Acta paediatrica
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Multicenter Study
Pain management in French neonatal intensive care units.
The aim of this study was to investigate pain management in neonatal intensive care units (NICUs) in France and to identify factors associated with variability across units. A questionnaire sent to 143 heads of level II or III NICUs investigated the use of pain scores, pain management organization and pharmacological treatment in five clinical situations (endotracheal intubation, prolonged mechanical ventilation, acute stage of necrotizing enterocolitis, central venous catheter insertion and cephalhaematoma). The response rate was 81%. Among the 35 (30%) units that used no pain scores, 40% ascribed this to lack of knowledge. Factors associated with failure to use pain scores were level II status, no university affiliation, no surgical patients and neonatal patients only. Among the units that scored pain, 78% used valid scores for acute pain and 73% for prolonged pain. Written guidelines were available for acute pain in 65% of units and for prolonged pain in 36%. The rate of pharmacotherapy use varied widely across the five clinical situations studied (from 16 to 77%) and across units for a given clinical situation. Also extremely variable were the regimens used in each situation and the dosages of analgesics and sedatives. Only 11% of units adjusted dosages to gestational age. ⋯ Pain assessment was performed in the most French NICUs, but a strong heterogeneity for pain treatment was observed. Reference to recently published pain management guidelines and new randomized trials could be useful to optimize pain treatment in NICUs.
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Randomized Controlled Trial Multicenter Study Clinical Trial
A randomized double-blind, placebo-controlled trial of the EMLA patch for the reduction of pain associated with intramuscular injection in four to six-year-old children.
The effectiveness of a eutectic mixture lidocaine-prilocaine topical anaesthetic cream (EMLA) patch compared with a placebo patch in the reduction of pain associated with intramuscular immunization was evaluated. As part of the study, 161 children (aged 4-6-y) undergoing routine diphtheria, pertussis, tetanus and polio (DPTP) immunization in five urban and five rural private office settings were randomly assigned to an EMLA patch (n = 83) or a placebo patch control group (n = 78). Pain measurements included: child's self-report on a Faces Pain Scale; facial action on the Child Facial Coding System; the Children's Hospital of Eastern Ontario Pain Scale and parent and technician ratings on a Visual Analogue Scale. Parents also rated their own and their child's immunization-related anxiety on a Visual Analogue Scale. The EMLA patch group had significantly less pain on all four pain measures compared with the placebo group. Of the children in the placebo group, 43% had clinically significant pain, compared with 17% of children in the EMLA patch group. No severe adverse symptoms occurred as a result of either EMLA or placebo patch application. ⋯ The EMLA patch reduced immunization pain in 4 to 6-y-old children during needle injection.
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Multicenter Study
No resuscitation orders and withdrawal of therapy in French paediatric intensive care units. Groupe Francophone de Réanimation et d'Urgences Pédiatriques.
To determine the incidence of different modes of death in French paediatric intensive care units and to compare patients' characteristics, including a severity of illness score (Paediatric Risk of Mortality: PRISM score) and prior health status (Paediatric Overall Performance Category scale), according to the mode of death. ⋯ Decisions to limit or to withdraw supportive care were made for a majority of patients dying in French paediatric intensive care units. Chronic health evaluation and severity of illness index are not sufficient to describe dead-patient populations.
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Multicenter Study Comparative Study
Mothers' perceptions of their preterm infants treated in an incubator or on a heated water-filled mattress: a pilot study.
Ten Swedish and 23 Turkish mothers delivering premature infants with a birth weight of less than 2000 g were investigated concerning their attitudes and feelings towards their newborn babies when the infants were treated either in an air-heated incubator or on a heated water-filled mattress (HWM). The first interview took place during the first few days after delivery and the second interview in the case of the Swedish study two weeks later and in the Turkish study one week later. ⋯ These feelings had changed strikingly by the time of the second interview among the mothers whose infants were treated on the HWM, but persisted to a large extent among the mothers whose infants remained in an incubator. The results of both investigations indicate that the mothers' perceptions of their infants improves when the prematurely born infant is treated on an HWM instead of in an incubator.