Center for Clinical and Translational Research at Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio; Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, Ohio.
Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Pediatr Neurol. 2019 Jan;90:13-23. doi: 10.1016/j.pediatrneurol.2018.10.001. Epub 2018 Oct 10.
BACKGROUND/GOAL: Assessment and treatment of neonatal pain is difficult because current scales are rarely validated against brain-based evidence. We sought to systematically evaluate published evidence to extract validation of the most promising markers of neonatal pain.
We searched four databases using germane MeSH terms. We focused on assessments of pain and/or nociception that had at least two measures among behavioral, physiological, or cortical components in preterm and/or term neonates. We evaluated studies for quality of evidence and strength of recommendations using standardized tools.
Fifteen articles met our inclusion criteria. Among the behavioral components uncovered in this review, the withdrawal reflex and changes in facial expression are the most strongly associated with nociception-specific brain activity. These associations may be influenced by gestational age and change over time. Physiological signs, such heart rate and oxygen saturation, have little to no association with this type of response.
Current assessments of neonatal pain include behavioral components that are associated with nociceptive processing, but also other less valid components, while omitting newer measures based on neuroscientific research.
背景/目标：评估和治疗新生儿疼痛具有一定难度，因为目前的评估方法很少与基于大脑的证据相吻合。本研究旨在系统性地评估已发表的证据，以提取最有希望的新生儿疼痛标志物的验证结果。
我们使用相关的 MeSH 术语搜索了四个数据库。我们的重点是对疼痛和/或伤害感受进行评估，这些评估至少有两个指标是在早产儿和/或足月新生儿的行为、生理或皮质成分中进行的。我们使用标准化工具评估研究的证据质量和推荐强度。
共有 15 篇文章符合我们的纳入标准。在本研究中发现的行为成分中，退缩反射和面部表情变化与特定于伤害感受的大脑活动关联最密切。这些关联可能受到胎龄和时间变化的影响。生理迹象，如心率和血氧饱和度，与这种反应几乎没有关联。
目前的新生儿疼痛评估包括与伤害感受处理相关的行为成分，但也包括其他不太有效的成分，同时忽略了基于神经科学研究的新措施。
