Lance M Relland, Caitlin P Kjeldsen, Arnaud Jeanvoine, Lelia Emery, Kathleen Adderley, Rachelle Srinivas, Maeve McLoughlin, Nathalie L Maitre
{"title":"基于振动的减轻新生儿和婴儿皮肤穿刺毒性诱发反应:随机对照试验。","authors":"Lance M Relland, Caitlin P Kjeldsen, Arnaud Jeanvoine, Lelia Emery, Kathleen Adderley, Rachelle Srinivas, Maeve McLoughlin, Nathalie L Maitre","doi":"10.1136/archdischild-2023-326588","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>To assess the effect of a non-noxious vibratory stimulus on noxious-evoked cortical responses to skin puncture and to determine whether the presence of certain behavioural components may be used to predict such cortical responses.</p><p><strong>Design: </strong>Randomised controlled trial.</p><p><strong>Setting: </strong>Level IV neonatal intensive care unit at a stand-alone children's hospital.</p><p><strong>Patients: </strong>134 hospitalised infants between 36 and 52 weeks' postmenstrual age and ordered to receive a clinically required laboratory draw.</p><p><strong>Interventions: </strong>Infants randomised to receive the intervention, a vibratory stimulus at the site of skin puncture beginning 10 s prior to a heel stick, or the control, no vibration.</p><p><strong>Main outcome measures: </strong>Electroencephalography and video recording time-locked to the deployment of the lancet for the skin puncture. Noxious-evoked cortical responses were measured by the area under the curve in the somatosensory region contralateral to the skin puncture. Behavioural responses were coded through video analysis.</p><p><strong>Results: </strong>Noxious-evoked cortical responses were significantly reduced in participants receiving the vibratory stimulus compared with the control (frontal, p<0.0001; central, p<i>=</i>0.0088; central-parietal, p<i>=</i>0.0111). There were no significant differences in behavioural responses between groups (all p>0.05).</p><p><strong>Conclusions: </strong>A non-noxious vibratory stimulus presented prior to and continuing simultaneously with skin puncture significantly mitigates nociception in hospitalised infants. The presence or absence of facial expression components is inadequate to reliably predict pain signalling in the brain.</p><p><strong>Trial registration number: </strong>NCT04050384.</p>","PeriodicalId":8177,"journal":{"name":"Archives of Disease in Childhood - Fetal and Neonatal Edition","volume":null,"pages":null},"PeriodicalIF":3.9000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Vibration-based mitigation of noxious-evoked responses to skin puncture in neonates and infants: a randomised controlled trial.\",\"authors\":\"Lance M Relland, Caitlin P Kjeldsen, Arnaud Jeanvoine, Lelia Emery, Kathleen Adderley, Rachelle Srinivas, Maeve McLoughlin, Nathalie L Maitre\",\"doi\":\"10.1136/archdischild-2023-326588\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>To assess the effect of a non-noxious vibratory stimulus on noxious-evoked cortical responses to skin puncture and to determine whether the presence of certain behavioural components may be used to predict such cortical responses.</p><p><strong>Design: </strong>Randomised controlled trial.</p><p><strong>Setting: </strong>Level IV neonatal intensive care unit at a stand-alone children's hospital.</p><p><strong>Patients: </strong>134 hospitalised infants between 36 and 52 weeks' postmenstrual age and ordered to receive a clinically required laboratory draw.</p><p><strong>Interventions: </strong>Infants randomised to receive the intervention, a vibratory stimulus at the site of skin puncture beginning 10 s prior to a heel stick, or the control, no vibration.</p><p><strong>Main outcome measures: </strong>Electroencephalography and video recording time-locked to the deployment of the lancet for the skin puncture. Noxious-evoked cortical responses were measured by the area under the curve in the somatosensory region contralateral to the skin puncture. Behavioural responses were coded through video analysis.</p><p><strong>Results: </strong>Noxious-evoked cortical responses were significantly reduced in participants receiving the vibratory stimulus compared with the control (frontal, p<0.0001; central, p<i>=</i>0.0088; central-parietal, p<i>=</i>0.0111). There were no significant differences in behavioural responses between groups (all p>0.05).</p><p><strong>Conclusions: </strong>A non-noxious vibratory stimulus presented prior to and continuing simultaneously with skin puncture significantly mitigates nociception in hospitalised infants. The presence or absence of facial expression components is inadequate to reliably predict pain signalling in the brain.</p><p><strong>Trial registration number: </strong>NCT04050384.</p>\",\"PeriodicalId\":8177,\"journal\":{\"name\":\"Archives of Disease in Childhood - Fetal and Neonatal Edition\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":3.9000,\"publicationDate\":\"2024-10-18\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Archives of Disease in Childhood - Fetal and Neonatal Edition\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1136/archdischild-2023-326588\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PEDIATRICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Archives of Disease in Childhood - Fetal and Neonatal Edition","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1136/archdischild-2023-326588","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PEDIATRICS","Score":null,"Total":0}
Vibration-based mitigation of noxious-evoked responses to skin puncture in neonates and infants: a randomised controlled trial.
Objective: To assess the effect of a non-noxious vibratory stimulus on noxious-evoked cortical responses to skin puncture and to determine whether the presence of certain behavioural components may be used to predict such cortical responses.
Design: Randomised controlled trial.
Setting: Level IV neonatal intensive care unit at a stand-alone children's hospital.
Patients: 134 hospitalised infants between 36 and 52 weeks' postmenstrual age and ordered to receive a clinically required laboratory draw.
Interventions: Infants randomised to receive the intervention, a vibratory stimulus at the site of skin puncture beginning 10 s prior to a heel stick, or the control, no vibration.
Main outcome measures: Electroencephalography and video recording time-locked to the deployment of the lancet for the skin puncture. Noxious-evoked cortical responses were measured by the area under the curve in the somatosensory region contralateral to the skin puncture. Behavioural responses were coded through video analysis.
Results: Noxious-evoked cortical responses were significantly reduced in participants receiving the vibratory stimulus compared with the control (frontal, p<0.0001; central, p=0.0088; central-parietal, p=0.0111). There were no significant differences in behavioural responses between groups (all p>0.05).
Conclusions: A non-noxious vibratory stimulus presented prior to and continuing simultaneously with skin puncture significantly mitigates nociception in hospitalised infants. The presence or absence of facial expression components is inadequate to reliably predict pain signalling in the brain.
期刊介绍:
Archives of Disease in Childhood is an international peer review journal that aims to keep paediatricians and others up to date with advances in the diagnosis and treatment of childhood diseases as well as advocacy issues such as child protection. It focuses on all aspects of child health and disease from the perinatal period (in the Fetal and Neonatal edition) through to adolescence. ADC includes original research reports, commentaries, reviews of clinical and policy issues, and evidence reports. Areas covered include: community child health, public health, epidemiology, acute paediatrics, advocacy, and ethics.