Perception of pain and distress in intubated and mechanically ventilated newborn infants by parents and health professionals

BMC Pediatrics

Ruth Guinsburg²  Amélia Miyashiro Nunes dos Santos²  Luciana Sabatini Doto Tannous Elias¹ 

[1] Universidade Federal de São Paulo and Professor at Faculdade de Medicina de Catanduva - Faculdades Integradas Padre Albino, Catanduva, SP, Brazil;Division of Neonatal Medicine at Escola Paulista de Medicina, Universidade Federal de São Paulo, Rua Vicente Felix 77 apt 09, São Paulo, SP 01410-020, Brazil

关键词: Pain assessment;    Newborn;    Stress;    Distress;    Pain;   

Others  :  1139020
DOI  :  10.1186/1471-2431-14-44

 received in 2013-10-10, accepted in 2014-02-13,  发布年份 2014

【 摘 要 】

Background

An understanding of perceptions of parents and health caregivers who assist critically ill neonates is necessary to comprehend their actions and demands. Therefore this study aim to analyze the agreement among parents, nurse technicians and pediatricians regarding the presence and intensity of pain and distress in mechanically ventilated and intubated newborn infants.

Methods

Cross-sectional study comprising 52 infants and 52 trios of adults composed of one parent, one nurse technician, and one pediatrician who all observed the same infant. All infants were intubated and under mechanical ventilation and were not handled during the observations. Each newborn was simultaneously observed by the trio of adults for 1 minute to evaluate the presence of pain and distress. The intensity of pain and distress that the adults believed was felt by the infants was marked in a visual analogical scale. Adults’ agreement about the simultaneous presence of pain and distress in each infant was analyzed by marginal homogeneity and Cochran tests. The agreement about the intensity of pain and distress in each infant was studied by Bland-Altman plot and intraclass correlation coefficient (ICC).

Results

The assessments of pain and distress were heterogeneous in all three investigated groups of adults as determined by the results of a Bland-Altman plot. The presence of distress was more frequently reported compared with pain (marginal heterogeneity, p < 0.01). The pain and distress scores in each adult group were not correlated as shown by ICC [parents, 0.36 (95% CI: 0.01-0.63); nurses 0.47 (0.23-0.66); pediatricians, 0.46 (0.22-0.65)].

Conclusions

Adults systematically underscore pain in comparison to distress in mechanically ventilated newborns, without recognizing the association between them.

【 授权许可】

   
2014 Elias et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Wilson-Costello D: Is there evidence that long-term outcomes have improved with intensive care? Semin Fetal Neonatal Med 2007, 12:344-354.
• [2]Anand KJ, Hall RW: Love, pain, and intensive care. Pediatrics 2008, 121:825-827.
• [3]Leslie AT, Akers KG, Martinez-Canabal A, Mello LE, Covolan L, Guinsburg R: Neonatal inflammatory pain increases hippocampal neurogenesis in rat pups. Neurosci Lett 2011, 501:78-82.
• [4]Anand KJ, Scalzo FM: Can adverse neonatal experiences alter brain development and subsequent behavior? Biol Neonate 2000, 77:69-82.
• [5]Grunau RE, Holsti L, Peters JW: Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med 2006, 11:268-275.
• [6]Walker SM, Franck LS, Fitzgerald M, Myles J, Stocks J, Marlow N: Long-term impact of neonatal intensive care and surgery on somatosensory perception in children born extremely preterm. Pain 2009, 141:79-87.
• [7]Bellieni CV, Iantorno L, Perrone S, Rodriguez A, Longini M, Capitani S, et al.: Even routine painful procedures can be harmful for the newborn. Pain 2009, 147:128-131.
• [8]International Association for the Study of Pain: Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain 1979, 6:249.
• [9]Hatfield LA, Polomano RC: Infant distress: moving toward concept clarity. Clin Nurs Res 2012, 21:164-182.
• [10]Franck LS, Bruce F: Putting pain assessment into practice: Why is it so painful? Pain Res Manage 2009, 14:13-20.
• [11]Breau LM, McGrath PJ, Stevens B, Beyene J, Camfield C, Finley GA, et al.: Judgments of pain in the neonatal intensive care setting: a survey of direct care staffs’ perceptions of pain in infants at risk for neurological impairment. Clin J Pain 2006, 22:122-129.
• [12]Hamers JP, Abu-Saad HH, Halfens RJ, Schumacher JN: Factors influencing nurses’ pain assessment and interventions in children. J Adv Nurs 1994, 20:853-860.
• [13]Elias LS, Guinsburg R, Peres CA, Balda RC, Santos AM: Disagreement between parents and health professionals regarding pain intensity in critically ill neonates. J Pediatr (Rio J) 2008, 84:35-40.
• [14]Bland JM, Altman DG: Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986, 1:307-310.
• [15]Bland JM, Altman DG: Measuring agreement in method comparison studies. Stat Methods Med Res 1999, 8:135-160.
• [16]Kleinbaum DG, Kupper LL: Applied Regression Analysis and Other Multivariable Methods. Boston: Duxbury Press; 1978.
• [17]Balda R, Almeida M, Peres C, Guinsburg R: Factors that influence the practice of healthcare professionals regarding pain management in newborn infants. Rev Paul Pediatr 2009, 27:160-167.
• [18]Balda R, Guinsburg R: Perceptions of neonatal pain. Neorev 2007, 8:e533-542.
• [19]Goubert L, Craig KD, Vervoort T, Morley S, Sullivan MJ, Williams AC, et al.: Facing others in pain: the effects of empathy. Pain 2005, 118:285-8.
• [20]Slater R, Cantarella A, Franck L, Meek J, Fitzgerald M: How well do clinical pain assessment tools reflect pain in infants? PLoS Med 2008, 5:e129.
• [21]Simons SH, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D: Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med 2003, 157:1058-1064.
• [22]Stevens BJ, Johnston CC, Grunau RV: Issues of assessment of pain and discomfort in neonates. J Obstet Gynecol Neonatal Nurs 1995, 24:849-855.