Stress response and procedural pain in the preterm newborn: the role of pharmacological and non-pharmacological treatments.
Repeated invasive procedures occur routinely in neonates who require intensive care, causing pain at a time when it is developmentally unexpected. Multiple lines of evidence suggest that repeated and prolonged pain exposure alters their subsequent pain processing, long-term development, and behaviour. Primary outcome of this study was to evaluate the reduction of procedural pain induced by "heel-lances" in preterm newborns with three different treatment [administration of fentanyl (FE, 1-2 μg/kg), facilitated tucking (FT), sensorial saturation (SS)]. Secondary outcome was the measurement of the levels of cytokines as markers of stress correlated to pain. A prospective randomized controlled trial (RCT) comparing three different pharmacological or non-pharmacological treatments was performed involving 150 preterm newborn (gestational age 27-32 weeks). No other analgesic treatment was performed during the study. CRIES score was used to evaluate the procedural pain. The results showed that the reduction in the pain score was greater in FE and SS groups than FS group. The differences were statistically significant (p < 0.01). The levels of IL-6, IL-8, and TNF-α were higher in the FT individuals than in the FE or SS-treated infants at 1 day (p < 0.01), at 3 days (p < 0.01), and at 7 days (p < 0.01) of life.


CONCLUSIONS
The findings of this study suggest that FE and SS provide a superior analgesia in preterm neonates during procedural pain. In particular, sensorial saturation seems to be an important non-pharmacological alternative treatment to prevent and reduce the procedural pain in preterm newborn.
Neonatal Intensive Care Unit, Department of Pediatrics, University of Messina, Via Consolare Valeria, CAP 98100, Messina, Italy. egitto@unime.it
Eloisa
E
Gitto
Salvatore
S
Pellegrino
Maria
M
Manfrida
Salvatore
S
Aversa
Giuseppe
G
Trimarchi
Ignazio
I
Barberi
Russel J
RJ
Reiter
D000701:Analgesics, Opioid / Q000494:pharmacology / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001800:Blood Specimen Collection / Q000009:adverse effects; D060867:Facilitated Tucking; D005260:Female; D005283:Fentanyl / Q000494:pharmacology / Q000627:therapeutic use*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007275:Injections, Intravenous; D015850:Interleukin-6 / Q000097:blood; D016209:Interleukin-8 / Q000097:blood; D008297:Male; D010146:Pain / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010812:Physical Stimulation; D011446:Prospective Studies; D013312:Stress, Physiological / Q000187:drug effects; D016896:Treatment Outcome; D014409:Tumor Necrosis Factor-alpha / Q000097:blood
D000701:Analgesics, Opioid; D015415:Biomarkers; D015850:Interleukin-6; D016209:Interleukin-8; D014409:Tumor Necrosis Factor-alpha; D005283:Fentanyl