Advances in neonatal care : official journal of the National Association of Neonatal Nurses
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To examine the issue of pain assessment in infants by acquiring all available published pain assessment tools and evaluating their reported reliability, validity, clinical utility, and feasibility. ⋯ When choosing a pain assessment tool, one must also consider the infant population and setting, and the type of pain experienced. The decision should be made after carefully considering the existing published options. Confidence that the instrument will assess pain in a reproducible way is essential, and must be demonstrated with validity and reliability testing. Using an untested instrument is not recommended, and should only occur within a research protocol, with appropriate ethics and parental approval. Because pain is a multidimensional phenomenon, well-tested multidimensional instruments may be preferable.
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To examine the relationship of family coping, resources, and strains on family adjustment over time following the NICU experience. ⋯ Family adjustment improved over time for mothers but decreased for fathers. Fathers of infants with ongoing health problems reported significantly poorer family adjustment. Family resources were related to family adjustment and decreased over time for both parents. Families used more coping mechanisms and different coping patterns over time.
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Case Reports
Facial submandibular cellulitis associated with late-onset group B streptococcal infection.
A complete history and systematic physical examination are important first steps in assessing any infant. In some instances these steps may provide immediate clues to a potentially life-threatening illness. This article presents the case of a former 26-week male infant, who presented on day of life 42, 32 weeks gestation corrected, with increased respiratory distress and an evolving lesion on the left lower cheek. ⋯ Serotypes were not available to aid in distinguishing between recurrent or persistent GBS versus a new occurrence of late-onset disease. A brief overview of late-onset GBS infections and their cutaneous manifestations, along with a step-by-step guide to physical examination, is provided. The differential diagnosis for facial cellulitis is reviewed with an emphasis on early recognition and treatment in light of the escalated risks for persistent or recurrent GBS infection in infants with GBS cellulitis.
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Randomized Controlled Trial Clinical Trial
A randomized controlled trial evaluating the efficacy of tetracaine gel for pain relief from peripherally inserted central catheters in infants.
Insertion of peripherally inserted central catheters (PICC) is a commonly performed procedure in both preterm and term infants. Tetracaine 4% gel (Ametop; Smith & Nephew Inc, St. Laurent, Quebec), a topical anesthetic, although reported to be effective for reducing the pain of venipuncture in neonates, has not been investigated for the management of pain associated with the PICC procedure. ⋯ Tetracaine gel was not effective for pain relief for PICC insertion in infants. Its use for pain relief cannot be recommended based on the results of this study. Other pharmacologic, behavioral, and physical interventions should be investigated for safety and relief of procedural pain in this population of infants.
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Randomized Controlled Trial Clinical Trial
The influence of gestational age on the efficacy and short-term safety of sucrose for procedural pain relief.
Physiologic and behavioral responses to procedural pain are influenced by gestational age (GA). Compared with term neonates, hospitalized preterm neonates are subjected to more painful procedures aimed at improving their clinical outcome. Although several trials to determine the efficacy of sucrose for managing procedural pain have been conducted, none have examined the influence of GA. ⋯ In a secondary analysis of a larger RCT, sucrose and NNS was the most efficacious intervention for single heel lances in each of 3 GA groups. However, infants of lower GA experienced more adverse events. Research on the efficacy and safety of repeated doses of oral sucrose, tested in infants from a wide range of GA, is required.