bellieni

Neonatal incubators are important tools for sick newborns in the first few days of life. Nevertheless, their electric engine, often very close to the newborn's body, emits electromagnetic fields (EMF) to which newborns are exposed. Aim of this paper is to review the available literature on EMF exposure in incubators, and the effects of such exposures on newborns that have been investigated. We retrieved 15 papers that described the EMF exposure in incubators and their biological effects on babies. EMF levels in incubators appear to be between 2 and 100 mG, depending on the distance of the mattress from the electric engine. In some cases, they exceed this range. These values interfere with melatonin production or with vagal tone. Even caregivers are exposed to high EMF, above 200 mG, when working at close contact with the incubators. EMF have been described as potentially hazardous for human health, and values reported in this review are an alert to prevent babies' and caregivers' exposure when close to the incubators. A precautionary approach should be adopted in future incubator design, to prevent high exposures of newborns in incubators and of caregivers as well. I suggest the following sources: Fetal and neonatal efects of EMF http://bioinitiative.org/report/wp-content/uploads/pdfs/sec19_2012_Fetal_neonatal_effects_EMF.pdf Electromagnetic fields in neonatal incubators: the reasons for an alert.https://www.ncbi.nlm.nih.gov/pubmed/28988507

Thanks, Keith, for this careful commentary. Just a few words to say that some may think that parents' approval of a trial is sufficient for being ethical; it's an error: parents should only shield babies from stress and from every risk, they aren't allowed to permit any type of harm to their babies (even when this harm seems minimal or transitory… and it isn’t). Thanks for pointing out the possibilities of analgesia during eye observations: according to authors' conclusions in both reviews you quote, we considered these approaches insufficient as "screening remains a painful procedure" and "pain scores remained consistently high". I hope journals and IRB will consider these data. Carlo Bellieni

Several scales to assess pain in newbrns exist: both for acute and for postsurgical pain. Scales for postsurgical or chronical pain are few and easy to use. I recently wondered if pain scales for acute pain are really necessary: they seem scarcely used in clinical practice though they are more than 40(!), they are often complicated, and -above all- they give a pain score when the procedure is over, i.e., when (I fear) it is too late. Acute pain scales do not consider the context of the procedure, but only babies' reactions; therefore they should simultaneously use and combineseveral indicators. I proposed to settle for pain detection instead of pain scoring. It is easy: you should first wonder if your procedure can actually stimulate nociceptors, then you should see if it provokes a sudden reaction: this is a contextual detection of pain: easy, reliable and useful. What is your opinion about this idea? Acta Paediatr. 2015 Mar;104(3):221-4. doi: 10.1111/apa.12882. Epub 2015 Jan 7. Should we assess pain in newborn infants using a scoring system or just a detection method? Bellieni CV1, Tei M, Buonocore G. Author information Abstract Newborn infants' pain should be scored indirectly using dedicated pain scales. Unfortunately, while some scales for prolonged pain have given good results, a gold standard to assess acute pain does not exist. Acute pain scales still have weak points, most are complex and are scarcely used in neonatal departments. Moreover, carefully scoring pain in clinical practice seems redundant, because any avoidable pain is a concern. This suggests that researchers must find new ways to assess acute pain. A possible approach is to settle for pain detection instead of pain scoring in selected cases. Here, we describe a two-point method that illustrates this approach. CONCLUSION: For everyday practice, detecting pain is more useful than scoring it; acute pain scales should be reserved for research, for those clinical settings where the personnel has received a careful training and where overcrowding and hurry are absent.