Paediatric & neonatal pain最新文献

{"title":"Objective Detection of Newborn Infant Acute Procedural Pain Using EEG and Machine Learning Algorithms.","authors":"Jean-Michel Roué, Amir Avnit, Behnood Gholami, Wassim M Haddad, Kanwaljeet J S Anand","doi":"10.1002/pne2.70001","DOIUrl":"10.1002/pne2.70001","url":null,"abstract":"<p><p>Observer-dependent infant pain scales have limitations including discontinuous assessments and the lack of healthcare professionals' availability. We hypothesized that applying agnostic machine learning approaches to neonatal electroencephalographic (EEG) analysis may reveal features of the infant response to acute pain. EEG was recorded from 30 neonates undergoing acutely painful procedures (18 males, 34.0-41.7 weeks gestation at birth). EEG recordings were randomly assigned to training (<i>n</i> = 20) and testing (<i>n</i> = 10) datasets. Functional connectivity measures were calculated for each infant before and after pain-inducing procedures. A grid search including five machine learning models was conducted on the training dataset, and each model was evaluated using leave-one-subject-out cross-validation. An optimal model, having the highest F-1 score, was obtained and evaluated on the independent testing dataset. A gradient boosting model with 12 features showed optimal performance, with 90% area under the receiver operating characteristic curve suggesting high specificity (0.90) and precision (0.90). The five highest ranked features corresponded to EEG electrode pairs: T7-P4, Fz-CP5, FC1-TP10, CP6-Cz, and Fz-F3, suggesting involvement of the contralateral temporal gyrus, opercular cortex, thalamus, and bilateral insula in infant pain processing. Preliminary changes in functional connectivity indicate infant pain processing. Future machine learning algorithms can integrate physiological and behavioral parameters with EEG changes to accurately assess the complexity of infant pain responses. <b>Trial Registration:</b> ClinicalTrials.gov identifier: NCT03330496.</p>","PeriodicalId":94166,"journal":{"name":"Paediatric & neonatal pain","volume":"7 1","pages":"e70001"},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891568/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improved Post-Operative Outcomes and Reduced Narcotic Use With ERAS Protocol in a Pediatric Ambulatory Surgery Setting.","authors":"Niharika Singh, Jane Ahn, Xin Chen, Sherwin Park, Sunitha Singh, Stefanie Cardamone, Rachel Davis, Helen Hsieh, Robert P Moore","doi":"10.1002/pne2.70004","DOIUrl":"10.1002/pne2.70004","url":null,"abstract":"<p><p>Compared to the adult literature, there are few enhanced recovery after surgery (ERAS) protocols standardized in the pediatric population. The objective of the current study is to determine if the implementation of an ERAS protocol would improve patient outcomes in the ambulatory pediatric urologic population. A retrospective analysis was performed on pediatric patients who underwent urologic procedures (circumcision, orchiopexy, hypospadias correction, and urethroplasty) in the ambulatory surgical setting affiliated with a tertiary pediatric hospital. Outcomes measured include opioid use, home pain control, time in recovery, need for rescue pain medications, and adverse events between pediatric patients receiving standard of care (<i>n</i> = 30) and pediatric patients receiving the ERAS protocol (<i>n</i> = 29). The application of the ERAS pathway led to significantly increased opioid-free care (7% vs. 43%, <i>p</i> < 0.01). There was a reduction in the cost of care, a trend toward reduced opioid use, a trend toward reduced PACU stays for ERAS patients, and families of ERAS patients reported a 100% rate of well-controlled pain at home. These changes occurred without any increased need for rescue pain medications (16% vs. 13%, <i>p</i> = 1) or any change in adverse events (0% vs. 0%, <i>p</i> = 1.0). Postoperative pain measures are improved in pediatric patients receiving the ERAS protocol in an ambulatory surgery setting when compared to patients receiving the standard of care, without an increased risk of adverse events or the need for rescue analgesia. Therefore, this work serves as a proof of concept that ERAS protocols can improve postoperative outcomes in the pediatric ambulatory surgical population.</p>","PeriodicalId":94166,"journal":{"name":"Paediatric & neonatal pain","volume":"7 1","pages":"e70004"},"PeriodicalIF":0.0,"publicationDate":"2025-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11891489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring children's preferences for graphic symbols to represent pain-related words.","authors":"Ensa Johnson, Nina Swanepoel, Gunilla Thunberg","doi":"10.1002/pne2.12128","DOIUrl":"10.1002/pne2.12128","url":null,"abstract":"<p><p>Children who are hospitalized may sometimes not be able to communicate verbally to self-report their pain or other symptoms due to medical conditions, medical interventions, or communication difficulties. As such, these children may need other means, such as augmentative and alternative communication (AAC) strategies, in this case, graphic symbols, to express their pain-related experiences and receive applicable treatment. Choosing suitable graphic symbols to represent pain-related words contributes to the effective use and implementation of visual support. This study explored the preferences of 6.0-9.11-year-old (years; months) children with typical development regarding graphic symbols to represent pain-related words. These symbols were selected from two commonly used and widespread symbol resources: Picture Communication Symbols (PCS®) and Aragonese Portal of Augmentative and Alternative Communication (ARASAAC) symbols. A descriptive, quantitative study design was employed, including a total of 30 typically developed South African children. Data were collected by means of an electronic questionnaire and analyzed using descriptive and inferential statistics. Probability values were determined and predictions, as well as inferences, were implemented. The results showed that the children preferred ARASAAC symbols to represent most pain-related words (<i>p</i> < 0.001). It is important to consider stakeholders' (in this case, children's) input on their preferences in designing communication support to enable participation during the clinical decision-making process.</p>","PeriodicalId":94166,"journal":{"name":"Paediatric & neonatal pain","volume":"6 4","pages":"174-193"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831532","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prolonged magnesium sulfate infusion as adjuvant analgesia in postoperative transplant patients in the pediatric ICU: Preliminary results of a feasibility study.","authors":"Joseph C Resch, Shelby Graf, Ranad Ghalban, Srinath Chinnakotla, Gwenyth Fischer","doi":"10.1002/pne2.12131","DOIUrl":"10.1002/pne2.12131","url":null,"abstract":"<p><p>The opioid crisis has emphasized identification of opioid-sparing analgesics. This study was designed as a prospective trial with retrospective control group to determine feasibility for implementing a high-dose prolonged magnesium sulfate infusion for adjuvant analgesia in the pediatric intensive care unit. Approval was granted for study of children receiving total pancreatectomy with islet cell autotransplantation and liver transplantation ages 3-18 years. Study exclusions were pregnancy, neuromuscular disease, hypersensitivity, preoperative creatinine >1.5 times upper limit normal, arrhythmia or pacemaker presence, and clinician concern. Eleven patients were enrolled between January 2020 and December 2022. Magnesium sulfate bolus (50 mg/kg) followed by intravenous infusion (15 mg/kg/h) was initiated in the operating room and extended postoperatively (maximum 48 h). Serum magnesium levels were monitored serially. To prioritize safety, infusion dose was decreased by 5 mg/kg/h for levels greater than 3.5 mg/dL. Clinical team otherwise followed standard multimodal pain practice. Primary outcome was oral morphine equivalent per kg per day during intensive care course (maximum 7 days). Secondary outcomes focused primarily on magnesium safety, including hemodynamic variables, electrolyte variables, respiratory support, and opioid-related side effects. There were no serious adverse events. Treatment group trended toward slightly higher intravenous fluid requirement (~1 bolus), however no increase in blood product. Treatment and control groups were otherwise comparable in targeted outcomes and overall adverse event profile. Use of a high-dose magnesium sulfate infusion protocol for analgesic postoperative use in select transplant recipients appears feasible for continued optimization of study in the PICU.</p>","PeriodicalId":94166,"journal":{"name":"Paediatric & neonatal pain","volume":"6 4","pages":"203-212"},"PeriodicalIF":0.0,"publicationDate":"2024-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645970/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831533","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prompt again: How consistently useful are artificial intelligence chatbot responses when prompted with concerns about the reality of paediatric chronic pain?","authors":"Joshua W Pate, Rebecca Fechner, Scott D Tagliaferri, Hayley Leake, Bruno Saragiotto","doi":"10.1002/pne2.12129","DOIUrl":"10.1002/pne2.12129","url":null,"abstract":"","PeriodicalId":94166,"journal":{"name":"Paediatric & neonatal pain","volume":"6 4","pages":"111-163"},"PeriodicalIF":0.0,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cold and vibration for children undergoing needle-related procedures: A non-inferiority randomized clinical trial.","authors":"Ariane Ballard, Christelle Khadra, Olivier Fortin, Estelle Guingo, Evelyne D Trottier, Benoit Bailey, Naveen Poonai, Sylvie Le May","doi":"10.1002/pne2.12125","DOIUrl":"10.1002/pne2.12125","url":null,"abstract":"<p><p>The use of a rapid, easy-to-use intervention could improve needle-related procedural pain management practices in the context of the Emergency Department (ED). As such, the Buzzy device seems to be a promising alternative to topical anesthetics. The aim of this study was to determine if a cold vibrating device was non-inferior to a topical anesthetic cream for pain management in children undergoing needle-related procedures in the ED. In this randomized controlled non-inferiority trial, we enrolled children between 4 and 17 years presenting to the ED and requiring a needle-related procedure. Participants were randomly assigned to either the cold vibrating device or topical anesthetic (4% liposomal lidocaine; standard of care). The primary outcome was the mean difference (MD) in adjusted procedural pain intensity on the 0-10 Color Analogue Scale (CAS), using a non-inferiority margin of 0.70. A total of 352 participants were randomized (cold vibration device <i>n</i> = 176, topical anesthetic cream <i>n</i> = 176). Adjusted procedural pain scores' MD between groups was 0.56 (95% CI:-0.08-1.20) on the CAS, showing that the cold vibrating device was not considered non-inferior to topical anesthetic. The cold vibrating device was not considered non-inferior to the topical anesthetic cream for pain management in children during a needle-related procedure in the ED. As topical anesthetic creams require an application time of 30 min, cost approximately CAD $40.00 per tube, are underused in the ED setting, the cold vibrating device remains a promising alternative as it is a rapid, easy-to-use, and reusable device.</p>","PeriodicalId":94166,"journal":{"name":"Paediatric & neonatal pain","volume":"6 4","pages":"164-173"},"PeriodicalIF":0.0,"publicationDate":"2024-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11645969/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142831531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived distress due to nasopharyngeal swab collection: Correspondence.","authors":"Pathum Sookaromdee, Viroj Wiwanitkit","doi":"10.1002/pne2.12124","DOIUrl":"10.1002/pne2.12124","url":null,"abstract":"","PeriodicalId":94166,"journal":{"name":"Paediatric & neonatal pain","volume":"6 2","pages":"44"},"PeriodicalIF":0.0,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11163226/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141307719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Special issue on “Children's and adolescents' rights to participate in their pain management”","authors":"Juan Bornman, Stefan Nilsson","doi":"10.1002/pne2.12116","DOIUrl":"https://doi.org/10.1002/pne2.12116","url":null,"abstract":"The dialogues between children and adolescents and their healthcare providers are essential in managing pain in accordance with the child's interests and wishes. It can, however, be challenging to ensure that pain management is in the child's best interest due to a myriad of reasons. One of these relates to the specific communicative challenges that exist in this population, that might arise because of the child's level of development, including receptive and expressive communication skills, the particular illness and treatment (e.g., tracheotomy), distress, and/or disabilities. It is therefore unsurprising that children and adolescents are regarded as vulnerable groups in pediatric healthcare. The importance of using person-centred care has been emphasized in healthcare to facilitate the voices of children and young people and as a way in which their views can be respected. The use of person-centred care promotes the child and adolescent's narratives and emphasizes the use of shared decision-making to be the primary source of pain management decisions.1 This approach is also in line with the United Nation's Convention on the Rights of the Child,2 and specifically with Article 24 that focusses on health. Other articles of this convention also apply. For example, Article 12 highlights respect for children's views and allows them the opportunity to give their opinions freely, specifically about issues that directly affect them. In addition, Article 13 emphasizes children's right to share their thoughts freely in terms of what they learn, think, and feel and that this can be done by talking, drawing, or writing. The nexus between these two articles and person-centred care is thus clear. Likewise, Article 17, which focusses on access to information from the Internet, radio, television, newspapers, books, etcetera, is equally relevant. Article 17 also urges adults (in this case healthcare providers) to ensure that the information provided to children is not harmful and that it is in a language format that all children can understand. Previous research has demonstrated that parent's assessments of pain symptoms in children and adolescents differ from the child's and adolescent's own assessment.3 Self-reports of the evaluation of pain management should be the first choice in pediatric healthcare. However, children's rights, as described above, are not always prioritized, and healthcare provider's own measurements often guide the decision-making around children and adolescents´ pain management.4 This means that it is necessary to develop and implement new strategies that optimize shared decision-making in pediatric healthcare. In an attempt to allow children and adolescents to take on a greater role in their own pain management, new tools and interventions are required to support acute and chronic pain measurement and treatment. This special issue includes five papers that showcase and expand knowledge about children's rights in pain management. Articles","PeriodicalId":94166,"journal":{"name":"Paediatric & neonatal pain","volume":"89 23","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135091750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain communication in children with autism spectrum disorder: A scoping review","authors":"Ensa Johnson, Karen van Zijl, Ariné Kuyler","doi":"10.1002/pne2.12115","DOIUrl":"https://doi.org/10.1002/pne2.12115","url":null,"abstract":"Children with autism spectrum disorder (ASD) experience social interaction and communication challenges and often display repetitive, restricted patterns of behavior, activities, and interests. The concept of pain is regarded as one of the most complex human stressors due to its subjective and personal nature and the influences of multiple internal and external factors. Due to the complexity of this disorder, it remains concerning how children with ASD communicate their pain and how observers (i.e., parents, carers, and health care practitioners) respond to these children's pain communication. This scoping review aimed to identify how children with ASD communicate or express their pain. Ten studies met the inclusion criteria for further data extraction. Through reflexive thematic analysis, two main themes were identified: verbal and nonverbal responses used by children with ASD to communicate their pain that could influence pain assessment and management strategies. This review highlighted that children with ASD utilized various verbal and nonverbal methods to communicate their pain experiences and that these methods differed compared to children without disabilities. Furthermore, this review emphasizes the importance of holistic pain assessment strategies as well as additional pictorial support for children with ASD. This review recommends that future research should focus on understanding how the inclusion of different stakeholders in pain assessment for children with ASD, can contribute to holistic pain assessment.","PeriodicalId":94166,"journal":{"name":"Paediatric & neonatal pain","volume":"157 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135856867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cortisol levels are related to neonatal pain exposure in children born very preterm at age 18 months in two independent cohorts.","authors":"Mia A McLean, Lisa Nakajima, Cecil M Y Chau, Joanne Weinberg, Anne R Synnes, Steven P Miller, Ruth E Grunau","doi":"10.1002/pne2.12112","DOIUrl":"10.1002/pne2.12112","url":null,"abstract":"<p><p>Exposure to pain-related stress from frequent invasive procedures in the neonatal intensive care unit (NICU) has been associated with altered physiological stress regulation, neurodevelopment, and behavior in children born very preterm (≤32 weeks gestation). Previously, in a cohort born 2003-2006 (Cohort 1), we found that, at 18 months corrected age (CA), children born extremely low gestational age (ELGA; 24-28 weeks) and very low gestational age (VLGA; 29-32 weeks), had higher pre-test cortisol levels and a different pattern of cortisol output across a developmental assessment involving cognitive challenge compared to children born full-term (FT; 39-41 weeks). Also, greater neonatal pain-related stress exposure among the preterm children was related to higher pre-test cortisol levels. Given the adverse long-term effects of neonatal pain in preterm infants and the ensuing rise in clinical concerns to appropriately manage pain in the NICU in recent years, we aimed to examine whether our findings from Cohort 1 would still be evident in an independent cohort (Cohort 2) born 2006-2011 and recruited from the same tertiary NICU in Vancouver, Canada. We also compared the cortisol patterns, clinical and socio-demographic factors, and their interrelationships between the two cohorts. In Cohort 2, our findings using multi-level modeling support and extend our earlier findings in Cohort 1, demonstrating that children born ELGA display higher pre-test cortisol levels than FT. As well, greater cortisol output across assessment was related to more anxiety/depressive behaviors in children born VLGA. Importantly, children born ELGA were exposed to less neonatal pain/stress, mechanical ventilation, and morphine in Cohort 2 than Cohort 1. In both cohorts, however, cortisol levels and patterns were related to neonatal pain/stress and clinical factors (days on mechanical ventilation, overall morphine exposure). Despite less exposure to pain/stress and adverse clinical factors in Cohort 2 compared to Cohort 1, cortisol levels and patterns across cognitive challenge in preterm children at 18-month CA were consistent across the two independent cohorts. These findings highlight that, despite improvements to neonatal care, children born extremely preterm continue to display altered HPA axis activity, which is associated with their poorer neurodevelopmental and behavioral outcomes.</p>","PeriodicalId":94166,"journal":{"name":"Paediatric & neonatal pain","volume":"5 3","pages":"86-95"},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b6/bb/PNE2-5-86.PMC10514780.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41165619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}