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1. Is There an Association Between Fetal Scalp Electrode Application and Early-Onset Neonatal Sepsis in Term and Late Preterm Pregnancies? A Case–Control Study

Author

Nao Nakatsuka, Khalid Aziz, Robert Verity, Manoj Kumar, and Venu Jain

Subjects
Adult, medicine.medical_specialty, Cardiotocography, Pregnancy Trimester, Third, Infant, Newborn, Diseases, Alberta, Young Adult, Pregnancy, Sepsis, Humans, Medicine, Electrodes, Fetus, Scalp, medicine.diagnostic_test, Neonatal sepsis, business.industry, Obstetrics, Infant, Newborn, Case-control study, Obstetrics and Gynecology, Odds ratio, medicine.disease, medicine.anatomical_structure, Case-Control Studies, Gestation, Female, business, Infant, Premature
Abstract

Objective Early-onset neonatal sepsis (EONS), defined as neonatal sepsis occurring within the first week after birth, is a major cause of morbidity and mortality. Fetal scalp electrode application, used for fetal heart rate monitoring during labour, could potentially increase the risk of EONS. The objective of this study was to determine whether this practice is associated with a significant risk for EONS in term and late preterm pregnancies. Methods This case–control study enrolled subjects from three maternity hospitals in Edmonton. Cases were neonates with EONS who were born at ≥ 34 weeks between January 1, 2000, and March 1, 2011. Two control subjects were enrolled for each case identified. Control subjects were neonates of similar gestation (≥ 34 weeks), born at the same hospital site, who did not develop EONS. Maternal charts were accessed for information about fetal scalp electrode application and potential confounding variables. Results Forty cases and 80 control subjects were identified. There was no difference in the rate of exposure to fetal scalp electrode in cases (6/40) and control subjects (10/80) (OR 1.24; 95% CI 0.42 to 3.68, P=0.92). The association between fetal scalp electrode application and EONS remained non-significant despite adjustment for confounders. Conclusion We did not detect an association between the use of fetal scalp electrode and EONS, but our study was powered to detect only a strong association between the exposure of interest and the disease outcome. We cannot rule out a weakly positive association that may still exist.

Published
2012

2. Intravenous nalbuphine 50 µg·kg-1 is ineffective for opioid-induced pruritus in pediatrics

Author

Nao Nakatsuka, Carolyne J. Montgomery, Yvonne I. Csanyi-Fritz, Leeann Phillips, Stephan Malherbe, Kathy Reid, Justin J. Kingsley, Joanne Lim masc, J. Mark Ansermino, Colleen A. Court, Ramona A. Kearney, and Sean C. Minogue

Subjects
medicine.medical_specialty, integumentary system, Butorphanol, business.industry, General Medicine, Hydromorphone, Nalbuphine, law.invention, Anesthesiology and Pain Medicine, Opioid, Randomized controlled trial, law, Anesthesia, Anesthesiology, medicine, Morphine, skin and connective tissue diseases, Prospective cohort study, business, medicine.drug
Abstract

Purpose This investigation evaluated the efficacy of nalbuphine in treating postoperative opioid-induced pruritus (Pr) in pediatric patients.

Published
2006

3. Abstract

Author

Tejinder S. Chhina, Harry Lapierre, Zane S. Jackson, Howard M. Leong-Poi, Jerome M. Teitel, David A. Latter, Bradley H. Strauss, Peter L. Gross, C. David Mazer, Richard Brull, Colin J. L. McCartney, Sherif Abbas, Hugo Nova, Regan Rawson, Vincent W. S. Chan, Joel Katz, Brent Graham, Dimitri Anastakis, Herbert von Schroeder, Alexandre Lallo, Pierre Drolet, Mélanie Lacroix, Kong E. You-Ten, Valerie B. Caraiscos, Erin M. Elliot, Victor Y. Cheng, John F. MacDonald, Beverley A. Orser, Bertrand Lau, Ban C. H. Tsui, Heather L. Mollison, William P. S. McKay, Rajesh Patel, Vance Chow, October Negraeff, Rana Karam, H. Yang, K. Raymer, R. Butler, J. Parlow, R. Roberts, David C. Campbell, Terrance W. Breen, Stephen Halpern, Holly Muir, Robert Nunn, Rita Katznelson, Keyvan Karkouti, Mohammed Ghannam, Esam Abdelnaem, Jo Carroll, Stuart McCluskey, Terrence M. Yau, Jacek Karski, Gregory M. T. Hare, Xiamao Li, Rong Qu, May S. M. Cheung, Carla Coackley, Andrew J. Baker, Michael Ronayne, Dajun Song, Frances Chung, Barnaby Ward, Suntheralingam Yogendran, Carolyn Sibbick, Lisa C. Silcox, Ted L. Ashbury, Brian Milne, Elizabeth G. VanDen Kerkhof, Pamela J. Morgan, Doreen Cleave-Hogg, Susan DeSousa, Louie Wang, Jelka Lujic, Niamh I. Donnelly, Clint J. Torok-Both, Barry Finegan, Michael J. Jacka, Barry A. Finegan, Rajiv Chawla, Ravi K. Agrawal, Mahendra Kumar, David H. Goldstein, James E. Paul, Monakshi Sawhney, W. Scott Beattie, Richard F. McLean, Joel L. Parlow, Deborah A. Tod, Dmitri Souzdalnitski, Elena Sourovtseva, Donald Livingstone, Gil Faclier, Jason Sawyer, Joseph Kay, Arsenio Avila, Mrinalini Balki, Pirjo H. Manninen, Karolinah Lukitto, Michael B. Lukins, Keya Quader, Munisha Agarwal, Rakhi Kawatra, J. S. Dali, Peter H. Mak, Geraldine Jose, Sean R. Hall, Murray Hong, Ivan L. Rapchuk, Karen Loo, Alain Deschamps, Asaha Suzuki, Akifumi Kanai, Sumio Hoka, Anthony M. -H. Ho, Manoj K. Karmakar, Anna Lee, Winnie Samy, Jie Yi, Paul B. S. Lai, Amy Cho, E. Stockton, S. Gowrie-Mohan, P. U. Ramanayake, S. Jothilingam, Ali Mirmansouri, Alese M. Wagner, Kirsten Cunningham, Shirley Perry, Sunil Desai, Clint Torok-Both, Kathryn DeKoven, Paul Brousseau, Orlando Hung, Adam Law, Derek Levangie, Ronald Cheverie, Karen M. Caputo, Robert Byrick, Martin Chapman, Kim Vicente, Glen Atlas, Josiane Léveillé, Dany Côté, Julie Soucy, Jean S. Bussières, Duminda N. Wijeysundera, George Djaiani, Vivek Rao, Michael A. Borger, Robert J. Cusimano, Anoush D. Moghadam, Abtin Heydarzadeh, Ashraf A. Fayad, Homer Yang, Elizabeth Ling, Paul K. Tenenbein, Doug Maguire, Roland Debrouwere, Peter C. Duke, Stephen E. Kowalski, Devashish Chakravarty, Jean-Yves Dupuis, Howard Nathan, Fraser Rubens, Roy Masters, Paul Hendry, Thierry Mesana, Hyun Ju Jung, Dmitri Chamchad, Valerie Arkoosh, Duminda Wijeysundera, Chris Chan, Kathleen Datillo, Joan Ivano, Cantwell Clark, Reed D. Quinn, John H. Braxton, Andreas H. Taenzer, Kristen M. Sullivan, Osama A. Al-Abdulhadi, Diane R. Biehl, Bill Y. Ong, Abdulaziz Boker, Kristine I. Stewart, Susan A. Shaw, Jeong-Yeon Hong, Susan K. Palmer, Rose Kung, Stephen H. Halpern, Jennifer A. Yee, Eric Goldszmidt, Crystal Chettle, Ralph Kern, Kristi Downey, Isabella Devito, Alison Macarthur, Niall L. Purdie, Pamela J. Angle, Christine Kurtz-Landy, David Streiner, Cathy Charles, Jo Watson MacDonnell, Desmond Lam, Lie Ming Lie, Jean E. Kronberg, Dorothy E. Thompson, Haiheng Dong, Ayman Hyder, Qinghua Wang, Wei-Yang Lu, Ngozi N. Imasogie, Atul Prahbu, Bruna Curti, Zoya Potyomkina, Matthew R. Belmont, Joseph Tjan, Cynthia A. Lien, Sanjay Patel, Charles Imarengiaye, Javad Peirovy, Reginald Edward, Frances F. Chung, Leonid Kayumov, David R. Sinclair, Henry J. Moller, Colin M. Shapiro, Guillaume Michaud, Guillaume Trager, Stephane Deschamps, Thomas M. Hemmerling, Janet Hsu, Patrick Cheng, John T. Granton, Alan D. Baxter, Salmaan Kanji, Adam D. Oxner, Karen J. Buth, Gregory M. Hirsch, Claudio DiQuinzio, Kristine A. Hirsch, A. Denault, P. Couture, M. Carrier, A. Fortier, D. Babin, J. C. Tardif, Jean-François Olivier, Fadi Basile, Ignatio Prieto, Nhiên Lê, Yuji Hirasaki, Patricia Murphy, Karen McRae, Thomas Waddell, Shaf Keshavjee, Peter Slinger, Adriaan Van Rensburg, Terry M. Yau, Eric Yeo, David Sutton, Michael Borger, Gilbert Blaise, Marius D. Gangal, Lan Gao, Stuart A. McCluskey, Wing Cheung, Bobby Metha, Humara Poonwala, Ludwik Fedorko, Johnson R. Symon, Mark D. Peterson, Carl C. P. Leipoldt, Michelle Clunie, William P. S. Mckay, Grant Miller, Joanne Guay, Louise Lortie, Soochang Son, Yunhee Kim, Toshimi Arai, Masao Yamashita, Denise Rohan, Ross Barlow, Sean J. Barbour, J. Mark Ansermino, Christine A. Vandebeek, Rangamani K. Raman, Nao Nakatsuka, Carolyne J. Montgomery, Erik D. Skarsgard, Colleen A. Court, James S. Galton, Mark W. Crawford, Basem Naser, Clifford Carter, Richard Liu, Andrew G. Usher, Dominic A. Cave, Cathy Tang, Jason A. Hayes, and Juliana M. Tan

Subjects
Anesthesiology and Pain Medicine, General Medicine
Published
2004

4. Intravenous nalbuphine 50 µg·kg(-1) is ineffective for opioid-induced pruritus in pediatrics

Author

Nao, Nakatsuka, Sean C, Minogue, Joanne, Lim Masc, Carolyne J, Montgomery, Colleen A, Court, Yvonne, Csanyi-Fritz, J Mark, Ansermino, Stephan, Malherbe, Ramona A, Kearney, Leeann, Phillips, Kathy, Reid, and Justin, Kingsley

Abstract

This investigation evaluated the efficacy of nalbuphine in treating postoperative opioid-induced pruritus (Pr) in pediatric patients.After Ethics Board approval, the dual site, tertiary care teaching centre study recruited 212 subjects, age ≥ seven years, who received opioid analgesia postoperatively. A modified, self-report colour analogue scale (CAS) scored pruritus intensity (PrI). Subjects who reported PrI score ≥ 5/10 were randomized to treatment with nalbuphine 50 µg·kg(-1) iv (max 5 mg) or saline placebo. A pruritus intensity difference (PrID) ≥ 50% was considered a positive outcome.Of 260 subjects approached, 212 consented and 184 received opioids. Median age was 13 yr (range 7-19) and median weight was 51 kg (range 19.6-134.8 kg). Pruritus intensity ≥ 5/10 occurred in 37 (20.1%) subjects. Intravenous morphine [patient-controlled analgesia (PCA)/continuous infusion] was associated with Pr in 68% of subjects over a wide dose range (9.4-63.2 µg·kg(-1)·hr(-1)). Pruritis occurred in 36% of patients in the PCA group compared to continuous opioid infusion (27%) and epidural administration (27%). Pruritus intensity difference ≥ 50% was achieved in 55.6% of nalbuphine and 57.9% of saline-treated subjects.This preliminary report suggests that nalbuphine 50 µg·kg(-1) iv is not effective in treating postoperative opioidinduced pruritus in pediatric patients. The modified CAS score and PrID warrant further investigation.Évaluer l'efficacité de la nalbuphine contre le prurit (Pr) postopératoire induit par les opioïdes chez des patients pédiatriques. MéTHODE: Nous avons recruté 212 sujets de ≥ sept ans qui ont reçu une analgésie opioïde postopératoire. Une échelle analogique de couleur (EAC) modifiée pour l'auto-évaluation a mesuré les scores d'intensité du prurit (IPr). Répartis au hasard, les sujets dont les scores d'IPr étaient ≥ 5/10 ont reçu de la nalbuphine à 50 µg·kg(-1) iv (5 mg maximal) ou un placebo salin. Une différence d'intensité de prurit (DIPr) ≥50% était considérée positive. RéSULTATS: Des 260 sujets rencontrés, 212 ont participé à l'étude et 184 ont reçu des opioïdes. L'âge moyen a été de 13 ans (7-19) et le poids moyen de 51 kg (19,6-134,8 kg). Un prurit ≥ 5/10 a été noté chez 37 (20,1 %) des sujets. De la morphine intraveineuse [en analgésie auto-contrôlée (AAC) ou en perfusion continue] a été associée à du Pr chez 68 % des sujets pour un grand éventail de doses (9,4-63,2 µg·kg(-1)·h(-1)). Le prurit s'est manifesté chez 36 % des patients avec l'AAC comparée à la perfusion d'opioïde continue (27 %) et à l'administration péridurale (27 %). Une différence d'intensité du prurit ≥ 50 % a été atteinte chez 55,6 % des sujets qui recevaient la nalbuphine et 57,9 % de ceux qui avaient le placebo.La nalbuphine iv à 50 µg·kg(-1) n'est pas efficace pour traiter le prurit postopératoire induit par les opioïdes chez des patients pédiatriques. Le score modifié à l'EAC et la DIPr devront être étudiés plus à fond.

Published
2006

5. Placebo equal to nalbuphine for pruritus in pediatrics

Author

Yvonne Csanyi-Fritz, Ramona A. Kearney, Kathy Reid, Joanne Lim, J. Mark Ansermino, Nao Nakatsuka, Colleen A Court, Stephan Malherbe, Carolyne J. Montgomery, Leeann Phillips, and Sean C Minogue

Subjects
business.industry, Sedation, medicine.medical_treatment, General Medicine, Placebo, Nalbuphine, Anesthesiology and Pain Medicine, Opioid, Anesthesia, medicine, Vomiting, medicine.symptom, business, Saline, medicine.drug
Abstract

METHODS After approval by the University Research Ethics Boards, the dual centre study planned to recruit 268 subjects, age ≥ 7, receiving continuous opioid analgesia post-operatively who understood the self-report Colour Analogue Scale (CAS) to score pruritus intensity (PrI). Sample size was estimated to demonstrate a 25% improvement compared to placebo (α=0.05 and 1-β=0.8). Subjects who reported PrI score ≥ 5/10 were randomized to treatment with nalbuphine 50 mcg/kg IV (max 5 mg) or saline placebo. PrI, analgesia (VAS), sedation (5 point score), and side effects of headache, vomiting, and dizziness (yes/no) were recorded at 30 and 60 min. A Pruritus Intensity Difference (PrID) of ≥ 50% was considered a positive outcome. Subjects with PrI score ≥ 5/10 at 60 min. received nalbuphine 50 mcg/kg IV (max 5 mg).

Published
2005

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