| 1. |
- Calvert, Clara, et al.
(author)
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Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries
- 2023
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In: Nature Human Behaviour. - : Springer Nature. - 2397-3374. ; 7:4, s. 529-544
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Journal article (peer-reviewed)abstract
- Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.
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| 2. |
- Campbell-Yeo, Marsha, et al.
(author)
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Assessment and Management of Pain in Preterm Infants : A Practice Update
- 2022
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In: Children. - : MDPI. - 2227-9067. ; 9:2
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Journal article (peer-reviewed)abstract
- Infants born preterm are at a high risk for repeated pain exposure in early life. Despite valid tools to assess pain in non-verbal infants and effective interventions to reduce pain associated with medical procedures required as part of their care, many infants receive little to no pain-relieving interventions. Moreover, parents remain significantly underutilized in provision of pain-relieving interventions, despite the known benefit of their involvement. This narrative review provides an overview of the consequences of early exposure to untreated pain in preterm infants, recommendations for a standardized approach to pain assessment in preterm infants, effectiveness of non-pharmacologic and pharmacologic pain-relieving interventions, and suggestions for greater active engagement of parents in the pain care for their preterm infant.
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| 3. |
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| 4. |
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| 5. |
- Campbell-Yeo, Marsha, et al.
(author)
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Neonatal pain
- 2022
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Conference paper (other academic/artistic)abstract
- This is a workshop led by professors Marsha Campbell-Yeo, Halifax, Mats Eriksson, Örebro, and Denise Harrison, Melbourne. Neonatal pain will be discussed from a clinical and scientific view.
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| 6. |
- Campbell-Yeo, Marsha, et al.
(author)
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Pain in the Neonate
- 2024. - 3
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In: Managing Pain in Children and Young People. - : John Wiley & Sons. - 9781119645641 ; , s. 220-240
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Book chapter (other academic/artistic)abstract
- This chapter provides an overview of the epidemiology and adverse outcomes associated with untreated pain in neonates, in addition to current best evidence regarding the assessment, prevention and management of neonatal pain. Most guidelines on neonatal pain management declare pain assessment to be essential for achieving optimal pain and stress management. Investigations into the efficacy of using machine learning automated techniques to accurately analyse signals from infants and evaluate if they indicate pain are ongoing. Facilitated tucking is a physical containment intervention that involves placing hands on the head and limbs of an infant undergoing a painful procedure to maintain them in a side-lying flexed fetal position. Paracetamol is one of the most commonly used analgesic drugs in the neonatal intensive care unit. Opioids are the mainstay for the effective treatment of moderate to severe pain across all age groups, including neonates.
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| 7. |
- Campbell-Yeo, Marsha, et al.
(author)
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Redefining and implementing parent controlled analgesia through active parent engagement in neonatal pain treatment
- 2017
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Conference paper (peer-reviewed)abstract
- Involvement of parents in neonatal pain management is of increased interest in both research and clinical settings. From an evolutionary view, the mother is the optimal source of physical and psychological support for the infant, both as a fetus and after birth. Hospital care and medical interventions are sources of separation and stress, leading to a diminished capacity for the infant to endure painful procedures and situations. After decades of healthcare providers not recognising newborn infants’ capacity to feel pain and the associated adverse outcomes, most surgical and end-of-life pain is now prevented and treated with pharmacological methods. However, the drugs used are often not effective for the most common repeated painful procedures, and have potential short and long-term adverse effects. Recent research has thus focused on finding non-pharmacological interventions as a substitute to drugs, or to decrease the drug-doses needed for optimal analgesia. Several of these interventions involve parents, e.g. skin-to-skin care, breastfeeding, or facilitated tucking by parents.In this workshop we suggest redefining PCA from Patient Controlled Analgesia to Parent Controlled Analgesia that includes the parents of the newborn infant. This implies a change of role of parents, from being present or being advocates for their infant, to being responsible for their infants as pain-free. We will discuss obstacles and facilitators, in both high and low resource settings, for implementing a structured and highly recommended participation of parents in the pain management of their infant.
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| 8. |
- Eriksson, Mats, Professor, 1959-, et al.
(author)
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Assessment of pain in newborn infants
- 2019
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In: Seminars in Fetal & Neonatal Medicine. - : Saunders Elsevier. - 1744-165X .- 1878-0946. ; 24:4
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Journal article (peer-reviewed)abstract
- Hospitalized newborn infants experience pain that can have negative short- and long-term consequences and thus should be prevented and treated. National and international guidelines state that adequate pain management requires valid pain assessment. Nociceptive signals cause a cascade of physical and behavioral reactions that alone or in combination can be observed and used to assess the presence and intensity of pain.Units that are caring for newborn infants must adopt sufficient pain assessment tools to cover the gestational ages and pain types that occurs in their setting. Pain assessment should be performed on a regular basis and any detection of pain should be acted on. Future research should focus on developing and validating pain assessment tools for specific situations.
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| 9. |
- Ilhan, Emre, et al.
(author)
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What is the definition of acute episodic and chronic pain in critically ill neonates and infants? A global, four-stage consensus and validation study
- 2022
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 12:3
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Journal article (peer-reviewed)abstract
- Objectives: To define and validate types of pain in critically ill neonates and infants by researchers and clinicians working in the neonatal intensive care unit (NICU) and high dependency unit (HDU).Design: A qualitative descriptive mixed-methods design.Procedure/s: Each stage of the study was built on and confirmed the previous stages. Stage 1 was an expert panel to develop definitions; stage 2 was a different expert panel made up of neonatal clinicians to propose clinical characteristics associated with the definitions from stage 1; stage 3 was a focus group of neonatal clinicians to provide clinical case scenarios associated with each definition and clinical characteristics; and stage 4 was a survey administered to neonatal clinicians internationally to test the validity of the definitions using the clinical case scenarios.Results: In stage 1, the panel (n=10) developed consensus definitions for acute episodic pain and chronic pain in neonates and infants. In stage 2, a panel (n=8) established clinical characteristics that may be associated with each definition. In stage 3, a focus group (n=11) created clinical case scenarios of neonates and infants with acute episodic pain, chronic pain and no pain using the definitions and clinical characteristics. In stage 4, the survey (n=182) revealed that the definitions allowed an excellent level of discrimination between case scenarios that described neonates and infants with acute episodic pain and chronic pain (area under the receiver operating characteristic=0.87 and 0.89, respectively).Conclusions: This four-stage study enabled the development of consensus-based and clinically valid definitions of acute episodic pain and chronic pain. There is a need to define and validate other pain types to inform a taxonomy of pain experienced by neonates and infants in the NICU and HDU.
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| 10. |
- KC, Ashish, 1982-, et al.
(author)
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Changes in preterm birth and stillbirth during COVID-19 lockdowns in 26 countries.
- 2023
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In: Nature human behaviour. - : Springer Science and Business Media LLC. - 2397-3374. ; 7:4, s. 529-544
-
Journal article (peer-reviewed)abstract
- Preterm birth (PTB) is the leading cause of infant mortality worldwide. Changes in PTB rates, ranging from -90% to +30%, were reported in many countries following early COVID-19 pandemic response measures ('lockdowns'). It is unclear whether this variation reflects real differences in lockdown impacts, or perhaps differences in stillbirth rates and/or study designs. Here we present interrupted time series and meta-analyses using harmonized data from 52 million births in 26 countries, 18 of which had representative population-based data, with overall PTB rates ranging from 6% to 12% and stillbirth ranging from 2.5 to 10.5 per 1,000 births. We show small reductions in PTB in the first (odds ratio 0.96, 95% confidence interval 0.95-0.98, P value <0.0001), second (0.96, 0.92-0.99, 0.03) and third (0.97, 0.94-1.00, 0.09) months of lockdown, but not in the fourth month of lockdown (0.99, 0.96-1.01, 0.34), although there were some between-country differences after the first month. For high-income countries in this study, we did not observe an association between lockdown and stillbirths in the second (1.00, 0.88-1.14, 0.98), third (0.99, 0.88-1.12, 0.89) and fourth (1.01, 0.87-1.18, 0.86) months of lockdown, although we have imprecise estimates due to stillbirths being a relatively rare event. We did, however, find evidence of increased risk of stillbirth in the first month of lockdown in high-income countries (1.14, 1.02-1.29, 0.02) and, in Brazil, we found evidence for an association between lockdown and stillbirth in the second (1.09, 1.03-1.15, 0.002), third (1.10, 1.03-1.17, 0.003) and fourth (1.12, 1.05-1.19, <0.001) months of lockdown. With an estimated 14.8 million PTB annually worldwide, the modest reductions observed during early pandemic lockdowns translate into large numbers of PTB averted globally and warrant further research into causal pathways.
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| 11. |
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| 12. |
- Olsson, Emma, 1980-, et al.
(author)
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Cultural adaptation and harmonization of four Nordic translations of the revised Premature Infant Pain Profile (PIPP-R)
- 2018
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In: BMC Pediatrics. - : BioMed Central. - 1471-2431. ; 18
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Journal article (peer-reviewed)abstract
- Background: Preterm infants are especially vulnerable to pain. The intensive treatment often necessary for their survival unfortunately includes many painful interventions and procedures. Untreated pain can lead to both short- and long-term negative effects. The challenge of accurately detecting pain has been cited as a major reason for lack of pain management in these non-verbal patients. The Premature Infant Pain Profile (PIPP) is one of the most extensively validated measures for assessing procedural pain in premature infants. A revised version, PIPP-R, was recently published and is reported to be more user-friendly and precise than the original version. The aims of the study were to develop translated versions of the PIPP-R in Finnish, Icelandic, Norwegian, and Swedish languages, and to establish their content validity through a cultural adaptation process using cognitive interviews.Methods: PIPP-R was translated using the recommendations from the International Society for Pharmacoeconomics and Outcomes Research and enhanced with cognitive interviews. The respondent nurse was given a copy of the translated, national version of the measure and used this together with a text describing the infant in the film to assess the pain of an infant in a short film. During the assessment the nurse was asked to verbalize her thought process (thinking aloud) and upon completion the interviewer administered probing questions (verbal probing) from a structured interview guide. The interviews were recorded, transcribed, and analyzed using a structured matrix approach.Results: The systematic approach resulted in translated and culturally adapted versions of PIPP-R in the Finnish, Icelandic, Norwegian and Swedish languages. During the cultural adaptation process several problems were discovered regarding how the respondent understood and utilized the measure. The problems were either measure problems or other problems. Measure problems were solved by a change in the translated versions of the measure, while for other problems different solutions such as education or training were suggested.Conclusions: This study have resulted in translations of the PIPP-R that have content validity, high degree of clinical utility and displayed beginning equivalence with each other and the original version of the measure.
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| 13. |
- Olsson, Emma, 1980-, et al.
(author)
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Translation, cultural adaptation and validation of the revised version of the Premature Infant Pain Profile : An effort to improve pain assessment in infants in the Nordic countries
- 2015
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Conference paper (peer-reviewed)abstract
- Background: In order to effectively treat pain in the neonatal period and diminish its negative effects, pain must be recognized and properly assessed. Objective: a) Translate the revised version of Premature Infant Pain Profile (PIPP-R) (1, 2) scale into Finnish, Icelandic, Norwegian and Swedish languages. b) Test the content validity of each of the translated versions. Design: a) translation and cultural adaption following the ISPOR recommendations (3) and b) testing of content validity using cognitive interviews. Setting: Finland, Iceland, Norway and Sweden, with cognitive debriefing and interviews at selected neonatal units (NU). Participants: In each country 5-10 nurses working in the NU will be included through purposeful sampling. Procedures: Phase a): The following steps of the ISPOR protocol will be followed: 1)Preparation, 2) Forward translation, 3) Reconciliation, 4) Back translation, 5) Back translation review, 6) Harmonization, 7) Cognitive debriefing, 8) Review of cognitive debriefing results and finalization, 9) Proofreading, 10) Final report. Phase b): Interviews to gain an understanding concerning the respondents’ understanding of PIPP-R will be performed. Respondents’ first perform a pain assessment with the preliminary version of the scale while verbalizing their thought processes (Think Aloud) followed by an interview based on a semi-structured interview guide (Verbal Probing). Measures: National data will be analyzed in accordance with a predefined problems matrix (4). Results: None obtained yet. However; members of our research group have previous experience with the original PIPP scale from both research and clinical practice and have tested out the proposed translation methodology in a previous validation study (4).Conclusions: Having well validated pain assessment measures available, is a necessary first step for efficient treatment of pain in vulnerable preterm infants. This collaboration among the Nordic countries will help to standardize and develop our pain management practices and contribute to further building the PEARL research network.
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| 14. |
- Ullsten, Alexandra, 1967-, et al.
(author)
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Parent-led neonatal pain management : a narrative review and update of research and practices
- 2024
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In: Frontiers in Pain Research. - : Frontiers Media S.A.. - 2673-561X. ; 5
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Research review (peer-reviewed)abstract
- Introduction: Research related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents’ vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills.Methods: In this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research.Results: Parents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain- reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent’s and infant’s needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals’ attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants’ procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change.Conclusion: Parent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management.
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