Development, empirical testing and adaptation of a theory of procedural pain management in preterm infants

La douleur chez les prématurés est un phénomène complexe qui est influencé par de nombreux facteurs. Malgré de nombreuses études, le soulagement de la douleur des prématurés demeure une préoccupation actuelle. Afin de guider adéquatement la recherche, l’utilisation d’une théorie permet de définir et de circonscrire les éléments qui seront évalués ainsi que les moyens utilisés pour l’évaluation des variables ciblées, l’interprétation des résultats et leurs retombées.Le but de cette thèse était de développer, d’évaluer et d’adapter une théorie portant sur la gestion de la douleur procédurale des prématurés afin d’offrir une perspective théorique regroupant différents éléments influençant l’évaluation et le soulagement de la douleur. Le développement de la théorie Pain Assessment and INterventions in Neonatology (PAIN-Neo) a été réalisée à partir d’une analyse critique des perspectives théoriques en douleur pédiatrique ainsi que par le biais d’une revue exhaustive des écrits visant à recenser les facteurs impliqués dans la gestion de la douleur des prématurés au niveau empirique. L’évaluation de certains liens postulés dans cette théorie a été effectuée par la réalisation d’une revue systématique auprés des prématurés (n=1028) et d’une étude transversale quantitative auprès d’infirmières œuvrant en néonatologie (n=202). La théorie PAIN-Neo propose une vision innovante de la gestion de la douleur procédurale chez le prématuré, pour les chercheurs et les cliniciens en néonatologie, en intégrant le prématuré, les professionnels de la santé et les parents, tout en considérant les différents facteurs individuels et contextuels influençant la douleur pour ces trois acteurs.Pain in preterm infants is a complex phenomenon that is influenced by many factors related to specific characteristics of the preterm infant, health care professional and parents. Despite numerous studies in various disciplines in the past decades, pain management in preterm infants remains a current concern due to the lack of effective interventions, prompting the need for further research. In order to adequately guide research, a theory is mandatory to define and circumscribe the variables that will be evaluated, the interpretation of results, and their implications.This thesis aimed to develop, evaluate, and adapt a theory to procedural pain in preterm infants in order to provide a theoretical perspective on elements influencing the assessment and management of pain in this population. The development of the Pain Assessment and INterventions in Neonatology (PAIN-Neo) theory was based on a critical analysis of existing pediatric pain theories, as well as an exhaustive review of the literature to identify the variables involved in pain management of preterm infants at the empirical level. The theory was evaluated with a systematic review with a meta-analysis including studies on preterm infants (n=1028) and a quantitative cross-sectional study of neonatal nurses (n=202).The PAIN-Neo theory proposes an innovative vision of procedural pain management in the preterm infant for neonatal researchers and clinicians, by integrating the preterm infant, the healthcare professional and the parents, while considering the different individual and contextual factors influencing pain for these three actors

Olfactive stimulation interventions for managing procedural pain in preterm and full-term neonates: a systematic review protocol

Abstract Background While hospitalized in the NICU, preterm neonates undergo many painful procedures. This may be the same for full-term neonates when longer hospitalization is required. Untreated and repeated pain has short-term as well as long-term consequences for these neonates. Pharmacological pain management methods have many limitations in their applications for both preterm and full-term neonates. A combination of different non-pharmacological methods is recommended for pain management. The effect of olfactive stimulation as a non-pharmacological pain management method was investigated by a few studies in the past years with premature and term neonates, but no systematic review has been conducted. The objective of this systematic review is to evaluate the effect of olfactive stimulation intervention on the pain response of preterm and full-term neonates during painful procedures. Methods An electronic search will be conducted in various databases such as PubMed (1946 to date), MEDLINE (1946 to date), CINAHL (1981 to date), Embase (1947 to date), PsycINFO (1806 to date), Web of Science (1945 to date), CENTRAL and Scopus (1960 to date), and Proquest, without restriction for the year of publication. Only studies published in English or French will be included. The search will be conducted using the following three concepts: pain, odors, and neonates. Selection of articles, data extraction, and assessment of risk of bias will be conducted by two independent researchers. A third researcher will intervene in case of disagreement. According to the availability of studies and data homogeneity, the results will be combined to perform a meta-analysis, or they will be described by a narrative synthesis. Discussion This systematic review will provide light on the current state of knowledge on the effectiveness of olfactive stimulation interventions for managing pain in preterm and full-term neonates. This review will guide clinical practice as well as research to improve preterm and full-term neonates’ pain management and prevent short-term and long-term complications caused by pain. Systematic review registration PROSPERO CRD4201705802

Management of procedural pain in preterm infants through olfactive stimulation with mothers’ milk: A pilot study

Introduction: Repeated and untreated pain can lead to long-term consequences in preterm infants, such as pain hypersensitivity and impaired motor and intellectual development. Studies on pharmacological and non-pharmacological interventions for pain management in preterm infants are limited. Thus, we piloted an intervention based on olfactive stimulation with mothers’ milk. Objective: To assess the feasibility, acceptability, and preliminary effects of an olfactive stimulation intervention with mothers’ milk for procedural pain in preterm infants. Methods: A pilot study was conducted with mothers, nurses, and preterm infants. Twelve preterm infants were familiarized to the odor of their mother’s milk 9 hours before heel prick. During heel prick, mothers’ milk odor was combined with standard care by placing a pad saturated with mothers’ milk beneath the infant’s nose. Pain was measured using Preterm Infant Pain Profile-Revised tool. Mothers (n=11) and nurses (n=20) completed questionnaires regarding feasibility and acceptability. Results: More than 80% of mothers and nurses reported that the olfactive stimulation intervention was feasible and acceptable. Time taken for preterm infants’ heart rate and oxygen saturation to return to the baseline was reduced and pain scores were lower when the mothers’ milk pad was placed at 1 millimeter(mm) of the infant’s nose. Discussion and conclusion: The olfactive stimulation intervention is feasible and acceptable for nurses and mothers. The observed preliminary effects suggest that a pad saturated in mother’s milk placed 1 mm from the preterm infants’ nose could reduce the pain response. A randomized clinical trial should be conducted to assess the effectiveness of this intervention.Introduction : La douleur répétée et non traitée peut entraîner des conséquences à long terme chez les nouveau-nés prématurés, comme une hypersensibilité à la douleur, une altération des développements moteur et intellectuel. Les interventions pharmacologiques et non pharmacologiques pour le soulagement de la douleur chez les nouveau-nés prématurés sont limitées. Objectif : Évaluer la faisabilité, l’acceptabilité et les effets préliminaires d’une intervention de stimulation olfactive avec du lait maternel pour la douleur procédurale des prématurés. Méthodes : Une étude pilote a été menée auprès de mères, d’infirmières et de nouveau-nés prématurés. Douze nouveau-nés prématurés ont été familiarisés avec l’odeur du lait de leur mère durant 9 heures. Pendant le prélèvement sanguin au talon, l’odeur du lait maternel était combinée avec les soins standards. La douleur a été mesurée à l’aide de l’outil Preterm Infant Pain Profile-Revised. Les mères (n=11) et les infirmières (n=20) ont rempli des questionnaires d’acceptabilité et de faisabilité. Résultats : Plus de 80% des mères et des infirmières ont déclaré que l’intervention était faisable et acceptable. Le temps nécessaire pour que le rythme cardiaque et la saturation en oxygène des nouveau-nés prématurés reviennent à la normale a été réduit et les scores de douleur étaient plus faibles lorsque la compresse imbibée de lait maternel était placée à 1 millimètre (mm) du nez du nouveau-né. Discussion et conclusion : L’intervention de stimulation olfactive est faisable et acceptable pour les infirmières et les mères. Les effets préliminaires suggèrent qu’une compresse imbibée de lait maternel placée à 1 mm du nez du nouveau-né prématuré réduirait sa douleur. Un essai clinique randomisé devrait être mené pour évaluer l’efficacité de cette intervention

Effectiveness of interventions during NICU hospitalization on the neurodevelopment of preterm infants: a systematic review protocol

Abstract Background Previous systematic reviews have examined preterm infants’ long-term neurodevelopment after neonatal intensive care unit (NICU) discharge, although none have explored the effectiveness of interventions on preterm infants’ neurodevelopment during NICU hospitalization. The aim of this review is to evaluate whether interventions, i.e., sensory stimulation, parental involvement, and control of environment, improve preterm infants’ neurodevelopment during their NICU hospitalization. Methods Experimental studies such as randomized controlled/clinical trials (RCTs) and cluster RCT will be included in this systematic review. Selected studies will be published in English or in French, in the past 15 years from 2002 to 2017. The following electronic databases will be searched to locate relevant studies: CINAHL, MEDLINE, PubMed, EMBASE (OVID), Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science. For all steps in selecting studies, agreement will be reached between two experts in neonatology. Data extraction will be performed independently by the two same experts and will then be compared. The Cochrane assessment tool will be used to screen the studies for risk of bias. A meta-analysis will be performed if the included studies are sufficiently homogeneous. Results will be analyzed using a standardized mean difference (with a 95% confidence interval). Statistical heterogeneity will be evaluated using the χ 2 test at the significance level of 0.1 and the I 2 with the classification suggested by PRISMA-P. If possible, subgroup analyses will be carried out considering preterm infants’ gestational age, length of NICU hospitalization, and the characteristics of the intervention such as who delivered it, the type, the dose, the frequency, and the duration. Data synthesis will be performed using the RevMan 5.1 software. Publication bias and selection of variables in publication will be examined using the graphical method of funnel plot and with the statistical test of Egger. Quality of the evidence of all outcomes will be assessed using the Grades of Recommendations Assessment, Development and Evaluation (GRADE) Working Group. Discussion The results of this systematic review will highlight which interventions are effective for promoting preterm infants’ neurodevelopment during NICU hospitalization and will contribute to the body of knowledge in neonatal care by providing guidance for NICU clinical practice and research. Systematic review registration PROSPERO CRD4201704707

Additional file 1: of Olfactive stimulation interventions for managing procedural pain in preterm and full-term neonates: a systematic review protocol

PRISMA-P 2015 checklist (DOCX 29 kb

Additional file 2: of Effectiveness of early interventions for parental sensitivity following preterm birth: a systematic review protocol

CINAHL search strategy. (DOCX 130 kb

Additional file 1: of Effectiveness of early interventions for parental sensitivity following preterm birth: a systematic review protocol

PRISMA-P 2015 checklist. (DOCX 34 kb

Effectiveness of interventions on early neurodevelopment of preterm infants: a systematic review and meta-analysis

Abstract Background As preterm infants’ neurodevelopment is shaped by NICU-related factors during their hospitalization, it is essential to evaluate which interventions are more beneficial for their neurodevelopment at this specific time. The objective of this systematic review and meta-analysis was to evaluate the effectiveness of interventions initiated during NICU hospitalization on preterm infants’ early neurodevelopment during their hospitalization and up to two weeks corrected age (CA). Methods This systematic review referred to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA] guidelines and was registered in PROSPERO (CRD42017047072). We searched CINAHL, MEDLINE, PubMed, EMBASE (OVID), Cochrane Systematic Reviews, CENTRAL, and Web of Science from 2002 to February 2020 and included randomized controlled/clinical trials conducted with preterm infants born between 24 and 366/7 weeks of gestation. All types of interventions instigated during NICU hospitalization were included. Two independent reviewers performed the study selection, data extraction, assessment of risks of bias and quality of evidence. Results Findings of 12 studies involving 901 preterm infants were synthesized. We combined three studies in a meta-analysis showing that compared to standard care, the NIDCAP intervention is effective in improving preterm infants’ neurobehavioral and neurological development at two weeks CA. We also combined two other studies in a meta-analysis indicating that parental participation did not significantly improve preterm infants’ neurobehavioral development during NICU hospitalization. For all other interventions (i.e., developmental care, sensory stimulation, music and physical therapy), the synthesis of results shows that compared to standard care or other types of comparators, the effectiveness was either controversial or partially effective. Conclusions The overall quality of evidence was rated low to very low. Future studies are needed to identify interventions that are the most effective in promoting preterm infants’ early neurodevelopment during NICU hospitalization or close to term age. Interventions should be appropriately designed to allow comparison with previous studies and a combination of different instruments could provide a more global assessment of preterm infants’ neurodevelopment and thus allow for comparisons across studies. Trial registration Prospero CRD42017047072

Additional file 2: of Effectiveness of interventions during NICU hospitalization on the neurodevelopment of preterm infants: a systematic review protocol

MEDLINE search strategy. (PDF 181 kb