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Non-Pharmacological Pain Control in the Neonate
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Non-Pharmacological Pain Control in the Neonate
Allison Spirk
The University of Texas at Arlington
College of Nursing and Health Innovation
N4325 Nursing Research
Summer 2020
PICO Question
PICO
Question
"Among neonates admitted to the Neonatal Intensive Care Unit,does implementing non-pharmacological interventions compared to those not receiving any interventions improve pain control during an invasive procedure?"
Some Information on Pain:
Background
- Neonates can potentially be exposed to around 150 invasive and painful procedures in just one day.
- When pain goes untreated in the neonate, it can effect prognosis and recovery, and possibly go on to effect neurological development.
(dos Santos et al., 2015)
Pain Scale for Neonates
NIPS:
Neonatal Pain Scale that observes the following:
- Face
- Crying
- Breathing
- Positioning of Arms and Legs
- Position
- State of Consciousness
(dos Santos et al., 2015)
When observing neonates in the NICU, research showed that neonates who had non-pharmacological interventions performed were consoled faster, had less crying time, and less movement of limbs was witnessed.
Research Facts
(dos Santos et al., 2015)
Implications
Research shows even simple procedures such as heel sticks for blood collection without pain control interventions can effect pain receptors in the neonate and eventually negatively influence future processing of pain.
(Keels & Sethna, 2016)
Non-Pharmacological Interventions Used:
Non-Pharmacological Interventions
- Non-nutritive sucking (pacifier with sucrose solution)
- swaddling with a blanket
Benefits of Sucrose:
"The mechanism is an orally mediated increase in endogenous opioid. The analgesic effect lasts 5-8 minutes making it an ideal strategy for the management of short term pain" (Royal Children's Hospital, 2018).
SUCROSE
0.2 ml dose directly inserted into the neonates mouth can stimulate an opioid release, causing a stress-reducing effect (Harrison et al., 2015).
Recommendations
Recommendations:
- Implement non-nutritive sucking or swaddling with every invasive procedure
- Keep sucrose readily available at every patient's bedside
- Get parents involved in care (ex: let parents give sucrose with pacifier during procedure)
References
dos Santos, G.C., de Medeiros Lima, L., Barbosa de Oliveira, G., Roque de Souza, A., & dos Santos Freitas, V. (2015). Nursing intervention for pain control in newborns: Effectiveness of non-pharmacological actions. Journal of Nursing UFPE / Revista de Enfermagem UFPE, 9(8), 8784-8791. https://doi-org.ezproxy.uta.edu/10.5205/reuol.7696-67533-1-SP-1.0908201504
References
References Continued
References Cont'd:
Harrison, D., Yamada, J., Adams-Weber, T., Ohlsson, A., & Beyene, J. (2015). Sweet tasting solutions for reduction of needle-related procedural pain in children aged one to 16 years. Cochrane Database of Systematic Reviews, 5, N.PAG. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008408.pub3/full
Keels, E., & Sethna, N. (2016). Prevention and management of procedural pain in the neonate: An update. Pediatrics, 137(2), 33-45. https://doi.org/10.1542/peds.2015-4271
Royal Children’s Hospital Melbourne. (2018). Sucrose (oral) for procedural pain management in infants. Retrieved from https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/Sucrose_oral_for_procedural_pain_management_in_infants/