Pain Assessment among African Neonates
American Journal of Pediatrics
Volume 2, Issue 2, March 2016, Pages: 4-9
Received: Aug. 11, 2016; Accepted: Aug. 29, 2016; Published: Oct. 11, 2016
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Desire Aime Nshimirimana, Department of Health Systems Management, School of Medicine & Health Sciences, Kenya Methodist University, Nairobi, Kenya
Donald Kokonya, Department of Mental Health, School of Medicine, Masinde Muliro University of Science & Technology, Kakamega, Kenya
Jeanne Marie Claude Uwurukundo, Department of Pediatrics & Neonatology, School of Medicine, National University of Rwanda, Butare, Rwanda
Phocas Biraboneye, Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya
Fred Were, Department of Paediatrics & Child Health, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
Cyprien Baribwira, Department of Pediatrics & Neonatology, School of Medicine, National University of Rwanda, Butare, Rwanda
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Neonates who require treatment and venous drawing of blood samples in the newborn units are subjected to acute and painfully invasive procedures. Several tools to assess pain among newborns have been developed and are widely used in developed countries, but in Africa, there is limited experience in the assessment pain among newborns. This study assessed physiological and behavioral responses to pain among neonates during invasive procedures performed in a newborn unit in Rwanda. A total of 60 neonates born at gestational age of 28-42 weeks at the National University of Rwanda Teaching and Referral Hospital in the year 2005 were enrolled into this study. Blood pressures, heart and respiratory rates, oxygen saturation levels, the Neonatal Facing Coding System (NFCS) and Neonatal Acute Pain (APN) pain tools were and scores recorded before, immediately and 5, 10, 15 and 20 minutes after procedures were recorded. Physiological parameters were compared using the Wilcoxon Signed Ranks Test while the NFCS and APN were compared using the McNemar Test. All (100%) neonates experienced acutely peak pain in the first 5 minutes of the invasive procedures with peak responses recorded at 2.5 minutes and no pain (resolution) after 15 minutes among 81% of the neonates and only 6% experienced pain after 20 minutes. The increases in systolic blood pressures immediately after inflicting pain, 5, 10, 15 and 20 minutes were statistically significant (p<0.001, p<0.001, p<0.005 and p<0.046) respectively compared to the diastolic blood pressures whose significant increases were at 5 and 10 minutes, (p<0.001 and p<0.001) respectively. Respiratory rates were significantly high at the onset (p<0.001), 5 minutes (p<0.001) and 10 minutes later (p<0.002). Heart rates significantly increased at the onset of the procedures (p<0.000), 5 minutes (p<0.001) and after 10 minutes (p<0.033). Decrease in oxygen saturation immediately after the procedures was significant (p<0.001). Oxygen saturation immediately after the procedures significantly increased up to 5 minutes (p<0.001) and 10 minutes (p<0.001). Invasive procedures caused acute pain among neonates in the African settings but to date, neonatal practice had not been given its due consideration with the aim of reducing pain among African neonates.
Pain, Assessment, Neonates, Physiological, APN, NFCS, Africa
To cite this article
Desire Aime Nshimirimana, Donald Kokonya, Jeanne Marie Claude Uwurukundo, Phocas Biraboneye, Fred Were, Cyprien Baribwira, Pain Assessment among African Neonates, American Journal of Pediatrics. Vol. 2, No. 2, 2016, pp. 4-9. doi: 10.11648/j.ajp.20160202.11
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McGrath PJ and Unruh AM. The Social Context of Neonatal Pain. Clinical Perinatology. 2002; 29 (3): 555-72.
Australian and New Zealand College of Anesthetists. Acute Pain Management: Scientific Evidence. National Health and Medical Research Council. Australian Government. Second Edition 2005.
Prevention and Management of Pain in the Neonate: An Update. American Academy of Paediatrics, Committee on Fetus and Newborn and Section on Surgery, Section on Anesthesiology and Pain Medicine, Canadian Paediatric Society and Fetus and Newborn Committee. Paediatrics 2006; 118; 2231-41.
Szymanski B. A comparative Study of Preterm Infant Pain Tools. During a Common NICU Procedure. Master’s and Doctoral Projects. Paper 40. 2005 Medical college of Ohio.
Cignacco E, Mueller R, Hamers J P H and Gessler P. Pain assessment in the neonate using the Bernese Pain Scale for Neonates Early Hum Dev. 2004; 78 (2): 125-31.
Mathew J P and Mathew L J. Assessment and management of pain in infants. Postgraduate Medical Journal, 2003; 79: 438–443.
National Health and Medical Research Council. Acute Pain Management: Scientific Evidence. Commonwealth of Australia 1999. November, 1998.
Stevens BJ, editor. Pain in neonates and infants: pain research and clinical management series. Elsevier; 2007.
Debillon T, Zupan V, Ravault N, Magny J-F and Dehan M. Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. BMJ Arch Dis Child Fetal Neonatal Ed 2001; 85: F36–F41.
Pitetti D R. Do No Harm but First Do Not Hurt. CMAJ • JUNE 21, 2005; 172 (13) Warnock F and Sandrin D. Comprehensive description of newborn distress behavior in response to acute pain. 2004 Feb; 107 (3): 242-55.
Gharavi, b, Schott, c, Nelle, m., Reiter, g. and Linderkamp, o. Pain management and the effect of guidelines in neonatal units in Austria, Germany and Switzerland. Pediatrics International 2007, 49: 652–658.
Lago, p., Guadagni, a., Merazzi, d., Ancora, g., Bellieni, c. v., Cavazza, a. and the pain study group of the italian society of neonatology, Pain management in the neonatal intensive care unit: a national survey in Italy. Pediatric Anesthesia 2005, 15: 925–931.
FitzGerald M. Developmental Biology of Inflammatory Pain. British Journal of Anesthesia 1995; 75: 177-185.
Bellieni C V, Bagnoli F and Buonocore G. Alone No More: Pain in Premature Children. Ethics& Medicine 2003, 19: 1: 5-10.
Riddell P R and Craig D K. Judgments of Infant Pain: The Impact of Caregiver Identity and Infant Age. J Pediatr Psychol. 2007 Jun; 32 (5): 501-11.
Carbajal R, Veerapen S, Couderc S, Jugie M and Ville Y. Analgesic effect of breast feeding in term neonates: randomised controlled trial. Bmj 2003 volume 326 4.
MARCEAU J. Pilot study of a pain assessment tool in the Neonatal Intensive Care Unit. J. Paediatr. Child Health (2003) 39, 598–601.
Gordon et al. American Pain Society Recommendations for Improving the Quality of Acute and Cancer Pain Management: American Pain Society Quality of Care Task Force. Arch Intern Med. 2005; 165 (14): 1574-1580.
Anand KJ, Barton BA, McIntosh N, Lagercrantz H, Pelausa E, Young T E… and Vasa R. Analgesia and sedation in preterm neonates who require ventilatory support: results from the NOPAIN trial. Neonatal Outcome and Prolonged Analgesia in Neonates. Arch Pediatr Adolesc Med 1999 Apr: 153 (4): 331-8. Arkansas.
Koot M H, Grunau E R, Tibboel D, Peters B W J, de Boer J, van Druenen J M, and Duivenvoorden J H. Neonatal Facial Coding System for assessing postoperative pain in infants: item reduction is valid and feasible. The clinical journal of pain. 2003; 19: 353–363.
Taksande Amar M, Vilhekar KY, Jain M, Chitre D. Pain response of neonates to venipuncture, The Indian Journal of Paediatrics, 2005, 72 (9): 751-753.
Cochran, W. G. (1977). Sampling techniques (3rd ed.). New York: John Wiley & Sons.
Carbajal R, Paupe A, Hoenn E, Lenclen R, Olivier-Martin M. APN: evaluation behavioral scale of acute pain in newborn infants (APN). Arch Pediatr. 1997 Jul; 4 (7): 623-8.
Peters JW, Koot HM, Grunau RE, de Boer J, van Druenen MJ, Tibboel D, Duivenvoorden HJ. Neonatal Facial Coding System for assessing postoperative pain in infants: item reduction is valid and feasible. Clin J Pain. 2003 Nov-Dec; 19 (6): 353-63.
Guinsburg R, de Araujo PC, Branco de Almeida MF. et al. Differences in pain expression between male and female newborn infants. Pain. 2000, 85 (1-2): 127-33.
Pereira, Andrea Lübe de S Thiago et al. Validity of behavioral and physiologic parameters for acute pain assessment of term newborn infants. Sao Paulo Med. J., 1999, 117 (2): 72-80.
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