Pain is a major problem in sick newborn infants, especially for those needing intensive care. Pharmacological pain relief is the most commonly used, but might be ineffective and has side effects, including long-term neurodevelopmental sequelae. The effectiveness and safety of alternative analgesic methods are ambiguous. The objective was to review the effectiveness and safety of non-pharmacological methods of pain relief in newborn infants and to identify those that are the most effective. PubMed and Google Scholar were searched using the terms: “infant”, “premature”, “pain”, “acupuncture”, “skin-to-skin contact”, “sucrose”, “massage”, “musical therapy” and ‘breastfeeding’. We included 24 studies assessing different methods of non-pharmacological analgesic techniques. Most resulted in some degree of analgesia but many were ineffective and some were even detrimental. Sucrose, for example, was often ineffective but was more effective than music therapy, massage, breast milk (for extremely premature infants) or non-invasive electrical stimulation acupuncture. There were also conflicting results for acupuncture, skin-to-skin care and musical therapy. Most non-pharmacological methods of analgesia provide a modicum of relief for preterm infants, but none are completely effective and there is no clearly superior method. Study is also required to assess potential long-term consequences of any of these methods.

https://www.mdpi.com/2227-9067/5/10/130/pdf

A Review of Non-Pharmacological Treatments for Pain Management in Newborn Infants.

Background Frequent infant crying is associated with parental exhaustion, depression, or even infant hospitalization and shaken baby syndrome. Effective prompt soothing methods are lacking for infants under 6 months. We examined whether swaddling, sound, and movement evoked an immediate calming response (CR) when parents soothed their infants and using a smart crib, and whether infant age affected the CR. Methods Infants’ CR was assessed in a community sample of 69 infants (0–6 months) in a counterbalanced experiment with two conditions (parent, smart crib) each composed of three two-minute phases (baseline, supine, soothing). During baseline 1, parent and infant were sitting together; in supine 1, fussiness was elicited by putting the infant suddenly supine, followed by parental soothing (shushing and jiggling of the swaddled infant). Baseline 2, supine 2, and soothing by the crib followed. Fussiness was observed and infant heart rate (HR) and heart rate variability (HRV) were recorded. The CR was operationalized as decreased fussiness and HR, and increased HRV during soothing compared to lying supine. Results Infant fussiness and HR were lower in both soothing phases compared to the supine phases. Infant HRV tended to be higher during parental soothing than during supine, but did not significantly differ between mechanical soothing and supine. Younger infants responded with a stronger CR (decreased fussiness and increased HRV) to parental soothing, but not to mechanical soothing. For HR, infants’ CR was stronger in the crib than in the parent condition, whereas for HRV, infants’ CR was stronger in the parent condition. For fussiness, infants’ CR tended to be stronger in the parent condition. Conclusion Parental and mechanical soothing using swaddling, sound, and movement promptly induced a CR in infants. This has important clinical implications for soothing fussy and crying infants. Future studies should investigate the effects of parental versus mechanical soothing in the home setting.

/pdf/infant-crying-and-the-calming-response-parental-versus-1sy17xtvac.pdf

Infant crying and the calming response: Parental versus mechanical soothing using swaddling, sound, and movement.

One of the more common and important challenges in the imaging of children is minimizing image degradation caused by motion. This is especially important in MRI, which is often preferable in the pediatric population due to better tissue characterization and lack of ionizing radiation. However, due to the length of time needed for most examinations, MRI is among the most sensitive to disruption by patient motion. Traditionally, deep conscious sedation or general anesthesia was the most common method of reducing motion in children who are unable or unwilling to follow direction. As the drawbacks and risks of anesthesia in children become more known and accepted, the development and optimization of means of mitigating motion and anxiety in children without the use of sedation or anesthesia becomes more urgent. In this article we describe the risks of sedation in the pediatric population and explore current methods of reducing both patient anxiety and imaging degradation from motion in the unsedated, free-breathing child. Level of Evidence: 5 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2019;50:365-376.

Free-breathing unsedated MRI in children: Justification and techniques.

Aim This study aims to experimentally determine effects of three different methods (swaddling; swaddling and holding; swaddling, holding and breastfeeding) used during heel lancing on pain levels in healthy term neonates. Methods This study was a prospective, randomized controlled trial. The sample of newborns (n = 160) were allocated to the groups (group 1, control; group 2, swaddling; group 3, swaddling and holding; group 4, swaddling, holding and breastfeeding) by blocked randomization. The study data were obtained using an information form, and the Neonatal Infant Pain Scale (NIPS). Results The procedural pain scores of group 4 were lower than group 1, group 2 and group 3. Both the total crying time and the first calming time of the groups swaddling, holding and breastfeeding, were shorter than the swaddling, swaddling and holding and the control group. Conclusions As a result, all the three methods are effective in reducing the pain felt during heel lancing in the newborn. However, swaddling, holding and breastfeeding is more effective than the other methods.

Effects of three different methods used during heel lance procedures on pain level in term neonates

Aim The aim of this study is to compare the effect of two different bathing methods training given during pregnancy on the mother's experience, satisfaction and newborn's physiological and behavioral parameters during the first bathing of the newborn at home. Methods A mixed methods research was used in this study. The groups were determined as swaddled bathing (SB) (n = 31) and tub bathing (TB) (n = 31). After training given to the groups, the first bath of the newborn in both groups was built by the mothers. The body temperature, heart rate, oxygen saturation, respiration rate, crying times, stress parameters of the newborns and mother satisfaction in both groups were evaluated. The open-ended questions were used to determine mothers' experiences. Results There was a statistically significant difference between the groups in terms of oxygen saturation, respiration rate, crying time, face/forehead grimacing, unrest and maternal satisfaction. Four categories and 14 subcategories made up the qualitative part of the study which includes the experiences of the mother about two different bathing methods. "The feelings and worries of the mothers about first bathing" refers to the participants in both groups how they feel during the first bathing; "Positive aspects of this method compared to other bath method" and "Negative aspects of this method compared to other bath method" refers to positive and negative aspects of different bathing methods applied to groups; "Difference between the applied bathing method and other methods" refers to differences they observed when compared to other bathing methods. The mothers in the SB group had less fear of drowning hazard and injuring the newborn, and the fear of uneasiness and the newborn slipping down from hands were more frequent in the TB group. Conclusion It was determined that both bath methods reduced body temperature, the SB method decreased the stress of newborns and had a positive effect on mother satisfaction and experience.

Effect of newborn bathing training with the swaddled and tub bathing methods given to primiparous pregnant women on the mother's experience, satisfaction and newborn's stress during the first bathing of the newborn at home: A mixed method study.

The Effect of Swaddling on Pain, Vital Signs, and Crying Duration during Heel Lance in Newborns.

Summary Objective: To determine the relationship between marital adjustment of mothers who have babies between 1-4 months old and their maternal attachment; as well as the relationship of maternal attachment and marital adjustment with sociodemographic characteristics. Method: The research is descriptive and correlational. Its sample consists of 113 mothers. Maternal Attachment Index (MAI) and Marital Adjustment Scale (MAS) are used as data collection tools. Results: We found that, for mothers who participated in this research, the average level of maternal attachment is 92.17 ± 8.49, and the average level of marital adjustment is 43.06 ± 7.90. We discovered that the maternal attachment level is higher for mothers who have completed high school and university, those who breastfeed their babies exclusively and whose spouses help care for the baby. We also discovered that the Marital Adjustment Score is higher among mothers who are employed, get married by companionship (not arranged), continue attending pregnancy classes and whose duration of marriage is between 1-5 years and 10-15 years. There is weak positive relationship (r=0.38; p=0.00) between marital adjustment and maternal attachment; and the regression analysis that is run to explain this relationship is statistically significant (F=26.131; p<0.05). Conclusion: In our study, the level of maternal attachment was high, while the level of marital adjustment was liminal. There are many factors affecting sociodemographic characteristics, pregnancy and baby care. The level of marital adjustment for mothers increases the maternal attachment.

A Review on the Relationship Between Marital Adjustment and Maternal Attachment

The purpose of this randomized controlled study was to determine the effect of 3 positions given to preterm infant during heelstick procedure on the pain and durations of crying and procedure. The sample of the study consisted of 90 preterm infants (30 in each group). The heelstick procedure was video recorded. Data from the pain scores, durations of crying, and procedure were collected watching the video recordings. It was determined that the pain mean score of the infants in the control group (supine on the crib) (5.50 ± 2.13) was statistically significantly higher than that of the infants in the positions of upright (3.00 ± 2.17) and supine on the lap (3.20 ± 2.46) (P .05). Giving the positions of upright or supine on the lap during heelstick is effective in reducing pain, shortening the duration of crying, and calming down the infant. Heelstick in the position of upright on the lap shortened the procedure duration and allowed the infants to be subjected to less painful procedure. It is recommended for nurses to take the preterm infants on their laps during heel lancing and give them the upright position, in particular.

The Effect of 3 Positions Given to Preterm Infants During Heelstick Procedure on Pain and Durations of Crying and Procedure.

Bebek Bakımında: Geleneksel Kundaklama mı?, Güvenli Sarmalama mı?

Objective: This study investigated the practices used by mothers of babies with infantile colic to reduce infantile colic and the mothers’ perceptions on the effectiveness of these practices. Materials and Methods: The sample of this descriptive study consisted of the mothers of 257 babies aged 4-12 months who were being monitored by two Family Health Centres in Istanbul. The data of the study was collected through a 26-item questionnaire on which the mothers could mark the t practices they used to reduce infantile colic. Results: The methods that were found the most useful based on the perception of the mothers were the mother’s avoidance of consumption of foods and drinks that produce gas (97%), chancing positions (96.7%), massage (95.7%), listening to the sound of a hair dryer (95.2%) and warmth treatment to the abdomen (91.7%). Conclusion: Consequently, the mothers performed effective and valid practices. However, it was found that the frequency of performing some practices that have high utilisation rates was low. Accordingly, it would be useful to inform the mothers of babies who are at the ages of 2 weeks-4 months at the time of their paediatric health monitoring about the effective and easily performed practices for reducing colic.

/pdf/the-practices-used-by-mothers-to-infantile-colic-and-their-hhz82p5esg.pdf

Zeynep Erkut

Papers

The Effect of Swaddling on Pain, Vital Signs, and Crying Duration during Heel Lance in Newborns.

A Review on the Relationship Between Marital Adjustment and Maternal Attachment

The Effect of 3 Positions Given to Preterm Infants During Heelstick Procedure on Pain and Durations of Crying and Procedure.

Bebek Bakımında: Geleneksel Kundaklama mı?, Güvenli Sarmalama mı?

The practices used by mothers to infantile colic and their perceptions on the benefits of the practices