Search

OBJECTIVE: Whether parental presence during their children's painful medical procedures is advantageous with regard to child's pain-related outcomes is questionable. Research regarding this topic is equivocal and additional questions, such as whether levels of parental involvement may play a role as well, remain to be assessed. The purpose of this systematic review is to summarize and critically appraise the literature regarding the impact of parental presence versus absence during their children's painful medical procedures on the child's pain-related outcomes.METHODS: The review protocol was registered on Prospero (ID CRD42018116614). A systematic search in PubMed, Web of Science, and PsycArticles resulted in 22 eligible studies incorporating 2157 participants. Studies were considered eligible if they included children (≤ 18 years old) undergoing a painful medical procedure and compared parental presence and/or involvement with parental absence during the procedure.RESULTS: The children's pain-related outcomes included self-reported pain intensity, self-reported fear, anxiety and distress, observed pain-related behavior, and physiological parameters. Overall, evidence points in the direction of beneficial effects of parental presence versus absence with regard to children's self-reported pain intensity and physiological parameters, whereas mixed findings were recorded for children's self-reported fears, anxiety and distress, and observed pain-related behaviors.CONCLUSIONS: : In order to provide clear recommendations on how to involve the parent during the procedure, as well as for which type of children and parents parental presence has the best effects, further research is needed, as indicated in this review.

All critically ill adult patients in intensive care units (ICU) typically experience pain. Critically ill adults suffer pain of different intensities. It depends on individual characteristics, specific procedural interventions, and underlying diseases. Inadequate management of acute pain is a risk factor for the emergence of chronic pain, where the incidence is up to 33% into the ICU survivor population. For the management of pain, agitation, and delirium, several coexisting clinical practice guidelines have been published. The first problem is that the patient recovered in intensive care unit should not be able to communicate its pain state. Opioids are the analgesic drugs of choice in critically ill patients with non-neuropathic pain. All intravenous opioids have the same effects, respecting the equianalgesic table. Observational research has shown that opioids are the main analgesic treatment in over 80% of mechanically ventilated patients. It is interesting that opioid consumption in an ICU and the memory of painful experience are linked to the development of post-traumatic stress disorder after ICU discharge. In order to reduce the side effects and maintain analgesia, it is useful to associate adjuvant medications with opioids. An opportunity to improve patients' experience in an ICU is to manage pain through multimodal approaches.

Purpose The purpose of this study was to describe nurses perceptions of infants' procedural pain assessment and alleviation with non-pharmacological methods including parental guidance in departments of neonatal and infant medicine and Neonatal Intensive Care (NICUs). Design and methods A descriptive cross-sectional survey was carried out among all nurses (n= 149) who were working in neonatal and infant departments or NICUs in Estonian hospitals. Altogether, 128 questionnaires were returned and 111 respondents were eligible (75% response rate). The data were analysed using statistical methods. Results More than half of the nurses agreed that systematic documentation of the measurement of pain is necessary for nursing care and that it affects pain alleviation in infants. Half of the respondents (51%) confirmed that pain scales are important in the measurement of infants' pain, but 58% claimed they were able to assess pain in a reliable way without using pain assessment scales. Nurses also reported that they were unfamiliar with most pain scales and they were not routinely used in everyday practice. Nurses said that the most useful non-pharmacological pain alleviation methods were touching (83%) and positioning infants (78%), the most rarely used were skin-to-skin care (12%) and encouraging mothers to breastfeed the infant (34%). The majority of respondents (79%) reported that they do not know or do not have written instructions on pain assessment in their workplace, and only a few (10%) reported that they have participated in pain management courses during the last year. Conclusions There is a need to increase the use of pain assessment scales and pain documentation in everyday practice in those hospitals in Estonia. The use of scales in pain assessment was valued by few nurses. It seems that there is a lack of knowledge on non-pharmacological methods, and nurses reported using only a few non-pharmacological pain alleviation methods and guided parents on using them. Practice implications Nurses need pain management guidelines for everyday work, and in addition to nurses, written guidelines for parents are needed.

INTRODUZIONE:Quasi il 10% del dolore che colpisce i bambini con paralisi cerebrale (PC) deriva da una procedura medica. La clownterapia è una diffusa tecnica di distrazione per ridurre il dolore; alcune revisioni sistematiche valutano l'efficacia di questo intervento in ambito pediatrico, ma nessuna su bambini con PC. OBIETTIVO:Valutare l'effetto della clown terapia sul dolore procedurale nei bambini con PC. METODI:Revisione sistematica con meta-analisi di trial clinici con gruppo di controllo. Reperimento degli studi tramite interrogazione di database biomedici, risorse online e registri di trial. La clown terapia è stata confrontata con le cure standard. L'esito primario era il livello di dolore dopo l'intervento. Il rischio di bias è stato valutato con RoB 2. La dimensione d'effetto è stata calcolata con un modello a effetti casuali. RISULTATITre studi con 164 pazienti sono stati inclusi. Il rischio di bias è alto per due studi e solleva qualche dubbio per uno. Tutti gli studi hanno analizzato l'effetto della clown terapia sul dolore procedurale dopo l'iniezione di tossina botulinica. È stata rilevata una riduzione statisticamente non significativa del dolore nel gruppo di intervento rispetto a quello di controllo (DSM: -0,20, IC 95%: -0,56, 0,17). L'eterogeneità tra gli studi è elevata. CONCLUSIONE:La clown terapia per il dolore procedurale da iniezioni di tossina botulinica nei bambini con PC sembra efficace ma i limiti metodologici degli studi non consentono un giudizio definitivo. Mancano studi che valutino l'effetto dell’intervento su altre procedure a cui si sottopongono periodicamente i bambini con PC, BACKGROUND:Nearly 10% of the pain that affects children with cerebral palsy (CP) results from a medical procedure. Clown therapy is a popular distraction technique to reduce pain; some systematic reviews evaluate the efficacy of this intervention in the pediatric setting, but none on children with CP. AIM:To evaluate the effect of clown therapy on procedural pain in children with CP. METHODS:Systematic review with meta-analysis of clinical trials with control group. Retrieval of studies by querying biomedical databases, online resources and trial registers. Clown therapy was compared with standard care. The primary outcome was the pain level after surgery. The risk of bias was assessed with RoB 2. Effect size was calculated with a random effects model. RESULTS:Three studies with 164 patients were included. The risk of bias is high for two studies and raises some concerns for one. All studies analyzed the effect of clown therapy on procedural pain after botulinum toxin injection. There was a statistically non significant reduction in pain in the intervention group compared to the control group (SMD: -0.20, 95% CI: -0.56, 0.17). The heterogeneity between studies is high. CONCLUSION:Clown therapy for procedural pain from botulinum toxin injections in children with CP seems effective but the methodological limitations of the studies do not allow a definitive judgment. There is a lack of studies evaluating the effect of the intervention on other procedures that children with CP undergo periodically.

This Bachelor's thesis deals with the topic of procedural pain management in preterm newborns. Procedural pain is caused during medical procedures. Long-term exposure to pain has a variety of consequences, which is why it is very important to pay attention to the procedural pain prevention management. The first aim of the thesis was to explore the possibilities of assessing procedural pain in premature neonates. The second aim was to map the available methods of procedural pain management, followed by the final goal to identify the possibilities of involving mothers of premature neonates in the procedural pain prevention management. The research part of the paper was based on a qualitative investigation by means of questioning and observation. Data collection was carried out using in-depth interviews with paediatric nurses and mothers of premature neonates. Next part of the research involved observation of paediatric nurses during painful procedures. The information obtained was logged in observation sheets. Research has shown that there is currently a great effort to reduce the number of painful procedures that preterm newborns have to undergo. It was found that when evaluating procedural pain, all circumstances must be taken into account and not evaluated only according to a given scale. According to the research, the most effective of the non-pharmacological methods of pain relief is direct contact between mother and child. Pharmacological methods of pain relief are used in rare cases. It was also confirmed that there is currently a great effort to involve parents in the care of preterm newborns, but this needs to be further intensified and fathers need to be engaged more, for example. The results obtained from the research can be used in the education of paediatric nurses. An educational leaflet for mothers has also been developed.

The study aims to: (a) evaluate whether watching cartoons during the performance of a medical procedure in a paediatric outpatient setting is effective in relieving pain; (b) if so, measure the effect size of the intervention; and (c) calculate the number of participants to be treated in order to have at least one subject with relieved pain (Number-Needed-to-Treat - NNT).

Einleitung: Bereits nach der Geburt werden sowohl frühgeborene Kinder, als auch gesunde Neugeborene vielen schmerzhaften medizinischen Eingriffe ausgesetzt. Schmerzexpositionen können langfristige Folgen für das spätere Leben haben, da sich die Säuglinge an diese negativen Stimulationen erinnern können. Wird ein Kind in den ersten Lebenswochen Schmerzen ausgesetzt, kann sich dies negativ auf die Entwicklung der geistigen und motorischen Fähigkeiten des Kindes auswirken. Der Einsatz von Analgetika wiederum kann zu unerwünschten Nebenwirkungen führen, deshalb befasst sich diese Arbeit mit sechs unterschiedlichen nichtmedikamentösen Interventionen, um Schmerzen bei Frühgeborenen zu lindern. Methodik: Für diese Literaturarbeit wurde eine Literaturrecherche in dem Zeitraum von Jänner bis Februar 2023 durchgeführt. Es wurden verschiedene Datenbanken, wie zum Beispiel Springer Link, CINAHL, PubMed sowie Academic Search Elite durchsucht, um passende Literatur für diese Thematik zu finden. Um die Ergebnisse eingrenzen zu können, wurden die Bool’schen Operatoren ,,AND‘‘ und/oder ,,OR‘‘ verwendet. Nach der Überprüfung auf das EMED-Format wurden zwölf Studien für diese Arbeit herangezogen. Ergebnisse: In dem Ergebnisteil wird auf die sechs nichtmedikamentösen Interventionen Kängurupflege, Facilitated Tucking, Swaddling, Non Nutritiv Sucking (NNS), Muttermilch und Saccharose näher eingegangen. Gezeigt hat sich, dass besonders die Kängurupflege eine hohe Wirksamkeit aufweist, ebenso Facilitated Tucking, Swaddling und NNS. Bei dem Einsatz von Saccharose und Muttermilch konnten keine signifikanten Ergebnisse festgestellt werden. Schlussfolgerung: Nicht pharmakologische Interventionen sollten in der Praxis häufiger eingesetzt werden, besonders die Maßnahmen, welche die taktile Wahrnehmung von Frühgeborenen stimulieren. Sie haben eine hohe Wirksamkeit und können leicht in den Pflegealltag integriert werden. Introduction: Right after birth, both prematurely born children and healthy newborns are exposed to many painful medical procedures. Pain exposures can have long-term consequences later in life because infants can remember these negative stimuli. If a child is exposed to pain in the first few weeks of life, this can have negative effects on the development of the child's mental and motor skills. Since the use of analgesics can lead to undesirable side effects, this work deals with six different non-drug interventions to relieve pain in preterm infants. Methodology: For this research paper a literature search was carried out from January to February 2023. A systematic review of the literature was conducted from multiple online databases such as Springer Link, CINAHL, PubMed and Academic Search Elite. To refine the search’s results the Boolean opertos were used. After checking out the EMED structure twelve studies were used for this paper. Results: The results describe both the interventions that stimulate tactile perception in preterm infants, such as kangaroo care, facilitated tucking, swaddling, NNS and also interventions that stimulate gustatory perception, e.g. sucrose and breast milk. It has been shown that kangaroo care in particular is highly effective, as well as facilitated tucking, swaddling and NNS. No significant results were found when using sucrose and breast milk. Conclusion: Non-pharmacological Interventions should be used more often in nursing practice. Especially the interventions that stimulate the tactile perception of premature babies. They are highly effective and can easily be integrated in the nursing process of premature babies.

Neta Bar Am,1 Jennifer Thull-Freedman,1 Samina Ali2 1Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; 2Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, and Women and Children’s Research Institute, University of Alberta, Edmonton, Alberta, CanadaCorrespondence: Samina AliDepartment of Pediatrics, 3-582 Edmonton Clinic Health Academy, 11405 – 87 Avenue, Edmonton, Alberta, T6G 1C9, CanadaTel +1 780 248-5575Fax +1 888 775-8876Email sali@ualberta.caPurpose: Many rural and community emergency departments (EDs) experience barriers to providing optimal pain care to children. In preparation for a quality improvement initiative, our team conducted a provincial pediatric pain management practice and needs assessment.Methods: An online survey was sent to ED administrators and educators from March to May 2017. Themes included pain assessment, pain and distress management strategies, available resources, education, barriers to care, and opportunities for improvement.Results: Forty-five respondents, from 31 EDs representing all five geographic health zones in Alberta, completed the survey. Use of a pain assessment tool was reported at 93.5% (29/31 sites) of the sites. Topical anesthesia was employed “most of the time” before suturing at 67% (18/27) of sites, versus 15% (4/27) before blood work or IV insertion. Eighty-one percent (22/27) of sites reported physically restraining children for procedures “often”, while 37% (10/27) reported use of comfort positioning “often”. Digital distraction devices were available at 37% (10/27) of sites. Reported challenges included lack of resources (33.3%, 12/36), staff education/knowledge (33.3%, 12/36), and absent policies/poor policy adherence (25.0%, 9/36). Opportunities for improvement included staff member education (73.5%, 25/34) and more resources (58.8%, 20/34). Respondents rated their site’s overall ability to manage children’s pain as 50/100 [IQR:21,61].Conclusion: General EDs report providing suboptimal children’s pain care, with use of physical restraint for medical procedures, and under-utilization of evidence-based, inexpensive treatment options. There are many gaps in children’s pain care in rural and community EDs which could be addressed through collaborative quality improvement initiatives.Keywords: children, rural, procedural pain, pain treatment

Hospitalized preterm infants experience painful medical procedures. Oral sucrose is the nonpharmacological standard of care for minor procedural pain relief. Infants are treated with numerous doses of sucrose, raising concerns about potential long-term effects. The objective of this study was to determine the long-term effects of neonatal oral sucrose treatment on growth and liver metabolism in a mouse model. Neonatal female and male mice were randomly assigned to one of two oral treatments ( n = 7–10 mice/group/sex): sterile water or sucrose. Pups were treated 10 times/day for the first 6 days of life with 0.2 mg/g body wt of respective treatments (24% solution; 1–4 μL/dose) to mimic what is given to preterm infants. Mice were weaned at age 3 wk onto a control diet and fed until age 16 wk. Sucrose-treated female and male mice gained less weight during the treatment period and were smaller at weaning than water-treated mice ( P ≤ 0.05); no effect of sucrose treatment on body weight was observed at adulthood. However, adult sucrose-treated female mice had smaller tibias and lower serum insulin-like growth factor-1 than adult water-treated female mice ( P ≤ 0.05); these effects were not observed in males. Lower liver S-adenosylmethionine, phosphocholine, and glycerophosphocholine were observed in adult sucrose-treated compared with water-treated female and male mice ( P ≤ 0.05). Sucrose-treated female, but not male, mice had lower liver free choline and higher liver betaine compared with water-treated female mice ( P < 0.01). Our findings suggest that repeated neonatal sucrose treatment has long-term sex-specific effects on growth and liver methionine and choline metabolism.

Aims The study aimed to determine the effect of using a crochet octopus to reduce acute pain and maintain optimal physiological measurements that develops during procedural pain in neonates. Materials and methods This was a parallel design randomized controlled study. During the procedure of heel lance, experimental groups were delivered a crochet octopus 10 min before the process and let them touch the octopus during and for up to 10 min after the procedure. Control group experienced the process without any intervention. SpO2, duration of crying of neonates and pain they experienced were evaluated. Results The study was completed with 100 (50 for the experimental group and 50 for the control group) term neonates. SpO2 of neonates, touching the crochet octopus during and after in second minute of the process was found higher and also the duration of crying was shorter during whole the process, and the pain they experienced due to the process was lower than the control group. Conclusions Crochet octopus affected physiological measurements of the neonates positively and reduced the procedural pain as well.

Children's heightened attention to pain and parental narrative style have been linked to the development of negatively-biased pain memories in children (i.e., recalling higher levels of pain and fear than initially reported, which robustly predicts maladaptive pain outcomes). However, the interplay between child attention bias and parental narrative style remains to be assessed. This study aims to fill this gap using enhanced paradigms assessing children's cognitive biases for cues signaling actual pain. Healthy school children (N = 63; 9-15 years old) received painful heat stimuli while performing a spatial cueing task measuring attention bias to cues signaling actual pain. Parent-child interaction upon completion of the painful task, was coded for parental narrative style (i.e., elaboration, repetition and evaluation). Children's pain-related memories were elicited two weeks later. Findings indicated that children showed an attention bias to cues signaling pain. Furthermore, children who were hypervigilant to pain cues benefitted from parents elaborating more about the pain experience, while children who avoided pain cues developed more negatively-biased pain memories if parents had a more elaborative style compared to a more evaluative parental style. In conclusion, this study suggests that optimal ways to talk about children's pain depend upon child characteristics (i.e., children's attention bias to pain).

La douleur et l’anxiété procédurales pédiatriques sont des phénomènes fréquents dans les milieux de soins, particulièrement chez les enfants et adolescents atteints d’un trouble du spectre de l’autisme (TSA), ceux-ci pouvant occasionner de multiples conséquences. Or, il existe des écrits présentant des interventions pour la gestion de la douleur et de l’anxiété procédurales pour les enfants et adolescents atteints d’un TSA. Toutefois, il ne semble pas exister d’écrits publiés qui regroupent l’état actuel des connaissances sur ce sujet. Ainsi, le but de cette revue de la portée était de faire état des connaissances sur les interventions permettant la gestion de la douleur et de l’anxiété procédurales chez les enfants et adolescents atteints d’un TSA. De ce fait, une revue de la portée a été réalisée. Le cadre conceptuel de Young (2005) sur la douleur procédurale pédiatrique et le modèle d’analyse thématique en psychologie de Braun et Clarke (2006) ont été utilisés afin de structurer cette revue. Les résultats ont permis d’identifier les interventions permettant, selon les écrits, une meilleure gestion de la douleur et de l’anxiété procédurales chez les enfants et adolescents atteints d’un TSA, soit classés selon quatre éléments d’interventions : 1) les caractéristiques de la procédure et l’environnement immédiat, 2) l’interaction des parents avec l’enfant, 3) l’interaction des professionnels de la santé avec l’enfant et 4) les interventions directes pharmacologiques et non pharmacologiques. Ces résultats appuient la pertinence d’une prise en charge globale de la douleur et de l’anxiété procédurales adaptée aux enfants et adolescents atteints d’un TSA., Pediatric procedural pain and anxiety are common in health care settings, particularly in children and adolescents with autism spectrum disorders (ASD). There is a body of literature outlining procedural pain and anxiety management interventions for children and adolescents with ASD. However, there does not appear to be any structured review published showing the current state of knowledge on this topic. Thus, the purpose of this study is to proceed to a structured review on interventions for the management of procedural pain and anxiety in children and adolescents with ASD. As such, a scoping review was conducted. Young's (2005) conceptual framework on pediatric procedural pain and the thematic analysis in psychology of Braun and Clarke (2008) were used to structure this review. The results made it possible to identify the interventions that have been reported in the literature to manage procedural pain and anxiety in children and adolescents with ASD. Those were categorized according to four elements of intervention 1) procedural characteristics and the immediate environment, 2) parent-child interaction, 3) health care professional-child interaction, and 4) direct pharmacological and nonpharmacological interventions. These findings support the appropriateness of procedural pain and anxiety management tailored to children and adolescents with ASD.

Immediately after birth, most newborns undergo a number of medical procedures to assess how the body functions. Some of these procedures are invasive and involve breaking the continuity of the baby's tissues, leading to pain and discomfort. Confirmation of pain sensation by newborns is relatively one of the newer scientific discoveries - this fact was not acceptable until the end of the 1980s. Therefore, analgesia was used very rarely during all medical procedures. Nowadays, medical personnel are aware that the youngest patients also feel pain and should be knowledgeable about its prevention and treatment. The aim of the study is to analyze the available studies on glucose supply as a way to reduce procedural pain in newborns. The non-systematic review of the literature was carried out according to the following keywords: pain, glucose, newborn, prevention, recommendations. Analyzes carried out in neonatal departments and a literature review have shown that pain prevention and treatment still pose many problems, as there are no clear guidelines as to how and methods to administer the therapy. Oral glucose is the most common pain reliever used in neonates during medical interventions. Its mechanism of action remains unclear, but it is believed to have a calming effect and reduce behavioral indicators of pain. The American Academy of Pediatrics recommends the administration of three doses of sucrose appropriate to the gestational age of the newborn, but there is concern about the long-term use of this preventive measure, especially in premature babies, who are at greater risk of hyperglycemia and disturbances in the development of the nervous system.

This study aimed to determine the effect of music listening on procedural pain intensity, anxiety, and comfort levels in patients during cystoscopy. This study was a prospective, randomized controlled trial. Study participants were randomly assigned to either a control or music group. The outcome measures were assessed using the Visual Analogue Scale, State Anxiety Scale, and General Comfort Questionnaire. A total of 36 patients in each group completed the study. The mean scores of pain in the music and control groups immediately after cystoscopy were 3.22 (

Resumen Objetivo Describir nuestra experiencia con un protocolo basado en el uso de sevoflurano para la sedacion y analgesia durante la infiltracion de toxina botulinica tipo A (BoNT-A), en ninos con paralisis cerebral (PC), especialmente en terminos de seguridad y eficacia. Material y metodos Estudio observacional retrospectivo de pacientes con PC a los que se realizo infiltracion con BoNT-A bajo sedacion con sevoflurano desde noviembre de 2012 hasta diciembre de 2019. Se revisaron las caracteristicas demograficas, las caracteristicas clinicas y funcionales, la efectividad de la sedacion, los eventos adversos (EA) y la satisfaccion del profesional. Resultados Se realizaron 387 sedaciones en 74 pacientes diagnosticados de PC. La sedacion efectiva se logro en el 100% de los procedimientos, facilitando la colaboracion durante la infiltracion y la satisfaccion del profesional. Se notificaron EA en el 6,02% de los procedimientos, siendo los mas frecuentes las nauseas y los vomitos (3,88%) y la hipoxemia transitoria (2,07%). No se informaron EA graves. No se encontro asociacion entre la incidencia de EA y las variables clinicas, funcionales o el riesgo antes de la anestesia. Conclusiones La sedacion con sevoflurano muestra resultados prometedores en terminos de seguridad y efectividad para el manejo de la agitacion y el dolor durante la infiltracion de BoNT-A en nuestra practica clinica diaria. Ademas, puede facilitar la infiltracion, permitir la exploracion bajo sedacion e infiltracion multinivel con buena tolerancia.

HINTERGRUND Trotz uber 50 psychometrisch validierter Beobachtungsverfahren gibt es bisher keinen Konsens uber das praktikabelste Schmerzassessment bei Neugeborenen. Die Items von NFCSshort und PIPP wurden mit der Schmerzeinschatzung der prozedurbeteiligten Behandler verglichen und es wurde evaluiert, ob eine Itemreduktion zu Gunsten der Alltagsanwendung moglich ware. MATERIAL UND METHODEN 52 Neugeborene wurden in unserer Beobachtungsstudie einer klinisch indizierten peripheren Venenpunktion unterzogen. Patient und Monitordaten wurden standardisiert auf Video aufgezeichnet. Die Schmerzintensitat wurden durch sieben unabhangige Untersucher mittels NFCSshort und PIPP bewertet und hinsichtlich der Variabilitat zwischen den Untersuchern verglichen. ERGEBNISSE Nur vier Items des PIPP (Herzfrequenz, Augenbrauenvorwolbung, zusammengekniffene Augen, betonte Nasolabialfalte) wiesen einen signifikanten Zusammenhang mit der geschatzten Schmerzhaftigkeit der Prozedur auf. Die Items 1 (Gestationsalter), 2 (Wachheitsgrad) und 4 (Sauerstoffsattigung) hatten bei keinem Untersucher Einfluss auf das Schmerzmessergebnis. Die Auswertung des NFCSshort zeigte bei zwei Untersuchern fur das Item 1 (Vorwolbung der Augenbrauen) und bei einem Untersucher fur das Item 2 (zusammengekniffene Augen) keine Einflusse auf das Messergebnis. DISKUSSION Die Ergebnisse der Studie legen eine Kurzung des PIPP um drei Items nahe, da diese keinen Einfluss auf das Schmerzmessergebnis zeigten. Eine Reduktion des PIPP um das Item Gestationsalter erscheint fraglich, da es in weiteren Studien als bedeutsames Item bewertet wurde. Ein Verzicht auf das Item Sauerstoffsattigung geht mit einem geringeren Messaufwand einher. Eine weitere Kurzung der bereits gekurzten Version (NFCSshort) auf weniger als funf Items ist auf Basis unserer Ergebnisse nicht zu empfehlen. BACKGROUND Despite more than 50 laboratory-evaluated measurement systems, there is no consensus on the most practicable pain assessment in newborns in daily practice. For this purpose, the items of NFCSshort and PIPP were compared to the pain assesment of the involved medical practitioner. The aim of the study was to evaluate whether an item reduction of the assesments in favor of everyday use is feasible. METHODS In 52 neonates of a paediatric ward venous blood collection was performed in this observational study. Cameras recorded patients and monitor in a standardized way. The pain intensity was assessed with NFCSshort and PIPP by seven independent observers. The ratings were compared for variability between observers. RESULTS Of the seven PIPP items, only four were significantly associated with procedural pain assessment for all seven observers (heart rate, brow bulge, eye squeeze, nasolabial furrow). For the NFCSshort, no significant association with procedural pain assessment was found for two observers for the item "brow bulge" and for one observer for the item "eye squeeze". CONCLUSION The results of the study suggest a possible reduction of the PIPP by three items. Disregarding item 1 (gestational age) appears questionable, since its impact as context variable has been proven repeatedly. The waiver of item 4 (oxygen saturation) is associated with less measuring effort. A further reduction of the already shortened version of the NFCS with ten items (NFCSshort, five items) is not recommended by our results.

Background and Objectives: Pain management in children is often inadequate, and the single most common painful procedure in children who are hospitalized is needle procedures. Virtual reality (VR) has been shown to decrease anxiety and pain in children undergoing painful procedures primarily in children from the age of 7 years. Our aim for this study is to investigate patient satisfaction and pain reduction by using a three-dimensional VR interactive game as a distraction in 4–7 years old children during venous cannulation. Methods: In this randomized clinical trial, we enrolled 106 children aged 4–7 years who were scheduled for venous cannulation. Patients assigned to the control group were adherent to standard of care, including topical numbing cream, positioning, and distraction in this group by games of choice on a tablet/smartphone. In the study group, children were adherent to standard of care and were distracted by an interactive VR game. Primary outcomes were patient satisfaction and the procedural pain assessed by using Wong–Baker Faces Pain Rating Scale; secondary outcomes were the procedural time and any adverse events. Results: We found an overall high level of patient satisfaction with our regime of topical numbing cream, positioning, and distraction. The primary outcome of pain during the procedure was median 20 mm (IQR 0–40) and 20 mm (IQR 0–55) (Wong–Baker 0–100 mm) in the VR group and the control group, respectively (difference: 0 mm, 95%CI: 0–20, p =.19). No significant difference was found in procedural times. The number of adverse effects was low, with no significant difference between the two groups. Conclusions: VR distraction is an acceptable form of distraction for children 4–7 years old when combined with topical numbing cream and positioning during preoperative venous cannulation. No difference was found between VR- and smartphone/tablet distraction.

Background: Due to the progress in neonatology, in particular, in the past three decades, the mortality rate among patients of intensive care units has decreased. However, this is connected not only with newborns needing to stay longer in the unit, but also with the exposure of newborns to many painful procedures and stresses. Lack of or insufficient pain prevention has a negative impact on the sensory or locomotor development of newborns. Despite the presence of guidelines based on scientific evidence, the use of pharmacological and non-pharmacological pain-management methods in newborns is still insufficient. Aim: The aim of the study was to: identify the knowledge nurses/midwives have of recommended non-pharmacological and/or pharmacological methods, in particular, in relation to medical intervention procedures; assess the interventions for pain relief applied by midwives/nurses most often in their clinical practice; examine the role of age, general work experience, education level and years of work of medical professionals on a neonatal ward, as well as the referral level of a unit, versus the application of pharmacological and non-pharmacological methods. Methods: A descriptive and quantitative study conducted in 2019 among Polish nurses/midwives working at neonatal intensive care units. Results: The analysis of the material reflected the deficit of knowledge and the insufficient daily use of recommended pain-relief measures among the respondents. Conclusions: The interpretation of data indicates that despite the clear and easily available recommendations of scientific societies concerning the mode of conduct in particular medical procedures, medical personnel do not apply those recommendations in their everyday practice. It is necessary to plan and implement education strategies for nurses/midwives on standard pain-management interventions during painful medical procedures.