Torrecárdenas University Hospital. Paediatric Intensive Care Unit. Almería, Spain.
Torrecárdenas University Hospital, Pediatrics Department, Almeria, Spain.
Pain Manag Nurs. 2021 Dec;22(6):798-805. doi: 10.1016/j.pmn.2021.05.008. Epub 2021 Jun 30.
Current research suggests a need to implement environmental, behavioral, and even nutritional interventions, with the objective of improving the comfort and stability of preterm newborn infants, as well as reducing their stress and pain levels. Several studies have used the salivary reactivity of cortisol to assess stress or pain in preterm infants. The aim of this study was to analyze the results of published randomized controlled trials that tested the effects of nonpharmacological interventions on cortisol as a treatment for heel lance pain/stress in preterm infants.
Published randomized controlled trials (RCTs) were searched in PubMed, Embase, CINHAL, Web of Science Cochrane Library, and Cochrane Database of Systematic Reviews, and six studies met the eligibility criteria. The quality of the included studies was appraised using Cochrane's Collaboration tool.
The meta-analysis showed that non-pharmacological interventions were associated with a reduction in levels of salivary cortisol in comparison with other interventions and controls, with fixed effect mean differences of -0.11, and with a 95% C.I. of -0.28 to -0.05. Prone-nest position, breast milk odor, kangaroo care, and twins co-bedding led to a decrease in cortisol levels in saliva.
Future studies should be performed on nonpainful interventions in order to gain more knowledge about the regulation of cortisol in saliva in preterm infants with involving control group and larger sample sizes.
目前的研究表明，需要实施环境、行为，甚至营养干预措施，以提高早产儿的舒适度和稳定性，降低他们的压力和疼痛水平。一些研究使用唾液皮质醇反应来评估早产儿的压力或疼痛。本研究旨在分析已发表的随机对照试验的结果，这些试验测试了非药物干预措施对皮质醇的影响，以治疗早产儿足跟采血疼痛/压力。
在 PubMed、Embase、CINHAL、Web of Science Cochrane Library 和 Cochrane 系统评价数据库中搜索已发表的随机对照试验（RCT），符合纳入标准的有 6 项研究。使用 Cochrane 协作工具评估纳入研究的质量。
荟萃分析表明，与其他干预措施和对照组相比，非药物干预措施与唾液皮质醇水平降低相关，固定效应平均差异为-0.11，95%置信区间为-0.28 至-0.05。俯卧位、母乳气味、袋鼠护理和双胞胎同床都导致唾液皮质醇水平下降。
未来应该进行非疼痛干预的研究，以便更多地了解涉及对照组和更大样本量的早产儿唾液皮质醇调节。
