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Background: To determine whether healthcare professionals perceive the pain of infants differently due to their understanding of that infant's level of risk for neurological impairment. Method: Neonatal Intensive Care Units (NICU's) at two tertiary pediatric centers. Ninety-five healthcare professionals who practice in the NICU (50 nurses, 19 physicians, 17 respiratory therapists, 9 other) participated. They rated the pain (0-10 scale and 0-6 Faces Pain Scale), distress (0-10), effectiveness of cuddling to relieve pain (0-10) and time to calm without intervention (seconds) for nine video clips of neonates receiving a heel stick. Prior to each rating, they were provided with descriptions that suggested the infant had mild, moderate or severe risk for neurological impairment. Ratings were examined as a function of the level of risk described. Results: Professionals' ratings of pain, distress, and time to calm did not vary significantly with level of risk, but ratings of the effectiveness of cuddling were significantly lower as risk increased [F (2,93) = 4.4, p = .02]. No differences in ratings were found due to participants' age, gender or site of study. Physicians' ratings were significantly lower than nurses' across ratings. Conclusion: Professionals provided with visual information regarding an infants' pain during a procedure did not display the belief that infants' level of risk for neurological impairment affected their pain experience. Professionals' estimates of the effectiveness of a nonpharmacological intervention did differ due to level of risk. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the incidence of complications in low birth weight neonates with surgically inserted central venous catheters (CVCs). STUDY DESIGN: Retrospective chart review of all neonates ≤ 1500-gm birth weight from three tertiary care neonatal intensive care units who required CVC insertion. RESULTS: A total of 112 CVCs was inserted in 104 neonates with birth weight of 798 (490 to 1380) gm, age 16 (3 to 179) days, for a duration of 21 (1 to 130) days. The birth weights of 85 neonates were ≤1000 gm. One or more complications associated with the CVC occurred in 59 patients (57%). Sepsis was the commonest complication, with 43 episodes in 38 patients, at a rate of 14.5 episodes/1000 catheter days. Using regression analysis, sepsis was associated with birth weight, male sex, and the duration for which the CVC remained in place. Five of the nine who developed superior vena cava syndrome and/or pleural effusions died. CONCLUSION: CVCs can provide venous access that is durable. However, in the LBW neonate, and especially in those of ≤1000 gm, there is a high incidence of associated complications. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate observed/expected (O/E) lung-to-head ratio (LHR) by ultrasound (US) and total fetal lung volume (TFLV) by magnetic resonance imaging as neonatal outcome predictors in isolated fetal congenital diaphragmatic hernia (CDH). Study Design: We conducted a retrospective study of 72 fetuses with isolated CDH, in whom O/E LHR and TFLV were evaluated as survival predictors. Results: O/E LHR on US and O/E TFLV by magnetic resonance imaging were significantly lower in newborn infants with isolated CDH who died compared with survivors (30.3 ± 8.3 vs 44.2 ± 14.2; P < .0001 for O/E LHR; 21.9 ± 6.3 vs 41.5 ± 17.6; P = .001 for O/E TFLV). Area under receiver-operator characteristics curve for survival for O/E LHR was 0.80 (95% confidence interval, 0.70–0.90). On multivariate analysis, O/E LHR predicted survival, whereas hernia side and first neonatal pH did not. For each unit increase in O/E LHR, mortality odds decreased by 11% (95% confidence interval, 4–17%). Conclusion: In fetuses with isolated CDH, O/E LHR (US) independently predicts survival and may predict severity, allowing management to be optimized. [ABSTRACT FROM AUTHOR]

Abstract: Multiple researchers have validated indicators and measures of infant pain. However, infants at risk for neurologic impairment (NI) have been under studied. Therefore, whether their pain responses are similar to those of other infants is unknown. Pain responses to heel lance from 149 neonates (GA>25–40 weeks) from 3 Canadian Neonatal Intensive Care units at high (Cohort A, n =54), moderate (Cohort B, n =45) and low (Cohort C, n =50) risk for NI were compared in a prospective observational cohort study. A significant Cohort by Phase interaction for total facial action (F (6,409) =3.50, p =0.0022) and 4 individual facial actions existed; with Cohort C demonstrating the most facial action. A significant Phase effect existed for increased maximum Heart Rate (F (3,431) =58.1, p =0.001), minimum Heart Rate (F (3,431) =78.7, p =0.001), maximum Oxygen saturation (F (3,425) =47.6, p =0.001), and minimum oxygen saturation (F (3,425) =12.2, p =0.001) with no Cohort differences. Cohort B had significantly higher minimum (F (2,79) =3.71, p =0.029), and mean (F (2,79) =4.04, p =0.021) fundamental cry frequencies. A significant Phase effect for low/high frequency Heart Rate Variability (HRV) ratio (F (2,216) =4.97, p =0.008) was found with the greatest decrease in Cohort A. Significant Cohort by Phase interactions existed for low and high frequency HRV. All infants responded to the most painful phase of the heel lance; however, infants at moderate and highest risk for NI exhibited decreased responses in some indicators. [Copyright &y& Elsevier]

In the past decade, our knowledge of pain in newborn infants has advanced considerably. However, infants at significant risk for neurologic impairment (NI) have been systematically excluded from almost all research on pain in neonates. The objectives of this study were to compare: (a) the nature, frequency and prevalence of painful procedures, (b) analgesics and sedatives administered, and (c) the relationship between painful procedures and analgesia for neonates at risk for NI. One hundred and ninety-four infants at high (cohort A, n=67), moderate (cohort B, n=59) and low (cohort C, n=68) risk for NI from two tertiary level Neonatal Intensive Care Unit''s in Canada were included in a retrospective cohort study on the first 7 days of life. Data were collected from medical records and analyzed using chi-square, ANOVA and regression approaches. All cohorts had a mean of >10 painful procedures per day during the first 2 days of life. There was an interaction effect between cohort group and day of life (F5,188=2.13, P<0.06) with cohort A having significantly more painful procedures on day 1 (F2,191=4.79, P<0.009). There was no statistical difference in the number of infants who received continuous infusion (F2,20=1.9, P=0.13) or bolus (F2,20=1.3, P=0.25) opioids or sedatives (F2,20=0.45, P=0.84) by cohort over the 7 day period. There was a statistical difference in bolus opioid administration for days 1 (P<0.05) and 2 (P<0.001) with less than 10% of infants in cohort A receiving bolus opioids compared with approximately 22–33% of infants in cohorts B and C. There was a statistically significant correlation between painful procedures and analgesic use (r=0.29, P<0.001), although significant associations existed for cohorts B and C only. The number of painful procedures and study site primarily accounted for the variance (61% in cohort B and 35% in cohort C) in analgesic use, while in cohort A, only study site contributed to the variance (16%). Neonates at the highest risk for NI had the greatest number of painful procedures and the least amount of opioids administered during the first day of life. There was no relationship between painful procedures and analgesic use in this group. As these infants are vulnerable to pain and its consequences, the rational underlying health professional strategies regarding painful procedures and analgesic use for procedural pain in this population urgently awaits exploration. [Copyright &y& Elsevier]