Early human development
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Early human development · Jun 2009
The behavioral pain response to heelstick in preterm neonates studied longitudinally: description, development, determinants, and components.
Preterm infants often experience multiple painful procedures during their stay in neonatal intensive care units (NICUs). The objectives of this study were to evaluate behavioral responses to heelstick in preterm newborns, characterize developmental changes and the effects of other demographic and clinical variables on the pain response, and estimate the contributions of individual Neonatal Infant Pain Scale (NIPS) behaviors to the summary pain score. ⋯ While behavioral responses to pain are attenuated in young, severely ill preterm newborns, they can be reliably detected. The most robust pain behaviors are crying, changes in arousal state, and facial grimacing.
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Early human development · May 2009
Pain reactivity and recovery in preterm neonates: latency, magnitude, and duration of behavioral responses.
Studies on acute-procedural pain in neonates have been based more on single behavioral scores than on response patterns. ⋯ To better assess and manage pain in preterm neonates, it is relevant to analyze the individual patterns of changes, focusing on the reactivity and also the recovery, during painful stimuli.
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Early human development · Feb 2009
ReviewClinical aspects of induced hypothermia in full term neonates with perinatal asphyxia.
Moderate hypothermia is a novel neuroprotective therapy for full term neonates with severe perinatal asphyxia. Although the therapy appears to be safe, admission to a level III neonatal intensive care unit of these patients is justified. ⋯ Further studies aiming at optimizing onset, duration, and depth of hypothermia in neonates are necessary. Combination of hypothermia with drugs may further improve neuroprotection in asphyxiated full term neonates.
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Continuous EEG monitoring with amplitude-integrated electroencephalography (aEEG) has become a part of the routine neurological care in the neonatal unit, especially in full-term infants with hypoxia-ischemia and in infants suspected of seizures. Its prognostic value after birth asphyxia is well established and seizure detection has improved with the new digital aEEG devices with access to the "real" EEG, and even with seizure detection in some devices. Recent experience shows that aEEG monitoring also appears to be very helpful in premature infants. ⋯ Cerebral oximetry is increasingly being used as a trend monitor in critically ill neonates. Its usefulness has been assessed in cardiac surgery, patent ductus arteriosus, hypoxia-ischemia and ventilation with high mean airway pressures. A combination of both monitoring modalities will probably become the future for neonatal neuromonitoring.