Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy.
Institute for Maternal and Child Health-IRCCS "Burlo Garofolo," Trieste, Italy
Pediatrics. 2018 Sep;142(3). doi: 10.1542/peds.2017-3416.
We studied neonatal cortical brain response to 4 types of nonpharmacological analgesia (oral glucose, expressed breast milk, maternal holding plus oral glucose, breastfeeding). We aimed to assess the differential effect of oral solutions (glucose, breast milk) given alone or combined with the maternal-infant relationship (holding, breastfeeding).
Eighty healthy term newborns undergoing a heel stick were randomly assigned to 4 parallel groups of 20 infants each: group 1, infants received a glucose solution on a changing table; group 2, infants received expressed breast milk on a changing table; group 3, infants received a glucose solution in their mothers' arms; and group 4, infants were breastfed by their mothers. Cortical activation in parietal, temporal, and frontal cortices was assessed by multichannel near-infrared spectroscopy. Pain expression was also evaluated.
Oral glucose alone or combined with maternal holding was associated with no cortical activation during heel stick. Expressed breast milk was associated with localized bilateral activation of somatosensory and motor cortices ( < .01). Breastfeeding was associated with extensive bilateral activation of somatomotor, somatosensory, and right parietal cortices ( < .01). Pain expression was lower with the maternal-infant relationship ( = .007).
Oral glucose, either alone or combined with maternal holding, appears to block or weaken cortical pain processing. Breast milk alone is associated with localized cortical activation. Breastfeeding is associated with extensive activation and may act by extending cortical processing. Maternal relationship, both combined with oral glucose and in breastfeeding, shows the greatest analgesic effect, although the neural patterns involved are distributed differently.
我们研究了新生儿皮质脑对 4 种非药物性镇痛方法（口服葡萄糖、母乳、母亲抱持加口服葡萄糖、母乳喂养）的反应。我们旨在评估单独给予口服溶液（葡萄糖、母乳）或结合母婴关系（抱持、母乳喂养）的差异效应。
80 例健康足月新生儿接受足跟采血，随机分为 4 个平行组，每组 20 例：组 1，婴儿在换尿布台上接受葡萄糖溶液；组 2，婴儿在换尿布台上接受母乳；组 3，婴儿在母亲的手臂中接受葡萄糖溶液；组 4，婴儿由母亲母乳喂养。通过多通道近红外光谱仪评估顶叶、颞叶和额叶皮质的皮质激活。还评估了疼痛表达。
足跟采血时，单独口服葡萄糖或与母亲抱持结合使用与皮质无激活相关。母乳与局部双侧感觉运动皮质激活相关（<0.01）。母乳喂养与广泛的双侧运动感觉和右侧顶叶皮质激活相关（<0.01）。与母婴关系相关时，疼痛表达较低（=0.007）。
单独口服葡萄糖或与母亲抱持结合使用，似乎会阻断或减弱皮质疼痛处理。单独的母乳与局部皮质激活相关。母乳喂养与广泛的激活相关，可能通过扩展皮质处理来发挥作用。母亲关系，无论是与口服葡萄糖结合还是在母乳喂养中，都显示出最大的镇痛效果，尽管涉及的神经模式分布不同。
