Liam Mahoney

The Association Between Parent’s and Healthcare Professional’s Behavior and Children’s Coping and Distress During Venepuncture

OBJECTIVES Examine the association between childrens distress and coping during venepuncture with parents and healthcare professionals behavior in a sample from the UK. METHODS Fifty children aged 7-16 years accompanied by a carer were videotaped while having venepuncture. Verbalizations of children, parents, and healthcare professionals were coded using the Child-Adult Medical Procedure Interaction Scale-Revised. RESULTS Childrens distress was associated with childs age, anxiety, and distress promoting behavior of adults (R(2) = .91). Childrens coping was associated with age, anxiety, and coping promoting behaviors of adults (R(2) = .57). Associations were stronger between healthcare professionals behavior and child coping; and between parents behaviors and child distress. Empathizing, apologizing, and criticism were not frequently used by adults in this sample (<12%). CONCLUSION This study supports and extends previous research showing adults behavior is important in childrens distress and coping during needle procedures. Clinical implications and methodological issues are discussed.

A Literature Review of the Pharmacokinetics and Pharmacodynamics of Dobutamine in Neonates

Since its discovery in 1975 dobutamine has been used off-label for treating hemodynamic insufficiency in newborns and children. We present a structured literature review of pharmacokinetic and pharmacodynamic data for dobutamine in the pediatric population. Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria. Where possible, results for the pharmacodynamic and pharmacokinetic effect of dobutamine were reported as pooled data. Forty-six papers met the inclusion criteria. With regard to pharmacodynamic data a number of studies reported significant increases in a number of clinical parameters such as heart rate, blood pressure, cardiac output across a wide range of pediatric populations. With regard to pharmacokinetic data studies reported that the infusion rate was positively correlated to plasma dobutamine concentration. There was great variability with regard to dobutamine clearance between individuals and as to whether it followed first- or zero-order elimination kinetics. While the pharmacodynamic effects of dobutamine appear to reflect the pharmacological profile of the drug, the pharmacokinetic data are difficult to interpret due to inhomogeneity between study populations ages, comorbidities, dobutamine dosages and methodologies. High-quality prospective pharmacokinetic and pharmacodynamic data especially in newborns are urgently required prior to a large randomized study.

What is the Evidence for the use of Adrenaline in the Treatment of Neonatal Hypotension

AIM The authors of this review present the current evidence of the physiology, indications and use of adrenaline in neonates, with particular focus on the treatment of hypotension. METHOD A structured literature search was performed across selected electronic databases, reference lists and related articles. Abstracts arising from the search were screened for relevance according to predefined inclusion criteria. Full articles for the selected abstracts were obtained and then reviewed. Articles were analysed through a two stage process until agreement was reached between the research team on the studies for inclusion. RESULTS We identified 187 animal and human studies (published between 1924-2011) using various methodologies but with two main themes: the physiology of endogenous adrenaline in neonates and the therapeutic uses of this hormone in neonatal medicine. The physiological studies measured catecholamine levels in cord blood, neonatal urine and blood, some in response to interventions such as suctioning, skin massage or morphine infusion. Within the therapeutic studies there was only one randomised controlled trial (RCT): a comparison of dopamine versus adrenaline involving 60 infants of < 32 weeks gestational age. CONCLUSION Despite the number of studies identified, we found few adequately-controlled studies on the therapeutic use of adrenaline in neonates. Future research should focus on RCTs comparing adrenaline to other commonly used inotropes.

The association of children's distress during venepuncture with parent and staff behaviours

Venepuncture and other needle-related procedures can distress children and have a lasting negative impact. Adults’ behaviour during these procedures may affect children’s reactions. However, the literature is contradictory and rarely considers verbal and non-verbal behaviour together. This study therefore examined the effect of adults’ verbal and non-verbal behaviour on children’s distress during venepuncture. Participants comprised 51 child and carer dyads and 10 staff members. Child anxiety was measured before the procedure. The procedure was recorded. The resulting audio-visual data were coded using the Child–Adult Medical Procedure Interaction Scale–Revised. Correlation analysis identified variables that were significantly associated with child distress: child anxiety, carer distress-promoting behaviour, staff distress-promoting behaviour and intimate distance. These were included in a path diagram of child distress. Exploration of the diagram identified that children’s anxiety was mostly strongly associated with children’s distress during venepuncture. Staff and carer behaviour did not increase children’s distress. The results suggest interventions to reduce children’s distress during venepuncture may be more effective if they focus on reducing children’s anxiety beforehand.

Cardiovascular Drug Therapy for Human Newborn: Review of Pharmacodynamic Data

BACKGROUND Circulatory failure in preterm and term newborn infants is commonly treated with inotropes or vasoactive medications. In this structured literature review, the available data on pharmacodynamic effects of the inotropes adrenaline, dobutamine, dopamine, levosimendan, milrinone, noradrenaline, and the vasoactive drugs vasopressin and hydrocortisone are presented. METHODS Structured searches were conducted to identify relevant articles according to pre-defined inclusion criteria which were human clinical trials published after 2000. RESULTS Out of 101 identified eligible studies only 22 studies met the criteria for evidence based practice guidelines level I to IV. The most prevalent pharmacodynamic effects were increase in blood pressure and/or heart rate, which were also the most frequently studied circulatory parameters. CONCLUSION This review demonstrates the need for further systematic studies on all reviewed drugs with incorporation of novel non-invasive biomarkers in this vulnerable patient group, for more timely and appropriate treatment for clinical efficacy.

Erratum to: A Literature Review of the Pharmacokinetics and Pharmacodynamics of Dobutamine in Neonates

Unfortunately, there were errors in the original publication of the article. The corrected text has been presented with this erratum. In the section titled Venous Measures, the fifth paragraph, line 11 should read: ‘‘Trifonova and Ismail-Zade [69] and Sakata et al. [59] observed a significant reduction in central venous pressure in response to infusions of dobutamine up to 2.2 mmHg.’’ It was erroneously published as ‘‘Trifonova and Ismail-Zade [69] and Sakata et al. [59] observed a significant reduction in central venous pressure in response to infusions of dobutamine up to 21 mmHg.’’ In the same section, line 3 should read: ‘‘In these two studies doses of 10 mcg/kg/min increased superior vena cava flow by 5.0 and 5.2 ml/kg/min, respectively, from baseline levels [13, 41]. Increasing the dose to 20 mcg/kg/min increased superior vena cava flow a further 5.4 and 1.7 ml/kg/min, respectively [13, 41].’’ which was erroneously published as ‘‘In these two studies doses of 10 mcg/kg/min increased superior vena cava flow by 5.1 and 5.2 ml/kg/min respectively from baseline levels [13, 41]. Increasing the dose to 20 mcg/kg/min increased superior vena cava flow a further 0.3 and 1.7 ml/kg/min respectively [13, 41].’’

A 24 hour study on the stability of dopamine and dobutamine under laboratory simulated neonatal ward conditions

Developmental problems in extremely preterm children with borderline intellectual functioning and free from neurosensory disabilities at 6.5 years in Sweden (the EXPRESS study)THE EXPRESS/CHARM STUDY : 6.5 YEAR OLD CHILDREN BORN EXTREMELY PRETERM ARE LESS PHYSICALLY ACTIVE THAN TERM PEERSEarly-life hyperglycemia in extremely preterm infants affects neurodevelopment at 6 years of age