Fulkoski Nick, Kecskes Zsuzsoka, Chaudhari Tejasvi
College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia.
Department of Neonatology, Centenary Hospital for Women and Children, Canberra, Australian Capital Territory, Australia.
J Paediatr Child Health. 2023 Mar;59(3):542-547. doi: 10.1111/jpc.16352. Epub 2023 Jan 29.
This study aims to characterise current pain management practices in extremely preterm infants (gestational age less than or equal to 28 weeks) admitted to neonatal intensive care unit (NICU).
Retrospective audit pertaining to patient characteristics, as well as minor painful procedures (MPP), pain mitigation and pain scoring in 25 extremely preterm infants admitted to a tertiary NICU in 2016 over the first 14 days of NICU admission. Opportunities to bundle MPP were identified according to pre-specified criteria. Bayley Scales of Infant Development, Third Edition (BSID-III) cognitive, language and motor composite scores were available from the neurodevelopmental follow-up clinic at 12- and 24-months of corrected age. Linear mixed methods regression was used to examine for correlation between increased exposure to MPP and BSID-III scores at follow-up.
Extremely preterm infants underwent an average of 11.24 ± 4.12 MPP per day for the first 14 days of NICU admission. Opportunities to bundle MPP were missed 75.98% (408/537) of the time; most of these were invasive blood collections. A total of 12.2% (481/3933) of MPP occurred within 4 h of pharmacological or non-pharmacological pain mitigation. BSID-III motor composite score was associated with an 11.75 (95% confidence interval 1.99, 21.27) decrease in patients experiencing more than or equal to the third quartile of MPP in the 14 days post-NICU admission (P = 0.0329, n = 42). Association was not found for BSID-III cognitive and language composite scores.
There is readily scope for quality improvement initiatives to reduce harm in extremely preterm infants admitted to NICU.
本研究旨在描述入住新生儿重症监护病房（NICU）的极早产儿（胎龄小于或等于28周）当前的疼痛管理实践情况。
对2016年入住一家三级NICU的25例极早产儿在NICU住院的前14天内的患者特征、轻微疼痛操作（MPP）、疼痛缓解及疼痛评分进行回顾性审计。根据预先设定的标准确定捆绑MPP的机会。在矫正年龄12个月和24个月时，可从神经发育随访门诊获得贝利婴幼儿发育量表第三版（BSID-III）的认知、语言和运动综合评分。采用线性混合方法回归分析，以检验MPP暴露增加与随访时BSID-III评分之间的相关性。
极早产儿在NICU住院的前14天内平均每天接受11.24±4.12次MPP。75.98%（408/537）的时间错过了捆绑MPP的机会；其中大多数是侵入性采血。共有12.2%（481/3933）的MPP发生在药物或非药物性疼痛缓解后4小时内。在NICU入院后14天内经历MPP超过或等于第三四分位数的患者中，BSID-III运动综合评分下降了11.75（95%置信区间1.99，21.27）（P = 0.0329，n = 42）。未发现BSID-III认知和语言综合评分与MPP之间存在关联。
在入住NICU的极早产儿中，质量改进措施有很大空间来减少伤害。
