Raylene Phillips

Procedural pain and oxidative stress in premature neonates.

UNLABELLED Preterm neonates exposed to painful procedures in the neonatal intensive care unit exhibit increased pain scores and alterations in oxygenation and heart rate. It is unclear whether these physiological responses increase the risk of oxidative stress. Using a prospective study design, we examined the relationship between a tissue-damaging procedure (TDP; tape removal during discontinuation of an indwelling central arterial or venous catheter) and oxidative stress in 80 preterm neonates. Oxidative stress was quantified by measuring uric acid (UA) and malondialdehyde (MDA) concentration in plasma before and after neonates (n = 38) experienced a TDP compared to those not experiencing any TDP (control group, n = 42). Pain was measured before and during the TDP using the Premature Infant Pain Profile (PIPP). We found that pain scores were higher in the TDP group compared to the control group (median scores, 11 and 5, respectively; P < .001). UA significantly decreased over time in control neonates but remained stable in TDP neonates (132.76 to 123.23 μM versus 140.50 to 138.9 μM; P = .002). MDA levels decreased over time in control neonates but increased in TDP neonates (2.07 to 1.81 μM versus 2.07 to 2.21 μM, P = .01). We found significant positive correlations between PIPP scores and MDA. Our data suggest a significant relationship between procedural pain and oxidative stress in preterm neonates. PERSPECTIVE This article presents data describing a significant relationship between physiological markers of neonatal pain and oxidative stress. The method described in this paper can potentially be used to assess the direct cellular effects of procedural pain as well the effectiveness of interventions performed to decrease pain.

Prevention of postpartum smoking relapse in mothers of infants in the neonatal intensive care unit

Objective:Approximately 40% of women who smoke tobacco quit smoking during pregnancy, yet up to 85% relapse after delivery. Those who resume smoking often do so by 2 to 8 weeks postpartum. Smoking mothers are more than twice as likely to quit breastfeeding by 10 weeks postpartum. The hospitalization of a newborn, while stressful, is an opportunity to emphasize the importance of a smoke-free environment for babies. Supporting maternal-infant bonding may reduce maternal stress and motivate mothers to remain smoke free and continue breastfeeding. The objective of this study was to reduce postpartum smoking relapse and prolong breastfeeding duration during the first 8 weeks postpartum in mothers who quit smoking just before or during pregnancy and have newborns admitted to the Neonatal Intensive Care Unit (NICU).Study Design:This study was an Institutional Review Board-approved prospective randomized clinical trial. After informed consent, mothers of newborns admitted to the NICU were randomized to a control or intervention group. Both groups received weekly encouragement to remain smoke free and routine breastfeeding support. Mothers in the intervention group were also given enhanced support for maternal-infant bonding including information about newborn behaviors, and were encouraged to frequently hold their babies skin-to-skin.Result:More mothers were smoke free (81 vs 46%, P<0.001) and breastfeeding (86 vs 21%, P<0.001) in the intervention than in the control group at 8 weeks postpartum.Conclusion:Interventions to support mother–infant bonding during a newborns hospitalization in the NICU are associated with reduced rates of smoking relapse and prolonged duration of breastfeeding during the first 8 weeks postpartum.

The Association Between Common Labor Drugs and Suckling When Skin‐to‐Skin During the First Hour After Birth

Abstract Background Intrapartum drugs, including fentanyl administered via epidural and synthetic oxytocin, have been previously studied in relation to neonatal outcomes, especially breastfeeding, with conflicting results. We examined the normal neonatal behavior of suckling within the first hour after a vaginal birth while in skin‐to‐skin contact with mother in relation to these commonly used drugs. Suckling in the first hour after birth has been shown in other studies to increase desirable breastfeeding outcomes. Method Prospective comparative design. Sixty‐three low‐risk mothers self‐selected to labor with intrapartum analgesia/anesthesia or not. Video recordings of infants during the first hour after birth while being held skin‐to‐skin with their mother were coded and analyzed to ascertain whether or not they achieved Stage 8 (suckling) of Widströms 9 Stages of newborn behavior during the first hour after birth. Results A strong inverse correlation was found between the amount and duration of exposure to epidural fentanyl and the amount of synthetic oxytocin against the likelihood of achieving suckling during the first hour after a vaginal birth. Conclusions Results suggest that intrapartum exposure to the drugs fentanyl and synthetic oxytocin significantly decreased the likelihood of the baby suckling while skin‐to‐skin with its mother during the first hour after birth.