Till Örebro universitet

Purpose This study aims to analyze global prescribing patterns for analgosedation in neonates during four critical care scenarios. The research explores existing patterns, their association with geographic and sociodemographic index (SDI), and adherence to evidence-based practices.

Methods Data from a 2024 global survey of 924 responses to 28 questions were analyzed, focusing on four items for their high variability: premedication in intubation (Q17), sedation in preterm (Q19) and full-term newborns (Q23), and perinatal asphyxia (Q26). Latent class analysis (LCA) classified neonatal intensive care unit (NICU) prescriptions into patterns, assigning participants to the most likely class. Demographic variables, including geographic region and SDI, were compared using chi-square tests to assess associations.

Results Three distinct prescribing patterns emerged for each scenario. In premedication during intubation, Europe and North America predominantly used Class 1, adhering to guidelines with fentanyl, atropine, and muscle relaxants. In contrast, Class 2, standard in Asia and Latin America-Caribbean, primarily utilized fentanyl and midazolam, with rare use of atropine and muscle relaxants. For analgosedation in newborns, higher-SDI NICUs favored fentanyl, while lower-SDI NICUs preferred midazolam or morphine combinations. In perinatal asphyxia cases, fentanyl was the leading choice in Class 3, especially in Europe. Dexmedetomidine use was limited, primarily appearing in Class 1 NICUs. 

Conclusion The study highlights substantial regional variability in neonatal analgosedation, influenced by SDI and geography. Despite established guidelines, gaps in evidence-based implementation persist. These findings underscore the need for global standardization of neonatal care protocols and further research on the long-term safety of midazolam and dexmedetomidine. 

Background/ObjectiveHospitalized neonates are subjected to a high number of painful procedures every day. Cumulative poorly treated pain can have negative consequences on short and long-term outcomes, negative effects that are further amplified by infant-maternal separation. Research has shown that parents want to be part of their hospitalized infants pain management and that it is safe and effective. Yet, the implementation of parent-led pain management in neonatal care is sub-optimal. The overall aim of the project is to expand parent-led neonatal pain management, resulting in less infant pain and potentially better neonatal health outcomes, along with improved parent mental health and well-being.

Method The project is carried out by an international research group with researchers and parent representatives from Canada, Finland, Italy and Sweden, and will follow the British Research Council’s framework for complex interventions. It is organized into four work packages (WPs): Theory and concept (WP1), Identifying the problem (WP2), Developing an instrument and algorithm for self-audit (WP3), and Intervention and implementation (WP4). Principles for patient-public involvement will also be followed, with parent representatives involved in planning and designing the project and when applicable in data collection and publication of results.

ResultAn international team consisting of clinicians, researchers and parent partners across four countries have commenced initial work from WP1: writing a position paper, performing a literature review, and conducting an analysis of the concept of parent-led pain management.

ConclusionThe POP-project builds on the contribution of parents, researchers and clinicians and has the potential to improve implementation of parent-led pain management for neonates world-wide.

Background Parents are a valuable but underutilizedresource in neonatal pain management. Involving parentshave shown to be efficient for pain relieving and combiningseveral parent-delivered methods could increase the effect.

Aim The aim of this study was to investigate the pain-relieving effects of parent-delivered pain managementcombining skin to skin contact (SSC), breastfeeding, andlive parental lullaby singing compared with SSC alone andwith standard care using oral glucose in healthy newborninfants.

Material and method Multicenter randomizedcontrolled trial with three parallel groups during routineblood sampling in postnatal care. Parent-infant dyads(n=225) were recruited from three health care regions inSweden and randomized to one of the three groups; 1 –standard care with oral glucose, 2- SSC 3 – a combinationof SSC, breastfeeding (if applicable) and live parentallullaby singing. Primary outcome was pain expressionassessed with Premature infant pain profile –Revised(PIPP-R), secondary outcomes were skin conductance andparents’ evaluation of pain, stress and meaningfulness.

Results Median PIPP-R was 5 (IQR 3–6) for group 1, 7(5–9) for group 2, and 7 (5–10) for group 3 (p < 0.001).There were no significant differences in skin conductance.Parents’ VAS-assessment (Figure 1) of infant pain rangedfrom a median of 9.5 to 17 mm, significantly higher ingroups 2 and 3 (p = 0.017). The parents rated their ownstress as low 4.5 - 6.5 mm and very high formeaningfulness 93 - 96 mm.

Conclusion This was the first large RCT to evaluate combined parent-delivered painmanagement including parents’ live singing. Pain scores remained within the mild to moderate range across all groups, with the infants receiving oral glucose having significantly lower pain scores. The results indicated that involving parents leads to low stress and high sense of meaningfulness. Combined parent-delivered pain management is feasible and safe.

Background

Engaging parents in parent-delivered pain relief in routine postnatal care is aligned with evidence-informed infant pain care and should be encouraged. This is part two of the mixed-methods SWEpap research project investigating combined parent-delivered pain management. Skin-to-skin contact (SSC) and breastfeeding are among the most studied parental pain-relieving interventions and are often combined for better effects. Live parental lullaby singing has not previously been investigated in combination with SSC and breastfeeding during painful procedures. This study investigated the efficacy of combined parent-delivered pain management versus standard care with oral glucose in healthy newborn infants during routine venipuncture.

Methods

This was a multicenter randomized controlled trial with three parallel groups. Parent–infant dyads (n= 225) were recruited from three healthcare regions in Sweden and randomized to one of the following three groups during routine venipuncture: 1) standard care with glucose; 2) SSC with parent; and 3) combination of SSC, breastfeeding (if applicable), and parents’ live singing. The primary outcome was pain expression assessed using Premature Infant Pain Profile—Revised (PIPP-R); the secondary outcomes were galvanic skin response (GSR) and parents’ evaluations of pain, stress, and meaningfulness using a visual analogue scale (VAS).

Results

The median PIPP-R was 5 (IQR 3–6) for group 1, 7 (5–9) for group 2, and 7 (5–10) for group 3 (p< 0.001). There were no significant differences in GSR. Parents’ VAS-assessment of infant pain ranged from a median of 9.5 to 17 mm, significantly higher in groups 2 and 3 (p= 0.017). The parents rated their own stress 4.5 - 6.5 (n.s.) and meaningfulness 93 - 96 (n.s.).

Conclusion

Pain scores remained within the mild to moderate range across all groups, with the infants receiving oral glucose having significantly lower pain scores. This was the first study combining SSC, breastfeeding, and parents’ live lullaby singing, and more research is needed to optimize parent-delivered pain management. Parent-delivered pain management combining SSC, breastfeeding, and parents’ live lullaby singing is a feasible and safe intervention with potential pain alleviating properties offering the parents a strong sense of meaningfulness and stress relief.

Needle procedures are one of the most common reasons for children to visit hospitals. If unaddressed, negative needle experiences can worsen over time and lead to needle noncompliance, needle fears, and healthcare avoidance. This mixed methods pilot study tested the effect of combined music therapy and standard pharmacological care compared to standard care alone on fear and discomfort in children in connection to a scheduled needle procedure. Children and their parents were also interviewed on their general experience of music therapy and how they regulated fear and discomfort during needle procedures while participating in music therapy. Thirty children aged 0 to 15 and their parents were recruited at the pediatric outpatient unit at The Central Hospital in Karlstad, Sweden. The participants were randomized to an intervention group with music therapy and to a control group that received standard care alone. The children rated their fear and discomfort before, during and after a needle procedure on a child-friendly visual analogue scale. The children and parents who were randomized to the music therapy condition were interviewed about their experiences of music therapy as procedural support. No significant differences between the intervention group and the group with standard care alone were found, indicating that the two groups were equivalent with regard to experienced fear and discomfort. The content analysis of the interviews indicated that the children and their parents considered that the music therapy intervention promoted the participants’ emotion regulation, promoted adaptive coping strategies for both children and the parents, and favorably but also ambivalently affected the context and interactions in the procedural room.

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.

Introduction: Research related to parent-led neonatal pain management is increasing, as is the clinical implementation. Skin-to-skin contact, breastfeeding and parents’ vocalizations are examples of pain reducing methods that give parents an opportunity to protect their infant from harm while alleviating their anxiety and developing their parenting skills.

Methods: In this paper we will provide a narrative review and describe the current research about parent-led neonatal pain management. Based on this we will discuss clinical challenges, implementation strategies and implications for future research.

Results: Parents express great readiness to embrace opportunities to increase their self-efficacy in their ability to address infant pain. Parent-led pain- reducing methods are effective, feasible, cost-effective, culturally sensitive, and can be individualized and tailored to both the parent’s and infant’s needs. Both barriers and facilitators of parent-led pain care have been studied in research highlighting structural, organizational, educational, and intra- and interpersonal aspects. For example, health care professionals’ attitudes and beliefs on parent-led methods, and their concern that parental presence during a procedure increases staff anxiety. On the other hand, the presence of a local pain champion whose duty is to facilitate the adoption of pain control measures and actively promote parent-professional collaboration, is crucial for culture change in neonatal pain management and nurses have a key role in this change. The knowledge-to-practice gap in parent-led management of infants’ procedure-related pain highlight the need for broader educational applications and collaborative professional, parental and research initiatives to facilitate practice change.

Conclusion: Parent-led neonatal pain management is more than simply a humane and compassionate thing to do. The inclusion of parent-led pain care has been scientifically proven to be one of the most effective ways to reduce pain associated with repeated painful procedures in early life and parents report a desire to participate. Focus on enablers across interprofessional, organizational and structural levels and implementation of recommended pediatric pain guidelines can support the provision of optimal evidence-based family-centered neonatal pain management.