|
Article Start
Newborns
in intensive care undergo many procedures that are associated with pain
and stress, and many of these procedures are performed without
medication or therapy to relieve the pain, according to a study
released on July 7, 2008 in JAMA.
According to the
authors of this study, this could instigate developmental issues.
"Repeated
invasive procedures occur routinely in neonates [a baby, from birth to
four weeks] who require intensive care, causing pain at a time when it
is developmentally unexpected. Neonates are more sensitive to pain than
older infants, children, and adults, and this hypersensitivity is
exacerbated in preterm neonates. Multiple lines of evidence suggest
that repeated and prolonged pain exposure alters their subsequent pain
processing, long-term development, and behavior. It is essential,
therefore, to prevent or treat pain in neonates," they write.
"Effective strategies to improve pain management in neonates require a
better understanding of the epidemiology and management of procedural
pain."
To study the frequency of these stressful procedures and
the corresponding use of analgesic or other pain relief, Ricardo
Carbajal, M.D., Ph.D., of the Hopital d'enfants
Armand Trousseau, Paris, and colleagues gathered data on neonatal pain.
To do this, direct bedside observations were made in intensive care
units (ICUs) in the Paris area. Taken between September 2005 and
January 2006, data was collected regarding all painful and stressful
procedures in the first fourteen days of admission, as well as the
corresponding medications (if any) used to relieve pain. The average
gestational period of the subjectswas 33 weeks, and the average length
of ICU stay was 8.4 days.
In
this period, 60,969 procedures were performed on the subjects. Of
these, 69.6% (42,413) were considered painful and 30.4% (18,556) were
considered stressful. Some examples of painful procedures include:
nasal and tracheal aspiration, heel stick, and adhesive removal. As a
group, the neonates received and average of 141 procedures, with a
daily average of 16. Of these, a median 75 painful procedures were
performed on each neonate, with an average of 10 painful procedures per
day.
When examining analgesic use, pain relievers were used in
a median 20% of the painful procedures performed in the study period.
When the nature of these pain relievers is examined, 2.1% of the
painful procedures were performed with pharmacological therapy, while
18.2% were with nonpharmacological-only therapy. 0.4% used both, and
79.2% were performed without any indicated in the procedure.
After
further analysis, several factors contributed to a greater use of
specific preprocedural analgesia, including: prematurity, parental
presence in procedures, daytime surgeries (between 7 a.m. and 6 p.m.)
and the day of hospitalization (between 2 and 14 days). Some factors
that decreased the changes of pain reliever use included: mechanical
ventilation, noninvasive ventilation, and the administration of
nonspecific but concurrent analgesia.
The authors write that this is an issue that requires attention in the
field of neonatal health. "Advances in neonatal care
in recent decades with increased survival of immature and sick neonates
have led to an increased number of invasive procedures that may cause
pain in these vulnerable neonates. The prevention of pain in critically
ill neonates is not only an ethical obligation, but it also averts
immediate and long-term adverse consequences," they day. "Strategies to
reduce the number of procedures in neonates are needed
urgently. The American Academy of Pediatrics recently emphasized the
need to incorporate a principle of minimizing the number of painful
disruptions in neonatal care protocols. Such strategies would aim at
bundling interventions, eliminating unnecessary laboratory or
radiographic procedures, using transcutaneous measurements when
possible, and minimizing the number of procedures performed after
failed attempts."
They conclude with a statistic highlighting this need: "The knowledge
that some vulnerable neonates
underwent 153 tracheal aspirations or 95 heel sticks in a two-week
period should elicit a thoughtful and relevant analysis on the
necessity and the risk-benefit ratio of our clinical practices."
Epidemiology and Treatment of Painful Procedures in Neonates
in Intensive Care Units
Ricardo
Carbajal; André Rousset; Claude Danan; Sarah Coquery; Paul Nolent;
Sarah Ducrocq; Carole Saizou; Alexandre Lapillonne; Michèle Granier;
Philippe Durand; Richard Lenclen; Anne Coursol; Philippe Hubert; Laure
de Saint Blanquat; Pierre-Yves Boëlle; Daniel Annequin; Patricia
Cimerman; K. J. S. Anand; Gérard Bréart
JAMA. 2008;300(1):60-70.
Click Here For Journal
Written by Anna Sophia McKenney
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today
Article End
|
