ABSTRACT
BACKGROUND: Studies on acute-procedural pain in neonates have been based more on single behavioral scores than on response patterns. AIM: To assess the individual reactivity and recovery pattern to the painful procedure of blood collection. STUDY DESIGN: A cross-sectional, within-group comparison trial. SUBJECTS: Forty-eight preterm and very low birth weight neonates hospitalized in a Neonatal Intensive Care Unit. OUTCOME MEASURES: The assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was recorded by video, and sleep-wake state was recorded at the bedside. The facial activity of the neonates was analyzed according to Neonatal Facial Coding System (NFCS). The pain reactivity pattern was analyzed using the measures of latency, magnitude, and duration of behavioral responses and by comparison between the different phases. RESULTS: In the Antisepsis phase, the neonates showed higher NFCS score and behavioral arousal than at Baseline. In the Puncture phase, the neonates showed higher NFCS score and behavioral activation than in Baseline and in Antisepsis. In Recovery-Dressing, 31% of neonates continued to show more behavioral activation than at Baseline. CONCLUSION: To better assess and manage pain in preterm neonates, it is relevant to analyze the individual patterns of changes, focusing on the reactivity and also the recovery, during painful stimuli.
Subject(s)
Blood Specimen Collection/adverse effects , Pain Measurement/methods , Pain/diagnosis , Pain/physiopathology , Cross-Sectional Studies , Facial Expression , Humans , Infant, Newborn , Infant, Premature , Infant, Very Low Birth Weight , Sleep/physiologyABSTRACT
The purpose of this study was to assess the behavioral and physiological reactivity of preterm neonates during different phases of a blood collection procedure involving arterial puncture. The sample consisted of 43 preterm and very low birth weight neonates with a postnatal age of 1 to 21 days who were hospitalized in the Neonatal Intensive Care Unit. The neonates were evaluated during the whole blood collection procedure. The assessment was divided into five consecutive phases: Baseline (BL); Antisepsis (A), covering the period of handling of the neonate for antisepsis prior to puncture; Puncture (P); Recovery-Dressing (RD), covering the period of handling of the neonate for dressing until positioning for rest in the isolette; and Recovery-Resting (RR). Facial activity was videotaped and analyzed using the Neonatal Facial Coding System (NFCS). The sleep-wake state and heart rate were registered at the bedside. There was a significant increase in NFCS score and heart rate, and more active behavior during phases A, P, and RD relative to BL. Regarding the tactile stimulation of the infant in pre-puncture (A) and post-puncture (RD), it was observed increased NFCS score, heart rate, and active behavior in comparison to the BL and RR phases. There was evidence of distress responses immediately before and after a painful event, quite apart from the pain reaction to the puncture procedure.
Subject(s)
Hyperalgesia/etiology , Hyperalgesia/physiopathology , Pain/etiology , Pain/physiopathology , Physical Stimulation/adverse effects , Punctures/adverse effects , Touch , Arteries , Humans , Hyperalgesia/diagnosis , Infant, Newborn , Infant, Premature , Male , Pain/diagnosisABSTRACT
The aim of the present study was to examine the efficacy and potential side effects of repeated doses of oral sucrose for pain relief during procedures in NICU. Thirty-three preterm neonates were randomly allocated in blind fashion into two groups, the sucrose group (SG=17) and the control group (CG=16). The responses of neonates to pain and distress were assessed during blood collection on four consecutive assessment (ass.) days. For the first assessment, the neonates did not receive any solution before the blood collection procedure. During the next three days, the SG received oral sucrose (25%; 0.5 ml/kg) and the CG received sterile water, 2 min before each minor acute painful procedure. The neonates were evaluated during blood collection each morning. The assessment was divided into five phases: Baseline (BL), Antisepsis (A), Puncture (P), Dressing (D), and Recovery (R). The neonates' facial activity (NFCS), behavioral state, and heart rate were evaluated. The data analysis used cut-off scores for painful and distressful responses. No side effects of using sucrose were detected. There were significantly fewer SG neonates with facial actions signaling pain than CG neonates in P (ass.2) and in A (ass.3). We found significantly fewer SG neonates in the awake state than CG neonates in P (ass.2 and ass.4). There were significantly fewer SG neonates crying during A (ass.2), P (ass.2 and ass.4), and D (ass.3). There was no statistical difference between-groups for physiological response. The efficacy of sucrose was maintained for pain relief in preterm neonates with no side effects.
Subject(s)
Infant, Premature , Pain/drug therapy , Sucrose/administration & dosage , Sucrose/adverse effects , Administration, Oral , Double-Blind Method , Female , Humans , Infant, Newborn , Infant, Premature/physiology , Male , Pain/physiopathology , Pain Measurement/drug effects , Pain Measurement/methods , Vomiting/chemically induced , Vomiting/physiopathologyABSTRACT
O presente estudo objetivou avaliar indicadores do desenvolvimento psicológico na fase escolar de crianças nascidas pré-termo com muito baixo peso e compará-los aos de crianças nascidas a termo, quanto às áreas intelectual, emocional e comportamental. A amostra foi composta por 40 crianças de 8 a 10 anos, subdivididas em 2 grupos: Pré-termo (PT), 20 crianças nascidas <37 semanas de idade gestacional e peso <1.500 g e A Termo (AT), 20 crianças nascidas a termo com peso >2.500g. Foram utilizados o Raven, o Desenho da Figura Humana e a Escala Comportamental Infantil. As crianças PT apresentaram mais freqüentemente nível intelectual inferior à média e problemas comportamentais em comparação às AT. Não houve diferença entre os grupos quanto aos aspectos emocionais. Os problemas de enurese, medo, tiques, impaciência e dificuldade de permanência nas atividades foram significativamente mais freqüentes no PT do que no AT. Verificou-se que, no grupo PT, quanto menor o nível intelectual das crianças, mais problemas de comportamento elas apresentavam.
Subject(s)
Child , Humans , Male , Female , Child Development , Cognition , Child Behavior/psychology , Emotions , Premature Birth/psychology , Infant, Premature/psychologyABSTRACT
O presente estudo objetivou avaliar indicadores do desenvolvimento psicológico na fase escolar de crianças nascidas pré-termo com muito baixo peso e compará-los aos de crianças nascidas a termo, quanto às áreas intelectual, emocional e comportamental. A amostra foi composta por 40 crianças de 8 a 10 anos, subdivididas em 2 grupos: Pré-termo (PT), 20 crianças nascidas <37 semanas de idade gestacional e peso <1.500 g e A Termo (AT), 20 crianças nascidas a termo com peso >2.500g. Foram utilizados o Raven, o Desenho da Figura Humana e a Escala Comportamental Infantil. As crianças PT apresentaram mais freqüentemente nível intelectual inferior à média e problemas comportamentais em comparação às AT. Não houve diferença entre os grupos quanto aos aspectos emocionais. Os problemas de enurese, medo, tiques, impaciência e dificuldade de permanência nas atividades foram significativamente mais freqüentes no PT do que no AT. Verificou-se que, no grupo PT, quanto menor o nível intelectual das crianças, mais problemas de comportamento elas apresentavam(AU)
