European journal of pediatrics
-
Randomized Controlled Trial
The effect of SonoPrep® on EMLA® cream application for pain relief prior to intravenous cannulation.
The aim the study was to determine the effect of SonoPrep® on the delivery and analgesic effects of EMLA® cream prior to intravenous (iv) cannulation in a tertiary pediatric emergency department. Children aged between 5 and 10 years were enrolled. Patients were randomized to receive either sonophoresis with SonoPrep® or sham sonophoresis followed by application of EMLA® cream for 5 min prior to iv cannulation. ⋯ The parent's perception of the child's pain was significantly lower in the study group vs. the control group by the VAS (median (percentiles 25th-75th), 10.0 (10.0-20.0) vs. 50.0 (15.0-80.0); p < 0.001) and Wong-Baker Face scale (median (percentiles 25th-75th), 2.0 (2.0-2.0) vs. 4.0 (2.5-4.5); p < 0.001). The researcher's evaluation of the child's discomfort was also significantly lower in the study group (2.0 (1.0-3.0) vs. 4.0 (2.5-4.5); p < 0.001). The application of sonophoresis using SonoPrep® followed by the 5-min application of EMLA® cream showed significant benefit in young children in terms of pain reduction and patient satisfaction.
-
The use of chloride-sodium ratio in the evaluation of metabolic acidosis in critically ill neonates.
Acid-base disturbances have been usually evaluated with the traditional Henderson-Hasselbach method and Stewart's physiochemical approach by quantifying anions of tissue acids (TA). It is hypothesized that an increase in tissue acids during metabolic acidosis would cause a compensatory decrease in the plasma chloride (Cl) relative to sodium (Cl-Na ratio) in order to preserve electroneutral balance. Therefore, we aimed to investigate the use of Cl-Na ratio as a bedside tool to evaluate the identifying raised TA in neonates as an alternative to complex calculations of Stewart's physiochemical approach. ⋯ Also, there was a positive correlation between Diff(NaCl) and SID, AG(corr), UMA, and TA. Base deficit and actual bicarbonate performed poorly in identifying the TA. In conclusion, our study suggested that Diff(NaCl) and Cl-Na ratio are simple and fast, and may be an alternative method to complex Stewart's physiochemical approach in identifying raised UMA and TA in critically ill neonates.
-
Randomized Controlled Trial Comparative Study
Stress response and procedural pain in the preterm newborn: the role of pharmacological and non-pharmacological treatments.
Repeated invasive procedures occur routinely in neonates who require intensive care, causing pain at a time when it is developmentally unexpected. Multiple lines of evidence suggest that repeated and prolonged pain exposure alters their subsequent pain processing, long-term development, and behaviour. Primary outcome of this study was to evaluate the reduction of procedural pain induced by "heel-lances" in preterm newborns with three different treatment [administration of fentanyl (FE, 1-2 μg/kg), facilitated tucking (FT), sensorial saturation (SS)]. Secondary outcome was the measurement of the levels of cytokines as markers of stress correlated to pain. A prospective randomized controlled trial (RCT) comparing three different pharmacological or non-pharmacological treatments was performed involving 150 preterm newborn (gestational age 27-32 weeks). No other analgesic treatment was performed during the study. CRIES score was used to evaluate the procedural pain. The results showed that the reduction in the pain score was greater in FE and SS groups than FS group. The differences were statistically significant (p < 0.01). The levels of IL-6, IL-8, and TNF-α were higher in the FT individuals than in the FE or SS-treated infants at 1 day (p < 0.01), at 3 days (p < 0.01), and at 7 days (p < 0.01) of life. ⋯ The findings of this study suggest that FE and SS provide a superior analgesia in preterm neonates during procedural pain. In particular, sensorial saturation seems to be an important non-pharmacological alternative treatment to prevent and reduce the procedural pain in preterm newborn.
-
Comparative Study Clinical Trial
Unilateral inguinal hernia: laparoscopic or inguinal approach. Decision making strategy: a prospective study.
The management of the contralateral region in a child with a known unilateral inguinal hernia is a debated issue among paediatric surgeons. The available literature indicates that the perspective of the child's parents is seldom. This study was performed to evaluate parents' views on this topic. ⋯ Conclusion There is no consensus about the management of paediatric patients with a unilateral inguinal hernia. We believe that a correct decision-making strategy for parents' choice is to propose them the both procedures. Our study shows that parents prefer laparoscopic inspection and repair in the vast majority of cases.