Neonatal Pain Management and Pain Monitoring Using New Methods: A Randomized Controlled Trial With Crossover Design
Overview
- Phase
- N/A
- Intervention
- Skin-to-skin contact
- Conditions
- Pain, Acute
- Sponsor
- University of Oulu
- Enrollment
- 36
- Locations
- 1
- Primary Endpoint
- Change in scores of Premature Infant Pain profile-Revised (PIPP-R) scale
- Status
- Recruiting
- Last Updated
- 2 years ago
Overview
Brief Summary
The aim of this randomized controlled study with crossover design is to examine the effectiveness of mother-driven interventions, skin-to-skin contact (SSC) and recorded mother's heartbeats as sound and vibration (MHB), compared to oral glucose in relieving neonatal acute pain related to heel lance as a painful procedure.
The effectiveness of interventions will be assessed using validated pain scales (PIPP-R and NIAPAS), changes in sensory cortex activation (near-infrared spectroscopy, NIRS) and changes in physiological indicators (oxygen saturation, heart rate, respiratory rate). The secondary objectives will include evaluating the effectiveness of interventions in relation to infant recovery and evaluating the use of NIRS monitoring in relation to neonatal pain assessment scales.
Investigators
Anna-Kaija Palomaa
PhD researcher
University of Oulu
Eligibility Criteria
Inclusion Criteria
- •Gestational Age (GA) at birth 32+0 - 42+0
- •Admitted to NICU
- •Parents are able to read, write and speak Finnish
Exclusion Criteria
- •With a postnatal age of 14 days or more
- •Apgar points were 6 or less at 5 minutes of age
- •Has been found grade III or IV cerebral haemorrhage
- •Major congenital anomalies
- •Has intubated or receiving a nCPAP
- •Has received analgesics or sedatives for less than 24 hours prior to the study
Arms & Interventions
Skin-to-skin contact
Neonates will be placed ventral skin-to-skin position with their mother at least thirty minutes prior the heel lance to give time to calm down following transfer. Skin-to-skin positioning will be taken account comfortable position as possible for mother and the baby, easy to access heel for blood sample and interference minimizing during video recording and continuous NIRS, ECG and oxygen saturation measurement. Skin-to-skin contact will be continued for approximately fifteen minutes after completion of blood sampling. In addition, the neonates will be given a 30% oral glucose solution two minutes prior the heel lance.
Intervention: Skin-to-skin contact
Mother's heartbeats as sound and vibration
Neonates will be placed in an incubator or a cot, depending on their gestational age, and will be supported on side position by nest-shaped rolls according to department's normal practice. The platform on which the mother's heartbeat will be played will be placed under mattress of the incubator or crib. The playing of the mother's recorded heartbeats will be started thirty minutes prior the heel lance and will be continued during and fifteen minutes after the blood sampling. In addition, the neonates will be given a 30% oral glucose solution two minutes prior the heel lance.
Intervention: Mother's heartbeats as sound and vibration
30% oral glucose
Neonates will be placed on in an incubator or a cot, depending on their gestational age, and will be supported on side position by nest-shaped rolls according to department's normal practice. The neonates will be given a 30% oral glucose solution two minutes prior the heel lance
Intervention: 30% oral glucose
Outcomes
Primary Outcomes
Change in scores of Premature Infant Pain profile-Revised (PIPP-R) scale
Time Frame: Measured immediately after painful procedure
Pain intensity will be assessed using pain assessment tool, the Premature Infant Pain Profile Revised (PIPP-R). PIPP-R is an internationally widely used multidimensional pain assessment scale consisting of three behavioral indicators, two physiological indicators, and two contextual indicators.
Change in scores of Neonatal Infant Acute Pain Assessment Scale (NIAPAS)
Time Frame: Measured immediately after painful procedure
Pain intensity will be assessed using pain assessment tool, the Neonatal Infant Acute Pain Assessment Scale (NIAPAS). NIAPAS is multidimensional pain assessment scale used in Finland. It consist of five behavioral indicators, three physiological indicators, and one contextual indicator.
Change of the activation in the somatosensory cortical areas following the noxious stimulation
Time Frame: Measured immediately after painful procedure
In this study pain will be assessed measuring changes cortical hemodynamics by near-infrared spectroscopy (NIRS). A 2-channel NIRS will be used. The emitted probe provides near-infrared light through on optical fiber will be is placed slightly posterior to Cz position with reference to the international EEG 10-20 system. The receive probes will be fastened over somatosensory and occipital area. In the area of the somatosensory cortex, receive probes will be placed 2 to 4 cm from the emitted probe so that they are placed slightly behind C3 or C4 point. The occipital region receive probe will be attached 2 to 4 cm from the emitted probe.
Change in heart rate (HR)
Time Frame: Measured immediately after procedure
Neonates' physiological reactions to procedural pain during heel lance will be monitored continuously and measured by recording changes in heart rate using bedside patient monitor.
Change in the activation in the somatosensory cortical areas following the noxious stimulation (baseline)
Time Frame: Baseline 1, measured pre-intervention
In this study pain will be assessed measuring changes cortical hemodynamics by near-infrared spectroscopy (NIRS). A 2-channel NIRS will be used. The emitted probe provides near-infrared light through on optical fiber will be is placed slightly posterior to Cz position with reference to the international EEG 10-20 system. The receive probes will be fastened over somatosensory and occipital area. In the area of the somatosensory cortex, receive probes will be placed 2 to 4 cm from the emitted probe so that they are placed slightly behind C3 or C4 point. The occipital region receive probe will be attached 2 to 4 cm from the emitted probe.
Change in the activation in the somatosensory cortical areas following the noxious stimulation
Time Frame: Baseline 2, measured pre-procedure
In this study pain will be assessed measuring changes cortical hemodynamics by near-infrared spectroscopy (NIRS). A 2-channel NIRS will be used. The emitted probe provides near-infrared light through on optical fiber will be is placed slightly posterior to Cz position with reference to the international EEG 10-20 system. The receive probes will be fastened over somatosensory and occipital area. In the area of the somatosensory cortex, receive probes will be placed 2 to 4 cm from the emitted probe so that they are placed slightly behind C3 or C4 point. The occipital region receive probe will be attached 2 to 4 cm from the emitted probe.
Change in oxygen saturation
Time Frame: Measured immediately after painful procedure
Neonates' physiological reactions to procedural pain during heel lance will be monitored continuously and measured by recording changes in oxygen saturation using bedside patient monitor.
Change in respiratory rate
Time Frame: Measured immediately after procedure
Neonates' physiological reactions to procedural pain during heel lance will be monitored continuously and measured by recording changes in respiratory rate using bedside patient monitor.
Secondary Outcomes
- Recovery measured by change in scores of the Premature Infant Pain profile-Revised (PIPP-R)(10 minutes after painful procedure)
- Recovery as measured by changes in somatosensory cortex activation(10 minutes after painful procedure)
- Recovery as measured by changes in respiratory rate(10 minutes after painful procedure)
- Recovery measured by change in scores of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS)(10 minutes after painful procedure)
- Recovery as measured by changes in heart rate (HR)(10 minutes after painful procedure)
- Recovery as measured by changes in oxygen saturation(10 minutes after painful procedure)