To Örebro University

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.

PURPOSE: Acquired brain injuries (ABI) have a profound impact on both individuals and their families, making psychosocial support a crucial component of neurorehabilitation. Understanding this support is essential for enhancing the services provided by healthcare social workers (HSWs). This study aimed to explore the experiences of individuals with ABI and their next of kin regarding psychosocial support, with a particular focus on the support received from HSWs.

METHOD: A total of 33 interviews were conducted, 23 with individuals with ABI and 10 with next of kin. Data were analyzed using qualitative content analysis.

RESULTS: Participants with ABI and their next of kin valued the support provided by HSWs in addressing challenges related to medical, emotional, financial, and social needs. The importance of informational support-such as explanations of the medical condition and treatment options-was emphasized, alongside instrumental support that helped individuals navigate complex welfare systems.

CONCLUSIONS: While counselling and crisis management are essential, the informational and practical support provided by HSWs should not be regarded as secondary. The need for support varies significantly-both between individuals and over time-highlighting the importance of tailoring interventions to each person's unique circumstances in order to achieve truly person-centered care.

Background/Objective: Protecting infants’ vulnerable brain during repeated painful procedures like blood-sampling and immunizations in early life is a top priority in neonatal health care. Use of parent-delivered pain management may safeguard the infant brain but at the brain level, it is still unclear what drives the analgesic effect ofparent-led interventions such as skin-to-skin contact, breastfeeding, and the parent’s live singing. The objective of this study is to advance our understanding of the synchronous neural mechanisms behind parent-led pain management in newborn pain care.

Method: Twenty mother-infant dyads will be studied during a planned blood sampling venepuncture, with skin-to-skin contact, breastfeeding and mother’s live singing. The potential interbrain synchronous cerebral activation in cortical regions of interest will be registered using functional Near-Infrared Spectroscopy (fNIRS) hyperscanning.Secondly, registration of skin conductance, heart rate variability, and the mother’s gaze will  be registered. Social and music interactions will be studied with microanalysis.

Result: Participant recruitment is ongoing.

Conclusion: Despite a growing body of evidence supporting parent-led pain management, health care professionals still don’t prioritize parent involvement in infants’ pain care. The results from this fNIRS hyperscanning project will hopefully advance both theoretical understanding and clinical practice in neonatal pain management and improve the parents’ possibilities to protect their infant’s brain from pain during the many painful procedures early in a child’s life.

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.

Acquired brain injury (ABI) is a life-changing experience for the individuals and their close relatives. Psychosocial support is critical in helping individuals adapt to and cope with the new conditions following a brain injury. However, knowledge about the different components of psychosocial support and their impact on people with acquired brain injury is limited. The aim of this interview study is to develop knowledge about important aspects of psychosocial support in the Swedish health care system by exploring the experiences and perceptions of people with ABI and their close relatives. Participants were aged 18 years and older, and had met with a hospital social worker at least twice. Semi structured interviews were conducted with twenty-three individuals with acquired brain injury and ten interviews with close relatives. The interviews were analyzed using qualitative content analysis. Preliminary findings indicate the importance of person-centered psychosocial support at different stages of brain injury rehabilitation. Participants share a wide range of experiences of accessing and shaping of the psychosocial support. Participants in this study experience a need for hospital social workers who know the common characteristics of having an ABI, but who are also interested in the person on a personal level. The participants is in need of psychosocial support with different designs, especially crisis support, supportive counselling, counselling for the close relatives, information and some practical help. Preliminary findings also indicate a need of a distinct way to access psychosocial support when needed.