Clinics in perinatology
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Clinics in perinatology · Sep 2013
ReviewSedation and analgesia to facilitate mechanical ventilation.
Regardless of age, health care professionals have a professional and ethical obligation to provide safe and effective analgesia to patients undergoing painful procedures. Historically, newborns, particularly premature and sick infants, have been undertreated for pain. ⋯ The authors review the use of sedation and analgesia to facilitate endotracheal tube placement and mechanical ventilation. Controversies regarding possible adverse neurodevelopmental outcomes after sedative and anesthetic exposure and in the failure to treat pain is also discussed.
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Clinics in perinatology · Sep 2013
ReviewThe association between epidural labor analgesia and maternal fever.
The association between epidural labor analgesia and maternal fever is complex and controversial. Observational, retrospective, before-and-after, and randomized controlled trials all support the association, with the most current evidence supporting the mechanistic involvement of noninfectious inflammation. Considering the clinically significant neonatal consequences that have been previously demonstrated, and the possibility of more common subclinical fetal brain injury that animal models imply, the avoidance of maternal fever during labor is imperative. With the current popularity of epidural analgesia in labor, it is important that clinicians delineate how epidurals cause maternal fever and how to block the noninfectious inflammatory response that seems to warm a subset of women laboring with epidurals.
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Optimal pain management can significantly impact the surgical outcome and length of stay in the neonatal intensive care unit (NICU). Regional anesthesia is an effective alternative that can be used in both term and preterm neonates. ⋯ Ultrasound guidance has increased the feasibility of using these techniques in neonates. Education and training staff in the use of continuous epidural infusions are important prerequisites for successful implementation of regional anesthesia in NICU management protocols.
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Accurate pain assessment in preterm and term neonates in the neonatal intensive care unit (NICU) is of vital importance because of the high prevalence of painful experiences in this population, including both daily procedural pain and postoperative pain. Over 40 tools have been developed to assess pain in neonates, and each NICU should choose a limited number of pain assessment tools for different populations and contexts. ⋯ Preterm neonates do not display behavior and physiologic indicators of pain as reliably and specifically as full term infants, and preterm infants are vulnerable to long term sequelae of painful experiences. "Brain-oriented" approaches for more objective measurement of pain in neonates may become available in the future. In the meantime, neonatal pain assessment tools need to be taught, implemented, and their ongoing use optimized to form a consistent, reproducible basis for the safe and effective treatment of neonatal pain.
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Clinics in perinatology · Sep 2013
ReviewNonpharmacological management of pain during common needle puncture procedures in infants: current research evidence and practical considerations.
All infants undergo painful procedures involving skin puncture as part of routine medical care. Pain from needle puncture procedures is suboptimally managed. ⋯ Adoption of nonpharmacologic pain-relieving interventions into routine clinical practice is feasible and should be a standard of care in the delivery of quality health care for infants. This review summarizes current knowledge about the epidemiology of pain from common needle puncture procedures in infants, the effectiveness of nonpharmacologic interventions, implementation considerations, and unanswered questions for future research.