Összefoglaló. Bevezetés: A neonatalis intenzív centrumokban kezelt betegek naponta számos fájdalmas beavatkozáson eshetnek át. A kezeletlen fájdalom következményeinek ismerete ellenére, fájdalmuk csillapítása még messze nem ideális. Célkitűzés: Obszervációs tanulmányunk célja az osztályunkon kezelt koraszülötteket és beteg újszülötteket ért fájdalmas beavatkozások gyakoriságának és természetének meghatározása volt. Vizsgáltuk a procedurális fájdalom esetén alkalmazott gyógyszeres és nonfarmakológiai fájdalomcsillapítók használatát, valamint a beavatkozások számát és a fájdalomcsillapítás alkalmazását befolyásoló tényezőket. Módszerek: A vizsgálatba az osztályunkon 2019. 09. 01. és 2019. 12. 31. között kezelt betegeket vontuk be. Prospektív adatgyűjtést végeztünk a hospitalizáció első 14 napján, egy erre a célra kialakított kérdőíven, amelyet az egészségügyi személyzet valós időben töltött ki. Eredmények: Kutatásunkba 143 gyermeket tudtunk bevonni. A vizsgálati időszak alatt 43-féle fájdalmas beavatkozás történt, összesen 13 314 alkalommal, amiből 12 953 első, 361 többszöri kísérlet volt. Gyermekenként átlagosan 93,1 beavatkozást végeztünk a hospitalizáció első 2 hetében, ami átlagosan 8,2 fájdalmas procedúrát jelentett naponta és gyermekenként. Fájdalomcsillapítás összesen 4190 alkalommal, a beavatkozások 31,5%-ában történt. Ennek 55,5%-a folyamatos gyógyszeres, 40,7%-a nem gyógyszeres, 2,5%-a alkalmi gyógyszeres, 1,3%-a kombinált terápia volt. A legkisebb születési súlyú, legrövidebb gestatiós időre született és a lélegeztetett koraszülöttek szenvedték el a legtöbb fájdalmas beavatkozást. Következtetés: Betegeink nagyszámú fájdalmas beavatkozáson esnek át, és ezek nagyobb részénél nem történik fájdalomcsillapítás. A beavatkozások tervezésével, összehangolásával, a gyógyszeres és nem gyógyszeres fájdalomcsillapítás kiterjedtebb alkalmazásával jobb fájdalommenedzsment lenne elérhető. Orv Hetil. 2021; 162(48): 1931–1939.
Summary. Introduction: Preterm infants and sick neonates treated in neonatal intensive care units may undergo numerous painful interventions. Despite rapidly growing knowledge about consequences of untreated pain, pain management of neonates is far from ideal. Objective: To determine the frequency and nature of painful procedures and corresponding analgesic therapies in neonates treated in a neonatal intensive care unit of a university teaching hospital in Hungary. Methods: A prospective observational study was performed between September and December 2019. We collected data of all painful procedures, pharmacological and non-pharmacological analgesic therapy performed on neonates during the first 14 days of hospitalization. For data collection, we used a questionnaire designed for this purpose, which was completed in real time by the medical staff. Results: 143 children were enrolled. 43 types of painful interventions were performed, a total of 13,314 times, of which 12,953 were the first, 361 multiple attempts. Each neonate was subjected to a mean of 93.1 interventions in the first 2 weeks of hospitalization, representing an average of 8.2 painful procedures per day per child. Pain relief was performed a total of 4190 times, in 31.5% of the interventions. Of this, 55.5% were continuous pharmacological, 40.7% non-pharmacological, 2.5% occasional drug, and 1.3% combination therapy. Ventilated neonates and preterm infants with shorter gestational age and lower birth weight had the most painful procedures. Conclusion: Patients treated in our unit undergo a large number of painful interventions, most of which are not accompanied by analgesia. Increased efforts are needed to promote our better pain management. Orv Hetil. 2021; 162(48): 1931–1939.
Hungarian Central Statistical Office. Infant mortality. [Központi Statisztikai Hivatal. Csecsemőhalálozás.] KSH, Statisztikai tükör, Budapest, 2019. február 22. Available from: http://www.ksh.hu/docs/hun/xftp/stattukor/csecsemohalalozas.pdf [accessed: May 15, 2021]. [Hungarian]
Brennan F, Lohman D, Gwyther L. Access to pain management as a human right. Am J Public Health 2019; 109: 61–65.
Anand KJ, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med. 1987; 317: 1321–1329.
Anand KJ, Carr DB. The neuroanatomy, neurophysiology and neurochemistry of pain, stress, and analgesia in newborns and children. Pediatr Clin North Am. 1989; 36: 795–822.
Giannakoulopoulos X, Sepulveda W, Kourtis P, et al. Fetal plasma cortisol and beta-endorphin response to intrauterine needling. Lancet 1994; 344: 77–81.
Slater R, Cantarella A, Gallella S, et al. Cortical pain responses in human infants. J Neurosci. 2006; 26: 3662–3666.
Hatfield LA. Neonatal pain: what’s age got to do with it? Surg Neurol Int. 2014; 5(Suppl 13): S479–S489.
Grunau RE, Holsti L, Peters JW. Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med. 2006; 11: 268–275.
Williams MD, Lascelles BD. Early neonatal pain – a review of clinical and experimental implications on painful conditions later in life. Front Pediatr. 2020; 8: 30.
Grunau RE. Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Med J. 2013; 4: e0025.
Brummelte S, Chau CM, Cepeda IL, et al. Cortisol levels in former preterm children at school age are predicted by neonatal procedural pain-related stress. Psychoneuroendocrinology 2015; 51: 151–163.
Duerden EG, Grunau RE, Guo T, et al. Early procedural pain is associated with regionally-specific alterations in thalamic development in preterm neonates. J Neurosci. 2018; 38: 878–886.
McPherson C, Miller SP, El-Dib M. The influence of pain, agitation, and their management on the immature brain. Pediatr Res. 2020; 88: 168–175.
Walker SM. Long-term effects of neonatal pain. Semin Fetal Neonatal Med. 2019; 24: 101005.
Gharavi B, Schott C, Nelle M, et al. Pain management and the effect of guidelines in neonatal units in Austria, Germany and Switzerland. Pediatr Int. 2007; 49: 652–658.
Lago P, Garetti E, Merazzi D, et al. Guidelines for procedural pain in the newborn. Acta Paediatr. 2009; 98: 932–939.
American Academy of Pediatrics Committee on Fetus and Newborn, American Academy of Pediatrics Section on Surgery, Canadian Paediatric Society Fetus and Newborn Committee. Prevention and management of pain in the neonate: an update. Pediatrics 2006; 118: 2231–2241.
Anand KJ, International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001; 155: 173–180.
Roué JM, Kuhn P, Lopez Maestro M, et al. Eight principles for patient-centred and family-centred care for newborns in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2017; 102: F364–F368.
Walker SM. Management of procedural pain in NICUs remains problematic. Paediatr Anaesth. 2005; 15: 909–912.
Cignacco E, Hamers JP, Stoffel L, et al. Routine procedures in NICUs: factors influencing pain assessment and ranking by pain intensity. Swiss Med Wkly. 2008; 138: 484–491. [Erratum: Swiss Med Wkly. 2009; 139: 32.]
Cruz MD, Fernandes AM, Oliveira CR. Epidemiology of painful procedures performed in neonates: a systematic review of observational studies. Eur J Pain 2016; 20: 489–498.
Orovec A, Disher T, Caddell K, et al. Assessment and management of procedural pain during the entire neonatal intensive care unit hospitalization. Pain Manag Nurs. 2019; 20: 503–511.
Roofthooft DW, Simons SH, Anand KJ, et al. Eight years later, are we still hurting newborn infants? Neonatology 2014; 105: 218–226.
Carbajal R, Rousset A, Danan C, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA 2008; 300: 60–70.
Jeong IS, Park SM, Lee JM, et al. The frequency of painful procedures in neonatal intensive care units in South Korea. Int J Nurs Pract. 2014; 20: 398–407.
Cignacco E, Hamers J, van Lingen RA, et al. Neonatal procedural pain exposure and pain management in ventilated preterm infants during the first 14 days of life. Swiss Med Wkly. 2009; 139: 226–232.
Britto CD, Rao Pn S, Nesargi S, et al. PAIN – perception and assessment of painful procedures in the NICU. J Trop Pediatr. 2014; 60: 422–427.
Chen M, Shi X, Chen Y, et al. A prospective study of pain experience in a neonatal intensive care unit of China. Clin J Pain 2012; 28: 700–704.
Kassab M, Alhassan AA, Alzoubi KH, et al. Number and frequency of routinely applied painful procedures in university neonatal intensive care unit. Clin Nurs Res. 2019; 28: 488–501.
Zeitlin J, Szamotulska K, Drewniak N, et al. Preterm birth time trends in Europe: a study of 19 countries. BJOG 2013; 120: 1356–1365.
Johnston C, Barrington KJ, Taddio A. Pain in Canadian NICUs: have we improved over the past 12 years? Clin J Pain 2011; 27: 225–232.
Orovec A, Disher T, Caddell K, et al. Assessment and management of procedural pain during the entire neonatal intensive care unit hospitalization. Pain Manag Nurs. 2019; 20: 503–511.
Goto T, Inoue T, Kamiya C, et al. Neonatal pain response to automatic lancet versus needle heel-prick blood sampling: a prospective randomized controlled clinical trial. Pediatr Int. 2020; 62: 357–362.
Collier M. Minimising pain and medical adhesive related skin injuries in vulnerable patients. Br J Nurs. 2019; 28: S26–S32.
Denyer J. Reducing pain during the removal of adhesive and adherent products. Br J Nurs. 2011; 20: S28, S30–S35.
Morrissey MJ, Duntley SP, Anch AM, et al. Active sleep and its role in the prevention of apoptosis in the developing brain. Med Hypotheses 2004; 62: 876–879.
Peirano PD, Algarín CR. Sleep in brain development. Biol Res. 2017; 40: 471–478.
Bertelle V, Sevestre A, Laou-Hap K, et al. Sleep in the neonatal intensive care unit. J Perinat Neonatal Nurs. 2007; 21: 140–148.
Simons SH, van Dijk M, van Lingen RA, et al. Routine morphine infusion in preterm newborns who received ventilatory support: a randomized controlled trial. JAMA 2003; 290: 2419–2427.
Carbajal R, Lenclen R, Jugie M, et al. Morphine does not provide adequate analgesia for acute procedural pain among preterm neonates. Pediatrics 2005; 115: 1494–1500.
McNair C, Campbell-Yeo M, Johnston C, et al. Non-pharmacologic management of pain during common needle puncture procedures in infants: current research evidence and practical considerations: an update. Clin Perinatol. 2019; 46: 709–730.
Hatfield LA, Murphy N, Karp K, et al. A systematic review of behavioral and environmental interventions for procedural pain management in preterm infants. J Pediatr Nurs. 2019; 44: 22–30.
Mangat AK, Oei JL, Chen K, et al. A review of non-pharmacological treatments for pain management in newborn infants. Children 2018; 5: 130.
Pillai Riddell RR, Racine NM, Gennis HG, et al. Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev. 2015; 12: CD006275.
Stevens B, Yamada J, Ohlsson A, et al. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2016; 7: CD001069
Bueno M, Yamada J, Harrison D, et al. A systematic review and meta-analyses of nonsucrose sweet solutions for pain relief in neonates. Pain Res Manag. 2013; 18: 153–161.
Lago P, Guadagni A, Merazzi D, et al. Pain management in the neonatal intensive care unit: a national survey in Italy. Paediatr Anaesth. 2005; 15: 925–931.
Anand KJ, Eriksson M, Boyle EM, et al. Assessment of continuous pain in newborns admitted to NICUs in 18 European countries. Acta Paediatr. 2017; 106: 1248–1259.
Maxwell LG, Fraga MV, Malavolta CP. Assessment of pain in the newborn: an update. Clin Perinatol. 2019; 46: 693–707.
Relland LM, Gehred A, Maitre NL. Behavioral and physiological signs for pain assessment in preterm and term neonates during a nociception-specific response: a systematic review. Pediatr Neurol. 2019; 90: 13–23.