Individual contextual factors in the validation of the Bernese pain scale for neonates: protocol for a prospective observational study

Background: The Bernese Pain Scale for Neonates (BPSN) is a multidimensional pain assessment tool that is already widely used in clinical settings in the German speaking areas of Europe. Recent findings indicate that pain responses in preterm neonates are influenced by individual contextual factors, such as gestational age (GA), gender and the number of painful procedures experienced. Currently, the BPSN does not consider individual contextual factors. Therefore, the aim of this study is the validation of the BPSN using a large sample of neonates with different GAs. Furthermore, the influence of individual contextual factors on the variability in pain reactions across GA groups will be explored. The results will be used for a modification of the BPSN to account for individual contextual factors in future clinical pain assessment in neonates. Methods and design: This prospective multisite validation study with a repeated measures design will take place in three university hospital neonatal intensive care units (NICUs) in Switzerland (Bern, Basel and Zurich). To examine the impact of GA on pain responses and their variability, the infants will be stratified into six GA groups ranging from 24 0/7 to 42 0/7. Among preterm infants, 2–5 routine capillary heel sticks within the first 14 days of life, and among full-term infants, two heel sticks during the first days of life will be documented. For each heel stick, measurements will be video recorded for each of three phases: baseline, heel stick, and recovery. The infants’ pain responses will be rated according to the BPSN by five nurses who are blinded as to the number of each heel stick and as to the measurement phases. Individual contextual factors of interest will be extracted from patient charts. Discussion: Understanding and considering the influence of individual contextual factors on pain responses in a revised version of the BPSN will help the clinical staff to more appropriately assess pain in neonates, particularly preterm neonates hospitalized in NICUs. Pain assessment is a first step toward appropriate and efficient pain management, which itself is an important factor in later motor and cognitive development in this vulnerable patient population. Trial registration: The study is registered in the database of Clinical Trial gov. Study ID-number: NCT 02749461. Registration date: 12 April 2016. Keywords: Pain assessment, Premature infants, Contextual factors, Diagnosti

Interprofessional Collaboration in a New Model of Transitional Care for Families with Preterm Infants – The Health Care Professional's Perspective

Background: Families with preterm infants find life after hospital discharge challenging and need tailored support to thrive. The “Transition to Home (TtH)”-model offers structured, individual support for families with preterm infants before and after hospital discharge. TtH improves parental mental health and competence, promotes child development and fosters interprofessional collaboration (IPC). Aim: Evaluate the TtH-models’ structure and implementation process and its associated interprofessional collaboration from the healthcare professional’s (HCP) perspective. Methods: This qualitative explorative study thematically analyzed four focus group inter- views (n=28 HCP) and an open-ended questionnaire with general pediatricians (n=8). Results: The main themes of the thematic analysis were the benefits of the TtH-model, tailored parental support, the challenges of changing interprofessional collaboration, facil- itators and barriers to successfully implementing the model, and feasibility and health economic limits. HCP acknowledge that continuous family-centered care led by an advanced practice nurse (APN) supports, strengthens, and relieves families with preterm infants in the transition from hospital to home. Families in complex situations benefit most. The TtH- model incorporates key aspects of integrated care like shared decision-making, considering family preferences, and defining the APN as the family’s main contact. HCP want network collaboration but found communication, cooperation, and reorganization challenging in the new IPC process. IPC challenges and involving many HCP in family care can create parental oversupply, negatively affect treatment outcomes, and raise health care costs. Conclusion: These challenges need to be addressed to ensure sustainable implementation of the model. The roles and tasks of HCP should be clearly distinguished from each other, and HCP must have time to learn this new form of IPC. Learning requires time, effective communication strategies, and leadership support. Political action is also required to imple- ment new models of care, including regulating advanced practice roles and developing new financing models

Enhancing Parents’ Well-Being after Preterm Birth—A Qualitative Evaluation of the “Transition to Home” Model of Care

There are few programs available aimed at preventing short- and long-term negative consequences after preterm birth and covering the entire care continuum. The “Transition to Home (TtH)” model is such a program, offering structured, individual support for families with preterm infants before and after hospital discharge. This study gathers and examines the parents’ views of receiving support from an interprofessional team under the TtH model of care during hospitalization and after discharge. Using a qualitative explorative design, 39 semi-structured interviews with parents were analyzed thematically. From this analysis, three main themes were identified: (1) TtH and the relevance of continuity of care; (2) Enhancement of parents’ autonomy and self-confidence; (3) Perception of interprofessional collaboration. Within these themes, the most relevant aspects identified were continuity of care and the appointment of a designated health care professional to anchor the entire care continuum. Emotional support complemented by non-medical approaches, along with strength-based and family resource-oriented communication, also emerged as key aspects. Continuous, family-centered care and well-organized interprofessional collaboration promote the well-being of the family after a premature birth. If the aspects identified in this study are applied, the transition from hospital to home will be smoothened for the benefit of affected families

Euphrasia Eye Drops in Preterm Neonates With Ocular Discharge: A Randomized Double-Blind Placebo-Controlled Trial

Aim: To investigate whether the early administration of Euphrasia eye drops® in preterm neonates presenting with ocular discharge fosters the resolution of the ocular discharge and reduces the need for topical antibiotic therapy, as compared to placebo. Methods: We conducted a randomized double-blind placebo-controlled trial at the University Children's Hospital Bern, Switzerland. Preterm neonates with white, yellow, or green ocular discharge were included. Infants were randomly assigned (1:1) to the Euphrasia arm (Euphrasia eye drops®, Weleda AG, Arlesheim) or the placebo arm (NaCl 0.9%). Euphrasia or placebo was administrated at a dose of one drop in each eye four times a day over a period of 96 h. The primary outcome was the treatment success, defined as no ocular discharge at 96 h and no use of topical antibiotic therapy during the 96-h intervention. Results: A total of 114 neonates were screened and 84 were randomized. Among neonates in the Euphrasia arm, 22 (55.0%) achieved our primary outcome compared to 21 (51.2%) in the placebo arm (p = 0.85). In the Euphrasia arm, time to resolution of reddening tended to fall within the shorter bracket of 24 to 48 h (24 (92.3%) vs. 12 (80.0%) in the placebo arm, p = 0.34) and relapse or first signs of reddening during the 96-h intervention tended to be lower [3 (7.9%) eyes vs. 8 (18.2%) eyes in the placebo arm, p = 0.17]. Tearing at 96 h tended to be lower in the Euphrasia arm [5 (12.8%) eyes in the Euphrasia arm vs. 12 (27.3%) eyes in the placebo arm, p = 0.10]. Discussion: Euphrasia did not significantly improve treatment success, defined as no ocular discharge at 96 h and no use of topical antibiotic therapy during the 96-h intervention. However, results suggest that Euphrasia may be of benefit for symptoms such as reddening and tearing, and thus improve the comfort of patients. Trial Registration: The trial is registered at the US National Institutes of Health (ClinicalTrials.gov) NCT04122300 and at the portal for human research in Switzerland SNCTP000003490. Keywords: Euphrasia drops; complementary medicine; congenital nasolacrimal duct obstruction; ocular discharge; preterm neonate

The nursing contribution to ethical decision making

Background: In the neonatal care units of the University Hospitals of Zurich and Bern, the nurse´s role in ethical decision-making is well established. However, nurses often reported uncertainty with regard to introducing the premature infant’s situation from the nursing perspective in ethics rounds. Aims: To empower neonatal nurses in fulfilling their role in the multiprofessional decision-making process, we performed a practice development project. On the basis of the Iowa model we developed a checklist for presenting the nursing history of premature infants in an ethically competent and responsible way. Conclusions: The ‘checklist for nursing assessment in the context of ethical decision-making’, equips nurses for their professional contribution to ethics rounds, making them better prepared to present the nursing perspective in a structured and thorough manner. Implications for practice: * The Iowa model supports practice development even with limited data availability * The instrument invigorates the neonatal nurse´s role in the multiprofessional ethical decision-making process * It is crucial to involve peers in practice developmen

Schmerzen bei Neugeborenen: die Geschichte einer Vernachlässigung.

Das Schmerzerleben von Neugeborenen war bis Ende der 1980erlahre von wissenschaftlichen Fehlannahmen und von einer gesellschaftlichen Vernachlässigung gekennzeichnet. Neugeborenen wurde die Fähigkeit zur Schmerzempfindung abgesprochen. Sie wurden ungeschützt schmerzhaften Prozeduren ausgesetzt. Heutige Frkenntnisse über die motorischen und kognitiven Langzeitfolgen einer frühen Schmerzexposition lassen den Schluss zu, dass Neugeborene nicht ohne Prävention prozeduralen Schmerzen ausgesetzt werden dürfen

Systematic Review of the Effectiveness of Involving Parents During Painful Interventions for Their Preterm Infants.

OBJECTIVE To systematically review the literature related to the effectiveness of parents' active involvement during painful interventions for their preterm infants. DATA SOURCES We performed a systematic search of PubMed, EMBASE/Ovid, CINAHL, Livivio, and PsycInfo using the keywords "preterm infants," "pain," and "parents." STUDY SELECTION Articles were eligible for inclusion if they were published between 2000 and 2021 and reported randomized controlled trials (RCTs) in which preterm infants underwent painful interventions, and parents were present and actively involved in pain-reducing measures. DATA EXTRACTION We used the Consolidated Standards of Reporting Trials (CONSORT) checklist for RCTs for data extraction. We assessed methodologic quality using critical appraisal for RCTs according to the Joanna Briggs Institute. DATA SYNTHESIS In total, 22 articles met the inclusion criteria. These articles reported 19 studies focused on kangaroo/skin-to-skin care, one focused on breastfeeding, and two focused on facilitated tucking. The methods used to evaluate pain in the infant varied substantially. Overall, kangaroo/skin-to-skin care and facilitated tucking resulted in clinically and statistically significant decreases in pain. For breastfeeding, effectiveness was linked to a more mature sucking pattern of the preterm infant. CONCLUSION The current evidence suggests that involving parents in pain-reducing measures during painful interventions for their preterm infants is beneficial. However, more research is needed for the different methods of involving parents in pain-reducing measures

Jetzt einsatzbereit: Der neue Berner Schmerzscore für Neugeborene BSN-R

Nach einer rigorosen Testung ist der Berner Schmerzscore für Neugeborene-Revised (BSN-R) für den klinischen Einsatz bereit. Die modifizierte Version des BSN gewichtet individuelle Kontextfaktoren wie das Gestationsalter, den Verhaltenszustand und den Beatmungsmodus stärker. So werden akute Schmerzzustände auch bei Frühgeborenen und sehr kranken Neugeborenen akkurater erkannt