Anita Mitchell

Adverse effects of pain on the nervous systems of newborns and young children: a review of the literature.

&NA; There are immediate and long‐lasting harmful consequences to the nervous system when infants experience severe or repetitive pain. These effects are especially significant in preterm infants, who are vulnerable to neurological damage during this critical time of neurodevelopment. Painful experiences may cause structural and physiological changes within the nervous system. Repeated painful procedures may result in decreased pain thresholds and hypersensitivity to pain. Immediate harmful effects of pain include physiologic instability and increased incidence of serious complications such as intraventricular hemorrhage. Painful stressors may lead to sleep disturbances, feeding problems, and inability to self‐regulate. Long‐term effects of pain may include altered pain perception, chronic pain syndromes, and somatic complaints. Repetitive pain in the preterm infant may be associated with attention deficit disorders, learning disorders, and behavioral problems in later childhood. Nursing involvement with pain management is crucial to achieve positive health outcomes for high‐risk infants and older children and adults who have experienced repetitive or severe pain as infants.

Physiologic effects of retinopathy of prematurity screening examinations.

Purpose:Preterm infants weighing less than 1500 g routinely undergo a series of eye examinations to screen for retinopathy of prematurity (ROP). While these examinations are important for the prevention of blindness, infants may suffer adverse physiologic events during and after the examination. The procedure includes administration of mydriatic eye drops that may be absorbed systemically and physical manipulation of the eye that is accompanied by stress and pain. The purpose of the study was to monitor changes in infant health status and adverse physiologic events in the 2 days after ROP eye screening. Subjects:The study used 50 preterm infants with a mean gestational age of 32 weeks, undergoing their first ROP examination in a NICU located in a university medical center. Design:This pilot study used a prospective, descriptive design. Methods:Physiologic changes and illness events were recorded before and for 2 days after the eye examination, using tools that tracked parameters of respiratory, cardiovascular, gastrointestinal, and neurological status. Data were collected directly from daily audits of medical records. McNemars test for comparing paired proportions and the signed rank test were used for comparing significance of physiologic changes before and after the ROP eye examination. Principal Results:Apnea events increased significantly (P = .04) in the 24- to 48-hour period after the eye examination compared with apnea events before the eye examination. These results were based on 39 infants who were not receiving ventilator support. There was a significant difference in the frequency of oxygen desaturation events between infants with and without apnea (0–24 hours after examination, P < .002; 25–48 hours after examination, P < .001). There were no significant differences in heart rate, cyanosis, gastric residuals, or seizures after the eye examinations. Conclusions:The ROP examinations may be associated with increased apnea, a clinically significant problem. Nursing implications include careful monitoring of infants during and after ROP eye examinations, discharge teaching for caregivers, and continued research on nursing interventions to prevent adverse physiologic events.

Does daily kangaroo care provide sustained pain and stress relief in preterm infants

OBJECTIVES 1. Determine whether stress in preterm infants, measured with salivary cortisol, decreases after five days of Kangaroo Care (KC) compared to five days of Standard Care (SC). 2. To determine whether kangaroo care provides sustainable pain relief beyond the period of skin-to-skin holding. STUDY DESIGN Preterm infants (n = 38) born at 27-30 weeks gestational age were randomized to either the KC or the SC group and received the allocated intervention starting on day of life (DOL) five and continuing for five days. Salivary cortisol was collected on DOL five and again on DOL ten. Differences were analyzed using repeated measures ANOVA and t tests. Pain during nasal suctioning over five days was assessed using the Premature Infant Pain Profile (PIPP). RESULT 1. Adequate saliva samples for salivary cortisol were collected for 13 KC infants and 11 SC infants. There was no main effect of group (p = 0.49), but there was a significant main effect of age (DOL five versus DOL ten), with salivary cortisol levels decreasing in both groups (p = 0.02). 2. Pain scores for both groups (n = 38) indicted mild to moderate pain during suctioning, with no significant difference in pain scores between groups. CONCLUSION 1. KC did not affect salivary cortisol levels in preterm neonates, but levels in both the KC and SC groups decreased over time from DOL five to ten. Salivary cortisol may vary with age of infant. 2. Infants experience pain during routine suctioning and may require pain management.

Effects of daily kangaroo care on cardiorespiratory parameters in preterm infants

BACKGROUND/AIMS Kangaroo care (KC) has possible benefits for promoting physiological stability and positive developmental outcomes in preterm infants. The purpose of this study was to compare bradycardia and oxygen desaturation events in preterm infants in standard incubator care versus KC. METHODS Thirty-eight infants 27 to 30 weeks gestational age were randomly assigned to 2 hours of KC daily between days of life 5 to 10 or to standard incubator care. Infants were monitored for bradycardia (heart rate <80) or oxygen desaturation (<80%). Analysis of hourly events was based on three sets of data: standard care group 24 hours daily, KC group during incubator time 22 hours daily, and KC group during holding time 2 hours daily. RESULTS The KC group had fewer bradycardia events per hour while being held compared to time spent in an incubator (p = 0.048). The KC group also had significantly fewer oxygen desaturation events while being held than while in the incubator (p = 0.017) and significantly fewer desaturation events than infants in standard care (p = 0.02). CONCLUSION KC reduces bradycardia and oxygen desaturation events in preterm infants, providing physiological stability and possible benefits for neurodevelopmental outcomes.

Oral sucrose and pain relief for preterm infants.

The frequency of painful procedures performed on preterm infants in the neonatal intensive care unit (NICU) presents a challenge to nurses who are attempting to provide effective pain relief, and to the infants themselves who may suffer adverse consequences in response to repeated painful procedures. One new pain relief intervention under study is the administration of oral sucrose, which may activate endogenous opioid systems within the body. Studies with preterm infants that have examined the use of oral sucrose as an analgesic during heelsticks and venipunctures have shown that sucrose is effective in reducing pain. Sucrose may also be combined with nonnutritive sucking to provide significant pain relief. The use of oral sucrose is now recommended with a wide range of painful procedures in the NICU. Promising results have been observed in studies with both term and preterm infants, but less research has occurred with preterm infants. Additional research is warranted to determine the most effective approaches for the administration of sucrose, to examine the effectiveness of sucrose with additional types of painful procedures, and to examine the effects of long-term repeated use of sucrose.

The effects of massage therapy to induce sleep in infants born preterm.

Purpose: The aim of this study was to determine whether massage therapy can be used as an adjunct intervention to induce sleep in infants born preterm. Methods: Thirty infants born at a minimum of 28 weeks gestational age, who were at the time of the study between 32 and 48 weeks adjusted gestational age, were randomly assigned to receive massage therapy on 1 day and not receive massage on an alternate day. The Motionlogger Micro Sleep Watch Actigraph recorded lower extremity activity on the morning of each day. Results: No significant difference was found between groups for sleep efficiency (P = .13) during the time period evaluated. Groups differed significantly during the time period after the massage ended with more infants sleeping on the nonmassage day (&khgr;2 = 4.9802, P = .026). Conclusions: Massage is well tolerated in infants born preterm and infants do not fall asleep faster after massage than without massage.

Web Camera Use of Mothers and Fathers When Viewing Their Hospitalized Neonate.

Background:Mothers and fathers of neonates hospitalized in a neonatal intensive care unit (NICU) differ in their experiences related to NICU visitation. Purpose:To describe the frequency and length of maternal and paternal viewing of their hospitalized neonates via a Web camera. Methods/Search Strategy:A total of 219 mothers and 101 fathers used the Web camera that allows 24/7 NICU viewing from September 1, 2010, to December 31, 2012, which included 40 mother and father dyads. We conducted a review of the Web cameras Web site log-on records in this nonexperimental, descriptive study. Findings/Results:Mothers and fathers had a significant difference in the mean number of log-ons to the Web camera system (P = .0293). Fathers virtually visited the NICU less often than mothers, but there was not a statistical difference between mothers and fathers in terms of the mean total number of minutes viewing the neonate (P = .0834) or in the maximum number of minutes of viewing in 1 session (P = .6924). Patterns of visitations over time were not measured. Implications for Practice:Web camera technology could be a potential intervention to aid fathers in visiting their neonates. Both parents should be offered virtual visits using the Web camera and oriented regarding how to use the Web camera. Implications for Research:These findings are important to consider when installing Web cameras in a NICU. Future research should continue to explore Web camera use in NICUs.

Mothers, infants, and DHA. Implications for nursing practice.

The purpose of this article is to describe the professional literature and current controversies concerning the relationship between essential fatty acids, especially Docohexaenoic Acid (DHA), and neurologic function. Although there is debate in the literature concerning just how much DHA is required for optimal neurologic functioning of infants, it is known that adequate DHA levels are dependent on an adequate dietary intake. However, common dietary practices today may not provide enough DHA. Because pregnancy and lactation are key times of rapid brain growth for the developing fetus and infant, nurses can be instrumental in teaching pregnant and lactating women diet-related information and promoting practices that help increase DHA levels. By understanding the importance of DHA in pregnancy and infancy, the nurse can take a more active role in essential health education.

Ce: Original Research

&NA; Background: Despite years of research and increasingly evidence-based practice, falls continue to be the most commonly reported adverse events experienced by hospitalized adults. Yet a majority of the relevant research has focused on predicting and preventing falls in general; there has been little focus on injurious falls. Purpose: The purpose of this retrospective study was to determine which patient factors are associated with injurious falls in hospitalized adults. Methods: The study sites adverse event reporting database was used to identify 1,369 patients who fell between January 1, 2006, and October 31, 2013. Of these, 381 (27.8%) subjects suffered injurious falls. Variables of interest included age, sex, fall history, use of diuretics, use of central nervous system medications, cognitive impairment, primary discharge diagnoses, abnormal laboratory values, impaired mobility, and body mass index. Findings: Bivariate analysis revealed a statistically significant association between injurious falls and having a primary discharge diagnosis of “symptoms, signs, and ill-defined conditions.” Having this discharge diagnosis was a significant predictor of injurious falls. Conclusions: Findings from this study may help hospital clinicians to better identify which patients are most at risk for injurious falls and to create better fall-related injury prevention interventions.

Does noninvasive electrical stimulation of acupuncture points reduce heelstick pain in neonates

Noninvasive electrical stimulation at acupuncture points (NESAP) for analgesia is used in children, but has not been widely studied in neonates. The purpose of this study was to determine whether NESAP alone or in combination with sucrose relieved heelstick pain in neonates.