A Randomized Controlled Trial: The Effect of Acupressure and Foot Reflexology on Pain During Heel-Lancing in Neonates

This randomized controlled study aimed to determine the effects of acupressure and foot reflexology on procedural pain during heel-lancing in newborns. This study was conducted with 105 neonates (35 foot reflexology group, 35 acupressure group, and 35 control group) who met the inclusion criteria and who were delivered by cesarean section between October 2017 and March 2018 at a state hospital in Turkey. A “Newborn Information Form” and a “Neonatal Pain, Agitation, and Sedation Scale” (N-PASS) were used to collect data. The study found a significant intergroup difference between pain scores of neonates during the procedures ( p < .05). Advanced analyses found that the pain scores in the acupressure and foot reflexology groups were similar, whereas the pain scores in the control group were higher than in the other two groups. Acupressure and foot reflexology administered during heel lancing in newborns are effective methods for reducing pain.

Respiratory Complications in Infants with Retinopathy of Prematurity (ROP) Requiring Laser Photocoagulation

Objective The objective of this paper was to describe peri-procedural events and complications of infants requiring laser photocoagulation for retinopathy of prematurity (ROP) in a level IV neonatal intensive care unit. Study Design A retrospective chart review was performed of neonates requiring ROP exams from January 2017 to August 2020. Baseline maternal and neonatal characteristics, ROP exam findings, and associated treatment were analyzed. Group characteristics were compared based on the need for laser photocoagulation. Subgroup analysis of the laser group including respiratory outcomes, cardiorespiratory index (CRI) scores, and pain scores was also performed. Results Neonatal and maternal characteristics in the laser (n = 27) and non-laser (n = 172) groups were assessed. Of the 81.5% (22/27) that required re-intubation for laser, 36% (8/22) had >1 intubation and 18% (4/22) had >1 extubation attempt. The average duration of intubation following laser was 2.46 ± 7.13 days, with 40% (9/22) needing peri-extubation steroids and 18% (4/22) racemic epinephrine to facilitate extubation. Mean total respiratory support time post-laser was 8.65 ± 15.23 days. Mean neonatal pain, agitation, and sedation scores after laser were zero immediately after the procedure, 0.09 ± 0.33 at 12 hours, 0.11 ± 0.47 at 24 hours, and 0.11 ± 0.51 at 48 hours. The mean CRI scores were 1 ± 0 immediately after the procedure, 1.17 ± 0.4 at 12 hours, 1.41 ± 0.20 at 24 hours, and 1 ± 0 at 48 hours. Conclusion Nearly all infants undergoing laser photocoagulation for ROP in our cohort required intubation and continued respiratory support. Despite stability during the procedure, complications from intubation were common. Key Points

Reduced BDNF Expression in Auditory Cortex Contributed to Neonatal Pain Induced Hearing Impairment and Dendritic Pruning Deficiency in Mice

Hearing loss in children is common especially in NICU with consequences of worse outcomes in speech, language, education, social functioning, cognitive abilities, and quality of life. Whether neonatal pain is link to increase risks for hearing loss remains to be explored. Here, we implemented Complete Freund's adjuvant (CFA) plantar injection and needle prick model to mimic neonatal pain in NICU during critical period of hearing development. Auditory brainstem response (ABR) test was used to determine the hearing threshold at 4w and 8w postnatal. Sufentanil and Oxycodone were used as analgesic to treat neonatal pain. Hair cell and ribbon synapse stanning were performed to detect cochlear function. Golgi-cox staining and BDNF immunofluorescence of auditory cortex were performed to determine dendritic spine pruning in auditory cortex. The dendritic pruning related protein CaMKII and Rac1/2 level were detected by western blot. We found that CFA induced neonatal pain and ABR threshold increased at 4w and 8w postnatal and the impairment were attenuated after analgesic administration. Neither the inner hair cell (IHC) nor the synapse of CFA mice was damaged in cochlear. CFA mice showed increased dendritic spine density at auditory cortex and reduced BDNF level. Furthermore, Rac1/2 and CaMKII might contributed to the disrupt dendritic spine pruning. Our study suggested that neonatal pain could induced hearing impairment in adulthood ascribed to the reduced BDNF level and AC dendritic spine pruning deficiency, optimal analgesic in early-life could beneficial for hearing development.

Developmental Care Implementation on preterm neonates in Ain Shams University Pediatric Hospitals: An interventional study

Introduction Developmental care is an approach to individualize care of infants to maximize neurological development and reduce long term cognitive and behavioral problems which may result from the stressful experience in the neonatal intensive care units like neonatal exposure to loud noise, bright light, heel pricking, orogastric suction and endotracheal intubation. It includes minimizing exposure to noise, light, proper skin to skin contact or kangaroo care, proper positioning, applying clustering of care and non-nutritive suckling. Objectives To study developmental care implementation and its relation to time to achieve full feed, length of hospital stay, amount of feeding, incidence of IVH, NEC & ROP, and consequently death in preterm neonates admitted to NICU. Patients and methods A Double arm randomized controlled clinical trial, care application, carried out on 60 preterms in the Neonatal Intensive Care Unit, Children's Hospital, Ain Shams university. Inclusion criteria of Developmental care group & controls (conventional care group) was; gestational age 29-36 week, no major congenital anomalies, and no pharmacological analgesics nor sedation were received before enrollment in the study. N-PASS (neonatal pain agitation sedation scale) and NISS (neonatal infant stressor scale) scores were assessed in both groups before and after developmental care implementation on developmental care group and conventional care application in conventional care group. Results N-PASS & NISS scores were decreased significantly with developmental care application, developmental care implementation resulted in a significant decrease in time to achieve full feed & length of hospital stay, there was a tendency to a decrease in incidence & grading of IVH, NEC & ROP, and consequently death in developmental care group compared to conventional care group. Conclusion Application of developmental care measures to NICU admitted preterm babies minimizes neonatal pain, stress, helps reaching amount of full feeding in a shorter time, with an increase in neonatal weight gain & a decrease in length of hospital stay.