Ferdosian Farzad, Esteghamat Reihaneh, Fallah Razieh, Shahraki Tamkin
Department of Pediatrics, Children Growth Disorder Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Student's Research Center, Shahid Beheshti University of Medical Sciences, Yazd, Iran.
Iran J Child Neurol. 2020 Winter;14(1):57-64.
Midazolam at a dosage of 0.5 mg/kg induces anxiolytic effects in 90% of children. This study was performed to elucidate whether intravenous midazolam with maternal presence is more efficient than intravenous midazolam alone in the reduction of pain and anxiety of lumbar puncture (LP) in 6 to 24-month-old children.
MATERIALS & METHODS: In this not-blinded clinical trial, we included 60 children aged 6 to 24 months old undergoing LP in the Pediatric Ward of Shahid Sadoughi Hospital, Yazd, Iran, from September 2014 to March 2015. The participants were randomly assigned to two groups, and all of them received painless injection of 0.5 mg/kg midazolam five minutes before LP. In group I, LP was performed with maternal presence and in group II, the mothers were absent. The primary outcomes included anxiety and pain scores before LP and during needle insertion to the skin for LP. The secondary outcomes comprised of success rates in the reduction of anxiety (anxiety score of four and more) and pain (pain score of less than three) when the needle was inserted to the skin for LP.
Twenty-eight girls and 32 boys were evaluated in the two groups. Maternal presence was found to be effective in the reduction of anxiety (2.7±0.65 vs. 3.83±0.87; P=0.001) and pain scores (3.8±1.75 vs. 6.1±1.63, P=0.001). In the maternal presence group, success rate in anxiety (76.7% vs. 16.6%; P=0.0001) and pain reduction (63.3 % vs. 6.7%; P=0.0001) was higher than in the midazolam alone group.
Maternal presence during lumbar puncture can reduce pain and anxiety among 6 to 24-month-old children.
0.5毫克/千克剂量的咪达唑仑可使90%的儿童产生抗焦虑作用。本研究旨在阐明在6至24个月大的儿童腰椎穿刺（LP）过程中，有母亲在场时静脉注射咪达唑仑是否比单独静脉注射咪达唑仑在减轻疼痛和焦虑方面更有效。
在这项非盲法临床试验中，我们纳入了2014年9月至2015年3月在伊朗亚兹德沙希德萨杜基医院儿科病房接受腰椎穿刺的60名6至24个月大的儿童。参与者被随机分为两组，所有儿童在腰椎穿刺前五分钟均接受了0.5毫克/千克咪达唑仑的无痛注射。第一组在母亲在场的情况下进行腰椎穿刺，第二组母亲不在场。主要结局包括腰椎穿刺前以及腰椎穿刺针插入皮肤过程中的焦虑和疼痛评分。次要结局包括在腰椎穿刺针插入皮肤时焦虑减轻（焦虑评分为4分及以上）和疼痛减轻（疼痛评分为低于3分）的成功率。
两组共评估了28名女孩和32名男孩。发现母亲在场在减轻焦虑（2.7±0.65对3.83±0.87；P = 0.001）和疼痛评分（3.8±1.75对6.1±1.63，P = 0.001）方面有效。在有母亲在场的组中，焦虑减轻成功率（76.7%对16.6%；P = 0.0001）和疼痛减轻成功率（63.3%对6.7%；P = 0.0001）高于单独使用咪达唑仑组。
腰椎穿刺过程中母亲在场可减轻6至24个月大儿童的疼痛和焦虑。
