Background & Aims
Sick term newborn and preterm babies may spend their first weeks of life in neonatal care where they experience a median of 75 necessary tissue-breaking procedures in the first two weeks alone.¹ Repeated pain during the rapid brain development occurring in the perinatal period is associated with long-term consequences, such as difficulties in memory and motor coordination²?³ and altered sensitivity to pain.? However, pain management is inconsistent because it is related to how the caregiver perceives the procedure??? rather than on established pain ratings. Adequate assessment, monitoring and pain management therefore requires a standard solution to quantify the severity of each intervention. To address this, we have already devised an evidence-based pain severity scale of the most common procedures in neonatal care.? The aim of the current project is to disseminate these results to staff and families in neonatal units.
Methods
The dissemination of estimated procedural pain and its management has two phases. The initial phase involved designing an infographic and an explanatory video guide. The message was developed iteratively following successive rounds of anonymised, informal feedback. A convenience sample of 11 parents, 14 neonatal nurses and midwifery assistants, and the communications team at a Level-III neonatal unit commented on usefulness, legibility, design, and aesthetics. Respondents identified potential accessible infographic display areas in the neonatal wards. In the second phase, we will pilot the use of the infographic in the same unit. We will then recruit neonatal staff and parent champions across 13 regional neonatal care delivery networks in the United Kingdom to disseminate the infographic to their local units and parent advisory groups. Champions will report back qualitative evaluation of the dissemination.
Results
The infographic was developed after 15 iterations and is now publicly available on the Pain in Childhood’s online resource page, a Special Interest Group of the International Association for the Study of Pain. Our key message on neuroprotection is ‘‘Prepare-Support-Protect’’. It refers to a traffic light colour chart ranking procedural severity with recommendations for pain mitigation??¹² to protect baby’s developing brain. Respondents identified key areas for displaying the infographic. Parents preferred areas that allow time for reading such as at the cotside or on doors to nursery rooms and breastmilk expressing areas. Neonatal staff identified areas accessed by multiple staff, including nursing stations and treatment rooms. Some staff identified busy halls of postnatal wards to be inappropriate as it may contribute to information overload for new parents. Initial pilot in dissemination of the infographic is currently being planned in the same Level-III neonatal unit.
Conclusions
Dissemination and development of an infographic is a collaborative effort. The infographic’s design improved with each iteration and feedback from diverse viewpoints. The next step is to evaluate the success of engagement and dissemination to frontline staff, parents, and the wider public.
References
1.Carbajal R, Rousset A, Danan C, et al. Epidemiology and treatment of painful
procedures in neonates in intensive care units. JAMA. 2008;300(1):60-70.
doi:10.1001/jama.300.1.60
2.Duerden EG, Grunau RE, Guo T, et al. Early Procedural Pain Is Associated with
Regionally-Specific Alterations in Thalamic Development in Preterm
Neonates. J Neurosci. 2018;38(4):878-886. doi:10.1523/JNEUROSCI.0867-17.2017
3.Chau CMY, Ranger M, Bichin M, et al. Hippocampus, Amygdala, and Thalamus
Volumes in Very Preterm Children at 8 Years: Neonatal Pain and Genetic
Variation. Front Behav Neurosci. 2019;13:51. Published 2019 Mar 19.
doi:10.3389/fnbeh.2019.00051
4.Walker SM, Melbourne A, O’Reilly H, et al. Somatosensory function and pain in
extremely preterm young adults from the UK EPICure cohort: sex-dependent
differences and impact of neonatal surgery. Br J Anaesth. 2018;121(3):623-635.
doi:10.1016/j.bja.2018.03.035
5.De Clifford Faugère G, Aita M, Feeley N, Colson S. Nurses’ Perception of
Preterm Infants’ Pain and the Factors of Their Pain Assessment and
Management. J Perinat Neonatal Nurs. 2022;36(3):312-326.
doi:10.1097/JPN.0000000000000676
6.Akuma AO, Jordan S. Pain management in neonates: a survey of nurses and
doctors. J Adv Nurs. 2012;68(6):1288-1301. doi:10.1111/j.1365-2648.2011.05837.x
7.Laudiano-Dray MP, Pillai Riddell R, Jones L, et al. Quantification of neonatal
procedural pain severity: a platform for estimating total pain burden in
individual infants. Pain. 2020;161(6):1270-1277.
doi:10.1097/j.pain.0000000000001814
8.Barrington K. Premedication for endotracheal intubation in the newborn
infant. Paediatr Child Health. 2011;16(3):159-171. doi:10.1093/pch/16.3.159
9.Johnston C, Campbell-Yeo M, Disher T, et al. Skin-to-skin care for procedural
pain in neonates. Cochrane Database Syst Rev. 2017;2(2):CD008435. Published
2017 Feb 16. doi:10.1002/14651858.CD008435.pub3
10.Pillai Riddell RR, Bucsea O, Shiff I, et al. Non-pharmacological management of
infant and young child procedural pain. Cochrane Database Syst Rev.
2023;6(6):CD006275. Published 2023 Jun 14.
doi:10.1002/14651858.CD006275.pub4
11.Shen Q, Huang Z, Leng H, Luo X, Zheng X. Efficacy and safety of non-
pharmacological interventions for neonatal pain: an overview of systematic
reviews. BMJ Open. 2022;12(9):e062296. Published 2022 Sep 28. doi:10.1136/bmjopen-2022-062296
12.Yamada J, Bueno M, Santos L, Haliburton S, Campbell-Yeo M, Stevens B. Sucrose analgesia for
heel-lance procedures in neonates. Cochrane Database Syst Rev. 2023;8(8):CD014806. Published
2023 Aug 30. doi:10.1002/14651858.CD014806
Presenting Author
Maria Pureza Laudiano-Dray
Poster Authors
Maria Laudiano-Dray
BSc
UCL
Lead Author
Dr Judith Meek
PhD
Neonatal Unit, Elizabeth Garrett Anderson Wing, University College London Hopital NHS Trust
Lead Author
Dr Lorenzo Fabrizi
PhD
Department of Neuroscience, Physiology and Pharmacology, University College London
Lead Author
Topics
- Patient Engagement and Co-Creation in Research and Education