28 research outputs found
Acute pain and stress in neonates : effects of sweet solutions and contribution of a multimodal pain assessment
Le nouveau-nĂ© hospitalisĂ© est exposĂ© de maniĂšre rĂ©pĂ©tĂ©e Ă des procĂ©dures douloureuses ou stressantes pouvant entraĂźner des consĂ©quences neurodĂ©veloppementales Ă court et long terme. La prĂ©vention de la douleur procĂ©durale est essentiellement basĂ©e sur lâutilisation de traitements non pharmacologiques parmi lesquels les solutions sucrĂ©es possĂšdent un niveau de preuve Ă©levĂ©. Cependant, leur efficacitĂ© a rĂ©cemment Ă©tĂ© remise en cause et leurs mĂ©canismes dâaction restent mal compris. Enfin, la dissociation parfois retrouvĂ©e entre les rĂ©ponses comportementales et corticales suggĂšre de monitorer la douleur de maniĂšre multimodale. Les objectifs de ce travail Ă©taient : 1) de comparer lâefficacitĂ© de lâallaitement maternel et du sucrose sur la douleur procĂ©durale en analysant spĂ©cifiquement les rĂ©ponses corticales, 2) dâĂ©tudier les effets pĂ©riphĂ©riques des solutions sucrĂ©es au niveau de neurones sensoriels de ratons, 3) dâĂ©valuer lâintĂ©rĂȘt dâun modĂšle dâĂ©valuation multimodale de la douleur chez le nouveau-nĂ© Ă terme et prĂ©maturĂ©. Aucune diffĂ©rence entre le sucrose et lâallaitement maternel nâa pu ĂȘtre objectivĂ©e sur les rĂ©ponses corticales(NIRS) Ă la douleur chez des nouveau-nĂ©s Ă terme Ă 3 jours de vie. Nous avons objectivĂ© un effet pĂ©riphĂ©rique du glucose et du sucrose sur des neurones sensoriels de ratons nouveau-nĂ©s, mĂ©diĂ© par TRPV1. L'effet du glucose Ă©tait associĂ© Ă une diminution de la libĂ©ration de la substance P. LâĂ©valuation multimodale de la douleur retrouvait des corrĂ©lations faibles Ă modĂ©rĂ©es entre le score NFCS et la conductance cutanĂ©e, le cortisol salivaire et les changements dâ [HbT] mesurĂ©s en NIRS. LâĂ©tude menĂ©e chez les nouveau-nĂ©s prĂ©maturĂ©s nous permettra de prĂ©ciser lâintĂ©rĂȘt de lâutilisation de la variabilitĂ© de la frĂ©quence cardiaque (indice NIPE instantanĂ©) dans cette indication afin de proposer un modĂšle multimodal fiable pour de futurs essais randomisĂ©s contrĂŽlĂ©s.Hospitalized newborns are exposed to repeated painful or stressful procedures that can lead to short- and long-term neurodevelopmental sequellae.The prevention of procedural pain is essentially based on the use of nonpharmacological treatments among which the sweet solutions appear to be among the most effective. However, their effectiveness has recently been challenged and their mechanisms of action remain poorly understood. Finally, the dissociation frequently found between behavioural and cortical responses shows the importance of monitoring pain in a multimodal way. The objectives of this work were 1) to compare the efficacy of breastfeeding and sucrose on procedural pain by specifically analyzing cortical responses, 2) to study the peripheral effects of sweet solutions on sensory neurons of newborn rats and 3) to evaluate the contribution of a multimodal pain assessment model in term and preterm neonates. No difference between sucrose and breastfeeding was measured on pain-evoked cortical responses (NIRS) in term neonates at 3 days of life.We reported a peripheral effect of glucose and sucrose on afferent sensory neurons from newborns rats mediated byTRPV1. The effect for glucose was associated with a decrease of substance P release.The multidimensional assessment of pain found mild to moderate correlations between the NFCS score, skin conductance, salivary cortisol and changes in [HbT] measured in NIRS.The study conducted in preterm newborns will specify the reliability of heart rate variability (instant NIPE index) in thisindication to provide a suited multimodal pain assessment model for future randomized controlled trials
Prematurity has no impact on the quality of parents' sleep 6 months after birth
Abstract Aim Due to the stress that is classically associated with the premature birth of a child, these parents may be prone to sleep disorders. The aim of this study was to compare sleep quality of preterm infants' parents with that of term infants' parents. Methods Prospective observational cohort study conducted at the University Hospital of Brest between January 2019 and January 2021. The primary outcome criterion was the score obtained by the parents on the Pittsburg Sleep Quality Index (PSQI) 6 months after their child's birth. Each parent was recruited in the days following their child's birth and completed the PSQI online. Results Overall, 316 parents were included. The median gestational age at birth was 34.3 (31.6â35.5) weeks in the preterm infant group and 39.7 (38.6â40.7) weeks in the term infant group. Of the 948 expected questionnaires, 771 were completed and collected. On average, 59% of the parents obtained a PSQI global score >5. Six months after birth, no differences were reported between parents of preterm and fullâterm infants. Conclusion This study did not reveal any difference between sleep quality of preterm infants' parents and term infants' parents
Cortical Pain Response of Newborn Infants to Venepuncture
International audienceOBJECTIVE:Sucrose administration and breastfeeding decrease behavioral expressions of pain in neonates. However, recent studies indicated that there is a persistent cortical response with sucrose. This study compared the efficacy of sucrose administration versus breastfeeding to decrease cortical responses to pain during venepuncture.PATIENTS AND METHODS:A randomized, prospective, controlled trial was conducted in a tertiary level maternity ward. Healthy, 3-day-old term neonates, undergoing venepuncture for neonatal screening, were randomly assigned to receive sucrose solution or be breastfed before venepuncture. Variations in the total hemoglobin concentration [HbT] in the contralateral somatosensory cortex were assessed with near infrared spectroscopy. The Neonatal Facial Coding System (NFCS) was used to assess reactions.RESULTS:There were 114 term neonates included, with 102 included for the primary outcome (breastfed group: 48; sucrose group: 54). Similar maximum increases in [HbT] were observed in both groups (mean±SD: sucrose group: 31.2±58.1âÎŒmol/L; breastfed group: 38.9±61.4âÎŒmol/L; P=0.70). Breastfed neonates presented more behavioral expressions that indicated pain compared with sucrose-administered neonates (46.8% vs. 26.8% of NFCS â„1, P=0.04). The maximum increase in [HbT] was persistent, although newborn infants who did not express behavioral signs of pain had lower concentrations than neonates who did (mean±SD: 21.2±29.1 vs. 60.0±89.8âÎŒmol/L, P<0.01).DISCUSSION:There was no difference in the cortical responses to pain during venepuncture in newborn infants who were administered sucrose versus those who were breastfed
A review of the characteristics, mechanisms and clinical significance of habituation in foetuses and newborn infants
Abstract Habituation has been a topic of interest since the early 20th century. We summarise the characteristics of habituation, the proposed habituation mechanisms, the associated cortical responses and the link between habituation and cognitive development. Behavioural and neuroimaging studies have highlighted the early sensory abilities of foetuses and newborn infants, with preterm newborn infants exhibiting decreased habituation and dishabituation capabilities that increase their environmental vulnerability. Habituation provides a foundation for the learning and cognition on which higher functions are constructed. It has been suggested that it is efficient for predicting cognitive developmental outcomes in term and preterm newborn infants
What Do We Know about Pruritus in Very Young Infants? A Literature Review
International audienceIn infants, pruritus is frequently considered as absent because they do not scratch themselves. Because pruritus could induce severe adverse effects in this vulnerable population, we aimed to review existing evidence on the ability of young infants to experience itch and on how to assess itch-related discomfort in this population. A literature review was performed (Pubmed, Google Scholar). Neurological itch pathways are well described. Skin development starts early during gestation. At 34 weeks of gestation, skin is almost complete while skin adaptations occur after birth. Newborn skin is neurologically functional, including the ability for young infants to feel pain. Similarities and interactions between pain and pruritus support the hypothesis that infants could feel pruritus. However, the existence of pruritus in infants has never been evidenced. Many itchy conditions can affect them, suggesting non-negligible prevalence of infant pruritus among which atopic dermatitis (AD) is the most studied disease. Studies reported a negative impact of AD on children and their families. There is no existing validated method to assess pruritus in infants, although they may feel pruritus and chronic pruritus can lead to serious adverse effects. To appropriately diagnose pruritus appears of great interest among young infants. Development of a method is required to this aim
Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit
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Tactile hypersensitivity in pre-term newborns
International audienceFor a long time, newborns, and a fortiori preterm ones, have been considered to be devoid of sensory perception and hence of pain perception. However, tactile perception is functional very soon during prenatal development. From 7 weeks post-conception, fetus show withdrawal reflex after a subtle tactile stimulation of the face. From 21 weeks, after the antero-posterior development of the tactile sensitivity, each part of the body reacts to a tactile stimulation. Still, the threshold of tactile sensitivity of premature newborns remains unknown. This study was performed on 10 preterms, born at 31.3 weeks of gestation (±4.7 s.d.) and tested when they had reached the term age (at least 37 weeks), 9 early-term (born at 37-38 weeks of gestation) and 10 full-term (born at 40-41 weeks of gestation) newborns tested between 2 and 4 days of postnatal age. Thirty adults were also tested (28.35 years old ±3.83 s.d.). The stimulation consisted in touching the back of the subject's hand with a 0.008g Von Frey filament. All subjects were tested twice: once using the filament and once using a fake stimulation. We considered as a response any behavioural change occurring within the first second after the stimulation. Preterm newborns showed strong, albeit non-localized, responses. This hypersensitivity was observed in half of the full-term newborns tested but neither in the early-term newborns nor in the adults tested. This study is the first to show a clear reaction to a so subtle stimulation, unperceivable by adults, underlying an exceptional tactile sensitivity in preterm newborns and an important gap between their and our sensory worlds. From birth, the preterm newborn is subjected to numerous tactile stimulation (delivery, nursing care, contacts with social and physical environments). These results open new lines of thoughts about routine practices
Higher tactile sensitivity in preterm infants at term-equivalent age: A pilot study
International audienceDespite a growing body of research on perinatal sensory abilities, data on the extent of tactile sensitivity and more particularly passive touch (i.e. sensitivity to a stimulation imposed on the skin) are relatively limited, and the development and processing of tactile function are still thus little known. This question is particularly of high importance for infants with atypical early development such as those born prematurely who are exposed to many sensory (including tactile) stimulations (being in a hospital setting) during a critical period of brain development and those born at early term whose birth occurs at the precise time of cortical reorganization, in particular in the sensory areas. Some parents and health-care providers have for instance reported that children born prematurely exhibit atypical (e.g. higher) sensitivity to âbenignâ tactile stimuli. In the present study, we hypothesized that preterm and early-term infants may show altered tactile sensitivity. We compared the behavioral responses around term-equivalent age of infants born either pre-term, early-term or at term to the application of a light (0.008 grams) mechanical stimulus. We found that almost all preterm infants perceive this tactile stimulus, contrarily to the two other groups of infants. This extreme tactile sensitivity may be due to experiential, maturational or more likely both processes. We also compared the tactile sensitivity of these infants to that of adults. We found that adults were irresponsive to the light mechanical stimulus. This finding opens not only new insights in understanding development of tactile processing, but also new lines of thought about the particular sensory world of premature and early-term infants and hence about the potential impact of early care practices
Actigraphy is not a reliable method for measuring sleep patterns in neonates.
International audiencePolysomnography is the gold standard for studying sleep, but it is complex to use, and this can be problematic in clinically unstable preterm infants. We evaluated the reliability of actigraphy and polysomnography in detecting sleep-wake patterns in newborn infants. A prospective, monocentric study was conducted that measured the sleep patterns of 48 infants: 24 late preterm neonates born at 34-36 weeks of gestational age and 24 term neonates. We used both polysomnography and the Actiwatch Mini during a three-hour period and then compared the results from the two methods. The baseline measurements for the preterm and terms groups were as follows: gestational age (34.5 weeks and 39.2 weeks), birthweight (2368 g and 3393 g) and age (6.4 days and 0.72 days). With the Actiwatch Mini, sensitivity for the late preterm and full-term infants was 78% and 87% for the leg actigraph and 78% and 93% for the arm actigraph. For specificity, the respective figures were 42% and 31% for the leg and 34% and 20% for the arm. Actigraphy using the Actiwatch Mini was not a reliable method for measuring sleep patterns in healthy late preterm and term neonates a few days after birth
The newborn infant parasympathetic evaluation index for acute procedural pain assessment in preterm infants
International audienceBackground: Accurate assessments of pain in hospitalized preterm infants present a major challenge in improving the short- and long-term consequences associated with painful experiences. We evaluated the ability of the newborn infant parasympathetic evaluation (NIPE) index to detect acute procedural pain in preterm infants.Methods: Different painful and stressful interventions were prospectively observed in preterm infants born at 25 + 0 to 35 + 6 weeks gestation. Pain responses were measured using the composite Premature Infant Pain Profile Revised (PIPP-R) scale, the NIPE index, and skin conductance responses (SCR). Outcome measures were correlations between the NIPE index, the PIPP-R score, and the SCR. Sensitivity/specificity analyses tested the accuracy of the NIPE index and SCR.Results: Two hundred and fifty-four procedures were recorded in 90 preterm infants. No significant correlation was found between PIPP-R and the NIPE index. PIPP-R and SCR were positively correlated (r = 0.27, P < 0.001), with stronger correlations for painful procedures (r = 0.68, P < 0.001) and especially for skin-breaking procedures (r = 0.82, P < 0.001). The NIPE index and SCR had high sensitivity and high negative predictive values to predict PIPP-R > 10, especially for skin-breaking painful procedures.Conclusions: We found no significant correlation between the NIPE index and PIPP-R during routine painful or stressful procedures in preterm infants.Impact: Exposure to repetitive pain can lead to neurodevelopmental sequelae. Behavior-based pain scales have limited clinical utility, especially for preterm infants. New devices for monitoring physiological responses to pain have not been validated sufficiently in preterm infants. This study found that the NIPE index was not significantly correlated to the validated PIPP-R scale during acute procedural pain. Secondary analysis of this study showed that NIPE index and SCRs may help to exclude severe pain in preterm infants. In clinical practice, measurements of physiological parameters should be combined with behavior-based scales for multidimensional pain assessments