| 1. |
- Andersen, Randi Dovland, et al.
(författare)
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Pain assessment practices in Swedish and Norwegian neonatal care units
- 2018
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Ingår i: Scandinavian Journal of Caring Sciences. - : Blackwell Publishing. - 0283-9318 .- 1471-6712. ; 32:3, s. 1074-1082
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The use of measurement scales to assess pain in neonates is considered a prerequisite for effective management of pain, but these scales are still underutilised in clinical practice.AIM: The aim of this study was to describe and compare pain assessment practices including the use of pain measurement scales in Norwegian and Swedish neonatal care units.METHODS: A unit survey investigating practices regarding pain assessment and the use of pain measurement scales was sent to all neonatal units in Sweden and Norway (n = 55). All Norwegian and 92% of Swedish units responded.RESULTS: A majority of the participating units (86.5%) assessed pain. Swedish units assessed and documented pain and used pain measurement scales more frequently than Norwegian units. The most frequently used scales were different versions of Astrid Lindgren's Pain Scale (ALPS) in Sweden and Echelle Douleur Inconfort Noveau-Ne (EDIN), ALPS and Premature Infant Pain Profile (PIPP) in Norway. Norwegian head nurses had more confidence in their pain assessment method and found the use of pain measurement scales more important than their Swedish colleagues.CONCLUSION: The persisting difference between Swedish and Norwegian units in pain assessment and the use of pain measurement scales are not easily explained. However, the reported increased availability and reported use of pain measurement scales in neonatal care units in both countries may be seen as a contribution towards better awareness and recognition of pain, better pain management and potentially less suffering for vulnerable neonates.
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| 2. |
- Arribas, Christina, et al.
(författare)
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Global cross-sectional survey on neonatal pharmacologic sedation and analgesia practices and pain assessment tools : impact of the sociodemographic index (SDI)
- 2024
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Ingår i: Pediatric Research. - : Nature Publishing Group. - 0031-3998 .- 1530-0447.
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Tidskriftsartikel (refereegranskat)abstract
- Background: There is variability in the use of sedatives and analgesics in neonatal intensive care units (NICUs). We aimed to investigate the use of analgesics and sedatives and the management of neonatal pain and distress.Methods: This was a global, prospective, cross-sectional study. A survey was distributed May–November 2022. The primary outcome of this research was to compare results between countries depending on their socio-sanitary level using the sociodemographic index (SDI). We organized results based on geographical location.Results: The survey collected 1304 responses, but we analyzed 924 responses after database cleaning. Responses from 98 different countries were analyzed. More than 60% of NICUs reported having an analgosedation guideline, and one-third of respondents used neonatal pain scales in more than 80% of neonates. We found differences in the management of sedation and analgesia between NICUs on different continents, but especially between countries with different SDIs. Countries with a higher SDI had greater availability of and adherence to analgosedation guidelines, as well as higher rates of analgosedation for painful or distressing procedures. Countries with different SDIs reported differences in analgosedation for neonatal intubation, invasive ventilation, and therapeutic hypothermia, among others.Conclusions: Socio-economic status of countries impacts on neonatal analgosedation management.
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| 3. |
- Baylis, Rebecca, et al.
(författare)
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First-time events between parents and preterm infants are affected by the designs and routines of neonatal intensive care units
- 2014
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Ingår i: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 103:10, s. 1045-1052
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Tidskriftsartikel (refereegranskat)abstract
- Aim: Early parental bonding with preterm babies is particularly important, and the aim of our study was to explore when parents experienced what they regarded as important events for the first time while their infant was in the neonatal intensive care unit (NICU).Methods: The study was part of a longitudinal project on Kangaroo Mother Care at two Swedish university hospitals. The parents of 81 infants completed questionnaires during their infants' hospital stay.Results: Most parents saw and touched their infants immediately after birth, but only a few could hold them skin to skin or swaddle them. Other important events identified by parents included the first time they performed care giving activities and did so independently, interaction and closeness with the infant, signs of the infant's recovery and integration into the family. The timing of the events depended on the physical design of the NICU, whether parents' could stay with their infant round-the-clock and when they were allowed to provide care under supervision and on their own.Conclusion: The design and routines of the NICU dictated when parents first interacted with their infants. Clinical guidelines that facilitate early contact with preterm babies can help parents to make the transition to their parental role.
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| 4. |
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| 5. |
- Gradin, Maria, 1963-, et al.
(författare)
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Pain reduction at venipuncture in newborns : oral glucose compared with local anesthetic cream
- 2002
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Ingår i: Pediatrics. - : American Academy of Pediatrics (AAP). - 0031-4005 .- 1098-4275. ; 110:6, s. 1053-1057
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Tidskriftsartikel (refereegranskat)abstract
- Objective. A number of studies have shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures. The local anesthetic cream EMLA has recently been shown to be safe for use in neonates. This study compared the pain-reducing effect of orally administered glucose with that of EMLA cream during venipuncture in newborns.Methods. Randomized, controlled, double-blind study including 201 newborns undergoing venipuncture for clinical purposes. Ninety-nine of the newborns received EMLA on the skin and orally administered placebo (sterile water), and 102 received glucose 30% orally and placebo (Unguentum Merck) on the skin. Symptoms associated with pain at venipuncture were measured with the Premature Infant Pain Profile (PIPP) scale (also validated for full-term infants). Heart rate and crying time were recorded.Results. There were no differences in background variables between the 2 groups.The results shows that the PIPP scores were significantly lower in the glucose group (mean: 4.6) compared with the EMLA group (mean: 5.7). The duration of crying in the first 3 minutes was significantly lower in the glucose group (median: 1 second) than in the EMLA group (median: 18 seconds). There were significantly fewer patients in the glucose group who were scored having pain (defined as PIPP score above 6); 19.3% compared with 41.7% in the EMLA group. The changes in heart rate were similar in both groups.Conclusions. We found that glucose is effective in reducing symptoms associated with pain from venipuncture in newborns and seems to be better than the local anesthetic cream EMLA.
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| 6. |
- Gradin, Maria, 1963-
(författare)
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Procedural pain reducing methods and pain assessment in newborns
- 2004
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Our knowledge of pain in neonates has increased significantly during the last fifteen years.We now have an improved understanding of the pain system and of the negative effects of untreated pain. Advances in neonatal care have increased the nwnber of preterm and severely ill infants who are treated in neonatal intensive care units (NICU). These infants are subjected to a variety of painful procedures as part of their management. Sufficient pain relief is needed and for this, valid pain assessment is one prerequisite.The aim of this research was to improve the management of procedural pain and to examine the assessment of neonatal pain in clinical practice.In an earlier study, oral glucose was found to reduce pain during blood sampling. To further evaluate the pain-reducing effect of oral glucose and to compare this effect with different blood sampling techniques, a trial was performed. The pain score was lower and crying time shorter in the venipuncture group than in the heel stick group when no glucose was given. When glucose was administered, the pain score was lower in both glucose groups than in the groups not receiving glucose (paper I).In a randomized, controlled study, the effect of oral glucose was compared with that of a topical local anaesthetic, EMLA, during venipuncture. The pain scores were found to be lower in the glucose group and fewer infants were scored as having pain. Crying time was also shorter in the glucose group (paper II).To compare the pain-reducing effect of oral glucose with that of breast-feeding shortly before venipuncture, a new trial was performed. The pain score was significantly lower in the infants receiving glucose than in those not given glucose. There was no significant difference in pain score between the infants who were fed and the fasting infants (paper III).In a previous study we found an increase in heart rate in newboms when they received glucose as pain relief. We therefore investigated whether oral glucose in itself could cause an increase in heart rate in healthy infants. In a trial, infants were randomized to receive oral glucose or placebo without undergoing any painful procedure. The heart rate was significantly higher in the glucose than in the placebo group (paper IV).Activation of endogenous opioids is suggested as one possible mechanism underlying the pain-reducing effect of oral glucose. We therefore investigated whether administration of an opioid antagonist would reduce the effect of oral glucose at heel stick in full-term newboms. There were no significant differences in pain score or crying between the group receiving an opioid antagonist before oral glucose and the group receiving placebo before oral glucose during heel stick (paper V).To document whether pain is assessed in Swedish neonatal units and by what methods, a questionnaire was distributed to all neonatal wards in Sweden in 1993, and again in 1998. Only a small proportion of neonatal units in Sweden attempted to assess pain. There was a minor increase in the nwnber of wards that used a structured method for pain scoring. Docwnentation of pain is still inadequate and needs to be improved (paper VI). We compared parental assessment during blood sampling with measurement of the pain score with a multidimensional tool and crying. There was low agreement between these variables during the procedure (paper III).In conclusion, we found that oral glucose reduces signs of pain from both heel stick and venipuncture blood sampling. Oral glucose reduces pain better than does EMLA cream and better than if the infant is breast-fed shortly before the procedure. Oral glucose increases the heart rate in infants and the pain-reducing effect of oral glucose in newboms was not diminished by injection of an opioid antagonist. Parental assessment of an infant's pain cannot replace measurement by pain scores. The pain assessment at neonatal units in Sweden needs to be improved.
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| 7. |
- Olsson, Emma, 1980-, et al.
(författare)
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Skin-to-skin contact for pain relief : a bibliometric analysis
- 2013
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Konferensbidrag (refereegranskat)abstract
- Introduction & Aims: Skin-to-skin contact originated as a life-saving alternative to conventional neonatal care in low-resource settings. Later research has focused on its advantages for e.g. breastfeeding, mother-infant attachment and also for pain-relief. This study is a part of a larger bibliometric project, analyzing neonatal pain research from 2000 to 2012, as a follow up of a previous investigation (1).Methods: PubMed, PsychInfo, Cochrane, and EBSCO databases were searched using terms relating to pain, neonatal care, infancy, skin-to-skin contact and kangaroo mother care. In addition literature was searched from personal knowledge, reference lists in retrieved articles and from the International Network of Kangaroo Care Bibliography (2). The articles in the final inclusion were analyzed according to publication data and type of research and also type of pain.Results: A final number of 87 articles were included in the analysis. Publication rate increased from an average of 2.5 articles per year the first 5-year period; 2000-2004, to 8.2 2005-2009 and 12.0 2010-2012. Eighty-eight per-cents were published in English language and the main publishing countries were USA with 34 % and Canada with 24 % of the articles. Randomized controlled trials constituted 33 % of the included articles, followed by 14 % other original research. Twenty per-cents were systematic reviews and 34 % guidelines, position papers or commentaries. The most common topic for the studies were procedural pain (61 %) followed by general pain issues (32 %). Of the first authors, 62 % were nurses and 28 % physicians.Discussion & Conclusions: Research about skin-to-skin contact as pain relieving measure shows an increasing trend over the last decade, both randomized trials and other original research, which is also seen in the increasing number of reviews and guidelines built on the results of this scientific work. The large proportion of nurses performing skin-to-skin contact research shows that skin-to-skin contact is a multi-professional team-based intervention. A next step would be to study compliance with the guidelines and the implementation process of skin-to-skin contact for pain-relief.References1. Baños, J. E., Ruiz, G., & Guardiola, E. (2001). An analysis of articles on neonatal pain published from 1965 to 1999. Pain Res Manag, 6(1), 45-50.2. Ludington-Hoe, S. Kangaroo Care Bibliography. Available at http://www.kangaroocareusa.org/uploads/KCBIB2012_May.pdfThe authors have no conflict of interest to declare.
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| 8. |
- Oras, Paola, 1980-, et al.
(författare)
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Breastfeeding Patterns in Preterm Infants Born at 28-33 Gestational Weeks
- 2015
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Ingår i: Journal of Human Lactation. - : SAGE Publications. - 0890-3344 .- 1552-5732. ; 31:3, s. 377-385
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies of breastfeeding patterns during preterm infants' first year of life are scarce but are important for providing breastfeeding mothers of preterm infants with optimal support.Objective: This study aimed to describe breastfeeding patterns in preterm infants up to 1 year of corrected age.Methods: As part of a larger study on kangaroo mother care in Sweden, a 24-hour breastfeeding diary was sent home after discharge from hospital, and at 2, 6, and 12 months of the infant's corrected age. Eighty-three mothers responded to the follow-up questionnaires, and the number of respondents to the breastfeeding diary was 48 at discharge, 43 at 2 months, 22 at 6 months, and 8 at 12 months. Infants were born at a median (range) gestational age of 32 (28-33) weeks. Breastfeeding patterns were analyzed according to durations, frequencies per 24 hours, and intervals between sessions.Results: In exclusively breastfed infants, the median (range) breastfeeding session frequency was 14 (8-26) times per 24 hours including 4 (1-9) times per night after discharge (n = 24) and 10 (6-25) times per 24 hours including 2 (0-5) times per night at 2 months (n = 23). In partially breastfed infants, the median (range) frequency was 5 (1-14) times per 24 hours including 2 (0-4) times per night at 6 months (n = 20) and 5.5 (1-12) times per 24 hours including 2 (0-3) times per night at 12 months (n = 8).Conclusion: Mothers reported large variations in breastfeeding patterns, with higher median breastfeeding session frequencies than previously described in term infants in affluent settings.
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| 9. |
- Oras, Paola, 1980-, et al.
(författare)
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Skin-to-skin contact is associated with earlier breastfeeding attainment in preterm infants
- 2016
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Ingår i: Acta Paediatrica. - Hoboken, USA : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 105:7, s. 783-789
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Tidskriftsartikel (refereegranskat)abstract
- Aim: This study investigated the effects of skin-to-skin contact on breastfeeding attainment, duration and infant growth in preterm infants, as this has not been sufficiently explored.Methods: A prospective longitudinal study on Kangaroo mother care was carried out, comprising 104 infants with a gestational age of 28+0 to 33+6 and followed up to one year of corrected age. Parents and staff recorded the duration of skin-to skin contact during the stay in the neonatal intensive care unit (NICU). Medical data were collected through patient records and follow-up questionnaires were filled in by parents.Results: The 53 infants who attained full breastfeeding in the NICU did so at a median (range) of 35+0 (32+1 to 37+5) weeks of postmenstrual age and skin-to-skin contact was the only factor that influenced earlier attainment in the regression analysis (R(2) 0.215 p<0.001). The daily duration of skin-to-skin contact during the stay in the NICU did not affect the duration of breastfeeding or infant growth after discharge. Furthermore, infant growth was not affected by the feeding strategy of exclusive, partial breastfeeding or no breastfeeding.Conclusion: A longer daily duration of skin-to-skin contact in the NICU was associated with earlier attainment of exclusive breastfeeding.
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| 10. |
- Scherman, Elna, et al.
(författare)
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Procedural pain in neonates : Do nurses follow national guidelines? A survey to Swedish neonatal units
- 2014
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Ingår i: Journal of Neonatal Nursing. - : Elsevier. - 1355-1841 .- 1878-089X. ; 10:1, s. 31-36
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: to investigate if nurses at neonatal units in Sweden have adopted national guidelines when neonates are exposed to intravenous catheter, capillary heel prick, venepuncture and injections, to identify the frequency of documentation of pharmacological and behavioural treatments and to compare the answers from the nurses with results from an earlier national survey completed by the chief neonatologists at the same units.Design and sample: Four nurses at a total of 44 neonatal units in Sweden, received questionnaires. A total number of 116 surveys were analysed (response rate 66 %).Main outcome and results: All units had written guidelines for prevention and treatment of pain. Behavioural treatments were used in every painful procedure in the study, but only1/5 used EMLA® often or always. There was a higher tendency to document the use of drugs than behavioural treatments. The chief neonatologist reported higher use of glucose than did nurses.Conclusions: Swedish national guidelines are not used consistently in some neonatal units. There is a considerably larger cohort of nurses who use behavioral treatments, rather than using drugs when painful procedures are performed. It was also evident that it was more common to document the use of drugs than behavioral treatments.
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| 11. |
- Strand, H., et al.
(författare)
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Kangaroo mother care in the neonatal intensive care unit : staff attitudes and beliefs and opportunities for parents
- 2014
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Ingår i: Acta Paediatrica. - : Wiley-Blackwell. - 0803-5253 .- 1651-2227. ; 103:4, s. 373-378
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To compare attitudes towards Kangaroo mother care (KMC) among staff in two high-tech neonatal intensive care units, which provided parents with different opportunities to get involved in their infants' care.Method: Questionnaires were completed by healthcare staff in Unit A, which provided parents with unrestricted access so that they could provide continuous KMC, and Unit B, where parents could only practice KMC intermittently.Results: Unit A staff were more positive about the benefits and use of KMC, including its use in unstable infants, and rated their knowledge and practical skills more highly than staff in the other unit. Unit B staff also appreciated the method, but expressed more hesitation in using it with unstable infants. In particular, they stressed the need to adapt the physical environment of the NICU to enable parents to stay with their infants and practice the method.Conclusion: Staff working in the NICU that gave parents unrestricted access were more positive about KMC than staff in the NICU that offered limited opportunities for parents to stay with their children. This finding suggests that it is important to eliminate unjustifiable obstacles to the presence of parents in the NICU, so that they can provide KMC.
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| 12. |
- Thernström Blomqvist, Ylva, 1974-, et al.
(författare)
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Pain Assessment and Management in Swedish Neonatal Intensive Care Units
- 2020
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Ingår i: Pain Management Nursing. - : Elsevier. - 1524-9042 .- 1532-8635. ; 21:4, s. 354-359
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To investigate registered nurses' (RNs') and physicians' knowledge, attitudes, and experiences regarding assessing and managing pain in infants at seven level III neonatal intensive care units (NICUs) in Sweden.DESIGN: Descriptive and explorative study using an online questionnaire.METHODS: A researcher-developed online questionnaire with 34 items about knowledge, attitudes, and experiences regarding pain assessment and management was emailed to 306 RNs and 79 physicians working at seven neonatal intensive care units (NICUs) in Sweden.RESULTS: Most NICUs had pain assessment guidelines, but there was a discrepancy regarding interprofessional discussions of pain assessments. A total of seven different pain assessment instruments were reported from the included NICUs and RNs were reportedly those who usually performed the pain assessments. Most respondents expressed a positive attitude toward pain assessment but recognized a lack of intervention after the assessment. Forty-six percent (n = 11) of the physicians said they had sufficient knowledge of assessing pain using pain assessment instruments, versus 75% (n = 110) of the RNs. Difficulties assessing pain in certain populations of infants, such as the most premature infants and infants receiving sedative medicines, were recognized.CONCLUSIONS: RNs in this study reported that their pain assessments did not lead to appropriate pain management interventions. They were thus discouraged from further pain assessments or advocating for ethical pain management. An interprofessional team effort is needed to effectively assess and manage pain in neonates.
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