Neonatal Pain

Background: The aim of this review of the literature was to find and summarize relevant research evidence available within the scientific sources and gray literature in accordance with the JBI recommendations. Search question: What effect does Basal Stimulation have on the cognitive–behavioral functions or temperament of a preterm or disabled infant? Methods: The following sources were searched: PSYCINFO, MEDLINE, PsycArticles, ERIC, Wiley Online Library, ProQuest Scopus, WOS, JSTOR, Google Scholar, and MedNar. The study contains an analysis of texts that have been published in the English, Czech, and German languages. The search time span was set at 15 years. Results: A total of 15 sources were found for the specified topic. Conclusions: In all cases, there was confirmation about the positive influence of the concept of “Basal Stimulation” on the cognitive–behavioral functions and temperament of premature and disabled children.

369 L a nascita pretermine continua ad essere una delle maggiori cause di morbilità e mortalità neonatale, nonostante la progressiva evoluzione delle cure intensive neonatali degli ultimi decenni. I neonati late preterm (LP), nati tra 34+0 e 36+6 settimane di gestazione, rappresentano circa il 10% di tutti i nati e più del 75% del numero totale dei pretermine. Negli anni è stata utilizzata una diversa terminologia per denominare questa categoria eterogenea di neonati (Near Term, Marginally Preterm, Moderately Preterm, Minimally Preterm, Mildly Preterm), spesso considerati al pari dei neonati a termine, in considerazione del peso alla nascita frequentemente al di sopra dei 2500 grammi, soglia di peso dei Low Birth Weight. Soltanto nel 2005 il National Institute of Child Health and Human Development li definì “late preterm” proprio per evidenziare la loro condizione di prematurità, indipendentemente dalle caratteristiche ponderali. La prevalenza dei LP è in costante aumento: da un lat...

Background: Large-scale, centralized data repositories are playing a critical and unprecedented role in fostering innovative health research, leading to new opportunities as well as dilemmas for the medical sciences. Uncovering the reasons as to why citizens do or do not contribute to such repositories, for example, to population-based biobanks, is therefore crucial. We investigated and compared the views of existing participants and non-participants on contributing to large-scale, centralized health research data repositories with those of ex-participants regarding the decision to end their participation. This comparison could yield new insights into motives of participation and non-participation, in particular the behavioural change of withdrawal. Methods: We conducted 36 in-depth interviews with ex-participants, participants, and non-participants of a three-generation, population-based biobank in the Netherlands. The interviews focused on the respondents’ decision-making processe...

At this time no one can deny anymore the ability of the fetus to respond to external physical stimuli. We have previously demonstrated that :1) Fetuses respond to vocal stimulation 2) The reaction is stronger if the stimulus comes from their mother 3) And even more important, if the speech is addressed to them 4) And / or has an emotional content 5) Neonates and fetuses respond in the same way whether mothers address them vocally or "silently". Aim of the study: We tested the individual response of twins in utero to a silent communication specifically addressed to each one. Methods: Eighty seven (87) women participated in the study. They were tested between 28 and 39 weeks of amenorrhea. A total of 349 tests comprise the study. In the experimental group, mothers were instructed to read a text in silence and to communicate silently (without speaking aloud) with one twin and subsequently with the other twin. In the control group, mothers were reading a text in silence during...

The C-tactile (CLTM) peripheral nervous system is involved in social bonding in primates and humans through its capacity to trigger the brain’s endorphin system. Since the mammalian cochlea has an unusually high density of similar neurons (type-II spiral ganglion neurons, SGNs), we hypothesise that their function may have been exploited for social bonding by co-opting head movements in response to music and other rhythmic movements of the head in social contexts. Music provides one of many cultural behavioural mechanisms for ‘virtual grooming’ in that it is used to trigger the endorphin system with many people simultaneously so as to bond both dyadic relationships and large groups. Changes in pain threshold across an activity are a convenient proxy assay for endorphin uptake in the brain, and we use this, in two experiments, to show that pain thresholds are higher when nodding the head than when sitting still.

End-of-life issues involving small babies are particularly challenging for doctors, particularly pediatricians as there are complex issues involved, including long-term disabilities (1) and the parents' wishes (1). Evaluations can be based on statistical risks (2) and case-by-case issues. Some authors (3) suggest that intensive care can be withheld when consciousness is compromised, but that raises questions about what level of consciousness equates to a baby being completely compromised (4). Other authors have questioned whether suspending therapies when the baby is not at their end-of-life is ethically right. Concerns have also been expressed that there is a risk that babies lives are undervalued, in comparison with older patients, because their life support is removed more easily than when adults have a similar prognosis (5). This article is protected by copyright. All rights reserved.

When somebody asks me what is ethical in pain treatment, my first answer is the latin motto " primum non nocere " (first, do not harm "). That's good, but too often this is confused with following protocols, thus it can become misleading. What have I against protocols? That they explain all about what you have to do, but nothing about how to do it. Therefore it happens that what you should do overshadows how you might do it. In short, pain treatment is not only a matter of procedures, but it involves a gestalt approach to the patient [1]. A gestalt approach is not only holistic medicine, but also an overlook on the entire environment, including the patient, his family, his hospital setting and his social world. Does it seem too much? In reality it is just the beginning. But let's examine what it means in medical practice: we have a lot of protocols on how to perform good analgesia and this is good; but any analgesic treatment is inadequate if it doesn't put the patient at ease, if it is not concerned with guaranteeing him comfort not only for the invasive procedure, but also for the whole stay in hospital, where this includes to allow relatives, friends and sometimes even pegs to visit and comfort the patient. The reason is simple: pain threshold increases or decreases with the level of attention awareness or distraction of the patient [2]: a stressed patient will feel more pain for the same painful treatment, but this is not included in any protocol. This is particularly true for those patients who cannot speak: babies, elders, mentally challenged people, who cannot claim for their rights among which pain treatment is one of the most relevant. Pain treatment is sort of a tripod: its first leg is the direct treatment of the patient's pain, the second leg is creating a comfortable environment , and the third is – paradoxically-the care of the caregivers. This has a name: gestalt. Gestalt is the idea that systems (physical, biological, chemical, social, economic, mental, linguistic ones) and their properties should be viewed as wholes, not just as a collection of parts; the whole is in the parts and the parts are in the whole, and this synthesis of whole and parts is reflected in the holistic character of the functions of the parts as well as of the whole. Thus, pain treatment is not just " pain treatment " , but taking care of the three above mentioned systems (patient, environment, caregivers). But this is rarely considered. Consider instead those procedures included in those projects extrapolated to humans from the procedures used in mechanic farms and assembly lines [3]. This closeness of human care and farm processes is decidedly alarming. Pain treatment cannot be a mechanical action, it cannot be severed from social, environmental, cultural and economic care; pain is not correctly framed and cured if the environment is not modulated, adapted and tailored on the patient, so to become friendly and careful. This is why protocols are not enough. And why they can paradoxically become harmful. They can overshadow the treatment of the person in favor of the treatment of the illness. This is the case of neonatal analgesia: though it is well-known that oral sucrose is not analgesic enough for procedural pain, it is still widely suggested, while other procedures that include human involvement such as sensorial saturation made of cuddles and sugar during pain [4] and breastfeeding are overshadowed. In the treatment and assessment of pain for mentally disabled people, the same protocols of average patients are applied, with the result of scaring these particular patients and of considering them as invisible [5], because nobody is trained to treat their pain. Even in the treatment of average people's pain, gestalt-related treatments such as mindfulness [6] are omitted and this can even lead people to require a withdrawal of life-saving cures just because their

Global cerebral ischemia occurs commonly in patients who have a variety of clinical conditions including cardiac arrest (CA), shock, and asphyxia. Unfortunately, survival with neurologic sequelae is common for adult and pediatric victims of cardiac arrest. Neurologic sequelae from brain injury are varied and constitute a spectrum that includes coma, seizures, ischemic stroke, delirium, and neurocognitive impairment. Most of the damage in the first hour is due to reperfusion injury leading to release of inflammatory mediators and reactive oxygen radicals.In the first hour of resuscitation of the child who has had a cardiac arrest, the mainstay of therapy is supportive management which include maintaining near normal pH, permissive hypercapnia, reduction of cerebral edema, maintainingnormothermia and euglycemia, maintaining blood pressure within normal limits, and maintaining nutrition. Therapeutic hypothermia, a novel intervention,shows promise but is not yet recommended widely outside of a research setting or a protocol based hospital environment.

The AAP's Fetus and Newborn Committee and Section on Anesthesiology and Pain Medicine recently published an update of the AAP's policy statement on the prevention and management of procedural pain in the neonate (1). The policy recommends that steps be taken to reduce the number of unnecessary procedures performed during infancy that cause pain to the child. Surprisingly, in the updated policy statement, there is only sporadic mention of pain control in connection with circumcision, likely the single most common source of neonatal pain in U.S. infant boys born at term.

Complete atrio-ventricular block (CAVB) presenting in-utero, as
widely known, is secondary to neonatal lupus unless proved
otherwise. We hereby report a neonate with CAVB associated
with heart defects presenting in-utero, without any evidence of
neonatal lupus. Hence, we emphasize the association of heart
defects in CAVB as the leading factor in diagnosing the etiology.