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Recently I've participated in a small scientific meeting with the neonatal team from Uppsala, Sweden, and from what I understand they are trying to involve parents in a more meaningful way to care for their infants during therapeutic hypothermia. I know that so far they have published this qualitative study https://onlinelibrary.wiley.com/doi/10.1111/apa.15431 and a bit earlier this study https://pubmed.ncbi.nlm.nih.gov/31084824/ :"Being unable to hold the infant skin-to-skin during HT has been shown to be stressful [10], and although skin-to-skin contact has to be limited due to thermoregulatory constraints, infant holding is indeed feasible [23]." I hope this gives you some fresh perspective I have no idea if we have anybody from Uppsala here, @Stefan Johanssondo you maybe know?

@Stefan Johanssonshal we make a folder "Podcasts" in our Links directory?

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!

@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 😂

Great comment @bimalc! I have discussed this topic also with one of my very experienced coworkers. Since our hospital trains also pediatric trainees that then leave to work in rural areas, she was strongly leaning towards intubation being a mandatory competency. She motivated her point of view saying that somewhere up in the North there might be nobody else to perform the intubation, so the trainee has to be able to intubate. But then I asked, "is intubation the goal, or securing the airways?". I think we need a shift in thinking- intubation is not the only way to secure the airways. Saying that I know that not many colleagues in the unit have had experience with LMA (basically only those who have had some experience in the surgery dept.). We would need to change the way we think and we teach-but it might be that currently the teachers might not have enough experience with the LMA to act as confident instructors. Many things to consider!

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 🤔

Great resources, thanks Vicky!!!

I think I found an interesting study about antepartum and intrapartum risk factors of neonatal encephalopathy. A bit old, but I think still very relevant when discussing the causes of hypoxic ischemic injury with parents! https://www.bmj.com/content/317/7172/1554.long https://www.bmj.com/content/317/7172/1549.long

Ooooh! Cool, thanks!!!

Hi, I would like to learn more about hypoxic-ischemic encephalopathy (HIE), can you recommend your favorite articles in the topic? I can totally read some reviews, or also original research papers if you think they are well written and relevant animal studies can also be interesting! Thanks!

@M C Fadous KhalifeWhat about the paper itself? How do you evaluate the evidence there?

@Vicky Payne- this is a really good question. It has reminded me of a blog entry I "committed" some time ago- not about intubation in presence of family, but about intubation on parent's chest 🔥🔥🔥 link is here below ⬇️⬇️ Of course, the level of evidence is anecdotal, but it's just a reminder for me that the impact on parents could be related to their very unique situation in the Unit. Are they only infrequent visitors there, or maybe primary caretakers? I think that might change their perspective a lot!