Dincer Emre, Özer Hamza, Topçuoğlu Sevilay, Karatekin Güner
Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Research and Training Hospital, Op. Dr. Burhanettin Öncel Cad No. 10, Üsküdar, Istanbul 34668, Turkey.
Department of Radiology, Bolu Abant İzzet Baysal University Medical Faculty, Bolu 14030, Turkey.
Children (Basel). 2023 Feb 10;10(2):347. doi: 10.3390/children10020347.
Ultrasonography is widely used in neonatological practice and studies investigating the hemodynamic effects of various treatment protocols or clinical situations. On the other hand, pain causes changes in the cardiovascular system; so, in the case of ultrasonography leading to pain in neonates, it may cause hemodynamic alterations. In this prospective study, we evaluate whether ultrasonographic application causes pain and changes in the hemodynamic system.
Newborns undergoing ultrasonographic examination were enrolled in the study. Vital signs, cerebral and mesenteric tissue oxygenation (StO) levels, and middle cerebral artery (MCA) Doppler measurements were recorded, and NPASS scores were calculated before and after ultrasonography.
We enrolled 39 patients in the study. After ultrasonography, Neonatal Pain, Agitation, and Sedation Scale (NPASS) scores were significantly higher ( < 0.01), and all vital signs (heart rate, respiratory rate, SpO, diastolic and systolic blood pressure; = 0.03; < 0.01, < 0.01, < 0.01, = 0.02, = 0.03, respectively) were altered. Cerebral ( = 0.008) and mesenteric ( = 0.039) StO levels were significantly lower in the whole study group, MCA end-diastolic velocity decreased ( = 0.02), and the resistive index ( = 0.03) increased in patients whose NPASS score was >7 after ultrasonography.
This study is the first to show that ultrasonography may cause pain in newborn patients, and alters vital signs and hemodynamic parameters. Therefore, precautions should be taken to protect newborn babies from pain during ultrasound applications, as they are already exposed to many noxious stimuli. Furthermore, pain scores should be considered in studies using ultrasonography and evaluating hemodynamic parameters to increase the reliability of the studies.
超声检查在新生儿科实践以及研究各种治疗方案或临床情况的血流动力学效应中被广泛应用。另一方面，疼痛会引起心血管系统的变化；因此，在超声检查导致新生儿疼痛的情况下，可能会引起血流动力学改变。在这项前瞻性研究中，我们评估超声检查的应用是否会导致疼痛以及血流动力学系统的变化。
接受超声检查的新生儿被纳入研究。记录生命体征、脑和肠系膜组织氧合（StO）水平以及大脑中动脉（MCA）多普勒测量值，并在超声检查前后计算新生儿疼痛、躁动和镇静量表（NPASS）评分。
我们招募了39名患者参与研究。超声检查后，新生儿疼痛、躁动和镇静量表（NPASS）评分显著更高（<0.01），所有生命体征（心率、呼吸频率、SpO、舒张压和收缩压；分别为 = 0.03；<0.01，<0.01，<0.01， = 0.02， = 0.03）均发生改变。在整个研究组中，脑（ = 0.008）和肠系膜（ = 0.039）StO水平显著降低，超声检查后NPASS评分>7的患者中，MCA舒张末期速度降低（ = 0.02），阻力指数（ = 0.03）升高。
本研究首次表明超声检查可能会使新生儿患者产生疼痛，并改变生命体征和血流动力学参数。因此，在超声检查过程中应采取预防措施，保护新生儿免受疼痛，因为他们已经暴露于许多有害刺激之下。此外，在使用超声检查并评估血流动力学参数的研究中应考虑疼痛评分，以提高研究的可靠性。
