Beta-endorphin concentration after administration of sucrose in preterm infants
Female; Humans; infant; Male; Pain Measurement; Prospective Studies; Intensive Care; Administration; beta-Endorphin/blood; Biomarkers of Pain; Newborn; Oral; Pain/drug therapy/etiology; Premature; Sucrose/administration & dosage
BACKGROUND: Sucrose is an effective analgesic for procedural pain in preterm infants. It has been hypothesized that its analgesic effects are mediated by the release of endogenous opioid neurotransmitters such as beta-endorphin. OBJECTIVE: To determine whether intraoral administration of sucrose was associated with an increase in serum beta-endorphin concentrations in preterm infants with a gestation period less than 29 weeks who were not exposed to a painful stimulus. METHODS: We performed a prospective open-label study in preterm infants admitted to 2 tertiary neonatal intensive care units. Each infant received a single dose of 30% sucrose intraorally during a 1- to 2-minute period. A blood sample was obtained using an indwelling arterial catheter to determine beta-endorphin concentration immediately before and 2 to 5 minutes after the commencement of sucrose administration. RESULTS: We enrolled 11 preterm infants with a mean +/- SD gestational age of 27.2 +/- 0.9 weeks and a mean +/- SD birth weight of 1018 +/- 238 g (1.02 +/- 0.24 kg) at a mean +/- SD postnatal age of 3.0 +/- 2.5 days. The mean +/- SD beta-endorphin concentration before and after sucrose administration was 60.4 +/- 30.5 pg/mL and 57.4 +/- 22.4 pg/mL, respectively (P =.45). No adverse events were observed during the study procedures. CONCLUSION: Intraoral administration of sucrose in preterm infants did not lead to an increase in serum beta-endorphin concentrations at a point in time when the analgesic effects of sucrose were presumed to be present.
2003
Taddio A; Shah V; Shah P; Katz J
Archives Of Pediatrics & Adolescent Medicine
2003
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1001/archpedi.157.11.1071" target="_blank" rel="noreferrer">10.1001/archpedi.157.11.1071</a>
Teaching Pediatric Intensive Care Physicians Communication Skills: The Enduring Effects
Objectives
Determine feasibility of a communication skills
training (CST) to prepare pediatric intensivists
for communicating bad news and assessing goals
of care in the pediatric intensive care unit
(PICU).
Describe the impact of CST on intensivist skill in
communication.
Original Research Background. Families of seriously
ill children describe unmet needs for honest information
presented empathetically, while intensivists
report inadequate training in having difficult
conversations.
Research Objectives. 1. To determine feasibility of
communication skills training (CST) to prepare pediatric
intensivists for communicating bad news and assessing
goals of care in the pediatric intensive care
unit (PICU). 2. To describe the impact of CST on intensivist
skill in communication.
Methods. Intensivists volunteered to undergo CST
with didactics, discussions with simulated parents,
and a videotaped OSCE exam. Surveys prior to the
intervention and one month after were tabulated for
descriptive statistics. Wilcoxon signed-rank tests
compared outcomes at 2 time points. 2 independent
trained reviewers scored the OSCE using a validated
tool.
Results. Twelve participants completed training. In
the post-CST survey, all participants agreed the
Vol. 51 No. 2 February 2016 Poster Abstracts 431
training gave them skills to communicate in challenging
situations, and they would recommend it to
peers. When comparing pre- and post-CST self-assessment
measures of intensivists’ information-seeking
from families, there was a significant increase 1 month
after training (p¼0.03), with intensivists more likely to
ask what kinds of information families need and what
their understanding of their child’s disease is, but no
significant changes in information seeking or giving,
which was not covered in the training. Finally, 11 of
the 12 intensivists received passing scores on the
OSCE as measured by a validated tool, with the
average score being 48.5 (SD 5.92) compared to 38.6
(SD 9.93) after training that was reported in the
literature.
Conclusion. This study provides evidence that intensivists
are willing to participate in CST and an OSCE
exam, and they find it worthwhile. There is also evidence
that they perceive an improvement in their skill
set as a result of having participated.
Implications for Research, Policy or
Practice. Offering realistic, simulation-based CST is
feasible and effective for training intensivists.
Walter J; Shah P; Odeniyi F; Madrigal V; Feudtner C
Journal Of Pain And Symptom Management
2016
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
DOI: http://dx.doi.org/10.1016/j.jpainsymman.2015.12.048
Neonatal Deaths: Prospective Exploration Of The Causes And Process Of End-of- Life Decisions.
Asphyxia Neonatorum/mortality; Canada/epidemiology; Cause Of Death; Chromosome Aberrations; Clinical Decision-making; Congenital Abnormalities/mortality; Humans; Hypoxia-ischemia Brain/mortality; Infant Extremely Premature; Infant Newborn; Infant Premature; Intensive Care Units Neonatal; Intracranial Hemorrhages/mortality; Lung Diseases/mortality; Patient Care Team; Practice Patterns Physicians'/statistics & Numerical Data; Prospective Studies; Term Birth; Withholding Treatment/statistics & Numerical Data
Ethics; Mortality; Neonatology; Palliative Care
OBJECTIVE:
To determine the causes and process of death in neonates in Canada.
DESIGN:
Prospective observational study.
SETTING:
Nineteen tertiary level neonatal units in Canada.
PARTICIPANTS:
942 neonatal deaths (215 full-term and 727 preterm).
EXPOSURE AND OUTCOME:
Explored the causes and process of death using data on: (1) the rates of withdrawal of life-sustaining treatment (WLST); (2) the reasons for raising the issue of WLST; (3) the extent of consensus with parents; (4) the consensual decision-making process both with parents and the multidisciplinary team; (5) the elements of WLST; and (6) the age at death and time between WLST and actual death.
RESULTS:
The main reasons for deaths in preterm infants were extreme immaturity, intraventricular haemorrhage and pulmonary causes; in full-term infants asphyxia, chromosomal anomalies and syndromic malformations. In 84% of deaths there was discussion regarding WLST. WLST was agreed to by parents with relative ease in the majority of cases. Physicians mainly offered WLST for the purpose of avoiding pain and suffering in imminent death or survival with a predicted poor quality of life. Consensus with multidisciplinary team members was relatively easily obtained. There was marked variation between centres in offering WLST for severe neurological injury in preterm (10%-86%) and severe hypoxic-ischaemic encephalopathy in full-term infants (5%-100%).
CONCLUSIONS AND RELEVANCE:
In Canada, the majority of physicians offered WLST to avoid pain and suffering or survival with a poor quality of life. Variation between units in offering WLST for similar diagnoses requires further exploration.
Hellmann J; Knighton R; Lee SK; Shah P; Andrews W; Payot A
Archives Of Disease In Childhood
2016
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
DOI: 10.1136/archdischild-2015-308425