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Olsson, Emma
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Pettersson, M., Olsson, E., Ohlin, A. & Eriksson, M. (2019). Neurophysiological and behavioral measures of pain during neonatal hip examination. Paediatric and Neonatal Pain, 1(1), 15-20
Open this publication in new window or tab >>Neurophysiological and behavioral measures of pain during neonatal hip examination
2019 (English)In: Paediatric and Neonatal Pain, ISSN 2637-3807, Vol. 1, no 1, p. 15-20Article in journal (Refereed) Published
Abstract [en]

Introduction: The aim of this study was to test the hypothesis that neonatal hip ex ‐amination causes pain in newborns. Pain assessment using instruments such as the Premature Infant Pain Profile‐Revised (PIPP‐R) scale is recommended, but recently physiological and neurophysiological measures, for example, near‐infrared spectros‐copy (NIRS) and galvanic skin response (GSR), have been used as well.

Methods: Heart auscultation and hip examination were performed, and the response of the newborn was registered by NIRS optodes, GSR electrodes, and a pulse oxime‐ter probe attached to the infant. The face of the newborn was filmed. Heart ausculta‐tion was used as a nonpainful reference.

Results: The pain scores for hip examination were higher than for the heart ausculta‐tion. Near‐infrared spectroscopy showed a significant higher increase from baseline in oxygenated hemoglobin (HbO2) on both sides of the cortex at hip examination compared with at heart auscultation (P = .011 and P= .017). Mean PIPP‐R scores for the hip examination compared with heart auscultation increased from 3.0 to 8.1 (P = .000). The GSR analyses of hip examination compared with heart auscultation showed a significant increase in area under small peaks during the hip examination (P = .016), however, not when measured in peaks per second (P = .104). Interrater reliability was calculated for the NIRS interpretations, with an intraclass correlation coefficient (ICC) range of 0.93‐1.0 (P = .000).

Discussion: Pain in newborns can have negative consequences, and pain prevention and treatment are therefore important. We conclude that neonatal hip examinations are painful and that the pain should be treated, for example, with oral sweet solution. This is a change from present routines during neonatal hip examination and is hoped to lead to a change in national guidelines.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
Neonatal hip examination, neonatal pain
National Category
Pediatrics Nursing
Research subject
Pediatrics; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-76413 (URN)10.1002/pne2.12006 (DOI)
Available from: 2019-09-14 Created: 2019-09-14 Last updated: 2019-11-22Bibliographically approved
Pettersson, M., Olsson, E., Ohlin, A. & Eriksson, M. (2019). Neurophysiological and behavioural measures of pain during neonatal hip examination. In: : . Paper presented at Barnveckan, Örebro, Sweden, April 1-4, 2019.
Open this publication in new window or tab >>Neurophysiological and behavioural measures of pain during neonatal hip examination
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background

In Sweden, all newborns are examined before discharge from the maternity ward to rule out innate abnormalities. Parts of this procedure, such as the hip examination, appear to cause pain and discomfort. Pain in newborns can have both short- and long-term negative consequences and preventing and treating this pain is therefore an important part of medical care. There are several ways to recognize and assess pain in newborn infants. Scales such as the Premature Infant Pain Profile-Revised (PIPP-R) are recommended, but recently physiological and neurophysiological measures, e.g. Near-infrared spectroscopy (NIRS) and Galvanic Skin Response (GSR) have been suggested to have pain-assessing properties.

The aim of the study was to test the hypothesis that neonatal hip examination causes pain in newborns.

Methods

The infant was placed on an examination table and a video camera was placed so the face of the newborn was filmed. A pulse oximeter probe, NIRS optodes and GSR electrodes were attached to the infant. Heart auscultation was chosen to be used as a non-painful comparative to hip examination.

Results

The results showed higher pain scoring for the hip examination than for the heart auscultation. NIRS, showed a significant difference in HbO2 on both sides of cortex (p=0,011 and p=0,017). Mean PIPP-R went from 3.0 during the heart auscultation to 8.1 during the hip examination (p=0.000). GSR analyses showed significant increase in area under small peaks during the hip examination (p=0.016), however not when measured in peaks per second (p=0.104). Interrater reliability was calculated for the NIRS interpretations, with an ICC-range of 0.93-1.0 (p=0.000).

Conclusion

We conclude that neonatal hip examinations are painful and that the pain should be treated, e.g. with oral sweet solution. 

Keywords
Pain, newborn infants
National Category
Pediatrics Nursing
Research subject
Pediatrics; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-73176 (URN)
Conference
Barnveckan, Örebro, Sweden, April 1-4, 2019
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-04-17Bibliographically approved
Pettersson, M., Olsson, E., Ohlin, A. & Eriksson, M. (2019). Neurophysiological and behavioural measures of pain during neonatal hip examination. In: : . Paper presented at 12th International Symposium on Pediatric Pain (ISPP), Basel Switzerland, June 16-20, 2019.
Open this publication in new window or tab >>Neurophysiological and behavioural measures of pain during neonatal hip examination
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Introduction and Purpose: In Sweden, all newborns are examined before discharge from the maternity ward to rule out innate abnormalities. Parts of this procedure, such as the hip examination, appear to cause pain and discomfort. Pain in newborns can have both short- and long-term negative consequences and preventing and treating this pain is therefore an important part of medical care. There are several ways to recognize and assess pain in newborn infants. Scales such as the Premature Infant Pain Profile-Revised (PIPP-R) are recommended, but recently physiological and neurophysiological measures, e.g. Near-in-frared spectroscopy (NIRS) and Galvanic Skin Response (GSR) have been suggested as superior pain measuring methods. The aim of the study was to test the hypothesis that neonatal hip examination causes pain in newborns.

Methods: The infant was placed on an examination table and a video camera was placed so the face of the newborn was filmed. A pulse oximeter probe, NIRS optodes and GSR electrodes were attached to the infant. Heart auscultation was chosen to be used as a non-painful comparative to hip examination.

Results: The results showed higher pain scoring for the hip examination than for the heart auscultation. NIRS, showed a significant difference in HbO2 on both sides of cortex (p=0,011 and p=0,017). Mean PIPP-R went from 3.0 during the heart auscultation to 8.1 during the hip examination (p=0.000). GSR analyses showed significant increase in area under small peaks during the hip examination (p=0.016), however not when measured in peaks per second (p=0.104). The interrater reliability for NIRS interpretations had an ICC-range of 0,93-1,0 (p<0,001). 

Conclusion: We conclude that neonatal hip examinations are painful and that the pain should be treated, e.g. with oral sweet solution.

Keywords
Pain, newborn infant, hip examination
National Category
Nursing Pediatrics
Identifiers
urn:nbn:se:oru:diva-74655 (URN)
Conference
12th International Symposium on Pediatric Pain (ISPP), Basel Switzerland, June 16-20, 2019
Available from: 2019-06-11 Created: 2019-06-11 Last updated: 2019-07-03Bibliographically approved
Pettersson, M., Olsson, E., Ohlin, A. & Eriksson, M. (2019). Neurophysiological and behavioural measures of pain during neonatal hip examination. In: : . Paper presented at RPA & RSOG 1st Joint Scientific Conference, Kigali, Rwanda, 11-13 September, 2019.
Open this publication in new window or tab >>Neurophysiological and behavioural measures of pain during neonatal hip examination
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: In Sweden, all newborns are examined before discharge from the maternity ward to rule out innate abnormalities. Parts of this procedure, such as the hip examination, appear to cause pain and discomfort. Pain in newborns can have both short- and long-term negative consequences and preventing and treating this pain is therefore an important part of medical care. There are several ways to recognize and assess pain in newborn infants. Scales such as the Premature Infant Pain Profile-Revised (PIPP-R) are recommended, but recently physiological and neurophysiological measures, e.g. Near-infrared spectroscopy (NIRS) and Galvanic Skin Response (GSR) have been suggested to have pain-assessing properties.

The aim of the study was to test the hypothesis that neonatal hip examination causes pain in newborns. 

Methods: The infant was placed on an examination table and a video camera was placed so the face of the newborn was filmed. A pulse oximeter probe, NIRS optodes and GSR electrodes were attached to the infant. Heart auscultation was chosen to be used as a non-painful comparative to hip examination. 

Results: The results showed higher pain scoring for the hip examination than for the heart auscultation. NIRS, showed a significant difference in HbO2 on both sides of cortex (p=0,011 and p=0,017). Mean PIPP-R went from 3.0 during the heart auscultation to 8.1 during the hip examination (p=0.000). GSR analyses showed significant increase in area under small peaks during the hip examination (p=0.016), however not when measured in peaks per second (p=0.104). Interrater reliability was calculated for the NIRS interpretations, with an ICC-range of 0.93-1.0 (p=0.000).

Conclusion: We conclude that neonatal hip examinations are painful and that the pain should be treated, e.g. with oral sweet solution. 

National Category
Pediatrics Nursing
Research subject
Pediatrics; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-76414 (URN)
Conference
RPA & RSOG 1st Joint Scientific Conference, Kigali, Rwanda, 11-13 September, 2019
Available from: 2019-09-14 Created: 2019-09-14 Last updated: 2019-09-17Bibliographically approved
Eriksson, M., Pettersson, M., Olsson, E. & Ohlin, A. (2019). Neurophysiological and behavioural measures of pain during neonatal hip examination. In: : . Paper presented at Svenskt smärtforum, Malmö, Sweden, October 17-18, 2019.
Open this publication in new window or tab >>Neurophysiological and behavioural measures of pain during neonatal hip examination
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: In Sweden, all newborns are examined before discharge from the maternity ward to rule out innate abnormalities. Parts of this procedure, such as the hip examination, appear to cause pain and discomfort. Pain in newborns can have both short- and long-term negative consequences and preventing and treating pain is therefore an important part of medical care. There are several ways to recognize and assess pain in newborn infants. Scales such as the Premature Infant Pain Profile-Revised (PIPP-R) are recommended, but recently physiological and neurophysiological measures, e.g. Near-infrared spectroscopy (NIRS) and Galvanic Skin Response (GSR) have been suggested to have pain-assessing properties.

Aim: The aim of the study was to test the hypothesis that neonatal hip examination causes pain in newborns. 

Method: The infant was placed on an examination table and a video camera was placed so the face of the newborn was filmed. A pulse oximeter probe, NIRS optodes and GSR electrodes were attached to the infant. Heart auscultation was chosen to be used as a non-painful comparative to hip examination.

Results: The results showed higher pain scoring for the hip examination than for the heart auscultation. NIRS, showed a significant difference in HbO2 on both sides of cortex. Mean PIPP-R went from 3.0 during the heart auscultation to 8.1 during the hip examination. GSR analyses showed significant increase in area under small peaks during the hip examination. 

Conclusion: We conclude that neonatal hip examinations are painful and that the pain should be treated, e.g. with oral sweet solution. 

Keywords
Pain, newborn infants, hip examination
National Category
Pediatrics Anesthesiology and Intensive Care
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-77277 (URN)
Conference
Svenskt smärtforum, Malmö, Sweden, October 17-18, 2019
Available from: 2019-10-14 Created: 2019-10-14 Last updated: 2019-10-21Bibliographically approved
Olsson, E., Pettersson, M., Eriksson, M. & Ohlin, A. (2019). Oral sweet solution to prevent pain during neonatal hip examination: a randomized controlled trial. Acta Paediatrica, 108(4), 626-629
Open this publication in new window or tab >>Oral sweet solution to prevent pain during neonatal hip examination: a randomized controlled trial
2019 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 108, no 4, p. 626-629Article in journal (Refereed) Published
Abstract [en]

Aim: To determine if oral glucose can have a pain relieving effect during routine hip exams in newborn infants.

Methods: In this randomized controlled study 100 newborn infants undergoing the routine physical examination including the potentially painful hip exam were included between March 2016 and April 2017. 50 infants were randomized to water (control) and 50 to oral glucose (intervention) before their examination. Pain was assessed using crying time, Astrid Lindgren and Lund Children's Hospital Pain and Stress Assessment Scale (ALPS‐Neo) and Visual analogue scale (VAS).

Results:  Total crying time (p=0.06), crying time during the hip examination (p=0.028), ALPS‐Neo (p=0.004) and VAS (p=0.006) (when assessed by the physician) were all significantly decreased in the group of infants receiving glucose. VAS assessment made by the parents did not reach statistical significance (p=0.127).

Conclusion:  Oral glucose given before the examination has a pain relieving effect during the hip exam in healthy newborn infants.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
Keywords
Hip examination, newborn, oral glucose, pain
National Category
Pediatrics Nursing
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-69112 (URN)10.1111/apa.14588 (DOI)000461014600008 ()30246505 (PubMedID)2-s2.0-85054926490 (Scopus ID)
Note

Funding Agency:

Research Committee of Region Örebro County 

Available from: 2018-09-29 Created: 2018-09-29 Last updated: 2019-06-19Bibliographically approved
Blomqvist, Y. T., Gradin, M. & Olsson, E. (2019). Pain Assessment and Management in Swedish Neonatal Intensive Care Units. Pain Management Nursing, Article ID S1524-9042(19)30250-4.
Open this publication in new window or tab >>Pain Assessment and Management in Swedish Neonatal Intensive Care Units
2019 (English)In: Pain Management Nursing, ISSN 1524-9042, E-ISSN 1532-8635, article id S1524-9042(19)30250-4Article in journal (Refereed) Epub ahead of print
Abstract [en]

AIMS: To investigate registered nurses' (RNs') and physicians' knowledge, attitudes, and experiences regarding assessing and managing pain in infants at seven level III neonatal intensive care units (NICUs) in Sweden.

DESIGN: Descriptive and explorative study using an online questionnaire.

METHODS: A researcher-developed online questionnaire with 34 items about knowledge, attitudes, and experiences regarding pain assessment and management was emailed to 306 RNs and 79 physicians working at seven neonatal intensive care units (NICUs) in Sweden.

RESULTS: Most NICUs had pain assessment guidelines, but there was a discrepancy regarding interprofessional discussions of pain assessments. A total of seven different pain assessment instruments were reported from the included NICUs and RNs were reportedly those who usually performed the pain assessments. Most respondents expressed a positive attitude toward pain assessment but recognized a lack of intervention after the assessment. Forty-six percent (n = 11) of the physicians said they had sufficient knowledge of assessing pain using pain assessment instruments, versus 75% (n = 110) of the RNs. Difficulties assessing pain in certain populations of infants, such as the most premature infants and infants receiving sedative medicines, were recognized.

CONCLUSIONS: RNs in this study reported that their pain assessments did not lead to appropriate pain management interventions. They were thus discouraged from further pain assessments or advocating for ethical pain management. An interprofessional team effort is needed to effectively assess and manage pain in neonates.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-78847 (URN)10.1016/j.pmn.2019.11.001 (DOI)31889663 (PubMedID)
Note

Funding Agencies:

Region Uppsala

Örebro County Council

Available from: 2020-01-01 Created: 2020-01-01 Last updated: 2020-01-08Bibliographically approved
Eriksson, M., Ahl, H., Bengtsson, K., Bruschettini, M., Norman, E., Olsson, E. & Naidu Vejayaram, D. (2019). Pain scales in clinical trials in newborn infants: a mapping of the evidence. In: : . Paper presented at 3rd jENS Congress of joint European Neonatal Societies, Maastricht, the Netherlands, September 17-21, 2019.
Open this publication in new window or tab >>Pain scales in clinical trials in newborn infants: a mapping of the evidence
Show others...
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background: Numerous clinical studies have aimed at finding a strategy to reduce the pain newborn infants are subjected to by their medical conditions and also by medical and caring procedures. Little is however known about whether the outcome measures in these trials are valid for the specific type of pain or group of infants included in the studies. There are today over 40 published scales, consisting of behavioral or physiological signals or a combination of both. The aim of this study was to evaluate the reporting of pain scales assessments that were most commonly used in all the published trials examining interventions related to neonatal pain.

Methods: A systematic and broad search up to January 2019 was performed in Embase, PubMed, PsycInfo, Cinahl, Cochrane Library, Scopus and Luxid. Randomized and quasi-randomized clinical trials on neonatal pain were included. Title and abstract screening followed by full text screening were performed by two independent researchers using an online tool for the preparation of systematic reviews (Covidence). Disagreements were resolved by a third researcher or in discussions within the group, as recommended in the Cochrane handbook. Data extraction and quality assessment were also performed by two researchers independently. 

Results: The systematic search retrieved 3715 scientific articles. Following screening, 342 studies with a total of 16210 infants were included, reporting data from the use of at least one neonatal pain assessment scale. Ninety per cent of the studies concerned procedural pain where the most frequently used pain scales were PIPP or PIPP-R (43%), followed by NIPS (17%). For ongoing or post-operative pain there was a more unclear pattern with COMFORT (24%) and NFCS (10%) as the most reported. We observed a wide variation of pain scales (Fig 1) and found numerous studies where pain scales were used that were not validated for the studied population or type of pain. In 11 papers self-constructed study-specific scales were used. The most frequent sources of procedural pain were heel lance (28% of the studies) followed by venipuncture (10%) and ROP-screening (5%).

Conclusion: This is the first scoping review reporting systematically how neonatal pain scales are used in clinical trials. There are a few validated pain assessment scales used in most clinical studies. It is crucial to choose an appropriate scale, validated for the type of pain and population of infants included in the study. The inappropriate use of pain scales raises serious concerns on ethical conduct of research and waste of resources.

 

Keywords
Neonatal Pain, Clinical Trials, Review
National Category
Pediatrics Nursing
Research subject
Pediatrics; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-76415 (URN)
Conference
3rd jENS Congress of joint European Neonatal Societies, Maastricht, the Netherlands, September 17-21, 2019
Projects
SANNI - Safe Analgesia for Neonatal Intensive Care
Available from: 2019-09-14 Created: 2019-09-14 Last updated: 2020-02-17Bibliographically approved
Eriksson, M., Ahl, H., Bengtsson, K., Bruschettini, M., Norman, E., Olsson, E. & Vejayaram, D. (2019). Pain scales in clinical trials in newborn infants: a mapping of the evidence. In: : . Paper presented at Svenskt smärtforum, Malmö, Sweden, October 17-18, 2019.
Open this publication in new window or tab >>Pain scales in clinical trials in newborn infants: a mapping of the evidence
Show others...
2019 (English)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

BackgroundNumerous clinical studies have aimed at reducing pain in newborn infants. Little is known about whether the outcome measures are valid for the specific type of pain or group of infants included. 

Aim: To evaluate the reporting of pain assessments used in published trials.

MethodsA systematic search up to January 2019 was performed in Embase, PubMed, PsycInfo, Cinahl, Cochrane Library, Scopus and Luxid. Randomized and quasi-randomized clinical trials were included. Title and abstract screening followed by full text screening were performed by two independent researchers. Data extraction and quality assessment were also performed by two researchers independently.

Results: The search retrieved 3715 articles. 342 studies with a total of 16210 infants were included. 90% of the studies concerned procedural pain where the most frequently used pain scales were PIPP or PIPP-R followed by NIPS For ongoing or post-operative pain COMFORT and NFCS were mostly used. We observed a wide variation of pain scales and found numerous studies where pain scales were used that were not validated for the studied population or type of pain. 

ConclusionThis is the first scoping review reporting systematically how neonatal pain scales are used in clinical trials. There are a few validated pain assessment scales used in most clinical studies. It is crucial to choose an appropriate scale, validated for the type of pain and population of infants included in the study. The inappropriate use of pain scales raises serious concerns on ethical conduct of research and waste of resources.

Keywords
Pain, newborn infants
National Category
Nursing Pediatrics
Research subject
Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-77275 (URN)
Conference
Svenskt smärtforum, Malmö, Sweden, October 17-18, 2019
Projects
SANNI - Safe Analgesia for Neonatal Intensive Care
Available from: 2019-10-14 Created: 2019-10-14 Last updated: 2020-02-17Bibliographically approved
Olsson, E., Anderzén-Carlsson, A., Attladottir, S. M., Axelin, A., Campbell-Yeo, M., Eriksson, M., . . . Dovland Andersen, R. (2018). Cultural adaptation and harmonization of four Nordic translations of the revised Premature Infant Pain Profile (PIPP-R). BMC Pediatrics, 18, Article ID 349.
Open this publication in new window or tab >>Cultural adaptation and harmonization of four Nordic translations of the revised Premature Infant Pain Profile (PIPP-R)
Show others...
2018 (English)In: BMC Pediatrics, ISSN 1471-2431, E-ISSN 1471-2431, Vol. 18, article id 349Article in journal (Refereed) Published
Abstract [en]

Background: Preterm infants are especially vulnerable to pain. The intensive treatment often necessary for their survival unfortunately includes many painful interventions and procedures. Untreated pain can lead to both short- and long-term negative effects. The challenge of accurately detecting pain has been cited as a major reason for lack of pain management in these non-verbal patients. The Premature Infant Pain Profile (PIPP) is one of the most extensively validated measures for assessing procedural pain in premature infants. A revised version, PIPP-R, was recently published and is reported to be more user-friendly and precise than the original version. The aims of the study were to develop translated versions of the PIPP-R in Finnish, Icelandic, Norwegian, and Swedish languages, and to establish their content validity through a cultural adaptation process using cognitive interviews.

Methods: PIPP-R was translated using the recommendations from the International Society for Pharmacoeconomics and Outcomes Research and enhanced with cognitive interviews. The respondent nurse was given a copy of the translated, national version of the measure and used this together with a text describing the infant in the film to assess the pain of an infant in a short film. During the assessment the nurse was asked to verbalize her thought process (thinking aloud) and upon completion the interviewer administered probing questions (verbal probing) from a structured interview guide. The interviews were recorded, transcribed, and analyzed using a structured matrix approach.

Results: The systematic approach resulted in translated and culturally adapted versions of PIPP-R in the Finnish, Icelandic, Norwegian and Swedish languages. During the cultural adaptation process several problems were discovered regarding how the respondent understood and utilized the measure. The problems were either measure problems or other problems. Measure problems were solved by a change in the translated versions of the measure, while for other problems different solutions such as education or training were suggested.

Conclusions: This study have resulted in translations of the PIPP-R that have content validity, high degree of clinical utility and displayed beginning equivalence with each other and the original version of the measure.

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Neonatal, pain, pain assessment
National Category
Nursing Pediatrics
Research subject
Pediatrics; Caring Sciences w. Medical Focus
Identifiers
urn:nbn:se:oru:diva-70116 (URN)10.1186/s12887-018-1322-5 (DOI)000449738300001 ()30409118 (PubMedID)2-s2.0-85056397623 (Scopus ID)
Available from: 2018-11-10 Created: 2018-11-10 Last updated: 2018-11-29Bibliographically approved
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