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BACKGROUND/SIGNIFICANCE The pain-reducing effect of applying vibration, which is used as a nonpharmacological method in pain management, is explained by the gate control theory developed by Melzack and Wall. Studies that are based on this theory have shown similar results to those of Melzack and Wall, indicating that pain-transmitting nerves are suppressed by vibrations, leading to higher pain thresholds. PURPOSE The study aimed to evaluate the effect of applying vibration to manage pain during heel lance procedures in newborns. METHODS This is a randomized, controlled experimental study. The study sample included 56 newborns determined using power analysis (vibration group = 28; control group = 28). For those in the vibration group, a vibrating device was used for approximately 30 seconds before the heel lance procedure and then continued throughout the procedure. No interventions were provided to the newborns in the control group. Pain in the newborns was evaluated by the nurse who performed the heel lance procedures, before the procedures and 15 to 20 seconds and 5 minutes after procedures, and by 2 specialists who viewed the video footage and conducted the Neonatal Infant Pain Scale examination. RESULTS The pain scores were significantly lower at 15 to 20 seconds and 5 minutes after the heel lance procedures in the group that received vibrations than in the control group (P < .05). IMPLICATIONS FOR PRACTICE The application of vibration, which is effective, nonpharmacological, and noninvasive, could help nurses manage pain in newborns as a nonpharmacological method. IMPLICATIONS FOR RESEARCH The number of studies that examine the effect that vibration has on pain associated with heel lance procedures in newborns is very limited, and it is recommended that further studies be conducted with larger sample sizes.

This paper examines perfectionist attempts to explain the prudential badness of pain (its badness for those who experience it). It starts by considering simple perfectionist explanations, finding them wanting, before considering the most sophisticated perfectionist attempt to explain prudential badness: Gwen Bradford’s tripartite perfectionism. The paper argues that Bradford’s view, though an improvement on earlier perfectionist proposals, still does not satisfactorily explain the full set of prudentially bad pains. It ends by showing how this provides grounds for a general kind of pessimism about perfectionism and the badness of pain and how this case undermines a general purported advantage of perfectionism over the objective list theory.

INTRODUCTION Perinatal palliative care (PnPC) is a growing field where healthcare providers from multiple disciplines are supporting families and providing holistic care for their babies with life-limiting illnesses. It is important to have an approach that includes the standardized management of end-of-life symptoms that are anticipated around the time of birth. AREAS COVERED A need was identified to develop medication orders for the initial pharmacological management of symptoms at end-of-life for infants with life-limiting conditions intended for use outside of an intensive care setting. The choice of medications was based on a review of the literature, discussion with content experts and guided by their ease of use, accessibility and noninvasive route of delivery. The recommendations can be used as a guide for the initial management of common symptoms encountered in perinatal palliative care. EXPERT OPINION There are studies looking at many qualitative aspects of perinatal palliative care including perceptions of care, decision-making, and bereavement; however, few specifically focus on symptom management in the delivery room and postpartum ward settings. There is a need for standardization of the medical management of infants born with life-limiting conditions whose parents choose to pursue palliative care.

Preterm infants undergo early separation from parents and are exposed to frequent painful clinical procedures, with resultant short- and long-term effects on their neurodevelopment. We aimed to establish whether the mother’s voice could provide an effective and safe analgesia for preterm infants and whether endogenous oxytocin (OXT) could be linked to pain modulation. Twenty preterm infants were exposed to three conditions—mother’s live voice (speaking or singing) and standard care—in random order during a painful procedure. OXT levels (pg/mL) in saliva and plasma cortisol levels were quantified, and the Premature Infant Pain Profile (PIPP) was blindly coded by trained psychologists. During the mother’s live voice, PIPP scores significantly decreased, with a concomitant increase in OXT levels over baseline. The effect on pain perception was marginally significant for singing. No effects on cortisol levels were found. The mother’s live voice modulated preterm infants’ pain indicators. Endogenous OXT released during vocal contact is a promising protective mechanism during early painful interventions in at-risk populations.

The present study evaluated the pain perception in preterm neonates during insertion of orogastric (OG) vs. nasogastric (NG) tube by measuring the cerebral regional oxygen saturation (crSO2) and premature infant pain profile-revised (PIPP-R) score. Randomized controlled cross-over trial. Fifty infants of mean (SD) gestational age of 31.54(2) and 31.64(2.2) weeks, birth weight of 1362(354) and 1507(365) grams were randomized into OG/NG (n = 25) and NG/OG (n = 25) sequences. Mean post-menstrual age at assessment was 33(2.8) and 33(1.5) weeks, and the difference between two interventions was 1.08(0.5) and 1.12(0.5) days in OG-NG and NG-OG, respectively. Mean crSO2(%) during insertion was significantly lower with NG compared to OG route. Mean PIPP-R score, heart rate variability, time to normalize crSO2, and the duration of cry were also significantly higher with NG insertion. Compared to OG, NG route of feeding tube insertion was associated with higher fluctuations in crSO2 and higher PIPP-R scores. CTRI/2020/03/023728.

A Study to Assess the Effectiveness of Oral Sucrose on Level of Pain during DPT Immunization among Infants at a Selected Hospital, Salem. Objectives:To assess the level of pain during DPT immunization among infants in experimental and control group. To determine the effectiveness of oral sucrose on level of pain during DPT immunization among infants in experimental and control group. To associate the level of pain during DPT immunization among infants in experimental and control group with their selected demographic variables. Operational Definitions Effectiveness Effectiveness refers to the reduced level of pain among infants in experimental group when compared to control group as measured by modified REILY infant pain Assessment Scale. Oral sucrose Oral sucrose refers to 24% sucrose solution (2ml) given to infants prior to administration of DPT immunization. DPT Immunization It is a vaccine administered intra muscularly in vastus lateralis to prevent DPT. Pain Pain refers to an unpleasant experience observed in the infant during injection as measured by using modified REILY infant pain assessment scale (facial expression, body movement, activity, cry, consolability). Infants Infants refer to the babies of 6 - 14 weeks of age receiving DPT immunization. Hypotheses H1: There will be significant difference in level of pain among infants in experimental and control group after oral sucrose administration during DPT immunization at P < 0.05 level. H2: There will be significant association between the level of pain during DPT immunization among infants in experimental and control group with their selected demographic variables at p

Objective To compare sucrose 24% oral gel formulation to liquid formula and breastfeeding during a heel prick in neonates. Study design In this comparative effectiveness research 195 neonates >36 weeks' gestation were randomised to three groups, receiving during heel stick: (i) breastfeeding, (ii) sucrose 24% liquid with non-nutritive sucking and (iii) sucrose 24% gel with non-nutritive sucking. The pain was assessed through the Neonatal Infant Pain Scale. Results All the methods analysed has shown to be effective in reducing pain. There was an increase in odds of pain following liquid sucrose compared to breastfeeding (OR = 1.60; 95% CI: 0.82-3.3; p = 0.17). A reduction of odds of pain was showed comparing sucrose to breastfeeding (OR = 0.78; 0.38-1.6; 0.48), and comparing sucrose gel to liquid formula (OR = 0.48; 0.23-0.96; p = 0.04). Conclusion Sucrose 24% gel with non-nutritive sucking seems to be a valid alternative when breastfeeding is not possible. Further research is needed.

BACKGROUND Ophthalmic examinations are a frequent source of pain and stress in premature infants. There is evidence for the use of supportive interventions during infant ophthalmic examinations to reduce pain and stress, but there are no standard recommendations for their implementation. PURPOSE The purpose of this quality improvement project was to implement evidence-based, supportive interventions during ophthalmic examinations in premature infants and evaluate the impact on pain, oxygen saturation, heart rate, bradycardic events, and neonatal stress cues. METHODS A preintervention and intervention group design was used. Primary outcomes were pain and oxygen saturation. Secondary outcomes were heart rate, number of bradycardic events, and number of neonatal stress cues. Independent-sample t tests were used to compare means of the measures in the preintervention and intervention groups. RESULTS Supportive interventions during ophthalmic examinations significantly reduced infant pain (during and after the examination), number of bradycardic events (during and after the examination), and number of neonatal stress cues (before, during, and after the examination). There was also a trend for supportive interventions to decrease pain before the examination. IMPLICATIONS FOR PRACTICE Supportive interventions during ophthalmic examinations are effective in reducing pain, bradycardic events, and neonatal stress cues in premature infants and can be successfully implemented as part of a unit-based protocol. IMPLICATIONS FOR RESEARCH Future research is needed to determine the long-term outcomes associated with supportive interventions during ophthalmic examinations in premature infants.

Introduction: Neonatal circumcisions are commonly performed in Nigeria, most often without anesthesia. The aim of this study was to determine whether anesthesia was required for neonatal circumcision. Materials and Methods: All new-born male neonates presenting for routine circumcision were considered for inclusion in the study. This was a randomized control study, comparing pain scores during circumcision with local anesthesia or without local anesthesia. A total of 72 neonates were randomly assigned to the two groups using computer-generated random numbers, with 36 in each group. The neonates were not matched for age or weight. All the anesthetic procedures and circumcisions were performed in identical manner by the principal investigators using the plastic bell technique. Approval for the study was obtained from the Research Ethics Committee of the hospital. Written voluntary informed consent was obtained from the parents of the neonates. Results: The mean age and weight of the neonates in the study were 17 ± 2 days and 3.2 ± 0.68 kg, respectively. The mean Neonatal/Infant pain score was 4.8 in the local anesthesia group and 6.0 in those without anesthesia. The mean transcutaneous PO2 was 90.47 ± 7.53 in those with anesthesia compared to 85.83 ± 5.61 in those without anesthesia. The mean heart rate was 133.88 ± 35.00 beats/min in the anesthesia group compared to 152.11 ± 79.80 in those without anesthesia. Neonates circumcised without local anesthesia had higher respiratory rate compared to those circumcised with local anesthesia. Conclusion: Neonates circumcised without local anesthesia had higher mean pain scores, heart rate, lower oxygen saturation and increased mean respiratory rate than those that had local anesthesia. Local anesthesia should be routinely used during neonatal circumcision.

Explore a music therapy (MT) intervention to support infant recovery post retinopathy of prematurity (ROP) exam. Prospective, double-masked, randomized, parallel group study of 100 preterm infants exposed to MT (recorded maternal singing/heartbeat) or standard care (SC). Premature Infant Pain Profile (PIPP) measured at: baseline, during the exam, and 1 and 5 min post exam. Recovery PIPP scores were less with MT vs. SC, but statistical significance not achieved (Mean ± sd: MT 1 min [5.81 ± 2.93] and 5 min [3.91 ± 1.73] vs. SC 1 min [6.40 ± 2.78] and 5 min [4.76 ± 2.07], p = 0.07). Recovery PIPP sores were significantly higher with SC compared to MT when eye exams were longer (p = 0.049) or when exams were more painful (p = 0.04). Recorded maternal singing and heartbeat can support recovery post ROP exam. For longer/more painful ROP exams, MT may be more effective than SC promoting recovery post exam.

The Implementation of Infant Pain Practice (ImPaC) Resource is an eHealth tool designed to support infant pain practice change and ultimately enhance pain outcomes. The aim of this study was to determine users' perspectives on usability, acceptability, and feasibility of the ImPaC Resource. A descriptive prospective mixed-methods quality improvement study was conducted at a pediatric hospital in Canada. Individual "think aloud" interviews were conducted in a nonclinical environment (Phase A); "near live" testing was conducted while users interacted with the Resource in clinical setting (Phase B); individual "think-aloud" interviews were conducted in a nonclinical environment (Phase C). Outcomes included usability (System Usability Scale-SUS), acceptability (Acceptability E-Scale-AES), and feasibility. Interview transcripts were coded per a priori themes using deductive content analysis to create a structured categorization matrix. In Phase A, 10 clinicians interacted with the Resource in individual sessions. Median SUS score was 73.75 (range 52.5-92.5). In Phase B, four clinicians implemented the Resource in the neonatal intensive care unit (NICU) over 4 months. Median SUS score was 85 (82.5-92.5), and median AES score was 24 (21-24). In Phase C, an enhanced prototype was produced, and the same users from Phase B navigated the Resource in individual sessions. Median SUS score was 88.75 (85-95), and median AES score was 27.5 (25-29). Users considered the Resource as feasible for implementation, easy to navigate, engaging, intuitive, comprehensive, and evidence-based. Users highlighted the potential transferability of the Resource to other contexts and settings. The enhanced version of the ImPaC Resource was usable, acceptable, feasible, and met users' expectations and requirements. Results lead the way for evaluation of the Resource in a nationwide cluster randomized trial including 18 NICUs. This knowledge-rich platform is expected to enhance infant pain practices and outcomes in diverse clinical settings.

Immunization pain is a stimulus that can cause trauma and changes affective response in the baby. Breastfeeding is the alternative strategies to reduce pain response due in invasive procedures. The aims of this study is to determine the effect of breastfeeding on infant pain levels when getting pentavalent immunization. This research using Randomized Controlled Trial design unblind, post-test design, with a sample of 70 healthy infants consisted of 34 respondents intervention group and 36 respondents of the control group were selected by random block technique. Breastfeeding intervention is given from two minutes before to 2 minutes after the immunization. In this study showed the pain level of intervention group is lower than the level of pain group (p = 0.000; α = 0.05). breast-fed infants when immunized can reduce the risk of severe pain by 80%, which compared to not breastfed infants. Further research on the effect of breast feeding for preterm infants pain response in invasive procedure.

Objective: To compare the effect of various non pharmacologic methods on pain in infants during vaccination as assessed by Neonatal Infant Pain Scale (NIPS). Design: Prospective randomized controlled trial. Sample: 120 infants for pentavalent vaccination (30 in each group G1, G2 G3 and G4).Methods: The enrolled infants were randomized into three intervention groups (Breast feeding G1, buzzy device group G2, Helfer technique group G3 and control group G4). During vaccination procedure was videographed and pain score assessed by independent blinded observer. Result: The mean pain score of four groups (G1, G2, G3 & G4) were 3.77, 3.80, 4.50 and 4.83. Breast feeding effectively reduces pain score than mechanical stimulation by buzzy device. Comparison of pain score of different group by F value is not significant at 0.05 level of significance. How to cite this article:Bhattacharya R, Batra B. Comparison of Effect of Various non-pharmacologic Methods on Pain in Infants during Vaccination. Int J Preven Curat Comm Med 2019; 5(4): 7-11. DOI: https://doi.org/10.24321/2454.325X.201922

There is increasing evidence that long-term outcomes for infants born prematurely are adversely affected by repeated exposure to noxious procedures. These interventions vary widely, for example, in the extent of damage caused and duration. Neonatal intensive care unit (NICU) procedures are therefore likely to each contribute differently to the overall pain burden of individual neonates, ultimately having a different impact on their development. For researchers to quantify the procedural pain burden experienced by infants on NICU, we aimed to estimate the pain severity of common NICU procedures using published pain scores. We extracted pain scores over the first minute (pain reactivity) from the literature, using 59 randomized controlled trials for 15 different procedures. Hierarchical cluster analysis of average pain scores resulted in 5 discrete severity groups; mild (n = 1), mild to moderate (n = 3), moderate (n = 7), severe (n = 3), and very severe (n = 1). The estimate of the severity of individual procedures provided new insight into infant pain reactivity which is not always directly related to the invasiveness and duration of a procedure; thus, both heel lance and skin tape removal are moderately painful procedures. This estimate of procedural pain severity, based on pain reactivity scores, provides a novel platform for retrospective quantification of an individual neonate's pain burden due to NICU procedures. The addition of measures that reflect the recovery from each procedure, such as brain activity and behavioural regulation, would further improve estimates of the pain burden of neonatal intensive care.

All infants experience pain in early life from procedures. Parents recognize pain as a prevalent issue, reporting a strong desire for more information on infant pain. The aim of this study was to explore and map the current evidence of parent-targeted educational interventions about infant pain, delivered throughout the perinatal period. Records were identified in PubMed, CINAHL, EMBASE, and ERIC databases and hand searching recent publications in 3 relevant journals. Records in English that described or evaluated educational interventions on infant pain management aimed at parents during the perinatal period were eligible for review and those not related to pain or aimed at healthcare providers were excluded. Evaluation was completed following the Methodology for JBI Scoping Reviews and standardized critical appraisal instruments from the Joanna Briggs Institute. Initial search yielded 6946 records, with 9 included in analysis. Six studies were quantitative, 2 qualitative, and 1 mixed methods. Included interventions contained information about parent-led pain management strategies for infants in the neonatal intensive care unit (n = 4), full term (n = 4), or both (n = 1). Despite being an area of high concern for parents of newborns, few studies addressed parent-targeted education regarding infant pain. Future research examining the impact and efficacy of these interventions addressing parental and neonatal outcomes is warranted.

Background Pain assessment is a key component of pain management and research in infants. We developed software to assist in coding of pain in infants called PAiN (Pain Assessment in Neonates). Aims The aims of this study were to evaluate the usability of PAiN in terms of effectiveness, efficiency, and satisfaction among novice and expert users and to compare the efficiency and satisfaction of PAiN to existing software for coding of infant pain among expert users. Methods A quantitative usability testing approach was conducted with two participant groups, representing novice and expert end-users. Testing included an observed session with each participant completing a pain assessment coding task, followed by administration of the Post Study System Usability Questionnaire and Desirability Toolkit. For comparison, the usability of existing coding software was also evaluated by the expert group. Results Twelve novice and six expert users participated. Novice users committed 14 noncritical navigational errors, and experts committed six. For experts, the median time for completing the coding task was 28.6 min in PAiN, compared to 46.5 min using the existing software. The mean Post Study System Usability Questionnaire score among novice (1.89) and expert users (1.40) was not significantly different (P = 0.0917). Among experts, the score for the existing software (4.83) was significantly (P = 0.0277) higher compared to PAiN (1.40). Lower scores indicate more positive responses. Conclusions Users were highly satisfied with PAiN. Experts were more efficient with PAiN compared to the existing software. The study was critical to ensuring that PAiN is error free and easy to use prior to implementation.

Background Electronic health (e-health) learning is a potential avenue to educate health professionals about accurately using infant pain assessment tools, although little is known about the impact of e-health interventions on clinical competence. Purpose To evaluate whether an e-health learning module for teaching the accurate use of the Premature Infant Pain Profile-Revised (PIPP-R) pain assessment tool results in immediate and sustained competency to assess infant pain. Methods Neonatal intensive care unit (NICU) nurses who participated in a larger study across 2 tertiary NICUs in Canada examining the implementation and clinical utility of the PIPP-R e-learning module completed 2 follow-up evaluations at 1 week and 3 months. Participants were asked to view a video recording of an infant undergoing a painful procedure and to assess the infant's pain intensity response using the PIPP-R measure. Immediate and sustained competency was assessed via interrater consensus of participant-reported PIPP-R scores compared with those of an experienced trained coder. Results Of the 25 eligible nurses, 22 completed 1-week and 3-month follow-up evaluations. At the 1-week follow-up, 84% of nurses scored the video accurately compared with 50% at 3 months. Behavioral pain indicators were more likely to be scored incorrectly than physiological indicators. Implications for practice Follow-up training after completion of the initial e-learning module training may improve competency related to the clinical use of the PIPP-R tool to assess infant pain over time. Implications for research Additional study regarding the need and timing of e-health training to optimize sustained competency in infant pain assessment is warranted.

BACKGROUND: Targeted neonatal echocardiography (Tn-Echo) is a non-invasive examination which may cause pain/discomfort and physiological instability in neonates, but there is little evidence for the same. We conducted this study to evaluate whether targeted neonatal echocardiography causes pain or physiological stress to newborn infants. METHODS: This cross-sectional study was conducted in a tertiary level NICU. Neonates undergoing targeted neonatal echocardiography were enrolled in this study. Pain was assessed using Premature Infant Pain Profile-Revised (PIPP-R) score before, during and after targeted neonatal echocardiography examination. Heart rate, oxygen saturation, perfusion index and blood pressure were also recorded at the same time points. RESULTS: A total of 88 neonates were enrolled. Mean (SD) PIPP-R score during Tn-Echo was 8.18 (2.6) versus 3.60 (1.8) and 4.24 (2.0) before and after respectively (p value

One of the biggest challenges in pain therapy is the evaluation of pain intensity of patients who cannot express their pain verbally. The measurement of pain is a time-consuming process. Therefore, we investigate the main factors that influence pain in infants. We use facial expressions and random forest to predict pain in the three pain classes aligned with the Premature Infant Pain Scale (PIPP). Using our method, we can classify between low, middle, and high pain with a balanced accuracy of 95.51 percent, setting the new benchmark for three-level pain assessment. Our classifier does not misclassify the highest pain class, which is desirable for the classification of pain. Our algorithm has the potential for creating more time for workers that are constantly under time-pressure.

Pain assessment is an essential foundation to mitigate pain and its consequences in the developing child. However, pain assessment in neonates and infants is challenging and, to date, there is no “gold standard” infant pain indicator, measure, or approach. This chapter encompasses (1) a comprehensive evaluation of the most current and well validated neonatal/infant pain assessment measures; (2) an overview on biomarkers and cortical indicators on neonatal/infant pain; (3) the integration of recommendations on pain-assessment measures and practices within clinical practice guidelines, policies, and procedures; and (4) challenges associated with neonatal and infant pain assessment in terms of research, clinical, and knowledge translation issues.

Purpose: Pain assessment is a key component of good pain management in hospitalized infants. This study aimed to translate and adapt a version of pain measurement in infants, the Premature Infant Pain Profile Revised (PIPP-R) into Indonesian. Method: The adaptation process of the measuring instrument used a modified Brislin method which included forward translation, back translation 1, group discussion 1, back translation 2, group discussion 2, and pilot testing on neonatal nurses: feasibility test, inter-rater reliability using intraclass correlation (ICC), and internal consistency using Cronbach's α coefficient. Results: The PIPP-R version in English has been translated into Indonesian. In general, nurses assessed this measuring instrument as feasible. The inter-rater reliability showed a high agreement (ICC = 0.968, P = 0.001) and this measuring instrument had good internal consistency (Cronbach's α = 0.856). Conclusion: The Indonesian version of PIPP-R is easy to use and shows good psychometric properties. The use of this measuring instrument will help nurses and researchers obtain accurate infant pain intensity measurement values. Keywords: Infants, Indonesia, Neonatal nurses, Pain, Pain measurement, Premature birth, Translating

The aim of this study was to test the hypothesis that neonatal hip examination causes pain in newborns. Pain assessment using instruments such as the Premature Infant Pain Profile-Revised (PIPP-R) scale is recommended, but recently physiological and neurophysiological measures, for example, near-infrared spectroscopy (NIRS) and galvanic skin response (GSR), have been used as well.Heart auscultation and hip examination were performed, and the response of the newborn was registered by NIRS optodes, GSR electrodes, and a pulse oximeter probe attached to the infant. The face of the newborn was filmed. Heart auscultation was used as a nonpainful reference.The pain scores for hip examination were higher than for the heart auscultation. Near-infrared spectroscopy showed a significant higher increase from baseline in oxygenated hemoglobin (HbOPain in newborns can have negative consequences, and pain prevention and treatment are therefore important. We conclude that neonatal hip examinations are painful and that the pain should be treated, for example, with oral sweet solution. This is a change from present routines during neonatal hip examination and is hoped to lead to a change in national guidelines.

Background: The study aimed to culturally adapt and validate Neonatal Infant Pain Scale (NIPS) for use in Vietnamese settings. Methods: The original NIPS was translated into Vietnamese using a standard protocol. Registered nurses of Neonatal Intensive Care Unit (NICU), Tien Giang General Hospital, Vietnam used the Vietnamese NIPS for assessing neonatal pain and then provided feedback on acceptability of the scale. Five registered nurses of NICU were randomly selected and used NIPS for assessing neonatal pain while watching thirty videos at two times, two weeks apart from each other. Pulse rates per minute and oxygen saturation (SpO2) were also recorded for validity evaluation. Intraclass correlation coefficients (ICC) with two-way random effects were applied to assess intra-rater and inter-rater reliability. Multilevel linear regression was applied to assess the association between NIPS score with pulse rates and SpO2 adjusting for raters, three periods and two assessments. Results: The Vietnamese NIPS was accepted and valued by nurses at the NICU. ICCs between the first and second assessments were from 0.53 to 1.00 for five raters before, during and after clinical procedures showing moderate to excellent intra-rater reliability. ICCs among five raters were moderate to good before and after, but poor (ICC

Background: Evidence demonstrates that controlling pain in the preterm infants during the neonatal periods is improving physiological, behavioral and hormonal outcomes. Eye shield and massage may play an important role as a non-pharmacological pain management during venipuncture. Aim: Is to investigate effect of eye shield and massage on preterm infants’ pain response during venipuncture. Patients and Methods: Time seriesquasi experimental research design was carried out on a randomized sample of 100 newborn infants attending the Neonatal Intensive Care Unit (NICU) of El Manial University Hospital (Kasr Al Ainy), (30control group,30 eye shield group and 30 massage group). Neonatal assessment tool and Preterm Infant Pain Profile (PIPP) were utilized for data collection. Results: There was a significant mean difference between control, eye shield and massage groups regarding PIPP pain assessment scores in three time frames (before venipuncture T0, during T1 and after T2) at P? 0.00 but there wasn’t a significant mean differences after 5 min (T3). Massage group had the fewest mean PIPP score during four time frames (3.50±0.97 before venipuncture, 8.16±1.91 during venipuncture, 4.30±4.30 after venipuncture and 3.22±0.81 after 5 minutes of venipuncture). Conclusion: ANOVA indicated that massage and eye shield groups showed a significant reduction in preterm infant’s pain response than control group during venipuncture but massage was more effective than eye shield. Recommendations: Further studies needed to evaluate the effect of massage in combination with eye shield on preterm infant pain response.

Background: Injectable vaccines are a common source of pain and distress for newborn babies. Sweet-tasting solutions such assucrose and 25% dextrose (25D) are described as effective strategies for pain relief in newborns. Objective: This study was doneto compare the analgesic efficacy of expressed breast milk (EBM) and 25D solution during vaccination with hepatitis B (Hep B)vaccine at birth. Materials and Methods: This study was conducted at the vaccination clinic in the pediatrics department of atertiary care hospital in southern India. The participants included healthy term babies and late preterm babies at the clinic duringtheir routine dose of Hep B at birth, during the study period from June 2017 to December 2017. A total of 70 consecutive neonateswere randomly allocated into two groups. 2 ml of either EBM or 2 ml of 25D solution was given 1 min before the injection. Theoutcome variables recorded were the duration of cry after injection and Neonatal Infant Pain Scale (NIPS) scores for both thegroups. Results: The duration of cry was found to be slightly higher in the group receiving EBM than those receiving 25D, althoughit was not found to be statistically significant. The neonates in the 25D group had lower NIPS scores than those in the EBM group.Conclusions: 25D appears to be a slightly better analgesic when compared to EBM during Hep B injection at birth.

The effectiveness of pain management relies on the choice and the correct use of suitable pain assessment tools. In the case of newborns, some of the most common tools are human-based and observational, thus affected by subjectivity and methodological problems. Therefore, in the last years there has been an increasing interest in developing an automatic machine-based pain assessment tool. This research is a preliminary investigation towards the inclusion of a scoring system for the vocal expression of the infant into an automatic tool. To this aim we present a method to compute three correlated indicators which measure three distress-related features of the cry: duration, dysphonantion and fundamental frequency of the first cry. In particular, we propose a new method to measure the dysphonantion of the cry via spectral entropy analysis, resulting in an indicator that identifies three well separated levels of distress in the vocal expression. These levels provide a classification that is highly correlated with the human-based assessment of the cry.

Optimizing neurodevelopment is a key goal of neonatal occupational therapy. In preterm infants, repeated procedural pain is associated with adverse effects on neurodevelopment long term. Calmer is a robot designed to reduce infant pain. The objective of this study was to examine the effects of Calmer on heart rate variability (HRV) during routine blood collection in preterm infants. In a randomized controlled pilot trial, 10 infants were assigned to either standard care ( n = 5, facilitated tucking [FT]) or Calmer treatment ( n = 5). HRV was recorded continuously and quantified using the area (power) of the spectrum in high and low frequency (HF: 0.15-0.40Hz/ms2; LF: 0.04-0.15 Hz/ms2) regions. Changes in HRV during three, 2-min phases (Baseline, Heel Poke, and Recovery) were compared between groups. Calmer infants had 90% greater parasympathetic activation ([PS] reduced stress) during Baseline, 82% greater PS activation during Poke, and 24% greater PS activation during Recovery than FT infants. Calmer reduced physiological preterm infant pain reactivity during blood collection.

The aim of this randomized controlled trial was to examine the efficacy of vein visualization devices and the routine method for insertion of peripheral intravenous catheters (PIVCs) in preterm infants. The study was conducted between June 2016 and April 2017 in the neonatal intensive care unit of Bakırköy Dr Sadi Konuk Education and Research Hospital. Participants (N = 90) were randomly assigned to the infrared group (n = 30), the transilluminator group (n = 30), or the control group (n = 30). Time to successful cannulation was significantly lower for the infrared group (8.70 ± 2.56 seconds) than for the transilluminator group (45.27 ± 30.83 seconds) and the control group (17.30 ± 8.40 seconds) (P ≤ .001). Success of the first attempt was significantly higher in the infrared and transilluminator groups than in the control group (P ≤ .05). Dwell time of the PIVC in place was significantly higher in the infrared group than in the transilluminator and control groups (P ≤ .05). Neonatal Infant Pain Scale scores were significantly higher in the transilluminator group (0.60 ± 0.855) than in the infrared (0.33 ± 0.182) and control groups (0.33 ± 0.182) while seeking an appropriate vein (P ≤ .001). The use of an infrared device provides efficacy in time to successful cannulation, success of the first attempt, length of the time the catheter is in place, and technique-related pain.

Background Stress during ambulance transportation has been described in adult healthy volunteers where indicators of stress such as heart rate, blood pressure, and cortisol increased significantly. In neonates, a few studies have described stress in ambulance with behavioural scales. However, there is no study in neonates assessing both behavioural and physiological indicators of stress simultaneously during ambulance transportation. Objective To assess the feasibility of a study aiming at identifying stress in clinically stable neonates during ambulance transportation in non-emergency situations. Methods Stable neonates transported by ambulance from September 2015 to January 2016 were eligible. Physiological and behavioural parameters of stress were measured during the entire transfer procedure, starting on the ward of departure until hospitalisation at destination. Physiological parameters included salivary cortisol concentration, heart rate, respiratory rate, and oxygen saturation. Behavioural parameters were measured with the Comfort Behavior and the Premature Infant Pain Profile-Revised scales. Results Twenty neonates were included. The study proved to be feasible, but collection of saliva for cortisol measurement was problematic. To reach a sufficient amount of saliva, the collection time had to be extended from 90 to 300 s. Physiological parameters demonstrated heterogeneous patterns of stress. Behavioural scores increased during the entire transfer procedure and did not return to baseline values, indicating discomfort, specifically during transfer from the cot into the transport incubator. Conclusions Salivary cortisol values were variable. Behavioural measurement of stress provided a more sensitive measure to detect low level of stress, as shown in our sample of stable neonates, during non-emergency transportation.

Introduction: Newborns born prematurely and treated in intensive care units are at greater risk of experiencing pain than patients treated in other units. Purpose: To evaluate the severity of pain perceived by children during the performance of medical procedures related to the treatment and care process. Materials and methods: The study was conducted at one of the Intensive Care Units in Opole. The study group consisted of 100 newborns, 60% of the subjects were prematurely born newborns, and 40% - were full-term. The degree of procedural pain associated with blood collection, peripheral puncture insertion, upper respiratory tract suction, gastric tube insertion and ophthalmic examination was assessed by an observation method using the standard Neonatal Infant Pain Scale Form (NIPS). Results: Out of the analysed medical procedures, 100% of children experienced acute, severe pain over the course of suction and ophthalmological examination. The highest perception of pain was experienced by 88.3% of premature newborns and 71.8% of full-term newborns. Over the course of medical procedures, 84% of male and 79.6% female newborns experienced acute pain. It was shown that the degree of pain perception was determined by the type of performed medical procedure (p=0.001) and the gestational age of the newborn (p=0.037). On the other hand, there was no correlation between the sex of the newborn child and the degree of pain perception (p=0.758). Conclusions: Based on the foregoing study result, bearing in mind the need to minimise the effects of pain stimulation, it seems important to use standardised tools to assess the severity of pain in newborns treated in Intensive Care Units on a larger scale.

This study aims to: (1) conduct a systematic review of YouTube videos showing newborn infants undergoing blood tests and (2) ascertain the use of recommended pain treatment strategies and infant pain during the filmed blood test. The pain was assessed using: (1) Neonatal Facial Coding System (NFCS) scores before, during and following the procedure; (2) Cry duration before and during the procedure. A total of 55 videos showing 63 procedures were included. Over half the babies cried and most babies scored the highest NFCS score of 4 at time of the poke as well as 15 s after the poke. YouTube videos of newborn infants undergoing blood sampling showed that recommended effective pain management interventions were rarely used and most infants were distressed during and following the procedure.

Invasive intervention can negatively affect prognosis, behavior, environmental adaptation in neonates. Some nonpharmacological pain management methods are used for effective pain treatment. This study investigated the effect of breastfeeding, kangaroo care, and facilitated tucking positioning on heel-stick pain in neonates.A quasi-experimental design was employed. The study was conducted in three family health centers in Kütahya/Turkey. The sample consisted of 140 healthy neonates with the gestational age of 37 weeks or more, birth weight greater than 2500 g, and no sucking problems. The sample was divided into four groups (breastfeeding, kangaroo care, facilitated tucking position, and control). Data were collected using a Baby-Mother Characteristics Questionnaire, a Physiological Parameter Follow-up Form, and the Neonatal Infant Pain Scale. Data were analyzed using chi-square, the one-way analysis of variance (ANOVA), Kruskal-Wallis, Student t-test, and Mann-Whitney U tests. The research adhered to ethical principles.The facilitated tucking position group cried less and experienced less pain during heel stick than the other groups (p 0.05). Breastfeeding, kangaroo care, and facilitating tucking help reduce heel-stick pain but facilitating tucking causes less crying and imposes less pain on neonates than the other methods.Facilitated tucking position may be preferred to reduce pain during heel stick.Using facilitated tucking positions and breastfeeding methods can assist healthcare professionals as supportive methods in pain management.

espanolObjetivo: comprobar la conectividad del prototipo APANICU 1.0 (Automatic Pain Assessment in Neonatal Intensive Care Units) y el software de la unidad para valorar el dolor en neonatos, y determinar la concordancia en la valoracion del dolor cuando se usa APANICU 1.0 frente a escalas validadas. Metodo: pilotaje del prototipo (APANICU) que combina y analiza parametros conductuales y fisiologicos del neonato, adquiere datos del monitor de constantes y registra la actividad del bebe con camara y microfono, calculando una cifra de dolor en tiempo real. El estudio se realizo en la Unidad de Cuidados Intensivos Neonatales del Hospital Universitario Joan XXIII (Tarragona). Dos observadores (A y B) valoraron el dolor del neonato usando las escalas Premature Infant Pain Profile (PIPP) y Susan Givens Bell (SGB), simultaneamente al volcado de APANICU. Se valoro la concordancia intraobservador mediante el coeficiente de correlacion intraclase y concordancia entre instrumentos mediante el coeficiente de correlacion Rho de Sperman. Resultados: 11 neonatos, edad gestacional media (DE) 32 (7,23) semanas. Coeficiente de correlacion intraclase (IC 95%) entre A y B con PIPP fue 0,516 (- 0,800; 0,870), con SGB fue 0,079 (- 2,422; 0,752). Coeficiente de correlacion de Spearman entre PIPP (A) y APANICU fue -0,144 (p= 0,67); entre SGB (A) y APANICU fue 0,115 (p= 0,74); entre PIPP (B) y APANICU fue 0,435 (p= 0,18), entre SGB (B) y APANICU fue de 0,077 (p= 0,82). Conclusion: APANICU 1.0 emite una cifra de dolor, pero necesita perfeccionarse, ya que los valores obtenidos no se correlacionaron adecuadamente. Se propone mejorar el software creando una version 2.0. EnglishObjective: to test the connectivity of the APANICU 1.0 (Automatic Pain Assessment in Neonatal Intensive Care Units) prototype and the software used in the unit to assess pain in newborns, and to determine the consistency in pain assessment when using APANICU 1.0 vs. validated scales. Method: pilot test of the prototype (APANICU) that combines and analyzes behavioral and physiological parameters of the newborn, obtains data from the vital signs monitor, and records the activity of the baby with camera and microphone, calculating a pain figure in real time. The study was conducted in the Neonatal Intensive Care Unit of the Hospital Universitario Joan XXIII (Tarragona). Two observers (A and B) assessed the pain of the newborn using the Premature Infant Pain Profile (PIPP) and Susan Givens Bell (SGB) scales, simultaneously with APANICU data dump. Consistency between observers was assessed through the coefficient of intra-class correlation, and consistency between instruments through the Spearman’s Rho coefficient of correlation. Results: eleven (11) newborns, with mean gestational age (SD): 32 (7.23) weeks. The coefficient of intra-class correlation (CI 95%) between A and B with PIPP was 0.516 (- 0.800; 0.870): and 0.079 (- 2.422; 0.752) with SGB. The Spearman’s Coefficient of Correlation between PIPP (A) and APANICU was -0.144 (p= 0.67); between SGB (A) and APANICU: 0.115 (p= 0.74); between PIPP (B) and APANICU: 0.435 (p= 0.18), and between SGB (B) and APANICU: 0.077 (p= 0.82). Conclusion: APANICU 1.0 issues a pain figure, but it needs improvement, because the values obtained were not adequately correlated. The proposal is to improve the software by creating a 2.0 version.