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PREMATÜR BEBEKLERE UYGULANAN AĞRILI İŞLEMLERİN SIKLIK VE ŞİDDETİNİN ARAŞTIRILMASI: PROSPEKTİF BİR ÇALIŞMA

Year 2020, Volume: 21 Issue: 1, 110 - 115, 20.03.2020
https://doi.org/10.18229/kocatepetip.544927

Abstract

ÖZET



Amaç:
Bu çalışma; hayatlarının ilk 48 saati içinde mekanik ventilasyon gereksinimi
olan ve gestasyonel yaşı 24 ila 37 hafta arasında değişen yenidoğanların yaşamlarının
ilk 14 gününde aldıkları rutin bakım sırasında maruz kaldığı ağrılı işlem
sıklığını ve ağrının şiddetini tespit etmeyi amaçlamaktadır.



Yöntem: İki
yıllık süre boyunca yenidoğan yoğun bakım ünitesinde yatırılarak takip edilen,
hayatlarının ilk 48 saati içinde mekanik ventilasyon gereksinimi olan, gestasyonel
yaşı 24 ila 37 hafta arasında değişen, yaşamlarının ilk 14 günü içinde
kaybedilmeyen, başka bir merkeze sevk edilmeyen veya kayıtlarında eksiklik
olmayan 28 yenidoğan çalışmaya alındı. İlk grupta gebeliğin 24. ila 28.
haftaları arasında doğan 11 yenidoğan yer alırken ikinci grupta gebeliğin 28.
ila 37. haftaları arasında dünyaya gelen 17 yenidoğan bulunmaktaydı.



Bulgular:
Gestasyonel yaşı 28. hafta ve daha büyük olan yenidoğanlarla
karşılaştırıldığında; gestasyonel yaşı 28. haftadan küçük olan yenidoğanlarda
gebelik yaşı anlamlı olarak daha düşüktür (p=0.018), kız bebek sayısı anlamlı
olarak daha fazladır (p=0.034) ve şifa ile taburcu olma oranı anlamlı olarak
düşüktür (p=0.012). Gestasyonel yaşı 28. hafta ve daha büyük olan
yenidoğanlarla karşılaştırıldığında; gestasyonel yaşı 28. haftadan küçük olan
yenidoğanlarda anlamlı olarak daha fazla sayıda nazal aspirasyon yapılmıştır ve
nazal aspirasyon, Yenidoğan Infant Ağrı Skalası skorunu anlamlı olarak
arttırmıştır (p=0.022).



Sonuç:
Yoğun bakım biriminde izlenirken herhangi bir ağrılı müdahale gerçekleştirilen
term ve preterm yenidoğanlarda stres hormonları hızla yükselir ve uzun süre
yüksek kalır. Böyle bir durumda etkin ve yeterli analjezi uygulandığında, yenidoğanlardaki
morbidite ve mortalite oranları azalır. Yenidoğanda ağrıya yol açabilecek
işlemlerin gerektiğinde ve dikkatle uygulanması, işlemlerle ilişkili ağrının da
uygun biçimde tedavi edilmesi gerekir.

References

  • REFERANSLAR1. Perry M, Tan Z, Chen J, Weidig T, Xu W, Cong XS. Neonatal Pain: Perceptions and Current Practice. Crit Care Nurs Clin North Am 2018; 30(4): 549-61.2. Carter BS. Pediatric Palliative Care in Infants and Neonates. Children (Basel) 2018 Feb 7; 5(2). pii: E21. 3. Carter BS, Brunkhorst J. Neonatal pain management. Semin Perinatol 2017; 41(2): 111-6.4. Field T. Preterm newborn pain research review. Infant Behav Dev 2017 Nov; 49:141-50. 5. Provenzi L, Guida E, Montirosso R. Preterm behavioral epigenetics: A systematic review. Neurosci Biobehav Rev 2018 Jan; 84: 262-71. 6. Valeri BO, Holsti L, Linhares MB. Neonatal pain and developmental outcomes in children born preterm: a systematic review. Clin J Pain 2015; 31(4): 355-62.7. Allegaert K, van den Anker JN. Neonatal pain management: still in search for the Holy Grail. Int J Clin Pharmacol Ther 2016; 54(7): 514-23. 8. Manworren RC, Stinson J. Pediatric Pain Measurement, Assessment, and Evaluation. Semin Pediatr Neurol 2016; 23(3): 189-200.9. Hatfield LA, Murphy N, Karp K, Polomano RC. A Systematic Review of Behavioral and Environmental Interventions for Procedural Pain Management in Preterm Infants. J Pediatr Nurs 2019 Jan - Feb; 44: 22-30. 10. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray S.B, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Network 1993; 12(6): 59- 64.11. Akdovan T. Sağlıklı yenidoğanlarda ağrının değerlendirilmesi, emzik verme ve kucağa alma yönteminin etkisinin incelenmesi. Yüksek lisans tezi, 1999, Marmara Üniversitesi, İstanbul.12. Gibbins S, Stevens B, McGrath PJ, Yamada J, Beyene J, Breau L, Camfield C, Finley A, Franck L, Johnston C, Howlett A, McKeever P, O'Brien K, Ohlsson A. Comparison of pain responses in infants of different gestational ages. Neonatology 2008; 93(1): 10-8. 13. Iversen JM, Uglem M, Indredavik MS, Romundstad PR, Nilsen KB, Sand T, Rygg M. Pain Sensitivity and Thermal Detection Thresholds in Young Adults Born Preterm With Very Low Birth Weight or Small for Gestational Age at Term Compared With Controls. J Pain 2018; 19(8): 873-84.14. Fitzgerald M. What do we really know about newborn infant pain? Exp Physiol 2015; 100(12): 1451-7.15. Walker SM. Biological and neurodevelopmental implications of neonatal pain. Clin Perinatol 2013; 40(3): 471-91. 16. Fitzgerald M. The development of nociceptive circuits. Nat Rev Neurosci 2005; 6(7): 507-20.17. Hartley C, Slater R. Neurophysiological measures of nociceptive brain activity in the newborn infant--the next steps. Acta Paediatr 2014; 103(3): 238-42. 18. Stevens B, McGrath P, Gibbins S, Beyene J, Breau L, Camfield C, Finley A, Franck L, Howlett A, McKeever P, O'Brien K, Ohlsson A, Yamada J. Procedural pain in newborns at risk for neurologic impairment. Pain 2003; 105(1-2): 27-35. 19. Gibbins S, Stevens B, Beyene J, Chan PC, Bagg M, Asztalos E. Pain behaviours in Extremely Low Gestational Age infants. Early Hum Dev 2008; 84(7): 451-8. 20. Bouza H. The impact of pain in the immature brain. J Matern Fetal Neonatal Med 2009; 22(9): 722-32. 21. Stevens B, McGrath P, Yamada J, Gibbins S, Beyene J, Breau L, Camfield C, Finley A, Franck L, Howlett A, Johnston C, McKeever P, O'Brien K, Ohlsson A. Identification of pain indicators for infants at risk for neurological impairment: a Delphi consensus study. BMC Pediatr 2006 Feb 2; 6: 1.22. Ranger M, Johnston CC, Anand KJ. Current controversies regarding pain assessment in neonates. Semin Perinatol 2007; 31(5): 283-8.23. Beltramini A, Milojevic K, Pateron D. Pain Assessment in Newborns, Infants, and Children. Pediatr Ann 2017; 46(10): e387-e395. 24. 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(11): 1058-64.25. Chen M, Shi X, Chen Y, Cao Z, Cheng R, Xu Y, Liu L, Li X. A prospective study of pain experience in a neonatal intensive care unit of China. Clin J Pain 2012; 28(8): 700-4.26. Anand KJ, Johnston CC, Oberlander TF, Taddio A, Lehr VT, Walco GA. Analgesia and local anesthesia during invasive procedures in the neonate. Clin Ther 2005; 27(6): 844-76.

INVESTIGATION OF THE FREQUENCY AND VIOLENCE OF PAINED PROCEDURES APPLIED TO PREMATURE BABIES: A PROSPECTIVE STUDY

Year 2020, Volume: 21 Issue: 1, 110 - 115, 20.03.2020
https://doi.org/10.18229/kocatepetip.544927

Abstract

OBJECTIVE: This study aims to determine the frequency of painful interventions and the severity of pain to which the premature newborns with need for mechanical ventilation have been exposed within the intensive care unit during the first 14 days of their lives.
MATERIAL AND METHODS: This is a prospective review of 28 preterm newborns who have been treated at the intensive care unit within two years. The inclusion criteria were having a gestational age between 24 and 37 weeks, requiring mechanical ventilation during the first 48 hours after delivery, surviving during the first 14 days of life and being treated at the study center during the survival period.
RESULTS: When compared to 17 newborns with gestational age >28 weeks, 11 newborns with gestational age ≤28 weeks had significantly lower gestastional age (p=0.018), higher percentage of female sex (p=0.034) and lower percentage of hospital discharge (p=0.012). When compared to 17 newborns with gestational age >28 weeks, 11 newborns with gestational age ≤28 weeks underwent significantly higher number of nasal aspirations and these aspirations were found to correlate with Neonatal Infant Pain Scale scores significantly and positively (p=0.022).
CONCLUSIONS: The levels of stress hormones increase and remain high in both term and preterm newborns undergoing painful procedures while being treated at the intensive care units. If sufficient and efficient analgesia is achieved in such cases, neonatal morbidity and mortality is reduced. In the newborns, painful procedures should be performed carefully and in accordance with the indications and related pain should be treated appropriately.

References

  • REFERANSLAR1. Perry M, Tan Z, Chen J, Weidig T, Xu W, Cong XS. Neonatal Pain: Perceptions and Current Practice. Crit Care Nurs Clin North Am 2018; 30(4): 549-61.2. Carter BS. Pediatric Palliative Care in Infants and Neonates. Children (Basel) 2018 Feb 7; 5(2). pii: E21. 3. Carter BS, Brunkhorst J. Neonatal pain management. Semin Perinatol 2017; 41(2): 111-6.4. Field T. Preterm newborn pain research review. Infant Behav Dev 2017 Nov; 49:141-50. 5. Provenzi L, Guida E, Montirosso R. Preterm behavioral epigenetics: A systematic review. Neurosci Biobehav Rev 2018 Jan; 84: 262-71. 6. Valeri BO, Holsti L, Linhares MB. Neonatal pain and developmental outcomes in children born preterm: a systematic review. Clin J Pain 2015; 31(4): 355-62.7. Allegaert K, van den Anker JN. Neonatal pain management: still in search for the Holy Grail. Int J Clin Pharmacol Ther 2016; 54(7): 514-23. 8. Manworren RC, Stinson J. Pediatric Pain Measurement, Assessment, and Evaluation. Semin Pediatr Neurol 2016; 23(3): 189-200.9. Hatfield LA, Murphy N, Karp K, Polomano RC. A Systematic Review of Behavioral and Environmental Interventions for Procedural Pain Management in Preterm Infants. J Pediatr Nurs 2019 Jan - Feb; 44: 22-30. 10. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray S.B, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Network 1993; 12(6): 59- 64.11. Akdovan T. Sağlıklı yenidoğanlarda ağrının değerlendirilmesi, emzik verme ve kucağa alma yönteminin etkisinin incelenmesi. Yüksek lisans tezi, 1999, Marmara Üniversitesi, İstanbul.12. Gibbins S, Stevens B, McGrath PJ, Yamada J, Beyene J, Breau L, Camfield C, Finley A, Franck L, Johnston C, Howlett A, McKeever P, O'Brien K, Ohlsson A. Comparison of pain responses in infants of different gestational ages. Neonatology 2008; 93(1): 10-8. 13. Iversen JM, Uglem M, Indredavik MS, Romundstad PR, Nilsen KB, Sand T, Rygg M. Pain Sensitivity and Thermal Detection Thresholds in Young Adults Born Preterm With Very Low Birth Weight or Small for Gestational Age at Term Compared With Controls. J Pain 2018; 19(8): 873-84.14. Fitzgerald M. What do we really know about newborn infant pain? Exp Physiol 2015; 100(12): 1451-7.15. Walker SM. Biological and neurodevelopmental implications of neonatal pain. Clin Perinatol 2013; 40(3): 471-91. 16. Fitzgerald M. The development of nociceptive circuits. Nat Rev Neurosci 2005; 6(7): 507-20.17. Hartley C, Slater R. Neurophysiological measures of nociceptive brain activity in the newborn infant--the next steps. Acta Paediatr 2014; 103(3): 238-42. 18. Stevens B, McGrath P, Gibbins S, Beyene J, Breau L, Camfield C, Finley A, Franck L, Howlett A, McKeever P, O'Brien K, Ohlsson A, Yamada J. Procedural pain in newborns at risk for neurologic impairment. Pain 2003; 105(1-2): 27-35. 19. Gibbins S, Stevens B, Beyene J, Chan PC, Bagg M, Asztalos E. Pain behaviours in Extremely Low Gestational Age infants. Early Hum Dev 2008; 84(7): 451-8. 20. Bouza H. The impact of pain in the immature brain. J Matern Fetal Neonatal Med 2009; 22(9): 722-32. 21. Stevens B, McGrath P, Yamada J, Gibbins S, Beyene J, Breau L, Camfield C, Finley A, Franck L, Howlett A, Johnston C, McKeever P, O'Brien K, Ohlsson A. Identification of pain indicators for infants at risk for neurological impairment: a Delphi consensus study. BMC Pediatr 2006 Feb 2; 6: 1.22. Ranger M, Johnston CC, Anand KJ. Current controversies regarding pain assessment in neonates. Semin Perinatol 2007; 31(5): 283-8.23. Beltramini A, Milojevic K, Pateron D. Pain Assessment in Newborns, Infants, and Children. Pediatr Ann 2017; 46(10): e387-e395. 24. 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(11): 1058-64.25. Chen M, Shi X, Chen Y, Cao Z, Cheng R, Xu Y, Liu L, Li X. A prospective study of pain experience in a neonatal intensive care unit of China. Clin J Pain 2012; 28(8): 700-4.26. Anand KJ, Johnston CC, Oberlander TF, Taddio A, Lehr VT, Walco GA. Analgesia and local anesthesia during invasive procedures in the neonate. Clin Ther 2005; 27(6): 844-76.
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Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Articles
Authors

Ahmet Afşin Kundak 0000-0003-4879-1967

Publication Date March 20, 2020
Acceptance Date October 1, 2019
Published in Issue Year 2020 Volume: 21 Issue: 1

Cite

APA Kundak, A. A. (2020). PREMATÜR BEBEKLERE UYGULANAN AĞRILI İŞLEMLERİN SIKLIK VE ŞİDDETİNİN ARAŞTIRILMASI: PROSPEKTİF BİR ÇALIŞMA. Kocatepe Tıp Dergisi, 21(1), 110-115. https://doi.org/10.18229/kocatepetip.544927
AMA Kundak AA. PREMATÜR BEBEKLERE UYGULANAN AĞRILI İŞLEMLERİN SIKLIK VE ŞİDDETİNİN ARAŞTIRILMASI: PROSPEKTİF BİR ÇALIŞMA. KTD. March 2020;21(1):110-115. doi:10.18229/kocatepetip.544927
Chicago Kundak, Ahmet Afşin. “PREMATÜR BEBEKLERE UYGULANAN AĞRILI İŞLEMLERİN SIKLIK VE ŞİDDETİNİN ARAŞTIRILMASI: PROSPEKTİF BİR ÇALIŞMA”. Kocatepe Tıp Dergisi 21, no. 1 (March 2020): 110-15. https://doi.org/10.18229/kocatepetip.544927.
EndNote Kundak AA (March 1, 2020) PREMATÜR BEBEKLERE UYGULANAN AĞRILI İŞLEMLERİN SIKLIK VE ŞİDDETİNİN ARAŞTIRILMASI: PROSPEKTİF BİR ÇALIŞMA. Kocatepe Tıp Dergisi 21 1 110–115.
IEEE A. A. Kundak, “PREMATÜR BEBEKLERE UYGULANAN AĞRILI İŞLEMLERİN SIKLIK VE ŞİDDETİNİN ARAŞTIRILMASI: PROSPEKTİF BİR ÇALIŞMA”, KTD, vol. 21, no. 1, pp. 110–115, 2020, doi: 10.18229/kocatepetip.544927.
ISNAD Kundak, Ahmet Afşin. “PREMATÜR BEBEKLERE UYGULANAN AĞRILI İŞLEMLERİN SIKLIK VE ŞİDDETİNİN ARAŞTIRILMASI: PROSPEKTİF BİR ÇALIŞMA”. Kocatepe Tıp Dergisi 21/1 (March 2020), 110-115. https://doi.org/10.18229/kocatepetip.544927.
JAMA Kundak AA. PREMATÜR BEBEKLERE UYGULANAN AĞRILI İŞLEMLERİN SIKLIK VE ŞİDDETİNİN ARAŞTIRILMASI: PROSPEKTİF BİR ÇALIŞMA. KTD. 2020;21:110–115.
MLA Kundak, Ahmet Afşin. “PREMATÜR BEBEKLERE UYGULANAN AĞRILI İŞLEMLERİN SIKLIK VE ŞİDDETİNİN ARAŞTIRILMASI: PROSPEKTİF BİR ÇALIŞMA”. Kocatepe Tıp Dergisi, vol. 21, no. 1, 2020, pp. 110-5, doi:10.18229/kocatepetip.544927.
Vancouver Kundak AA. PREMATÜR BEBEKLERE UYGULANAN AĞRILI İŞLEMLERİN SIKLIK VE ŞİDDETİNİN ARAŞTIRILMASI: PROSPEKTİF BİR ÇALIŞMA. KTD. 2020;21(1):110-5.

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