ABSTRACT
OBJECTIVE: To appraise critically and to synthesize existing Maternal Kangaroo Care (MKC) intervention studies for neonatal procedural pain. METHODS: Four electronic databases were systematically searched and eligible studies selected by two independent reviewers. Of 93 abstracts, 12 studies met the inclusion criteria. Findings were extracted and methodology assessed based on best-synthesis methodology. RESULTS: There is evidence that MKC can significantly reduce pain from a single pain procedure in full-term infants and stable preterm infants (>26 weeks GA). All 12 MKC studies reported significant reduction in pain behavior but measures of heart rate varied. However, current approaches to data analysis cannot tell us of the magnitude of treatment effects. CONCLUSIONS: Future studies need to clearly define their intervention, provide a guiding framework, explain their study methods and analyses and report effect sizes. This will help strengthen validity of the intervention and support recommendations for clinical application.
Subject(s)
Analgesia/methods , Infant Care/psychology , Mothers , Pain Management , Adult , Female , Humans , Infant, Newborn , Treatment OutcomeABSTRACT
OBJETIVOS: elaborar e validar o conteúdo e a aparência de um instrumento de avaliação da prontidão do prematuro em iniciar a transição da alimentação gástrica para via oral. MÉTODOS: para validação do conteúdo do instrumento e seu respectivo guia instrucional, estabeleceu-se um percentual mínimo de concordância de 85 por cento entre os "juízes ", fonoaudiólogos com experiência na área de neonatologia. RESULTADOS: obteve-se concordância acima de 85 por cento nos itens avaliados. O instrumento e guia instrucional validados ficaram constituídos dos seguintes itens: idade corrigida, estado de organização comportamental (estado de consciência, postura e tônus global), postura oral (lábios e língua), reflexos orais (procura, sucção, mordida e vômito) e sucção não-nutritiva (movimentação e canolamento de língua, movimentação da mandíbula, força de sucção, sucções por pausa, manutenção do ritmo de sucção por pausa e do estado alerta e sinais de estresse). CONCLUSÕES: o instrumento e guia instrucional objetivam e sistematizam a avaliação do bebê prematuro iniciar a transição da alimentação gástrica para via oral. Para o uso em unidades neonatais, há necessidade de sua validação clínica.
OBJECTIVES: to produce and validate the content and appearance of a tool for evaluating the readiness of preterm infants to begin the transition from gastric to oral feeding. METHODS: for the validation of the tool and accompanying instructions, the authors established a minimum percentage agreement of 85 percent among the 15 peers who participated in the study, all of them speech therapists with broad experience in the area of neonatology. RESULTS: the validated tool and accompanying instructions contained the following items: corrected gestational age, state of behavioral organization (state of consciousness, overall posture and overall muscle tone), oral posture (lips and tongue), oral reflexes (rooting, sucking, biting and gagging) and non-nutritive sucking (tongue movements, cupped tongue configuration, jaw movements, sucking force, sucking pause, maintaining the rhythm sucking and pause, maintaining an alert state and signs of stress). CONCLUSIONS: the tool and accompanying instructions aim to systematize the evaluation of preterm infants, beginning with the transition from gastric to oral feeding. Clinical validation is necessary before they can be used in neonatal wards.
Subject(s)
Humans , Infant, Newborn , Breast Feeding , Sucking Behavior/physiology , Infant, Premature , Intensive Care Units, Neonatal , Brazil , Child Development/physiology , Mother-Child Relations , Posture/physiologyABSTRACT
BACKGROUND AND PURPOSE: Several promising non-pharmacological interventions have been developed to reduce acute pain in preterm infants including skin-to-skin contact between a mother and her infant. However, variability in physiological outcomes of existing studies on skin-to-skin makes it difficult to determine treatment effects of this naturalistic approach for the preterm infant. The aim of this study was to test the efficacy of mother and infant skin-to-skin contact during heel prick in premature infants. METHOD: Fifty nine stable preterm infants (born at least 30 weeks gestational age) who were undergoing routine heel lance were randomly assigned to either 15 min of skin-to-skin contact before, during and following heel prick (n=31, treatment group), or to regular care (n=28, control group). Throughout the heel lance procedure, all infants were assessed for change in facial action (NFCS), behavioral state, crying, and heart rate. RESULTS: Statistically significant differences were noted between the treatment and control groups during the puncture, heel squeeze and the post phases of heel prick. Infants who received skin-to-skin contact were more likely to show lower NFCS scores throughout the procedure. Both groups of infants cried and showed increased heart rate during puncture and heel squeeze although changes in these measures were less for the treated infants. CONCLUSIONS: Skin-to-skin contact promoted reduction in behavioral measures and less physiological increase during procedure. It is recommended that skin-to-skin contact be used as a non-pharmacologic intervention to relieve acute pain in stable premature infants born 30 weeks gestational age or older.
