Procedural Pain Assessment in Infants Without Analgosedation: Comparison of Newborn Infant Parasympathetic Evaluation and Skin Conductance Activity - A Pilot Study

Objective: New technologies to measure pain responses, such as heart rate variability and skin conductance hold promise in the development of tools that can be reliable and quantifiable of detecting pain. The main objective of this study was to assess the capability of two monitors i.e., Newborn Infant Parasympathetic Evaluation (NIPE) and Skin Conductance Algesimeter for detecting procedural pain in non-anesthetized infants.Materials and Methods: Thirty-three non-anesthetized infants were enrolled to the study. To detect pain caused by heel stick, NIPE, and Skin Conductance monitors and behavioral pain scales were used. Three minutes before and just after heel stick, pain was evaluated by behavioral scales, and simultaneously over the whole period by NIPE and SCA.Results: A statistically significant decrease of NIPE Index and an increase of SCA values were found after the HS procedure. There were no statistically significant differences between the decrease in NIPEi values and the increase in PPS values between subgroups based on pain assessment by behavioral-scale scores.Conclusion: Both NIPE and SCA can be useful for detection of procedural pain and may constitue an additional valuable tool for better handling of pain among patients treated in NICUs. More studies on larger groups of patients are needed.

Maternal transmission as a symbiont sieve, and the absence of lactation in male mammals

Gut microbiomes of humans carry a complex symbiotic assemblage of microorganisms. As in all mammals, the special mode of feeding newborn infants through milk from the mammary gland enhances the opportunity for vertical transmission of elements of this microbiome. This has potential benefits, but it also brings with it some hazards for the host. We point out here that vertical transmission from both parents would allow host populations to be invaded by elements that are deleterious. In contrast, vertical transmission, when restricted to one parent, acts as a sieve preventing the spread of such elements. Because some transmission from mother to infant is unavoidable in placental mammals, uniparental transmission of symbionts, if it were to be selected, would require some separation of the father from the newborn infant. This paper therefore puts forward the hypothesis that the asymmetry in roles of mother and father, together with the hazards that come with biparental transmission, generate a selection pressure against male lactation in humans, and in mammals in general.

TRATAMENTO DE DERMATITE PERINEAL ASSOCIADA AO USO DE ANTIBIOTICOTERAPIA EM CRIANÇAS

Objetivo: Evidenciar, dentre as opções disponíveis, qual o tratamento mais efetivo para dermatite perineal associada ao uso de antibioticoterapia. Método: revisão integrativa de literatura que respeitou as seis etapas metodológicas do referencial adotado, realizada no segundo semestre de 2020, nas bases MEDLINE/Pubmed, CINAHL, SCOPUS e Web of Science. Utilizou-se os descritores em inglês: Newborn, Infant, diaper rash, therapeutics, juntamente com os operadores booleanos AND e OR. Foram avaliadas sete publicações, sendo que a síntese dos resultados foi originada da própria ordenação temática da revisão, por interpretação autoral. Resultados: Os tratamentos são distintos, de acordo com o grau da dermatite. Para a leve, utilizam-se cremes de barreira contendo óxido de zinco; para as moderadas a graves ou persistentes, além dos cremes de barreira, corticosteroides de baixa potência como hidrocortisona 1%, por curto período. Mediante infecção por Candida albicans requer-se antifúngicos, como a Nistatina, Miconazol ou Clotrimazol. Associado a infecção bacteriana podem ser utilizados antimicrobianos como a Mupirocina tópica. Conclusão: Em todos os estágios é importante que ocorram trocas frequentes de fralda e limpeza suave da área lesada, utilizando água e produtos de pH ácido ou neutro, além dos produtos mencionados.

QTc Intervals Are Prolonged in Late Preterm and Term Neonates during Therapeutic Hypothermia but Normalize Afterwards

Background: There are anecdotal reports on reversible QTc prolongation during therapeutic hypothermia (TH) for moderate to severe neonatal encephalopathy after asphyxia. As the QTc interval is a relevant biomarker for pharmacovigilance during medication development, a structured search and review on published neonatal QTc values to generate reference values is warranted to facilate medication development in this specific population. Methods: A structured search and literature assessment (PubMed, Embase, and Google Scholar) with ‘Newborn/Infant, QT and hypothermia’ was conducted (October 2021). Retrieved individual values were converted to QTc (Bazett) over postnatal age (day 1–7). Results: We retrieved 94 QTc intervals (during TH (n = 50, until day 3) or subsequent normothermia (n = 44, day 4–7)) in 33 neonates from 6 publications. The median (range) of QTc intervals during TH was 508 (430–678), and 410 (317–540) ms afterwards (difference 98 ms, or +28 ms/°C decrease). Four additional cohorts (without individual QTc intervals) confirmed the pattern and magnitude of the effect of body temperature on the QTc interval. Conclusions: We highlighted a relevant non-maturational covariate (°C dependent TH) and generated reference values for the QTc interval in this specific neonatal subpopulation. This knowledge on QTc during TH should be considered and integrated in neonatal medication development.

Study of Neuropeptide Substance P as A Marker of Pain in Newborn Infant

BACKGROUND: Prolonged and repeated untreated pain in newborn infant may produce a relatively permanent adverse long-term sequela. AIM: The aim of this study was to evaluate the potential role for neuropeptides substance P (SP) as neurochemical pain marker in newborn infants in order to decrease unnecessary use of analgesics and protect the developing brain. METHODS: This case-control study was conducted on 60 newborn infants. They were assigned to four groups, control preterm, sick preterm, control full term, and sick full term. All neonates were subjected to estimation of pain through neonatal infants pain score (NIPS) as well as Neuropeptide SP on the 1st and 5th day of life. The NIPS addresses five behavioral parameters (facial expression, crying, arm movement, leg movement, and state arousal) and one physiological parameter (breathing pattern). Results were further evaluated according to nature of the procedures; invasive and non-invasive procedures. RESULTS: There was a significant increase in the severity of pain score among the sick preterm and full-term infants after invasive procedures. There was a significant increase in SP in the sick preterm group than the control preterm on the 1st and 5th day of life; p were =0.003 and = 0.037, while full-term infants showed significant increase on the 5th day; p = 0.005. Furthermore, there was no significant difference in SP values between the preterm and full-term infants on the 1st and 5th day of life. SP increased significantly after invasive procedures than noninvasive procedures in the sick full-term and sick preterm infants weather in the 1st or 5th day of life. There was a significant correlation between the pain score NIPS and SP level on the 1st day of life. CONCLUSION: SP can be used as pain marker in sick preterm and full-term newborn infants. It showed increase with invasive procedures, acute and chronic pain.

QTc Intervals Are Prolonged in Late Preterm and Term Neonates During Therapeutic Hypothermia but Normalize Afterwards

Background: There are anecdotal reports on reversible QTc prolongation during therapeutic hypothermia (TH) for moderate to severe neonatal encephalopathy after asphyxia. As the QTc interval is a relevant biomarker to assess safety during medication development, a structured search and review on published neonatal QTc values to generate reference values is warranted to facilate medication development in this specific population. Methods: A structured search and literature assessment (PubMed, Embase, Google Scholar) with ‘Newborn/Infant, QT and hypothermia’ was conducted (October 2021). Retrieved individual values were converted to QTc (Bazett) over postnatal age (day 1-7). Results: We retrieved 94 QTc intervals [during TH (n=50, until day 3) or subsequent normothermia (n=44, day 4-7)] in 33 neonates from 6 publications. The median (range) of QTc intervals during TH was 508 (430-678), and 410 (317-540) ms afterwards (difference 98 ms, or +28 ms/°C decrease). Four additional cohorts (without individual QTc intervals) confirmed the pattern and magnitude of the effect of body temperature on the QTc interval. Conclusions: We added a relevant non-maturational covariate (TH, °C dependent) and generated reference values for the QTc interval in this specific neonatal subpopulation. This knowledge on QTc during TH should be considered and integrated in neonatal medication development.

An Efficient Classification of Neonates Cry Using Extreme Gradient Boosting-Assisted Grouped-Support-Vector Network

The cry is a loud, high pitched verbal communication of infants. The very high fundamental frequency and resonance frequency characterize a neonatal infant cry having certain sudden variations. Furthermore, in a tiny duration solitary utterance, the cry signal also possesses both voiced and unvoiced features. Mostly, infants communicate with their caretakers through cries, and sometimes, it becomes difficult for the caretakers to comprehend the reason behind the newborn infant cry. As a result, this research proposes a novel work for classifying the newborn infant cries under three groups such as hunger, sleep, and discomfort. For each crying frame, twelve features get extracted through acoustic feature engineering, and the variable selection using random forests was used for selecting the highly discriminative features among the twelve time and frequency domain features. Subsequently, the extreme gradient boosting-powered grouped-support-vector network is deployed for neonate cry classification. The empirical results show that the proposed method could effectively classify the neonate cries under three different groups. The finest experimental results showed a mean accuracy of around 91% for most scenarios, and this exhibits the potential of the proposed extreme gradient boosting-powered grouped-support-vector network in neonate cry classification. Also, the proposed method has a fast recognition rate of 27 seconds in the identification of these emotional cries.