a lesser extent as compared to 25% dextrose.

Valoración y manejo del dolor en neonatos

Durante las últimas 2 décadas ha aumentado el interés hacia el dolor que perciben los neonatos. Los niños hospitalizados en unidades de cuidados intensivos están expuestos a múltiples procedimientos dolorosos y, desafortunadamente, aún no se ha establecido un tratamiento adecuado para su manejo. Los objetivos de este estudio son: 1) aumentar la sensibilidad del médico ante el sufrimiento del neonato; 2) presentar las escalas más comunes para valorar el dolor en los neonatos (PIPP: Premature Infant Pain Profile; CRIES: Crying, Requires Oxygen to maintain saturation > 95%, Increased vital signs, Expression, Sleeplessness; NIPS: Neonatal Infants Pain Scale); y 3) proponer un manejo terapéutico para el dolor en los neonatos.

During the last 2 decades, awareness of neonatal pain is being increased. Pain has short and long term adverse effects. Babies hospitalized in neonatal intensive care units are exposed to many painful procedures; unfortunately, there is no general consensus in the approach and management of pain in newborns. The objectives of this report are: 1) Increase the awareness of neonatal pain among care givers; 2) present most common neonatal pain assessment scales (PIPP: Premature Infant Pain Profile; CRIES: Crying, Requires Oxygen to maintain saturation > 95 %, Increased vital signs, Expression, Sleeplessness; NIPS: Neonatal Infants Pain Scale); 3) discuss therapeutic approach to management of pain in newborns.