Archives of disease in childhood. Fetal and neonatal edition
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It is well recognised that reducing positive end expiratory pressure (PEEP) leads to an increase in the tidal volume and minute volume in ventilated neonates. The magnitude of this effect is perhaps not commonly appreciated, however. Effectively, PEEP is four times as potent as peak inflation pressure (PIP) in bringing about changes in tidal volume. ⋯ Similarly, increasing PEEP by 1 cm H2O was twice as effective as a 2 cm H2O decrease in PIP in reducing tidal volume (13 v 6%). Small (0.5-1 cm H2O) changes in PEEP can often be used to improve ventilation and carbon dioxide elimination. Levels of PEEP of 4-5 cm H2O may, at times, impair gas exchange and contribute to overdistension.
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Arch. Dis. Child. Fetal Neonatal Ed. · May 1994
Clinical TrialAlleviation of the pain of heel prick in preterm infants.
The hypothesis that the variability of physiological parameters may indicate pain or stress in the neonate was examined. Four parameters (heart rate, respiratory rate, transcutaneous oxygen tension, and carbon dioxide tension) were examined over a 2 minute epoch in response to a heel prick in an attempt to measure stress/pain in 35 preterm newborn infants (26-34 weeks' gestation) half of whom were receiving intensive care. The change in absolute values of these parameters did not discriminate a dummy procedure without prick from the actual procedure containing the prick (paired t test), but the variability of the parameters during an epoch showed significant discrimination. ⋯ The components of the mixture cause vasoconstriction that would reduce blood flow to the heel and lead to more squeezing which is likely to be painful in the presence of tissue damage. A nurse comforting the infant with tactile and vocal stimulation was slightly helpful but the use of a spring loaded lance was most successful in reducing the distress. The use of spring loaded lances may be more humane for heel pricks.
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A bedside technique for evaluating the behavioural response of healthy neonates to pain was assessed. Thirty six term infants (median gestational age 40 weeks; median postnatal age 4 days) and 31 preterm infants (median gestational age 34 weeks; median postnatal age 4 days) were assessed at the cotside for their response to heel preparation and heel lance for routine blood sampling. The facial actions of brow bulge, eye squeeze, nasolabial furrow, and open mouth were noted, and also the presence or absence of crying. ⋯ Brow bulge and nasolabial furrow were seen most often, and occurred more often than crying in the two groups. There was good interobserver agreement (94%). The consistency of response and the high degree of interobserver agreement makes this method of behavioural assessment of acute pain of use in healthy neonates.