McNair Carol, Chirinian Nevart, Uleryk Elizabeth, Stevens Bonnie, McAllister Mary, Franck Linda S, Taddio Anna, Shah Vibhuti
Division of Neonatology, The Hospital for Sick Children, Toronto, Ontario, Canada.
Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
Paediatr Child Health. 2022 Sep 26;27(8):454-463. doi: 10.1093/pch/pxac050. eCollection 2022 Dec.
Despite the availability of effective, safe, and feasible pain management strategies, infant pain remains undertreated. Parents can play a key role in advocating for or delivering pain management strategies if they are educated. To date, a quantitative synthesis of the effectiveness of parental education about pain management in the neonatal period has not been performed.
To systematically review the effectiveness of parental education during the neonatal period on pain management in infancy.
MEDLINE, EMBASE, PsycInfo, CINAHL, and the Cochrane Library were searched for relevant randomized controlled trials (RCTs) and non-randomized trials (NRTs) that evaluated parental education with respect to pain management during the neonatal period in any setting from inception to February 2021. Screening of article titles and abstracts and data extraction were performed in duplicate. The risk of bias was assessed using the Cochrane Risk Bias Tool 2.0 and the Risk of Bias in Non-randomized Studies of Interventions for RCTs and NRTs, respectively. As per the GRADE methodology, critically important and important outcomes were identified. Critically important outcomes included utilization of pain management strategies and infant pain. Important outcomes included parental knowledge about pain mitigation strategies, parental attitudes, compliance with painful procedures, procedure outcomes, and safety. Data were combined and presented as relative risk (RR) or mean or standardized mean difference (MD or SMD) with 95% confidence interval (CI).
Of the six studies eligible for inclusion, four studies were RCTs and two studies were NRTs. Written information and/or video were used to deliver parental education during the neonatal period in hospital settings in all studies. Four studies (two RCTs and two NRTs) reported on critically important outcomes. The risk of bias was low for the two RCTs and moderate to serious for the two NRTs. Utilization of pain management strategies was assessed for heel lance in the first 48 hours of life in two studies and for vaccine injection at 2 to 6 months of life in two studies. Higher utilization rate for pain management strategies was reported in the pain education group in three studies (RR 1.15, 95% CI 1.04, 1.26; N=2712). There was no difference in the mean number of pain management strategies used in one NRT tracking utilization tracking utilization as continuous data (MD 0.20, 95% CI -0.01, 0.41; N=178). Parent-reported infant pain scores were lower in the pain education group in one RCT (MD -0.16, 95% CI -0.27, -0.06; N=1615). The quality of evidence for the outcome of utilization of pain management strategies was very low while for the outcome of infant pain the quality of evidence was moderate. Five studies (3 RCTs and 2 NRTs) reported on important outcomes. The risk of bias was low for two RCTs and high for one RCT and moderate to serious for the two NRTs. Parental knowledge about pain management strategies (SMD 0.54, 95% CI 0.26, 0.82), parental confidence in their ability to manage pain (SMD 0.24, 95% CI 0.14, 0.34), parental satisfaction with education (MD 1.18, 95% CI 0.84, 1.52) and parental satisfaction with pain management (RR 1.05. 95% CI 1.01, 1.08) were increased in the pain education group. None of the included studies reported on procedural outcomes. No adverse events with the pain education nor the use of pain management interventions were reported in one study.
Parental education in the neonatal period was effective in increasing utilization of pain management strategies during painful procedures. Reduction of pain in infants is based on one study of moderate quality. Furthermore, parental education increased parental knowledge about pain management strategies, confidence in their ability to manage infant pain, and satisfaction with the education and pain management. Parental pain education should be incorporated into postnatal care.
尽管有有效、安全且可行的疼痛管理策略，但婴儿疼痛仍未得到充分治疗。如果父母接受教育，他们可以在倡导或实施疼痛管理策略方面发挥关键作用。迄今为止，尚未对新生儿期父母疼痛管理教育的有效性进行定量综合分析。
系统评价新生儿期父母教育对婴儿期疼痛管理的有效性。
检索MEDLINE、EMBASE、PsycInfo、CINAHL和Cochrane图书馆，查找从开始到2021年2月在任何环境下评估新生儿期父母疼痛管理教育的相关随机对照试验（RCT）和非随机试验（NRT）。文章标题和摘要筛选以及数据提取均重复进行。分别使用Cochrane偏倚风险工具2.0和干预性非随机研究偏倚风险工具评估RCT和NRT的偏倚风险。根据GRADE方法，确定了至关重要和重要的结局。至关重要的结局包括疼痛管理策略的使用和婴儿疼痛。重要结局包括父母对疼痛缓解策略知识、父母态度、对痛苦程序的依从性、程序结局和安全性。数据合并后以相对风险（RR）或均值或标准化均值差（MD或SMD）及95%置信区间（CI）呈现。
纳入的六项研究中，四项为RCT，两项为NRT。所有研究均在医院环境中使用书面信息和/或视频在新生儿期进行父母教育。四项研究（两项RCT和两项NRT）报告了至关重要的结局。两项RCT的偏倚风险较低，两项NRT的偏倚风险为中度至重度。两项研究评估了出生后48小时内足跟采血时疼痛管理策略的使用情况，两项研究评估了2至6个月龄疫苗接种时疼痛管理策略的使用情况。三项研究报告疼痛教育组疼痛管理策略的使用率更高（RR 1.15，95%CI 1.04，1.26；N = 2712）。一项将疼痛管理策略使用情况作为连续数据跟踪的NRT中，疼痛管理策略使用的平均数量无差异（MD 0.20，95%CI -0.01，0.41；N = 178）。一项RCT中，疼痛教育组父母报告的婴儿疼痛评分较低（MD -0.16，95%CI -0.27，-0.06；N = 1615）。疼痛管理策略使用结局的证据质量非常低，而婴儿疼痛结局的证据质量为中等。五项研究（三项RCT和两项NRT）报告了重要结局。两项RCT的偏倚风险较低，一项RCT的偏倚风险较高，两项NRT的偏倚风险为中度至重度。疼痛教育组父母对疼痛管理策略的知识（SMD 0.54，95%CI 0.26，0.82）、对管理疼痛能力的信心（SMD 0.24，95%CI 0.14，0.34）、对教育的满意度（MD 1.18，95%CI 0.84，1.52）和对疼痛管理的满意度（RR 1.05，95%CI 1.01，1.08）均有所提高。纳入的研究均未报告程序结局。一项研究未报告疼痛教育及疼痛管理干预使用中的不良事件。
新生儿期父母教育可有效提高痛苦程序中疼痛管理策略的使用率。基于一项中等质量的研究，婴儿疼痛有所减轻。此外，父母教育增加了父母对疼痛管理策略的知识、对管理婴儿疼痛能力的信心以及对教育和疼痛管理的满意度。应将父母疼痛教育纳入产后护理。
