Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Evaluation of prolonged pain in preterm infants with pneumothorax using heart rate variability analysis and EDIN (Échelle Douleur Inconfort Nouveau-Né, neonatal pain and discomfort scale) scores

  • Buyuktiryaki, Mehmet (Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital) ;
  • Uras, Nurdan (Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital) ;
  • Okur, Nilufer (Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital) ;
  • Oncel, Mehmet Yekta (Division of Neonatology, Department of Pediatrics, Katip Celebi University) ;
  • Simsek, Gulsum Kadioglu (Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital) ;
  • Isik, Sehribanu Ozluer (Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital) ;
  • Oguz, Serife Suna (Division of Neonatology, Zekai Tahir Burak Maternity Teaching Hospital)
  • Received : 2017.08.18
  • Accepted : 2018.07.16
  • Published : 2018.10.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: The EDIN scale (${\acute{E}}chelle$ Douleur Inconfort Nouveau-$N{\acute{e}}$, neonatal pain and discomfort scale) and heart rate variability has been used for the evaluation of prolonged pain. The aim of our study was to assess the value of the newborn infant parasympathetic evaluation (NIPE) index and EDIN scale for the evaluation of prolonged pain in preterm infants with chest tube placement due to pneumothorax. Methods: This prospective observational study assessed prolonged pain in preterm infants with a gestational age between 33 and 35 weeks undergoing installation of chest tubes. Prolonged pain was assessed using the EDIN scale and NIPE index. Results: There was a significant correlation between the EDIN scale and NIPE index (r=-0.590, P=0.003). Prolonged pain is significantly more severe in the first 6 hours following chest tube installation (NIPE index: 60 [50-86] vs. 68 [45-89], P<0.002; EDIN score: 8 [7-11] vs. 6 [4-8], P<0.001). Conclusion: Prolonged pain can be accurately assessed with the EDIN scale and NIPE index. However, evaluation with the EDIN scale is time-consuming. The NIPE index can provide instantaneous assessment of prolonged and continuous pain.

Keywords

References

  1. Hall RW, Anand KJ. Physiology of pain and stress in the newborn. NeoReviews 2005;2:e61-8.
  2. Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA 2008;300:60-70. https://doi.org/10.1001/jama.300.1.60
  3. Apkarian AV, Baliki MN, Geha PY. Towards a theory of chronic pain. Prog Neurobiol 2009;87:81-97. https://doi.org/10.1016/j.pneurobio.2008.09.018
  4. van Ganzewinkel CJ, Anand KJ, Kramer BW, Andriessen P. Chronic pain in the newborn: toward a definition. Clin J Pain 2014;30:970-7. https://doi.org/10.1097/AJP.0000000000000056
  5. Debillon T, Zupan V, Ravault N, Magny JF, Dehan M. Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001;85:F36-41. https://doi.org/10.1136/fn.85.1.F36
  6. Hummel P, Puchalski M, Creech SD, Weiss MG. Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain. J Perinatol 2008;28:55-60. https://doi.org/10.1038/sj.jp.7211861
  7. van Dijk M, Roofthooft DW, Anand KJ, Guldemond F, de Graaf J, Simons S, et al. Taking up the challenge of measuring prolonged pain in (premature) neonates: the COMFORTneo scale seems promising. Clin J Pain 2009;25:607-16. https://doi.org/10.1097/AJP.0b013e3181a5b52a
  8. Walter-Nicolet E, Annequin D, Biran V, Mitanchez D, Tourniaire B. Pain management in newborns: from prevention to treatment. Paediatr Drugs 2010;12:353-65. https://doi.org/10.2165/11318900-000000000-00000
  9. Lidow MS. Long-term effects of neonatal pain on nociceptive systems. Pain 2002;99:377-83. https://doi.org/10.1016/S0304-3959(02)00258-0
  10. Grunau RE, Holsti L, Peters JW. Long-term consequences of pain in human neonates. Semin Fetal Neonatal Med 2006;11:268-75. https://doi.org/10.1016/j.siny.2006.02.007
  11. Committee on Fetus and Newborn and Section on Anesthesiology and Pain Medicine. Prevention and management of procedural pain in the neonate: an update. Pediatrics 2016;137:e20154271. https://doi.org/10.1542/peds.2015-4271
  12. Butruille L, Jonckheere JD, Marcilly R, Boog C, Bras da Costa S, Rakza T, et al. Development of a pain monitoring device focused on newborn infant applications: The Neo Doloris Project. IRBM 2015;36:80-5. https://doi.org/10.1016/j.irbm.2015.01.005
  13. De Jonckheere J, Rakza T, Logier R, Jeanne M, Jounwaz R, Storme L. Heart rate variability analysis for newborn infants prolonged pain assessment. Conf Proc IEEE Eng Med Biol Soc 2011;2011:7747-50.
  14. Schaffer L, Burkhardt T, Muller-Vizentini D, Rauh M, Tomaske M, Mieth RA, et al. Cardiac autonomic balance in small-for-gestationalage neonates. Am J Physiol Heart Circ Physiol 2008;294:H884-90. https://doi.org/10.1152/ajpheart.00318.2007
  15. Faye PM, De Jonckheere J, Logier R, Kuissi E, Jeanne M, Rakza T, et al. Newborn infant pain assessment using heart rate variability analysis. Clin J Pain 2010;26:777-82. https://doi.org/10.1097/AJP.0b013e3181ed1058
  16. Ancora G, Mastrocola M, Bagnara C, Zola D, Pierantoni L, Rossi G, et al. Influence of gestational age on the EDIN score: an observational study. Arch Dis Child Fetal Neonatal Ed 2009;94:F35-8.
  17. Ancora G, Lago P, Garetti E, Pirelli A, Merazzi D, Mastrocola M, et al. Efficacy and safety of continuous infusion of fentanyl for pain control in preterm newborns on mechanical ventilation. J Pediatr 2013;163:645-51.e1. https://doi.org/10.1016/j.jpeds.2013.02.039
  18. Oberlander TF, Grunau RE, Pitfield S, Whitfield MF, Saul JP. The developmental character of cardiac autonomic responses to an acute noxious event in 4- and 8-month-old healthy infants. Pediatr Res 1999;45(4 Pt 1):519-25. https://doi.org/10.1203/00006450-199904010-00011
  19. Benarroch EE. Pain-autonomic interactions. Neurol Sci 2006;27 Suppl 2:S130-3. https://doi.org/10.1007/s10072-006-0587-x
  20. Parati G, Mancia G, Di Rienzo M, Castiglioni P. Point: cardiovascular variability is/is not an index of autonomic control of circulation. J Appl Physiol (1985) 2006;101:676-8. https://doi.org/10.1152/japplphysiol.00446.2006
  21. Smith SL, Lux R, Haley S, Slater H, Beachy J, Moyer-Mileur LJ. The effect of massage on heart rate variability in preterm infants. J Perinatol 2013;33:59-64. https://doi.org/10.1038/jp.2012.47
  22. Cong X, Ludington-Hoe SM, McCain G, Fu P. Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: pilot study. Early Hum Dev 2009;85:561-7. https://doi.org/10.1016/j.earlhumdev.2009.05.012

Cited by

  1. Heart Rate Variability in the Perinatal Period: A Critical and Conceptual Review vol.14, pp.None, 2018, https://doi.org/10.3389/fnins.2020.561186
  2. Available Instruments to Assess Pain in Infants vol.22, pp.10, 2018, https://doi.org/10.1542/neo.22-10-e644
  3. Neonatal heart rate variability: a contemporary scoping review of analysis methods and clinical applications vol.11, pp.12, 2018, https://doi.org/10.1136/bmjopen-2021-055209