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Neonatal pain management


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  • 2 weeks later...

I share this article too. Too often we don't mind about neonatal pain. Recent studies about epigenetic have shown that pain damages DNA in fetus and neonate. These alteration are then transmitted through the family.  In Italy we have a study group about pain in neonatology.

thanks for the article 

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  • 4 years later...

Hi, I'm digging up this topic- yesterday I got myself into a conversation with some colleagues about soothing pain in neonates with glucose gel. Of course it's a widely spread method, and I am not questioning this practice here with this post. I remembered however some article claiming that although glucose was soothing the symptoms of pain, in the end it did not mitigate the brain alterations that happened in the brain during painful stimulis ( I think this was the article https://journals.lww.com/pain/Abstract/2018/03000/Procedural_pain_and_oral_glucose_in_preterm.14.aspx).

Have you encountered more studies supporting this? I am wondering if this was the article I had read, because vaguely I remember the authors concluding that glucose is nice, but avoiding painful stimuli is even nicer. Or maybe it was all in my head 🤔

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30 minutes ago, piatkat said:

Hi, I'm digging up this topic- yesterday I got myself into a conversation with some colleagues about soothing pain in neonates with glucose gel. Of course it's a widely spread method, and I am not questioning this practice here with this post. I remembered however some article claiming that although glucose was soothing the symptoms of pain, in the end it did not mitigate the brain alterations that happened in the brain during painful stimuli ( I think this was the article https://journals.lww.com/pain/Abstract/2018/03000/Procedural_pain_and_oral_glucose_in_preterm.14.aspx).

Have you encountered more studies supporting this? I am wondering if this was the article I had read, because vaguely I remember the authors concluding that glucose is nice, but avoiding painful stimuli is even nicer. Or maybe it was all in my head 🤔

Hi, This 2011 article perhaps could shed some lights with some interesting cross-references.

https://www.iasp-pain.org/PublicationsNews/NewsletterIssue.aspx?ItemNumber=2075

Focusing your queries in particular, I would like to suggest an wonderful reference; the excerpt i.e. "Chapter 10, Nonpharmacological Treatment of Neonatal Pain" by R. Carbajal Pages 87-91, from "Neonatal Pain Suffering, Pain and Risk of Brain Damage in the Fetus and Newborn", Giuseppe Buonocore and Carlo V. Bellieni (Editors), Springer-Verlag Italia 2008. I tried to upload the file but it's 6.15 MB exceeding forum thread limit by far. If needed I could e-mail you anyway. Thanks and regards.

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@Francesco Cardona and @Sutirtha Roy thanks!!! 

The number of people quoting yesterday the Cochrane metanalysis to me was TOO damn high! I get it, it is a high level of evidence, but these studies were (all or mostly all) looking at pain score scales! And somebody very wise once told me "If we have several scales to asses the same thing, it means that none of them is actually very good" 😅

I don't want to fight with windmills there, but I am going to just post this video and hoping I won't get assassinated in the comments section 😂

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I was doing LP for a 2 day old full term 40+3 and we used sucrose to give some relief just before the procedure. For my self if feel that sucrose do not add any thing for such situation. 

they still feel the pain but deviate their attention same like when you put a dummy or your finger they will start to suck and stop crying. 

 

i am confused

😟😟

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On 5/14/2021 at 11:35 PM, tarek said:

I was doing LP for a 2 day old full term 40+3 and we used sucrose to give some relief just before the procedure. For my self if feel that sucrose do not add any thing for such situation. 

they still feel the pain but deviate their attention same like when you put a dummy or your finger they will start to suck and stop crying. 

 

i am confused

😟😟

Hi Tarek, 

I wish I had the knowledge and the experience to dispel your doubts here, but I can offer only a bit of text, sorry!😅

In the metanalysis Sucrose for analgesia in newborn infants undergoing painful procedures the Authors conclude :

"Sucrose is effective for reducing procedural pain from single events such as heel lance, venipuncture and intramuscular injection in both preterm and term infants (...). Investigators should be cautious when utilising existing evidence to answer questions on efficacy in other painful procedures that have been minimally addressed to date (e.g. lumbar punctures, peripherally inserted central catheter insertions, endotracheal intubation, chest tube insertions)." 

So what I understand is that the sucrose (with or without pacifier) can be beneficial for heel lance, venipuncture and intramuscular injection, because when used, it was causing favorable changes in pain scores (I think that the highest quality of evidence comes from studies that used PIPP (premature infant pain profile, includes heart rate assessment, oxygen saturation, facial actions).

 "There was high‐quality evidence for the beneficial effect of sucrose (24%) with non‐nutritive sucking (pacifier dipped in sucrose) or 0.5 mL of sucrose orally in preterm and term infants: Premature Infant Pain Profile (PIPP) 30 s after heel lance WMD ‐1.70 (95% CI ‐2.13 to ‐1.26; I2 = 0% (no heterogeneity); 3 studies, n = 278); PIPP 60 s after heel lance WMD ‐2.14 (95% CI ‐3.34 to ‐0.94; I2 = 0% (no heterogeneity; 2 studies, n = 164). There was high‐quality evidence for the use of 2 mL 24% sucrose prior to venipuncture: PIPP during venipuncture WMD ‐2.79 (95% CI ‐3.76 to ‐1.83; I2 = 0% (no heterogeneity; 2 groups in 1 study, n = 213); and intramuscular injections: PIPP during intramuscular injection WMD ‐1.05 (95% CI ‐1.98 to ‐0.12; I2 = 0% (2 groups in 1 study, n = 232)."

The question is- does the improvement in pain scores actually mean less painful stimuli for the brain. Or maybe what happens is that the baby just gets calmer, but the painful stimuli still harms the brain?

Maybe some SENIOR physician could pitch in and let us know what is their practice ;) When do you use sucrose and when you prefer to go with a painkiller? SO MANY QUESTIONS!

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