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Olsson, Emma
Publications (10 of 50) Show all publications
Arribas, C., Cavallaro, G., Gonzalez, J.-L., Lagares, C., Raffaeli, G., Smits, A., . . . Garrido, F. (2024). Global cross-sectional survey on neonatal pharmacologic sedation and analgesia practices and pain assessment tools: impact of the sociodemographic index (SDI). Pediatric Research
Open this publication in new window or tab >>Global cross-sectional survey on neonatal pharmacologic sedation and analgesia practices and pain assessment tools: impact of the sociodemographic index (SDI)
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2024 (English)In: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447Article in journal (Refereed) Published
Abstract [en]

Background: There is variability in the use of sedatives and analgesics in neonatal intensive care units (NICUs). We aimed to investigate the use of analgesics and sedatives and the management of neonatal pain and distress.

Methods: This was a global, prospective, cross-sectional study. A survey was distributed May–November 2022. The primary outcome of this research was to compare results between countries depending on their socio-sanitary level using the sociodemographic index (SDI). We organized results based on geographical location.

Results: The survey collected 1304 responses, but we analyzed 924 responses after database cleaning. Responses from 98 different countries were analyzed. More than 60% of NICUs reported having an analgosedation guideline, and one-third of respondents used neonatal pain scales in more than 80% of neonates. We found differences in the management of sedation and analgesia between NICUs on different continents, but especially between countries with different SDIs. Countries with a higher SDI had greater availability of and adherence to analgosedation guidelines, as well as higher rates of analgosedation for painful or distressing procedures. Countries with different SDIs reported differences in analgosedation for neonatal intubation, invasive ventilation, and therapeutic hypothermia, among others.

Conclusions: Socio-economic status of countries impacts on neonatal analgosedation management.

Keywords
Newborn infant, pain, survey
National Category
Pediatrics
Identifiers
urn:nbn:se:oru:diva-111609 (URN)10.1038/s41390-024-03032-7 (DOI)
Available from: 2024-02-15 Created: 2024-02-15 Last updated: 2024-02-19Bibliographically approved
Sundqvist, A.-S., Wahlqvist, M., Anderzen-Carlsson, A. & Olsson, E. (2023). An integrative review of interventions for children and adolescents with deafblindness. In: : . Paper presented at Nordic Conference in Nursing Research, Reykjavik, Iceland, 2-4 October, 2023.
Open this publication in new window or tab >>An integrative review of interventions for children and adolescents with deafblindness
2023 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Pediatrics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-109649 (URN)
Conference
Nordic Conference in Nursing Research, Reykjavik, Iceland, 2-4 October, 2023
Available from: 2023-11-09 Created: 2023-11-09 Last updated: 2023-11-09Bibliographically approved
Bäcke, P., Bruschettini, M., Blomqvist, Y. T., Sibrecht, G. & Olsson, E. (2023). Interventions for the Management of Pain and Sedation in Newborns Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: A Systematic Review. Pediatric Drugs, 25(1), 27-41
Open this publication in new window or tab >>Interventions for the Management of Pain and Sedation in Newborns Undergoing Therapeutic Hypothermia for Hypoxic-Ischemic Encephalopathy: A Systematic Review
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2023 (English)In: Pediatric Drugs, ISSN 1174-5878, E-ISSN 1179-2019, Vol. 25, no 1, p. 27-41Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Newborn infants undergoing therapeutic hypothermia (TH) are exposed to multiple painful and stressful procedures. The aim of this systematic review was to assess benefits and harms of pharmacological and non-pharmacological interventions for the management of pain and sedation in newborn infants undergoing TH for hypoxic-ischemic encephalopathy.

METHODS: We included randomized and observational studies reporting any intervention (either drugs or non-pharmacological interventions) to manage pain and sedation in newborn infants (> 33 weeks' gestational age) undergoing TH. We included any dose, duration and route of administration. We also included any type and duration of non-pharmacological interventions. Our prespecified primary outcomes were analgesia and sedation assessed using validated pain scales in the neonatal population; circulatory instability; mortality to discharge; and neurodevelopmental disability. A systematic literature search was conducted in the PubMed, Embase, CINAHL, Cochrane CENTRAL, Scopus, and Web of Science databases, with no language restrictions. Included studies underwent risk-of-bias assessment (Cochrane risk-of-bias tool and ROBINS-I) and data extraction performed by two authors independently. The plan had been to use effect measures such as mean difference for continuous outcomes and risk ratio for dichotomous outcomes, however the included studies are presented in a narrative synthesis due to their paucity and heterogeneity.

RESULTS: Ten studies involving 3551 infants were included-one trial and nine observational studies. Most studies examined the use of phenobarbital or other antiepileptic drugs with primary outcomes related to seizure activity. The single trial that was included compared pentoxifylline with placebo. Among the primary outcomes, six studies reported circulatory instability and five reported mortality to discharge without relevant differences; two studies reported on neurodevelopmental disability and one study reported on pain scale. Three studies were ongoing.

CONCLUSIONS: We found limited evidence to establish the benefits and harms of the interventions for the management of pain and sedation in newborn infants undergoing TH. Long-term outcomes were not reported. Given the very low certainty of evidence-due to imprecision of the estimates, inconsistency and limitations in study design (all nine observational studies with overall serious risk of bias)-for all outcomes, clinical trials are required to determine the most effective interventions in this population.

SYSTEMATIC REVIEW REGISTRATION: PROSPERO registration number: CRD42020205755.

Place, publisher, year, edition, pages
Springer, 2023
National Category
Pediatrics
Identifiers
urn:nbn:se:oru:diva-102646 (URN)10.1007/s40272-022-00546-7 (DOI)000895633200001 ()36481984 (PubMedID)2-s2.0-85143666312 (Scopus ID)
Funder
Örebro University
Available from: 2022-12-12 Created: 2022-12-12 Last updated: 2023-01-19Bibliographically approved
Ullsten, A., Carlsen Misic, M., Olsson, E., Andersen, R. D., Ericson, J., Eriksson, M. & Thernström Blomqvist, Y. (2023). O parent where art thou?: Family-integrated music therapy forneonatal procedural support. In: : . Paper presented at The 17th World Congress of Music Therapy, Vancouver, Canada, July 24–29, 2023.
Open this publication in new window or tab >>O parent where art thou?: Family-integrated music therapy forneonatal procedural support
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2023 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Pediatrics Art History
Identifiers
urn:nbn:se:oru:diva-107536 (URN)
Conference
The 17th World Congress of Music Therapy, Vancouver, Canada, July 24–29, 2023
Available from: 2023-08-14 Created: 2023-08-14 Last updated: 2023-08-17Bibliographically approved
Kinoshita, M., Olsson, E., Borys, F. & Bruschettini, M. (2023). Opioids for procedural pain in neonates. Cochrane Database of Systematic Reviews, 4(4), Article ID CD015056.
Open this publication in new window or tab >>Opioids for procedural pain in neonates
2023 (English)In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, Vol. 4, no 4, article id CD015056Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Neonates might be exposed to numerous painful procedures due to diagnostic reasons, therapeutic interventions, or surgical procedures. Options for pain management include opioids, non-pharmacological interventions, and other drugs. Morphine, fentanyl, and remifentanil are the opioids most often used in neonates. However, negative impact of opioids on the structure and function of the developing brain has been reported.

OBJECTIVES: To evaluate the benefits and harms of opioids in term or preterm neonates exposed to procedural pain, compared to placebo or no drug, non-pharmacological intervention, other analgesics or sedatives, other opioids, or the same opioid administered by a different route. SEARCH

METHODS: We used standard, extensive Cochrane search methods. The latest search date was December 2021.

SELECTION CRITERIA: We included randomized controlled trials conducted in preterm and term infants of a postmenstrual age (PMA) up to 46 weeks and 0 days exposed to procedural pain where opioids were compared to 1) placebo or no drug; 2) non-pharmacological intervention; 3) other analgesics or sedatives; 4) other opioids; or 5) the same opioid administered by a different route.

DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were pain assessed with validated methods and any harms. We used a fixed-effect model with risk ratio (RR) for dichotomous data and mean difference (MD) for continuous data, and their confidence intervals (CI). We used GRADE to assess the certainty of the evidence for each outcome.

MAIN RESULTS: We included 13 independent studies (enrolling 823 newborn infants): seven studies compared opioids to no treatment or placebo (the main comparison in this review), two studies to oral sweet solution or non-pharmacological intervention, and five studies (of which two were part of the same study) to other analgesics and sedatives. All studies were performed in a hospital setting. Opioids compared to placebo or no drug Compared to placebo, opioids probably reduce pain score assessed with the Premature Infant Pain Profile (PIPP)/PIPP-Revised (PIPP-R) scale during the procedure (MD -2.58, 95% CI -3.12 to -2.03; 199 participants, 3 studies; moderate-certainty evidence); may reduce Neonatal Infant Pain Scale (NIPS) during the procedure (MD -1.97, 95% CI -2.46 to -1.48; 102 participants, 2 studies; low-certainty evidence); and may result in little to no difference in pain score assessed with the Douleur Aiguë du Nouveau-né (DAN) scale one to two hours after the procedure (MD -0.20, 95% CI -2.21 to 1.81; 42 participants, 1 study; low-certainty evidence). The evidence is very uncertain about the effect of opioids on pain score assessed with the PIPP/PIPP-R scale up to 30 minutes after the procedure (MD 0.14, 95% CI -0.17 to 0.45; 123 participants, 2 studies; very low-certainty evidence) or one to two hours after the procedure (MD -0.83, 95% CI -2.42 to 0.75; 54 participants, 2 studies; very low-certainty evidence). No studies reported any harms. The evidence is very uncertain about the effect of opioids on episodes of bradycardia (RR 3.19, 95% CI 0.14 to 72.69; 172 participants, 3 studies; very low-certainty evidence). Opioids may result in an increase in episodes of apnea compared to placebo (RR 3.15, 95% CI 1.08 to 9.16; 199 participants, 3 studies; low-certainty evidence). The evidence is very uncertain about the effect of opioids on episodes of hypotension (RR not estimable, risk difference 0.00, 95% CI -0.06 to 0.06; 88 participants, 2 studies; very low-certainty evidence). No studies reported parent satisfaction with care provided in the neonatal intensive care unit (NICU). Opioids compared to non-pharmacological intervention The evidence is very uncertain about the effect of opioids on pain score assessed with the Crying Requires oxygen Increased vital signs Expression Sleep (CRIES) scale during the procedure when compared to facilitated tucking (MD -4.62, 95% CI -6.38 to -2.86; 100 participants, 1 study; very low-certainty evidence) or sensorial stimulation (MD 0.32, 95% CI -1.13 to 1.77; 100 participants, 1 study; very low-certainty evidence). The other main outcomes were not reported. Opioids compared to other analgesics or sedatives The evidence is very uncertain about the effect of opioids on pain score assessed with the PIPP/PIPP-R during the procedure (MD -0.29, 95% CI -1.58 to 1.01; 124 participants, 2 studies; very low-certainty evidence); up to 30 minutes after the procedure (MD -1.10, 95% CI -2.82 to 0.62; 12 participants, 1 study; very low-certainty evidence); and one to two hours after the procedure (MD -0.17, 95% CI -2.22 to 1.88; 12 participants, 1 study; very low-certainty evidence). No studies reported any harms. The evidence is very uncertain about the effect of opioids on episodes of apnea during (RR 3.27, 95% CI 0.85 to 12.58; 124 participants, 2 studies; very low-certainty evidence) and after the procedure (RR 2.71, 95% CI 0.11 to 64.96; 124 participants, 2 studies; very low-certainty evidence) and on hypotension (RR 1.34, 95% CI 0.32 to 5.59; 204 participants, 3 studies; very low-certainty evidence). The other main outcomes were not reported. We identified no studies comparing different opioids (e.g. morphine versus fentanyl) or different routes for administration of the same opioid (e.g. morphine enterally versus morphine intravenously).

AUTHORS' CONCLUSIONS: Compared to placebo, opioids probably reduce pain score assessed with PIPP/PIPP-R scale during the procedure; may reduce NIPS during the procedure; and may result in little to no difference in DAN one to two hours after the procedure. The evidence is very uncertain about the effect of opioids on pain assessed with other pain scores or at different time points. No studies reported if any harms occurred. The evidence is very uncertain about the effect of opioids on episodes of bradycardia or hypotension. Opioids may result in an increase in episodes of apnea. No studies reported parent satisfaction with care provided in the NICU. The evidence is very uncertain about the effect of opioids on any outcome when compared to non-pharmacological interventions or to other analgesics. We identified no studies comparing opioids to other opioids or comparing different routes of administration of the same opioid.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
National Category
Pediatrics
Identifiers
urn:nbn:se:oru:diva-105441 (URN)10.1002/14651858.CD015056.pub2 (DOI)37019853 (PubMedID)2-s2.0-85151702708 (Scopus ID)
Note

Se versionshistorik https://urn.kb.se/resolve?urn=urn:nbn:se:oru:diva-95889

Available from: 2023-04-24 Created: 2023-04-24 Last updated: 2023-04-24Bibliographically approved
Kinoshita, M., Olsson, E., Borys, F. & Bruschettini, M. (2023). Opioids for procedural pain in neonates. Cochrane Database of Systematic Reviews, 6, CD015056
Open this publication in new window or tab >>Opioids for procedural pain in neonates
2023 (English)In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, Vol. 6, p. CD015056-Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Neonates might be exposed to numerous painful procedures due to diagnostic reasons, therapeutic interventions, or surgical procedures. Options for pain management include opioids, non-pharmacological interventions, and other drugs. Morphine, fentanyl, and remifentanil are the opioids most often used in neonates. However, negative impact of opioids on the structure and function of the developing brain has been reported.

OBJECTIVES: To evaluate the benefits and harms of opioids in term or preterm neonates exposed to procedural pain, compared to placebo or no drug, non-pharmacological intervention, other analgesics or sedatives, other opioids, or the same opioid administered by a different route.

SEARCH METHODS: We used standard, extensive Cochrane search methods. The latest search date was December 2021.

SELECTION CRITERIA: We included randomized controlled trials conducted in preterm and term infants of a postmenstrual age (PMA) up to 46 weeks and 0 days exposed to procedural pain where opioids were compared to 1) placebo or no drug; 2) non-pharmacological intervention; 3) other analgesics or sedatives; 4) other opioids; or 5) the same opioid administered by a different route.

DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were pain assessed with validated methods and any harms. We used a fixed-effect model with risk ratio (RR) for dichotomous data and mean difference (MD) for continuous data, and their confidence intervals (CI). We used GRADE to assess the certainty of the evidence for each outcome.

MAIN RESULTS: We included 13 independent studies (enrolling 823 newborn infants): seven studies compared opioids to no treatment or placebo (the main comparison in this review), two studies to oral sweet solution or non-pharmacological intervention, and five studies (of which two were part of the same study) to other analgesics and sedatives. All studies were performed in a hospital setting. Opioids compared to placebo or no drug Compared to placebo, opioids probably reduce pain score assessed with the Premature Infant Pain Profile (PIPP)/PIPP-Revised (PIPP-R) scale during the procedure (MD -2.58, 95% CI -3.12 to -2.03; 199 participants, 3 studies; moderate-certainty evidence); may reduce Neonatal Infant Pain Scale (NIPS) during the procedure (MD -1.97, 95% CI -2.46 to -1.48; 102 participants, 2 studies; low-certainty evidence); and may result in little to no difference in pain score assessed with the Douleur Aiguë du Nouveau-né (DAN) scale one to two hours after the procedure (MD -0.20, 95% CI -2.21 to 1.81; 42 participants, 1 study; low-certainty evidence). The evidence is very uncertain about the effect of opioids on pain score assessed with the PIPP/PIPP-R scale up to 30 minutes after the procedure (MD 0.14, 95% CI -0.17 to 0.45; 123 participants, 2 studies; very low-certainty evidence) or one to two hours after the procedure (MD -0.83, 95% CI -2.42 to 0.75; 54 participants, 2 studies; very low-certainty evidence). The evidence is very uncertain about the effect of opioids on episodes of bradycardia (RR 3.19, 95% CI 0.14 to 72.69; 172 participants, 3 studies; very low-certainty evidence). Opioids may result in an increase in episodes of apnea compared to placebo (RR 3.15, 95% CI 1.08 to 9.16; 199 participants, 3 studies; low-certainty evidence): with one study reporting a concerning increase in severe apnea (RR 7.44, 95% CI 0.42 to 132.95; 31 participants, 1 study; very low-certainty). The evidence is very uncertain about the effect of opioids on episodes of hypotension (RR not estimable, risk difference 0.00, 95% CI -0.06 to 0.06; 88 participants, 2 studies; very low-certainty evidence). No studies reported parent satisfaction with care provided in the neonatal intensive care unit (NICU). Opioids compared to non-pharmacological intervention The evidence is very uncertain about the effect of opioids on pain score assessed with the Crying Requires oxygen Increased vital signs Expression Sleep (CRIES) scale during the procedure when compared to facilitated tucking (MD -4.62, 95% CI -6.38 to -2.86; 100 participants, 1 study; very low-certainty evidence) or sensorial stimulation (MD 0.32, 95% CI -1.13 to 1.77; 100 participants, 1 study; very low-certainty evidence). The other main outcomes were not reported. Opioids compared to other analgesics or sedatives The evidence is very uncertain about the effect of opioids on pain score assessed with the PIPP/PIPP-R during the procedure (MD -0.29, 95% CI -1.58 to 1.01; 124 participants, 2 studies; very low-certainty evidence); up to 30 minutes after the procedure (MD -1.10, 95% CI -2.82 to 0.62; 12 participants, 1 study; very low-certainty evidence); and one to two hours after the procedure (MD -0.17, 95% CI -2.22 to 1.88; 12 participants, 1 study; very low-certainty evidence). No studies reported any harms. The evidence is very uncertain about the effect of opioids on episodes of apnea during (RR 3.27, 95% CI 0.85 to 12.58; 124 participants, 2 studies; very low-certainty evidence) and after the procedure (RR 2.71, 95% CI 0.11 to 64.96; 124 participants, 2 studies; very low-certainty evidence) and on hypotension (RR 1.34, 95% CI 0.32 to 5.59; 204 participants, 3 studies; very low-certainty evidence). The other main outcomes were not reported. We identified no studies comparing different opioids (e.g. morphine versus fentanyl) or different routes for administration of the same opioid (e.g. morphine enterally versus morphine intravenously).

AUTHORS' CONCLUSIONS: Compared to placebo, opioids probably reduce pain score assessed with PIPP/PIPP-R scale during the procedure; may reduce NIPS during the procedure; and may result in little to no difference in DAN one to two hours after the procedure. The evidence is very uncertain about the effect of opioids on pain assessed with other pain scores or at different time points. The evidence is very uncertain about the effect of opioids on episodes of bradycardia, hypotension or severe apnea. Opioids may result in an increase in episodes of apnea. No studies reported parent satisfaction with care provided in the NICU. The evidence is very uncertain about the effect of opioids on any outcome when compared to non-pharmacological interventions or to other analgesics. We identified no studies comparing opioids to other opioids or comparing different routes of administration of the same opioid.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
National Category
Pediatrics
Identifiers
urn:nbn:se:oru:diva-106569 (URN)10.1002/14651858.CD015056.pub3 (DOI)37350685 (PubMedID)2-s2.0-85151702708 (Scopus ID)
Available from: 2023-06-26 Created: 2023-06-26 Last updated: 2023-06-28Bibliographically approved
Carlsen Misic, M., Olsson, E., Eriksson, M., Ericson, J. & Ullsten, A. (2023). Parents to new-born infants rated parent-delivered pain management as significantly meaningful during venepuncture. In: Örebro University's Nobel Day Festivities: Book of Abstracts. Paper presented at Nobel Day Festivites.
Open this publication in new window or tab >>Parents to new-born infants rated parent-delivered pain management as significantly meaningful during venepuncture
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2023 (English)In: Örebro University's Nobel Day Festivities: Book of Abstracts, 2023Conference paper, Poster (with or without abstract) (Refereed)
Abstract [en]

Background/Objective: Parents express great readiness to actively deliver comfort for their infant during painful procedures. Previous research shows evidence for the efficacy of skin-to-skin contact and breastfeeding, preferably in combination. Live parental lullaby singing combined with skin-to-skin contact and breastfeeding has not previously been investigated during painful procedures. Parents as pain management in Swedish neonatal care (SWEpap), is a cutting-edge interdisciplinary multi-center study with mixed methods. The randomized controlled trial investigates the efficacy of combined parent-delivered pain management compared with standard care during routine blood sampling of healthy newborn infants.

Method: The aim of this analysis was to investigate how meaningful the parents experienced providing procedural pain management to their newborn infant in the three treatment groups; standard care with glucose, skin-to-skin contact, or a combination of skin-to-skin contact, breastfeeding (if applicable) and live parental lullaby singing. The parents rated the meaningfulness of the various conditions on a 100 mm visual analogue scale (VAS) from “not meaningful” on the left end point, up to “most possible meaningful” on the right end point of the scale. The parents were also asked to comment on how they experienced providing pain management.

Result: A total number of 151 newborn infants with at least one parent, participated in this analysis. The mean VAS-ratings for meaningfulness were 82.1 for standard care with glucose, 89.5 for skin-to-skin contact, and 88.9 for combined interventions with live parental lullaby singing, breastfeeding and skin-to-skin contact. The ratings for parent-delivered pain-alleviation were significantly higher than for standard care (p=0.036). Parents in all groups expressed that it was meaningful to provide pain-relief and participate in the pain management of their newborn infant.

Conclusion: Parents found it meaningful to provide parent-delivered pain-alleviating interventions with skin-to-skin contact, breastfeeding and live parental lullaby singing during painful procedures in postnatal care. The parents stated that they will continue using these methods in future painful situations.

Keywords
Newborn Infant, Pain
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-110074 (URN)978-91-87789-92-2 (ISBN)
Conference
Nobel Day Festivites
Projects
SWEpap
Available from: 2023-12-06 Created: 2023-12-06 Last updated: 2023-12-13Bibliographically approved
Pessano, S., Romantsik, O., Olsson, E., Hedayati, E. & Bruschettini, M. (2023). Pharmacological interventions for the management of pain and discomfort during lumbar puncture in newborn infants. Cochrane Database of Systematic Reviews (9), Article ID CD015594.
Open this publication in new window or tab >>Pharmacological interventions for the management of pain and discomfort during lumbar puncture in newborn infants
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2023 (English)In: Cochrane Database of Systematic Reviews, ISSN 1469-493X, E-ISSN 1469-493X, no 9, article id CD015594Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Lumbar puncture (LP) is a common invasive procedure, most frequently performed to diagnose infection. Physicians perform LP in newborn infants with the help of an assistant using a strict aseptic technique; it is important to monitor the infant during all the steps of the procedure. Without adequate analgesia, LP can cause considerable pain and discomfort. As newborns have increased sensitivity to pain, it is crucial to adequately manage the procedural pain of LP in this population.

OBJECTIVES: To assess the benefits and harms, including pain, discomfort, and success rate, of any pharmacological intervention during lumbar puncture in newborn infants, compared to placebo, no intervention, non-pharmacological interventions, or other pharmacological interventions.

SEARCH METHODS: We searched CENTRAL, PubMed, Embase, and three trial registries in December 2022. We also screened the reference lists of included studies and related systematic reviews for studies not identified by the database searches.

SELECTION CRITERIA: We included randomized controlled trials (RCTs) and quasi-RCTs comparing drugs used for pain management, sedation, or both, during LP. We considered the following drugs suitable for inclusion. • Topical anesthetics (e.g. eutectic mixture of local anesthetics [EMLA], lidocaine) • Opioids (e.g. morphine, fentanyl) • Alpha-2 agonists (e.g. clonidine, dexmedetomidine) • N-Methyl-D-aspartate (NMDA) receptor antagonists (e.g. ketamine) • Other analgesics (e.g. paracetamol) • Sedatives (e.g. benzodiazepines such as midazolam)

DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. We used the fixed-effect model with risk ratio (RR) for dichotomous data and mean difference (MD) or standardized mean difference (SMD) for continuous data, with their 95% confidence intervals (CIs). Our main outcomes were successful LP on first attempt, total number of LP attempts, episodes of bradycardia, pain assessed with validated scales, episodes of desaturation, number of episodes of apnea, and number of infants with one or more episodes of apnea. We used the GRADE approach to evaluate the certainty of the evidence.

MAIN RESULTS: We included three studies (two RCTs and one quasi-RCT) that enrolled 206 newborns. One study included only term infants. All studies assessed topical treatment versus placebo or no intervention. The topical anesthetics were lidocaine 4%, lidocaine 1%, and EMLA. We identified no completed studies on opioids, non-steroidal anti-inflammatory drugs, alpha-2 agonists, NMDA receptor antagonists, other analgesics, sedatives, or head-to-head comparisons (drug A versus drug B). Based on very low-certainty evidence from one quasi-RCT of 100 LPs in 76 infants, we are unsure if topical anesthetics (lidocaine), compared to no anesthesia, has an effect on the following outcomes. • Successful LP on first attempt (first-attempts success in 48% of LPs in the lidocaine group and 42% of LPs in the control group) • Number of attempts per LP (mean 1.9 attempts, [standard error of the mean 0.2] in the lidocaine group, and mean 2.1 attempts [standard error of the mean 2.1] in the control group) • Episodes of bradycardia (0% of LPs in the lidocaine group and 4% of LPs in the control group) • Episodes of desaturation (0% of LPs in the lidocaine group and 8% of LPs in the control group) • Occurrence of apnea (RR 3.24, 95% CI 0.14 to 77.79; risk difference [RD] 0.02, 95% CI -0.03 to 0.08). Topical anesthetics compared to placebo may reduce pain assessed with the Neonatal Facial Coding System (NFCS) score (SMD -1.00 standard deviation (SD), 95% CI -1.47 to -0.53; I² = 98%; 2 RCTs, 112 infants; low-certainty evidence). No studies in this comparison reported total number of episodes of apnea. We identified three ongoing studies, which will assess the effects of EMLA, lidocaine, and fentanyl. Three studies are awaiting classification.

AUTHORS' CONCLUSIONS: The evidence is very uncertain about the effect of topical anesthetics (lidocaine) compared to no anesthesia on successful lumbar puncture on first attempt, the number of attempts per lumbar puncture, episodes of bradycardia, episodes of desaturation, and occurrence of apnea. Compared to placebo, topical anesthetics (lidocaine or EMLA) may reduce pain assessed with the NFCS score. One ongoing study will assess the effects of systemic treatment.

Place, publisher, year, edition, pages
John Wiley & Sons, 2023
National Category
Anesthesiology and Intensive Care
Identifiers
urn:nbn:se:oru:diva-108657 (URN)10.1002/14651858.CD015594.pub2 (DOI)001121806100019 ()37767875 (PubMedID)2-s2.0-85173936154 (Scopus ID)
Available from: 2023-10-02 Created: 2023-10-02 Last updated: 2024-01-23Bibliographically approved
Carlsen Misic, M., Ullsten, A., Olsson, E., Andersen, R. D., Ericson, J., Eriksson, M. & Thernström Blomqvist, Y. (2022). Balancing power by including parents as co-researchers: Live parental singing, breastfeeding, skin-to-skin-contact as procedural support in Swedish neonatal pain care. In: : . Paper presented at The 12th European Music Therapy Conference, Edinburgh, Scotland,[DIGITAL] June 8-12, 2022.
Open this publication in new window or tab >>Balancing power by including parents as co-researchers: Live parental singing, breastfeeding, skin-to-skin-contact as procedural support in Swedish neonatal pain care
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2022 (English)Conference paper, Oral presentation with published abstract (Refereed)
Abstract [en]

Frequent and inadequately treated pain combined with separation from the parent cause adverse interruptions to the parent-infant attachment process. The pain might harm the infant physically and psychologically including increasing the risk for abnormally heightened sensitivity to pain. Effective pain management strategies are needed and parent-delivered interventions such as infant-directed lullaby singing, breastfeeding and skin-to-skin contact where parents themselves mediate pain relief, is consistent with a modern understanding of pain and of family-integrated care. Important for translating research into practice is to involve healthcare professionals and parents as co-researchers. Neonatal pain research is an interdisciplinary field where music therapy has just started to publish results. The Nordic neonatal music therapy pain management strategy provides a theoretical and practical resource-oriented music therapy model of how parent-delivered infant-directed singing can be comprehensively used in interdisciplinary neonatal pain research. Parents as pain management in Swedish neonatal care (SWEpap), is a new cutting-edge interdisciplinary multi-centre clinical study with mixed methods. The collaborative participatory action research design for the qualitative part of the SWEpap study aims to democratise the research process involving both parents and health professionals in the knowledge-making. The second part of SWEpap is a randomised controlled trial informed by music therapy expertise and research using the Nordic neonatal music therapy pain management strategy as a theoretical framework for its design. The RCT will investigate the efficacy of combined pain management with live parental lullaby singing, breastfeeding and skin-to-skin contact compared with standard pain care during routine metabolic screening of newborn infants.

National Category
Pediatrics Nursing
Identifiers
urn:nbn:se:oru:diva-100680 (URN)
Conference
The 12th European Music Therapy Conference, Edinburgh, Scotland,[DIGITAL] June 8-12, 2022
Available from: 2022-08-16 Created: 2022-08-16 Last updated: 2022-08-19Bibliographically approved
Bruschettini, M., Olsson, E., Persad, E., Garratt, A. & Soll, R. (2022). Clinical rating scales for assessing pain in newborn infants. The Cochrane Library, 2022(3), Article ID MR000064.
Open this publication in new window or tab >>Clinical rating scales for assessing pain in newborn infants
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2022 (English)In: The Cochrane Library, E-ISSN 1465-1858, Vol. 2022, no 3, article id MR000064Article, review/survey (Refereed) Published
Abstract [en]

Objectives: This is a protocol for a Cochrane Review (methodology). The objectives are as follows:. To systematically review the current literature describing the development, content, and measurement properties of clinical rating scales for the assessment of pain in newborn infants. Copyright © 2022 The Cochrane Collaboration.

Place, publisher, year, edition, pages
John Wiley & Sons, 2022
National Category
Pediatrics
Identifiers
urn:nbn:se:oru:diva-110528 (URN)10.1002/14651858.MR000064 (DOI)2-s2.0-85126693139 (Scopus ID)
Available from: 2023-12-21 Created: 2023-12-21 Last updated: 2024-01-16Bibliographically approved
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