Cumulative sucrose exposure for repeated procedural pain in preterm neonates and neurodevelopment at 18 months of corrected age: a prospective observational longitudinal study.

INTRODUCTION: Oral sucrose is repeatedly administered to neonates in the neonatal intensive care unit (NICU) to treat pain from commonly performed procedures; however, there is limited evidence on its long-term cumulative effect on neurodevelopment. We examined the association between total sucrose volumes administered to preterm neonates for pain mitigation in the NICU and their neurodevelopment at 18 months of corrected age (CA). METHODS: A prospective longitudinal single-arm observational study that enrolled hospitalised preterm neonates <32 weeks of gestational age at birth and <10 days of life was conducted in four level III NICUs in Canada. Neonates received 0.1 mL of 24% sucrose 2 min prior to all commonly performed painful procedures during their NICU stay. Neurodevelopment was assessed at 18 months of CA using the Bayley Scales of Infant and Toddler Development, Third Edition (Bayley-III). Multiple neonatal and maternal factors known to affect development were adjusted for in the generalised linear model analysis. RESULTS: 172 preterm neonates were enrolled and 118 were included in the analysis at 18 months of CA. The total mean sucrose volume administered/neonate/NICU stay was 5.96 (±5.6) mL, and the mean Bayley-III composite scores were: cognitive 91 (±17), language 86 (±18) and motor 88 (±18). There was no association between Bayley-III scores and the total sucrose volume: cognitive (p=0.57), language (p=0.42) and motor (p=0.70). CONCLUSION: Cumulative sucrose exposure for repeated procedural pain in preterm neonates was neither associated with a delay in neurodevelopment nor neuroprotective effects at 18 months of CA. If sucrose is used, we suggest the minimally effective dose combined with other non-pharmacological interventions with demonstrated effectiveness such as skin-to-skin contact, non-nutritive sucking, facilitated tucking and swaddling. TRIAL REGISTRATION NUMBER: NCT02725814.

A scoping review of the epidemiology and treatment of painful procedures in hospitalized neonates: What has changed in the past three decades?

BACKGROUND: Care of newborns hospitalized in the neonatal intensive care unit (NICU) includes multiple painful procedures/day. Epidemiologic studies have reported the frequency and nature of procedures and treatment interventions. However, evidence on the changing trends in the nature and frequency of neonatal pain procedures or treatments over time is absent or inconclusive. We aimed to determine the frequency and nature of painful procedures/neonate/day in the NICU. DATABASES AND DATA TREATMENT: MEDLINE and Embase searches were conducted from database inception to July 2023. Studies that reported the nature and frequency of painful procedures and associated pain treatments in neonates were included. Standard inverse-variance random-effects meta-analyses were used to combine studies. Heterogeneity between studies was quantified using the I2 statistic. RESULTS: Of 2622 unique citations, 64 full-text articles were reviewed; 23 were included. Six additional studies identified in a previous review, and six publications from reference lists were added, resulting in 35 studies. The mean number of painful procedures/neonate/day was 7.38 (95% CI 5.60, 9.17; range <2 to 17). Although the frequency of painful procedures in more recent studies was reduced, it was not statistically significant (p = 0.16). Painful procedures were more frequent during longer observation periods. Needle-related procedures were most common and did not change over time. Procedure-related treatment was suboptimal and inconsistently reported. CONCLUSIONS: Frequency of painful procedures in the NICU has shown a clinically important decrease but has not significantly changed over time. A paradigm shift moving responsibility from providers to systems in changing pain practices in the NICU is required. SIGNIFICANCE STATEMENT: The decrease in the daily frequency of painful procedures in hospitalized neonates might be clinically relevant but is not yet statistically significant. Pain treatment is insufficiently documented and reported. This lack of progress in neonatal care might be a result of the complexity of defining pain and stress; inconsistencies in determining the burden of procedural pain; the influence of barriers and facilitators on practice change; and the focus on an individual rather than system responsibility for pain prevention and treatment.

Identification of Inflammatory Mediators in Saliva Samples From Hospitalized Newborns: Potential Biomarkers?

Saliva measurements serve as a noninvasive tool for clinically monitoring newborns (NB) and children, a vulnerable population with promising potential for both research and clinical practice. Saliva acts as a repository for various inflammatory biomarkers involved in diverse biological functions. Particularly for children, it offers numerous advantages when compared to plasma and urine sampling. Nevertheless, there is a significant knowledge gap regarding detectable levels of cytokines in the saliva of newborns and children, as well as studies aiming to assess the relationship of this content with physiological and pathological processes. OBJECTIVES: To characterize the levels of 11 inflammatory mediators (IFNg, IL1b, IL2, IL4, IL6, IL8, IL10, IL12, IL17, TNF, and VEGF) in saliva samples from NB on the first and second day of hospitalization in the Neonatal Intensive Care Unit (NICU). METHOD: Exploratory study, descriptive, nested within a primary clinical, observational, and prospective study, conducted in the NICU of a public hospital in São Paulo, Brazil. Demographic data and vital signs were recorded in the clinical records of 90 NB, and five saliva samples from 5 NB were collected between the first and second day of life (D1-D2) at approximately 8-hr intervals (8-9 am, 4-5 pm, and 11-12 pm). Saliva samples were used for the measurement of 11 cytokines (IFNg, IL1b, IL2, IL4, IL6, IL8, IL10, IL12, IL17, TNF, and VEGF). RESULTS: Five NBs participated in this exploratory study, and the vital signs showed variability from the first (D1) to the second day (D2) of hospitalization, variability similar to that of the total population of the primary study. The presence and levels of the 11 cytokines were detected in the saliva samples, as well as a statistical correlation between 10 cytokines (IFNg, IL1b, IL2, IL4, IL6, IL10, IL12, IL17, TNF, and VEGF) and vital signs. CONCLUSIONS: The novelty of measuring inflammatory mediators in saliva samples from hospitalized NBs in the NICU is highlighted, providing support and new perspectives for the development of clinical and experimental research and an opportunity for developing and implementing new salivary biomarkers in different population segments.

[Translating evidence: pain treatment in newborns, infants, and toddlers during needle-related procedures : German version]. / Umsetzung von Evidenz ­ Schmerztherapie bei Neugeborenen, Säuglingen und Kleinkindern während Nadelstichverfahren : Deutsche Fassung.

INTRODUCTION: Treatment of pain in preterm, sick, and healthy newborns and infants and toddlers (up to 2 years of age) is consistently reported to be inadequate, and effective strategies are poorly implemented. OBJECTIVES: To present existing evidence of effective pain treatment strategies during needle-related procedures and to highlight initiatives focused on translating evidence into practice. METHODS: This Clinical Update focuses on the 2022 International Association for the Study of Pain Global Year for Translating Pain Knowledge to Practice in the specific population of newborns, infants, and toddlers. Best evidence is reviewed, and existing knowledge translation strategies and programs available to implement evidence into practice are presented. RESULTS: Effective strategies for newborn and young infants during frequently occurring needle procedures include small volumes of sweet solutions, breastfeeding, or skin-to-skin care when feasible and culturally acceptable. In addition, strategies such as nonnutritive sucking, positioning, swaddling, gentle touch, facilitated tucking, and secure holding can be used. For toddlers, the evidence is less robust, and discerning between pain and distress is challenging. However, strategies recommended for needlerelated procedures include upright secure comfort holding by parents/caregivers, age-appropriate distraction, and topical anesthetics. Translation of effective pain management needs to involve the family, who need to be supported and empowered to comfort their child during painful procedures. Organizational, nationwide, and global initiatives aimed at improving implementation of effective pain treatments exist. CONCLUSION: There is evidence of effective pain management strategies for newborns, infants, and toddlers, and a great deal of effort is being made to translate knowledge into action.

A longitudinal observational study on the epidemiology of painful procedures and sucrose administration in hospitalized preterm neonates.

Although sucrose is widely administered to hospitalized infants for single painful procedures, total sucrose volume during the entire neonatal intensive care unit (NICU) stay and associated adverse events are unknown. In a longitudinal observation study, we aimed to quantify and contextualize sucrose administration during the NICU stay. Specifically, we investigated the frequency, nature, and severity of painful procedures; proportion of procedures where neonates received sucrose; total volume of sucrose administered for painful procedures; and incidence and type of adverse events. Neonates <32 weeks gestational age at birth and <10 days of life were recruited from four Canadian tertiary NICUs. Daily chart reviews of documented painful procedures, sucrose administration, and any associated adverse events were undertaken. One hundred sixty-eight neonates underwent a total of 9093 skin-breaking procedures (mean 54.1 [±65.2] procedures/neonate or 1.1 [±0.9] procedures/day/neonate) during an average NICU stay of 45.9 (±31.4) days. Pain severity was recorded for 5399/9093 (59.4%) of the painful procedures; the majority (5051 [93.5%]) were heel lances of moderate pain intensity. Sucrose was administered for 7839/9093 (86.2%) of painful procedures. The total average sucrose volume was 5.5 (±5.4) mL/neonate or 0.11 (±0.08) mL/neonate/day. Infants experienced an average of 7.9 (±12.7) minor adverse events associated with pain and/or sucrose administration that resolved without intervention. The total number of painful procedures, sucrose volume, and incidence of adverse events throughout the NICU stay were described addressing an important knowledge gap in neonatal pain. These data provide a baseline for examining the association between total sucrose volume during NICU stay and research on longer-term behavioral and neurodevelopmental outcomes.

Aleitamento materno exclusivo e uso da bolsa canguru em bebês a termo entre o primeiro e segundo mês de idade / Exclusive breastfeeding and the use of kangaroo slings among full-term infants between their first and second months of age / Amamantamiento materno exclusivo y uso de la bolsa canguro en bebés a término entre el primer y segundo mes de edad

Objetivo: verificar a associação entre o uso da bolsa canguru, desde a maternidade até o domicílio, e aleitamento materno exclusivo, entre o 1o e 2o mês de idade, em bebês a termo saudáveis; identificar o nível de autoeficácia para o aleitamento materno, das mães que utilizaram a bolsa canguru. Métodos: estudo transversal com mães que receberam uma bolsa canguru após o parto, na maternidade, e foram orientadas sobre manterem seus bebês nesta postura, pelo menos uma hora por dia. Entre um e dois meses após o nascimento, foram investigadas a frequência do uso da bolsa canguru, autoeficácia materna da amamentação e tipo de alimentação dos bebês. Para análise foi empregado o teste ꭓ2 ou Exato de Fisher e o coeficiente V de Cramer (p < 0,05). Resultados: participaram 98 mães. Todas utilizaram a bolsa canguru no alojamento conjunto, 39,8% utilizaram três ou mais vezes por semana, no domicílio entre o primeiro e segundo mês após o parto; 70,4% dos bebês permaneceram em Aleitamento Materno Exclusivo (AME), o nível da autoeficácia materna para amamentação foi alto. AME esteve associado ao uso da bolsa canguru no domicílio (p = 0,014). Conclusão: bebês a termo saudáveis podem se beneficiar do uso da bolsa canguru desde a maternidade, estendido até o domicílio.

Objectives: to verify the association between kangaroo slings used from maternity hospital to home, and exclusive breastfeeding among healthy full-term babies between the 1st and 2nd months of age; to identify breastfeeding self-efficacy level of those mothers using a kangaroo sling. Method: this cross-sectional study addressed mothers who received a kangaroo sling after giving birth, at maternity hospital, and were instructed to keep the babies in this posture at least one hour daily. The frequency with which the mothers used the kangaroo sling, breastfeeding self-efficacy, and the type of feeding were investigated between one and two months after delivery. ꭓ2 or Fisher's exact test and Cramer's V coefficient (p < 0.05) were adopted in the analysis. Results: ninety-eight mothers participated in the study. All of them used the kangaroo sling in rooming-in; 39.8% used it three or more times a week at home between the 1st and 2nd months after giving birth; 70.4% of the babies remained on Exclusive Breastfeeding (EBF), the level of breastfeeding self-efficacy was high, and EBF was associated with the use of a kangaroo sling at home (p = 0.014). Conclusion: healthy full-term babies can benefit from using a kangaroo sling, starting at the maternity hospital and extending its use to home.

Objetivo: verificar la asociación entre el uso de la bolsa canguro, desde la maternidad hasta el domicilio, y amamantamiento materno exclusivo, entre el 1o e 2o mes de edad, en bebés a término saludables; identificar el nivel de autoeficacia para el amamantamiento materno, de las madres que utilizaron la bolsa canguro. Métodos: estudio transversal con madres que recibieron una bolsa canguro después del parto, en la maternidad, y fueron orientadas sobre mantener sus bebés en esta postura, por lo menos una hora por día. Entre uno y dos meses después del nacimiento, fueron investigadas la frecuencia del uso de la bolsa canguro, autoeficacia materna del amamantamiento y tipo de alimentación de los bebés. Para el análisis fue empleado el test ꭓ2 o Exacto de Fisher y el coeficiente V de Cramer (p < 0,05). Resultados: participaron 98 madres. Todas utilizaron la bolsa canguro en alojamiento conjunto, 39,8% utilizaron tres o más veces por semana, en el domicilio entre el primero y segundo mes después el parto; 70,4%, de los bebés, permaneció en Lactancia Materno Exclusivo (LME); el nivel de la autoeficacia materna para amamantamiento fue alto. El LME estuvo asociado al uso de la bolsa canguro en el domicilio (p = 0,014). Conclusión: bebés a término saludables pueden beneficiarse del uso de la bolsa canguro desde la maternidad, extendido hasta el domicilio.

Sucrose analgesia for heel-lance procedures in neonates.

BACKGROUND: Sucrose has been examined for calming and pain-relieving effects in neonates for invasive procedures such as heel lance. OBJECTIVES: To assess the effectiveness of sucrose for relieving pain from heel lance in neonates in terms of immediate and long-term outcomes SEARCH METHODS: We searched (February 2022): CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and three trial registries. SELECTION CRITERIA: We included randomised controlled trials where term and/or preterm neonates received sucrose for heel lances. Comparison treatments included water/placebo/no intervention, non-nutritive sucking (NNS), glucose, breastfeeding, breast milk, music, acupuncture, facilitated tucking, and skin-to-skin care. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We reported mean differences (MD) with 95% confidence intervals (CI) using the fixed-effect model for continuous outcome measures. We assessed heterogeneity by the I2 test. We used GRADE to assess certainty of evidence. MAIN RESULTS: We included 55 trials (6273 infants): 29 included term neonates, 22 included preterm neonates, and four included both. Heel lance was investigated in 50 trials; 15 investigated other minor painful procedures in addition to lancing. Sucrose vs control The evidence suggests that sucrose probably results in a reduction in PIPP scores compared to the control group at 30 seconds (MD -1.74 (95% CI -2.11 to -1.37); I2 = 62%; moderate-certainty evidence) and 60 seconds after lancing (MD -2.14, 95% CI -3.34 to -0.94; I2 = 0%; moderate-certainty evidence). The evidence is very uncertain about the effects of sucrose on DAN scores compared to water at 30 seconds after lancing (MD -1.90, 95% CI -8.58 to 4.78; heterogeneity not applicable (N/A); very low-certainty evidence). The evidence suggests that sucrose probably results in a reduction in NIPS scores compared to water immediately after lancing (MD -2.00, 95% CI -2.42 to -1.58; heterogeneity N/A; moderate-certainty evidence). Sucrose vs NNS The evidence is very uncertain about the effect of sucrose on PIPP scores compared to NNS during the recovery period after lancing (MD 0.60, 95% CI -0.30 to 1.50; heterogeneity not applicable; very low-certainty evidence) and on DAN scores at 30 seconds after lancing (MD -1.20, 95% CI -7.87 to 5.47; heterogeneity N/A; very low-certainty evidence). Sucrose + NNS vs NNS The evidence is very uncertain about the effect of sucrose + NNS on PIPP scores compared to NNS during lancing (MD -4.90, 95% CI -5.73 to -4.07; heterogeneity not applicable; very low-certainty evidence) and during recovery after lancing (MD -3.80, 95% CI -4.47 to -3.13; heterogeneity N/A; very low-certainty evidence). The evidence is very uncertain about the effects of sucrose + NNS on NFCS scores compared to water + NNS during lancing (MD -0.60, 95% CI -1.47 to 0.27; heterogeneity N/A; very low-certainty evidence). Sucrose vs glucose The evidence suggests that sucrose results in little to no difference in PIPP scores compared to glucose at 30 seconds (MD 0.26, 95% CI -0.70 to 1.22; heterogeneity not applicable; low-certainty evidence) and 60 seconds after lancing (MD -0.02, 95% CI -0.79 to 0.75; heterogeneity N/A; low-certainty evidence). Sucrose vs breastfeeding The evidence is very uncertain about the effect of sucrose on PIPP scores compared to breastfeeding at 30 seconds after lancing (MD -0.70, 95% CI -0.49 to 1.88; I2 = 94%; very low-certainty evidence). The evidence is very uncertain about the effect of sucrose on COMFORTneo scores compared to breastfeeding after lancing (MD -2.60, 95% CI -3.06 to -2.14; heterogeneity N/A; very low-certainty evidence). Sucrose vs expressed breast milk The evidence suggests that sucrose may result in little to no difference in PIPP-R scores compared to expressed breast milk during (MD 0.3, 95% CI -0.24 to 0.84; heterogeneity not applicable; low-certainty evidence) and at 30 seconds after lancing (MD 0.3, 95% CI -0.11 to 0.71; heterogeneity N/A; low-certainty evidence). The evidence suggests that sucrose probably may result in slightly increased PIPP-R scores compared to expressed breast milk 60 seconds after lancing (MD 1.10, 95% CI 0.34 to 1.86; heterogeneity N/A; low-certainty evidence). The evidence is very uncertain about the effect of sucrose on DAN scores compared to expressed breast milk 30 seconds after lancing (MD -1.80, 95% CI -8.47 to 4.87; heterogeneity N/A; very low-certainty evidence). Sucrose vs laser acupuncture There was no difference in PIPP-R scores between sucrose and music groups; however, data were reported as medians and IQRs. The evidence is very uncertain about the effect of sucrose on NIPS scores compared to laser acupuncture during lancing (MD -0.86, 95% CI -1.43 to -0.29; heterogeneity N/A; very low-certainty evidence). Sucrose vs facilitated tucking The evidence is very uncertain about the effect of sucrose on total BPSN scores compared to facilitated tucking during lancing (MD -2.27, 95% CI -4.66 to 0.12; heterogeneity N/A; very low-certainty evidence) and during recovery after lancing (MD -0.31, 95% CI -1.72 to 1.10; heterogeneity N/A; very low-certainty evidence). Sucrose vs skin-to-skin + water (repeated lancing) The evidence suggests that sucrose results in little to no difference in PIPP scores compared to skin-to-skin + water at 30 seconds after 1st (MD 0.13, 95% CI -0.70 to 0.96); 2nd (MD -0.56, 95% CI -1.57 to 0.45); or 3rd lancing (MD-0.15, 95% CI -1.26 to 0.96); heterogeneity N/A, low-certainty evidence for all comparisons. The evidence suggests that sucrose results in little to no difference in PIPP scores compared to skin-to-skin + water at 60 seconds after 1st (MD -0.61, 95% CI -1.55 to 0.33); 2nd (MD -0.12, 95% CI -0.99 to 0.75); or 3rd lancing (MD-0.40, 95% CI -1.48 to 0.68); heterogeneity N/A, low-certainty evidence for all comparisons. Minor adverse events required no intervention. AUTHORS' CONCLUSIONS: Sucrose compared to control probably results in a reduction of PIPP scores 30 and 60 seconds after single heel lances (moderate-certainty evidence). Evidence is very uncertain about the effect of sucrose compared to NNS, breastfeeding, laser acupuncture, facilitated tucking, and the effect of sucrose + NNS compared to NNS in reducing pain. Sucrose compared to glucose, expressed breast milk, and skin-to-skin care shows little to no difference in pain scores. Sucrose combined with other nonpharmacologic interventions should be used with caution, given the uncertainty of evidence.

Empathy and psychological concerns among medical students in Brazil during the COVID-19 pandemic.

OBJECTIVE: Being in direct contact with COVID-19 patients for long periods increases the risk of infection among frontline workers. The purpose of this study was to identify levels of empathy and psychological concern among medical students during the COVID-19 pandemic. METHODS: An online cross-sectional study was conducted among medical interns divided into two groups: those who worked on the frontline (n = 87) and those who did not (n = 63) during the COVID pandemic. The students completed the Interpersonal Reactivity Index, Maslach Burnout Inventory, Perceived Stress Scale, and Patient Health Questionnaire. RESULTS: The majority of respondents were women (70.7%), and the mean age was 25.45 ± 3.93 years. In unadjusted analyses, those who worked with COVID-19 patients had a higher level of empathy, stress, burnout symptoms, and depressive symptoms. In the logistic regression analyses, students who worked on the frontline during the COVID-19 pandemic had a higher level of empathy (OR: 1.27; 95% CI: 1.16-1.14), higher perceived stress levels (OR: 1.21; 95% CI: 1.05-1.39), and greater burnout symptoms (OR: 1.19; 95% CI: 1.10-1.30). CONCLUSION: Medical students in the internship period who worked on the frontline during the COVID-19 pandemic had more psychological concerns and higher levels of empathy compared to those who did not work on the frontline.

The effectiveness of repeated sucrose for procedural pain in neonates in a longitudinal observational study.

Goal: To determine the analgesic effectiveness of repeated sucrose administration for skin-breaking (SB) procedures over the Neonatal Intensive Care Unit (NICU) hospitalization of preterm infants. Methods: Longitudinal observational study, conducted in four level III Canadian NICUs. Eligible infants were <32 weeks gestational age at birth, and <10 days of life at enrollment. Infants received 24% sucrose (0.12 ml) prior to all painful procedures. The Premature Infant Pain Profile - Revised (PIPP-R) was used at 30 and 60 seconds after a medically-required SB procedure as soon as possible after enrollment and weekly up to three additional times for scheduled procedures. Results: 172 infants (57.3% male, gestational age 28.35 (±2.31) weeks) were included. The mean 30 s PIPP-R scores were 6.11 (±3.68), 5.76 (±3.41), 6.48 (±3.67), and 6.81 (±3.69) respectively; there were no statistically significant interactions of study site by time (p = 0.31) or over time (p = 0.15). At 60 s, mean PIPP-R scores were 6.05 (±4.09), 5.74 (±3.67), 6.19 (±3.7), and 5.99 (±3.76) respectively; there were no study site by time interactions (p = 0.14) or differences over time (p = 0.52). There was a statistically significant site difference in the effectiveness of sucrose at 30 and 60 seconds (p < 0.01). Conclusions: Consistently low PIPP-R scores following a skin-breaking procedure indicated that the analgesic effectiveness of the minimal dose of sucrose was sustained over time in the NICU. Further research is required to determine the optimal combination of sucrose and other pain management strategies to improve clinical practice and the impact of consistent use of repeated use of sucrose on neurodevelopment.

Translating evidence: pain treatment in newborns, infants, and toddlers during needle-related procedures.

Introduction: Treatment of pain in preterm, sick, and healthy newborns and infants and toddlers (up to 2 years of age) is consistently reported to be inadequate, and effective strategies are poorly implemented. Objectives: To present existing evidence of effective pain treatment strategies during needle-related procedures and to highlight initiatives focused on translating evidence into practice. Methods: This Clinical Update focuses on the 2022 International Association for the Study of Pain Global Year for Translating Pain Knowledge to Practice in the specific population of newborns, infants, and toddlers. Best evidence is reviewed, and existing knowledge translation strategies and programs available to implement evidence into practice are presented. Results: Effective strategies for newborn and young infants during frequently occurring needle procedures include small volumes of sweet solutions, breastfeeding, or skin-to-skin care when feasible and culturally acceptable. In addition, strategies such as nonnutritive sucking, positioning, swaddling, gentle touch, facilitated tucking, and secure holding can be used. For toddlers, the evidence is less robust, and discerning between pain and distress is challenging. However, strategies recommended for needle-related procedures include upright secure comfort holding by parents/caregivers, age-appropriate distraction, and topical anesthetics. Translation of effective pain management needs to involve the family, who need to be supported and empowered to comfort their child during painful procedures. Organizational, nationwide, and global initiatives aimed at improving implementation of effective pain treatments exist. Conclusion: There is evidence of effective pain management strategies for newborns, infants, and toddlers, and a great deal of effort is being made to translate knowledge into action.

Implementação de intervenção de tradução e intercâmbio do conhecimento para manejo da dor do neonato / Implementación de intervención de traducción e intercambio de conocimiento para manejo del dolor del neonato / Implementation of a knowledge translation and exchange intervention for pain management in neonates

Resumo Objetivo Descrever o processo de implementação de uma intervenção multifacetada de tradução e intercâmbio do conhecimento para melhorar as práticas de manejo da dor, e avaliar a adoção desta intervenção pelos profissionais de saúde durante procedimentos dolorosos em neonatos. Métodos Estudo quase-experimental tipo antes e depois, realizado em uma unidade neonatal. A intervenção Evidence-Based Practice for Improving Quality , norteada pela estrutura conceitual The Promoting Action on Research Implementation in Health Services , foi implementada em duas etapas (preparação e implementação), e a sua adoção foi mensurada por indicadores clínicos relacionados ao manejo da dor, apresentados por meio de estatística descritiva. Resultados Após discussão sobre práticas existentes na unidade que necessitavam de mudança; síntese das evidências científicas atuais; e dados do contexto local; os membros do Conselho de Pesquisa e Prática da unidade elaboraram e implementaram metas coerentes e factíveis para mudança da prática no manejo da dor; selecionaram estratégias de tradução e intercâmbio do conhecimento; determinaram o público-alvo e os indicadores e implementaram as intervenções. Houve uma redução em 32,8% no número de procedimentos dolorosos realizados, e aumento entre 26,6 e 50,7% na utilização das escalas de avaliação da dor e de 25,1% na administração da glicose oral. Conclusão A intervenção multifacetada Evidence-Based Practice for Improving Quality é complexa, e possui processos que demandam conhecimento e habilidades, comprometimento dos diversos atores envolvidos, disponibilidade de tempo e investimento financeiro. Os indicadores analisados mostraram que a intervenção resultou em mudanças positivas na prática clínica no manejo da dor do neonato.

Resumen Objetivo Describir el proceso de implementación de una intervención multifacética de traducción e intercambio de conocimiento para mejorar las prácticas de manejo del dolor y evaluar la adopción de esta intervención por profesionales de la salud durante procedimientos dolorosos en neonatos. Métodos Estudio cuasi experimental tipo antes y después, realizado en una unidad neonatal. Se implementó la intervención Evidence-Based Practice for Improving Quality , norteada por la estructura conceptual The Promoting Action on Research Implementation in Health Services , en dos etapas (preparación e implementación), y su adopción fue medida mediante indicadores clínicos relacionados con el manejo del dolor, presentados por medio de estadística descriptiva. Resultados Después de discutir sobre prácticas existentes en la unidad que necesitaba cambios y realizar una síntesis de las evidencias científicas actuales y de datos del contexto local, los miembros del Consejo de Investigación y Práctica de la unidad elaboraron e implementaron metas coherentes y factibles para cambiar la práctica del manejo de dolor, seleccionaron estrategias de traducción e intercambio de conocimiento, determinaron el público destinatario y los indicadores e implementaron las intervenciones. Hubo una reducción del 32,8 % del número de procedimientos dolorosos realizados y un aumento de 26,6 a 50,7 % de utilización de las escalas de evaluación del dolor y del 25,1 % de la administración de glucosa oral. Conclusión La intervención multifacética Evidence-Based Practice for Improving Quality es compleja y contiene procesos que requieren conocimiento y habilidades, compromiso de los diferentes actores involucrados, disponibilidad de tiempo e inversión financiera. Los indicadores analizados mostraron que la intervención produjo cambios positivos en la práctica clínica del manejo del dolor del neonato.

Abstract Objective To describe the implementation process of a multifaceted knowledge translation and exchange intervention to improve pain management practices, and to evaluate the adoption of this intervention by health professionals during painful procedures in neonates. Methods A quasi-experimental before-and-after study developed in a neonatal unit. The Evidence-Based Practice for Improving Quality intervention guided by the conceptual framework The Promoting Action on Research Implementation in Health Services was implemented in two stages (preparation and implementation). Its adoption was measured by clinical indicators related to pain management presented through descriptive statistics. Results After discussion on existing practices in the unit that needed to be changed, synthesis of current scientific evidence and local context data, members of the unit's Research and Practice Council developed and implemented coherent and achievable goals for the change of practice in pain management, selected knowledge translation and exchange strategies, determined the target audience and indicators, and implemented the interventions. There was a 32.8% reduction in the number of painful procedures performed, an increase of 26.6-50.7% in the use of pain assessment scales and of 25.1% in the administration of oral glucose. Conclusion The multifaceted Evidence-Based Practice for Improving Quality intervention is complex, and has processes that demand knowledge and skills, commitment from the various actors involved, availability of time and financial investment. The analyzed indicators showed that the intervention resulted in positive changes in clinical practice in the management of pain in neonates.

Effects of Liquid and Bar Soaps on the Skin of Brazilian Newborns: A Randomized Controlled Trial.

INTRODUCTION: Compared to adults, newborns' skin has a thinner epidermis and stratum corneum with decreased hydration levels, higher transepidermal water loss, and a pH variation between 5.5 and 7.5. These characteristics can predispose to the occurrence of dryness, infections, and dermatological conditions. Water and liquid soap with adequate formulation have shown to be beneficial and safe for newborns' skin. However, studies evaluating the effect of bar soap, products widely used in Brazil and Latin America, are unknown. Therefore, the objective of this study was to compare the effects of liquid and bar soaps on the term newborns' skin. METHODS: This randomized controlled, parallel, single-blind clinical trial was conducted at a public university hospital in São Paulo, Brazil. 100 healthy term newborns with no congenital anomalies, acute diseases, or dermatological conditions were randomized to use liquid soap (experimental group) or bar soap (control group). Skin pH, transepidermal water loss, stratum corneum hydration, sebum content, and skin condition were assessed before and after the first bath, at 48 h, 14 days, and 28 days after birth. These evaluations were performed on the forearm, abdomen, buttocks, and thigh. In addition, the mother's perception of soap use was also evaluated. RESULTS: Data of 100 newborns were analyzed by intention to treat. The rate of retention was 53%. Newborns exposed to the liquid soap presented significantly better skin acidification (p < 0.001) and significantly better stratum corneum hydration (p < 0.001) than the skin of newborns exposed to the bar soap, regardless of the area evaluated. There were no significant differences in transepidermal water loss, sebum content, dryness, erythema, or skin breakdown and the mother's perceptions of the use of the soaps. CONCLUSION: Newborns in the experimental group presented better skin acidification and stratum corneum hydration when compared to newborns in the control group.

Nurses' Motivation, Knowledge, and Satisfaction with a Neonatal Pain Assessment e-Learning Course.

PURPOSE: To analyze nurses' motivation to learn, motivation to transfer, knowledge acquisition, and satisfaction with an e-Learning course about neonatal pain assessment. DESIGN: Quantitative, longitudinal, quasi-experimental study, conducted in a university affiliated hospital in São Paulo, Brazil, between April and October 2018. METHODS: Upon consent, nurses received two questionnaires electronically ("Demographics Survey" and "Motivation to Learn Survey") and were granted access to the e- Learning environment. During the 10-module course, nurses completed a "Pre-Test Questionnaire" (in unit one), and the "Post-Test Questionnaire", "Satisfaction Evaluation Survey", and "Motivation to Transfer Knowledge Survey" at completion of the course. Data were analyzed using R, version 3.6.2. RESULTS: 30 nurses were enrolled, the majority were female (93.33%), mean age 42.8 years (±7.6). The motivation to transfer knowledge (mean 4.09, ±0.53) was greater than the motivation to learn (mean 3.44, ±0, 33). There was significant increase in nurses' knowledge (p<0.0001) when comparing Post- and Pre-Test scores. Participants' satisfaction was overall positive regarding tutoring, virtual environment, self-evaluation, contents and activities, visual communication/layout. CLINICAL IMPLICATIONS: e-Learning allows nurses to increase their knowledge, to access evidence-based information, while offering a space for critical thinking, clinical reasoning, and decision-making in nursing care, ultimately contributing to quality of care and patient safety. CONCLUSIONS: The e-Learning course contributed to participants' knowledge acquisition, resulting in a positive impact on nurses' motivation to implement new knowledge about neonatal pain assessment in their clinical practice. The course was considered to be in a suitable environment, easy to handle, interactive and dynamic.

An exploratory case study investigating the implementation of a novel knowledge translation strategy in a pandemic: the Pandemic Practice Champion.

BACKGROUND: The clinical Pandemic Practice Champion (PPC) role was created in a large tertiary pediatric hospital as a knowledge translation (KT) strategy for implementing COVID-19 evidence-based knowledge. We aimed to describe the core components of the PPC role, the process of implementing the role, and the factors that hindered or facilitated role implementation. METHODS: An exploratory case study was undertaken. Semi-structured interviews were conducted virtually with stakeholders including PPC, managers, and front-line health care professionals (HCP). A directed approach to qualitative content analysis consistent with the Consolidated Framework for Implementation Research (CFIR) guided the analytic process. Inductive analyses and three stages of thematic synthesis were also conducted. RESULTS: Four PPC, 3 managers, and 6 HCP were interviewed. The core components of the PPC role consisted of (a) acting as knowledge experts and educators, (b) problem-solving for complex patient care issues, (c) conducting crisis management, and (d) acting as a resource to management, HCP, and families. Facilitators for successful implementation included access to external information, a supportive organizational context and culture, dedicated time and resources, and leadership support. Lack of clarity of role definition, insufficient time, pandemic uncertainty and fatigue, inability to change infrastructure, and access to external information hindered implementation. CONCLUSION: The PPC role was successfully implemented within a crisis context. Key barriers (role clarity, time, resources) and facilitators (organizational and leadership support) need to be considered when implementing the PPC role in practice. Future studies are needed to determine the intervention effectiveness of the champion role in changing HCP behavior and health outcomes and further examine implementation processes and mechanisms.

Oscillometric blood pressure measurement in a neonatal intensive care unit: a cross-sectional study

OBJECTIVE: The study aimed to evaluate how neonatal blood pressure measurement with the oscillometric method is performed by a nursing team, including patient preparation, documentation, materials, and equipment. METHOD: This cross-sectional study was conducted in a neonatal intensive care unit (NICU) through direct observation of procedures performed by nursing staff. A systematic script was used for observation and documentation of the procedure, patient reparation, and handling of equipment. The results were analyzed through inferential statistics. RESULTS: In a total of 150 observations, 60% or more of steps were classified as correct in 13 of the 26 target items. There was no difference between RNs and nurse technicians concerning the procedure´s success rate (p = 0.3933). Blood pressure measurement was obtained in the first attempt, according to the procedure´s adequacy (p <0.0001). CONCLUSION: Published recommendations for oscillometric blood pressure measurement were not followed completely. Continuing education should focus on routine procedures to ensure essential aspects of care.

Evaluation of the Premature Infant Pain Profile-Revised (PIPP-R) e-Learning Module: Immediate and Sustained Competency.

BACKGROUND: Electronic health (e-health) learning is a potential avenue to educate health professionals about accurately using infant pain assessment tools, although little is known about the impact of e-health interventions on clinical competence. PURPOSE: To evaluate whether an e-health learning module for teaching the accurate use of the Premature Infant Pain Profile-Revised (PIPP-R) pain assessment tool results in immediate and sustained competency to assess infant pain. METHODS: Neonatal intensive care unit (NICU) nurses who participated in a larger study across 2 tertiary NICUs in Canada examining the implementation and clinical utility of the PIPP-R e-learning module completed 2 follow-up evaluations at 1 week and 3 months. Participants were asked to view a video recording of an infant undergoing a painful procedure and to assess the infant's pain intensity response using the PIPP-R measure. Immediate and sustained competency was assessed via interrater consensus of participant-reported PIPP-R scores compared with those of an experienced trained coder. RESULTS: Of the 25 eligible nurses, 22 completed 1-week and 3-month follow-up evaluations. At the 1-week follow-up, 84% of nurses scored the video accurately compared with 50% at 3 months. Behavioral pain indicators were more likely to be scored incorrectly than physiological indicators. IMPLICATIONS FOR PRACTICE: Follow-up training after completion of the initial e-learning module training may improve competency related to the clinical use of the PIPP-R tool to assess infant pain over time. IMPLICATIONS FOR RESEARCH: Additional study regarding the need and timing of e-health training to optimize sustained competency in infant pain assessment is warranted.