A Systematic Review of Behavioral and Environmental Interventions for Procedural Pain Management in Preterm Infants
Linda A Hatfield1, Nancy Murphy2, Kelley Karp3
1Family and Community Health, University of Pennsylvania School of Nursing, Pennsylvania Hospital Department of Nursing, Philadelphia, PA, USA.
Insights
Behavioral interventions like facilitated tucking, oral sucrose, and kangaroo care effectively reduce pain responses in preterm infants during procedures. These methods offer significant pain mitigation for neonates in intensive care settings.
Area of Science:
- Neonatal care
- Pain management
- Evidence-based practice
Background:
- Behavioral and environmental interventions for neonatal procedural pain are underutilized and poorly documented.
- Preterm infants are particularly vulnerable to procedural pain, necessitating effective management strategies.
Purpose of the Study:
- To systematically review randomized controlled trials on behavioral and environmental interventions for managing procedural pain in preterm infants.
- To assess the impact of these interventions on the behavioral pain response of preterm infants.
Main Methods:
- Systematic review of 14 randomized controlled trials published within the last 5 years.
- Included studies focused on preterm infants in neonatal intensive care units, utilizing behavioral/environmental interventions and validated pain scales.
Main Results:
- Facilitated tucking, oral sucrose, and kangaroo care demonstrated significant reductions in both behavioral and physiological pain responses.
- These interventions were effective when used alone or in combination with other strategies.
Conclusions:
- Facilitated tucking, oral sucrose, and kangaroo care are effective in mitigating the biobehavioral pain response in preterm infants during painful procedures.
- Further rigorous research is needed to develop tailored pain management plans for preterm infants.
Problem:
Current research suggests behavioral and environmental interventions to prevent neonatal pain prior to an invasive procedure are rarely administered and seldom documented. The aim of this study was to systematically review findings from published randomized controlled trials that tested the effects of behavioral and environmental procedural pain management interventions on behavioral pain response in preterm infants.
Eligibility Criteria:
Randomized controlled trials examining the effects of behavioral and environmental pain management interventions on behavioral pain response in preterm infants were identified. Articles accepted for inclusion met the following criteria: English language, original, peer refereed, randomized controlled clinical trials published within the past 5 years, study sample: preterm infants, setting: neonatal intensive care units, study intervention behavioral and environmental, outcome pain measurement score from valid and reliable pain scale.
Sample:
Fourteen randomized controlled trials from a literature search of PubMed and Medline databases were included in this review.
Results:
Across all age groups, facilitated tucking, oral sucrose, and kangaroo care decreased behavioral and physiologic pain response alone and in combination with other behavioral and environmental interventions.
Conclusion:
Among preterm infants, facilitated tucking, oral sucrose, and kangaroo care significantly mitigates biobehavioral pain response associated with acutely painful procedures.
Implications:
Evidence suggests that behavioral and environmental interventions can decrease biobehavioral pain response associated with acutely painful procedures in preterm infants. This review highlights the need for rigorous studies to help healthcare providers to build a tailored pain treatment plan for preterm infants.
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