Consensus core outcome rating for the Japanese neonatal pain guidelines

IntroductionThe Japanese Neonatal Pain Guidelines Committee, led by the Japan Academy of Neonatal Nursing, uses the Grading of Recommendations, Assessment, Development, and Evaluation Working Group method to evaluate the quality of evidence and the strength of treatment recommendations. Ratings on the importance of outcomes related to neonatal pain have not been reported. This study aimed to reach a consensus on the importance of outcomes through a guideline panel composed of doctors, nurses, a nurse practitioner, a physical therapist, and families to ensure consistency in systematic reviews of neonatal pain and future revisions to the guidelines.MethodsA total of 26 professionals, including 21 medical personnel from clinical settings and academia and 5 parents from five family associations, participated in 3-stage eDelphi rounds.ResultsThe literature review and discussion identified 75 outcomes that were included in round one. The participants proposed three additional outcomes: 78 outcomes were scored in rounds two and three. Round three scores showed different stakeholder groups in terms of priority outcomes. Seventeen outcomes were included in the final core outcome and were considered critical for decision-making.ConclusionCore outcomes of the development of neonatal pain guidelines in Japan were identified. The assessment process of importance from this study highlights the difference in the perspectives of medical providers and parents on neonatal pain, thus, involving parents in the assessment and as the spokesperson for the infant admitted to the neonatal intensive care unit is important for a more inclusive evaluation of pain prevention and management

The Fate of Parathion in vivo

Parathion is distributed equally in the poisoned human bodies, as it has been in the case of experimental animals, and disappeared after 24-48 hours. This may be attributed to the splitting of parathion both p-nitrophenol and diethyl (thio) phosphate. The most part of p-nitrophenol is excreted in the urin within 1-2 days and only a part of it prolonged into a week accompaniing no sign of poisoning. It is said that diethyl (thio) phosphate is excreted similary, but poisonus (1/4-1/5 of parathion) for the human bodies and animals. The splitting above mentioned is based on the enzym action, including cholinesterase which is found in the animal sera and organ extracts. The parathion splitting action of serum is inhibited in the case of various kinds of disease

The cerebral hemodynamic response to phonetic changes of speech in preterm and term infants: The impact of postmenstrual age

Higher brain dysfunction, such as language delay, is a major concern among preterm infants. Cerebral substrates of cognitive development in preterm infants remain elusive, partly because of limited methods. The present study focuses on hemodynamic response patterns for brain function by using near-infrared spectroscopy. Specifically, the study investigates gestational differences in the hemodynamic response pattern evoked in response to phonetic changes of speech and cerebral hemispheric specialization of the auditory area in preterm infants (n = 60) and term infants (n = 20). Eighty neonates born between 26 and 41 weeks of gestational age (GA) were tested from 33 to 41 weeks of postmenstrual age (PMA). We analyzed the hemodynamic response pattern to phonemic and prosodic contrasts for multiple channels on temporal regions and the laterality index of the auditory area. Preterm infants younger than 39 weeks of PMA showed significantly atypical hemodynamic patterns, with an inverted response shape. Partial correlation analysis of the typicality score of hemodynamic response revealed a significant positive correlation with PMA. The laterality index of preterm infants from 39 weeks of PMA demonstrated a tendency rightward dominance for prosodic changes similar to term infants. We provide new evidence that alterations in hemodynamic regulation and the functional system for phonemic and prosodic processing in preterm infants catch up by their projected due dates. Keywords: Near-infrared spectroscopy, Preterm infants, Laterality, Speech perceptio