Original Article Evaluation of in Healthy Newborns and in Newborns with Developmental Problems (Down Syndrome)

- - - Maria Jose Aguilar Cordero, PhD,* Norma Mur Villar, PhD,† and Inmaculada Garcıa Garcıa, PhD‡

From the *Department of Nursing, - ABSTRACT: Faculty of Healthcare Science, University of Granada, Granada, Newborns are often subjected to invasive and painful medical proce- Spain, Nurse at the San Cecilio dures. This happens even more frequently when they require hospi- University Hospital of Granada, talization. The aim of this paper was to evaluate pain in healthy Spain; †University Medical of Cienfuegos, Cuba, Research Assistant newborns and in newborns with Down syndrome (DS). We performed at Research Group CTS 367, a prospective cohort study in the neonatal service of the San Cecilio Andalusian Research Plan, University Hospital in Granada (Spain) from January 2008 to Andalusian Regional Government, Spain; ‡Department of Nursing, September 2013. The universe of our study comprised a study group of Faculty of Healthcare Science, 20 newborns with DS and a control group of 20 newborns without DS. University of Granada, Granada, All of the were hospitalized, and thus had to undergo painful Spain. medical procedures. The variables studied were basal recovery time Address correspondence to Maria Jose (as reflected in crying and the normalization of biological constants), Aguilar Cordero, PhD, Universidad number of punctures, saturation, heartbeat, , de Granada, Departamento de response to skin-to-skin contact, and gestational age. The evaluation Enfermerıa, Facultad de Ciencias de la Salud, Av/ Madrid s/n - CP: was performed during blood extraction, vein canalization, and heel (18071), 18071 Granada, Spain. puncture. The significant differences in the basal recovery time be- E-mail: mariajaguilar@telefonica. tween the two groups of newborns indicated that those with DS were net slower to express pain, and when they did, their response was not as Received June 4, 2014; clearly defined as that of babies without DS. The oxygen saturation in Revised July 31, 2014; babies with DS after the puncture was found to be significantly lower Accepted August 4, 2014. than that of the control group (p < .001). The results of this study In this study, there is no conflict of revealed that babies with DS were not as quick to perceive pain after a interest concerning the financial puncture. However, when pain was finally perceived, it persisted for a support received or concerning the longer time. This situation should be taken into account in the design relationship of any of the authors. of pharmacologic and nonpharmacologic therapies. 1524-9042/$36.00 Ó 2015 by the American Society for Nursing Ó 2015 by the American Society for Pain Management Nursing http://dx.doi.org/10.1016/ j.pmn.2014.08.001

Pain Management Nursing, Vol 16, No 3 (June), 2015: pp 267-272 268 Aguilar Cordero, Mur Villar, and Garcıa Garcıa

BACKGROUND (Harrison, Evans, & Johnston, 2002; Hennequin, Faulks, & Allison, 2003). The assessment of pain in newborns is a priority for Other research measured pain by using both the health professionals. It is now known that infants feel limit method to assess reaction, and the level method. pain more intensely than individuals at other stages The results indicated that children with DS were more of life. However, because of their lack of verbalization sensitive to pain than the rest of the population and expression, it was once thought that newborns (Fitzgerald, 1995; Jessop, 2001). Nevertheless, there were less sensitive to pain. Fortunately, this has are also studies showing that increased concentrations changed, and there is now a great known about the of with activity, such as leu- neurophysiological mechanisms of neonatal pain enkephalin and dynorphin, affect children’s physiolog- (Allegaert et al., 2005; Belieni, Bagnoli, & Buonocore, ical responses and increase their pain threshold, 2003). meaning that children with DS may be less sensitive A study published in The Lancet proposed that to pain (Cua et al., 2007; Hennequin et al., 2003; impaired perception of pain in babies with Down syn- Krechel & Bildner, 1995). drome (DS) is not due to a delay in the transmission of The aim of this study was to compare pain in pain but to a cognitive deficiency. Thus, it indicates healthy newborns with babies with developmental that pain in these babies is associated with impaired problems (i.e., DS) during painful medical procedures. peripheral somatosensitive nerve function. Finally, monitored transmission showed a delay in the subjec- tive expression of pain after a painful sensory (Cehn & Fang, 2005). METHODS Currently, pain prevention is an essential part of A prospective cohort study was carried out at the neonatal care, not only for its ethical implications, neonatal care unit of the San Cecilio University Hospi- but also because of the painful stimuli that newborn tal, in Granada between January 2008 and September babies experience in pediatric units. Such painful stim- 2013. The population for the study consisted of 20 uli are accentuated in preterm and critically ill new- newborns with DS as the case group, and 20 newborns borns because they must endure numerous without DS as the control group. All the infants diagnostic and therapeutic procedures (Cehn & Fang, were hospitalized and had to experience painful 2005; Craig, 1998; Cua, Blankenship, North, Hayes, & procedures. Nelin, 2007; Delfrin, Petretz, & Carmeli, 2004; Variables, such as basal recovery time, were as- Fitzgerald & Beggs, 2001). sessed based on crying and the normalization of biolog- Infants with DS perceive pain differently than ical constants. Other variables included number of healthy infants do. In 2011, a group of researchers pre- punctures, oxygen saturation, heartbeat, blood pres- sented a scale designed to assess the behavior of 0- to 3- sure, response to skin-to-skin contact, and gestational year-old infants with DS in pain and demonstrated that age. Babies were placed near their mothers during the scale effectively evaluated distress and discomfort the puncture, and all these variables were analyzed 1 (Fitzgerald & Beggs, 2001). minute before the procedure (baseline) and 1 and 2 Endogenous opioids such as b-endorphin, en- minutes after post-puncture according to the protocol. kephalins, and dynorphins are pain-perception inhibi- Pain assessment was carried out in all babies whose tors. There are also other neurotransmitters involved parents had previously given their informed consent. in the reduction of pain perception, such as serotonin A pain rating scale was used to assess pain in term and g-aminobutiric acid (GABA) (Fonseca et al., 2008). and preterm newborns during painful medical proce- Pain perception in newborns is different from dures (Aguilar, 2012; Table 1). For the validation of pain perception in other stages of life. The difference the questionnaire, 30 experts were asked to rate the lies in its neurophysiology. Nociceptive impulses travel relevance of each item. To ascertain the degree of ade- upward through nonmyelinized paths resulting in a quacy of the scale items, we calculated the percentage relatively negative neurotransmission capacity. New- of experts who found each item to be relevant. Subse- borns may have higher concentrations of P-substance quently, the percentages obtained were added up and receptors and lower excitation and sensitization divided by the highest value, which was obtained thresholds. This would lead to higher nociceptive stim- when all items were considered relevant by all of the uli, all of which would result in a more severe pain experts. The value obtained was 0.775, which indi- sensation in infancy than in other life stages. Another cated the validity of the scale. Data processing was per- study demonstrated that children with DS are not formed with the c2 and Student’s t tests, considering as insensitive to pain, but that they express it differently significant p < .05. Download English Version: https://daneshyari.com/en/article/2679581

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