Gao Haixia, Xu Guihua, Li Fang, Lv Hui, Rong Hui, Mi Yuanyuan, Li Mei
School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.
Children's Hospital of Nanjing Medical University, Nanjing, China.
Pain. 2021 Jan;162(1):253-262. doi: 10.1097/j.pain.0000000000002015.
Repeated procedural pain may lead to increased secretion of cortisol and future neurobehavioral development disorders in preterm infants. Changes in the cortisol level may mediate the effect of neonatal repetitive procedural pain on altered childhood neurobehavioral development in preterm infants. However, few studies have investigated the effect of combined pharmacological, behavioral, and physical interventions over repeated painful procedures on pain response, cortisol level, and neurobehavioral development. This study examined (1) the efficacy and safety of sucrose combined with massage, music, non-nutritive sucking, and gentle human touch to treat preterm infants with repeated procedural pain; (2) the cortisol level at discharge from the neonatal intensive care unit (NICU); (3) neurobehavioral development at 40 weeks' corrected gestational age; and (4) the potential mediating effect of the cortisol level in the combined interventions on neurobehavioral development. Stable preterm infants (n = 76) were randomized to receive routine care or combined interventions across repeated painful procedures throughout their NICU stay. The Premature Infant Pain Profile scores in the early, middle, and late periods of the NICU stay were measured, as were the basal salivary cortisol level at admission and discharge, the Neonatal Behavioral Neurological Assessment score at 40 weeks' corrected gestational age, and the incidence of adverse effects during the study period. Our findings indicated that the combined interventions remained efficacious and safe for reducing repeated procedural pain, decreased the cortisol level at discharge, and promoted early neurobehavioral development in preterm infants. This effect may have been mediated through decreased cortisol levels and reduced repeated procedural pain.
反复的程序性疼痛可能导致早产儿皮质醇分泌增加以及未来出现神经行为发育障碍。皮质醇水平的变化可能介导新生儿反复程序性疼痛对早产儿儿童期神经行为发育改变的影响。然而，很少有研究调查联合药物、行为和物理干预对反复疼痛程序的影响，包括疼痛反应、皮质醇水平和神经行为发育。本研究考察了：（1）蔗糖联合按摩、音乐、非营养性吸吮和轻柔的人际接触治疗反复经历程序性疼痛的早产儿的有效性和安全性；（2）新生儿重症监护病房（NICU）出院时的皮质醇水平；（3）矫正胎龄40周时的神经行为发育情况；（4）联合干预中皮质醇水平对神经行为发育的潜在中介作用。稳定的早产儿（n = 76）被随机分为两组，在其NICU住院期间，一组接受常规护理，另一组接受针对反复疼痛程序的联合干预。测量了NICU住院早期、中期和晚期的早产儿疼痛量表评分，以及入院和出院时的基础唾液皮质醇水平、矫正胎龄40周时的新生儿行为神经评估评分，以及研究期间的不良反应发生率。我们的研究结果表明，联合干预对于减轻反复的程序性疼痛仍然有效且安全，降低了出院时的皮质醇水平，并促进了早产儿早期神经行为发育。这种效果可能是通过降低皮质醇水平和减少反复的程序性疼痛介导的。
