PREVENCIJA PROCEDURALNOG BOLA KOD TERMINSKE I PRETERMINSKE NOVOROĐENČADI – PRIMENJIVOST COMFORT SKALE
Ključne reči:
novorođenče, COMFORT skala, bolApstrakt
Uvod: Da bi se efikasno kupirao bol i umanjili njegovi negativni efekti u neonatalnom periodu, bitno je prepoznati ozbiljnost bolnih nadražaja, što je teško jer izostaje verbalna komunikacija sa pacijentom, pa se umesto toga koriste pouzdani alati sa procenu bola. Prepoznavanje mehanizma i pokazatelja bola značajno pomaže u prevenciji, praćenju i ublažavanju bola.
Cilj rada: Cilj našeg rada bio je ispitati primenjivost opservaciono-fiziološke COMFORT skale u terapiji proceduralnog bola.
Materijal i metode: U radu je ispitano ukupno 250 pacijenata, 120 dečaka i 130 devojčica koji obuhvataju i preterminsku i terminsku novorođenčad. Pacijenti su podeljeni prema gestacijskog starosti u 4 uzrastne kategorije (mlađi od 28 GN, 28-32 GN, 32-36 GN, 36-40 GN), a svi pacijenti su podeljeni u 2 grupe: prvu (gde je administriran analgetik pre započinjanja procedure) i drugu, gde analgetik nije dat.
Rezultati: Upoređivajući prosečne vrednosti COMFORT skale između dve grupe, kod svih vrsta proceduralnog bola, postojala je statistički značajna razlika u vrednosti, sa stepenom statističke značajnosti p<0,001, i to kod venepunkcije, intravenske kanulacije, intramuskularne injekcije, lumbalne punkcije, insercije NG sonde, plasiranja urinarnog katetera, previjanja rana, umbilikalne kateterizacije, rektalne irigacije, promene stomalnih kesa i diskova. Posmatrajući gestacijsku starost novorođenčadi i upoređivajući vrednost skale, postojala je statistički značajna razlika u vrednosti između dve komparirane grupe i to kod svih uzrastnih kategorija.
Zaključak: Na osnovu rezultata našeg rada pokazali smo da je COMFORT skala validan i pouzdan instrument za procenu stresa i bola kod novorođenčadi. Na osnovu rezultata, u kupiranju bola intravenska primena paracetamola se pokazala kao vrlo korisna.
Reference
Meskey H. Pain terms: a list with definitions and notes on usage. Pain 2016;6:249-152. PMID: 460932.
Bouza H. The impact of pain in the immature brain. J Matern Fetal Neoanatal Med 2009;22:722-732. DOI: https://doi.org/10.3109/14767050902926962. PMID: 19526425.
Fitzgerald M. The development of nociceptive circuits. Nat Rev Neurosci 2005;6:507–520. DOI: https://doi.org/10.1038/nrn1701. PMID: 15995722.
Basbaum AI, Bautista DM, Scherrer G, Julius D. Cellular and Molecural Mechanisms of Pain. Cell 2009;139(2):267-284. DOI: https://dx.doi.org/10.1016%2Fj.cell.2009.09.028. PMID: 19837031.
Errikson M, Campbell-Yeo M. Assesment of pain in newborn infants. Semin Fetal Neonatal Med 2019;24:101-103. DOI: https://doi.org/10.1016/j.siny.2019.04.003. PMID: 30987943.
Anand KJS. Defining pain in newborns: need for a uniform taxonomy? Acta Paediatr 2017;106:1438–1444. DOI: https://doi.org/10.1111/apa.13936. PMID: PMC5601230.
Olssona E, Ahlc H, Bengstssond K, Vejazarame D, Normance E, Bruschettinie M, Erikssona M. The use and reporting of neonatal pain scales: a systematic review of randomized trials. Pain 2021;353-360. DOI: https://doi.org/10.1097/j.pain.0000000000002046. PMID: PMC7808360.
Desai SA, Nanavati RN, Jasani BB, Kabra N. Comparasion of Neonatal Pain, Agitation, and Sedation Scale with Premature Infant Pain profile for the Assesssment of Acute Prolonged Pain in Neonates on Assisted Ventilation: A prospective Observational Study. Indian J Palliat Care 2017;23(3):287–292. DOI: https://doi.org/10.4103/ijpc.ijpc_42_17. PMCID: PMC5545954.
Brankovic D. Bol i stres kod novorođenčadi. U Milovanoić J (gl.ur). Fiziologija bola. Beograd: Book; 2013 str. 3-4.
Akuma AO, Jordan S. Pain management in neonates: A survey of nurses and doctors. J Adv Nurs 2012;68:1288‑1301. DOI: https://doi.org/10.1111/j.1365-2648.2011.05837.x. PMID: 21988718.
Carnevale F, Razack S. An item analysis of the COMFORT scale in a pediatric intensive care unit. Pediatr Crit Care Med 2002;3:177–180. DOI: https://doi.org/10.1097/00130478-200204000-00016. PMID: 12780990.
Boerlage AA, Ista E, Duivenvoorden HJ, de Wildt SN, Tibboel D, van Dijk M. The COMFORT behaviour scale detects clinically meaningful effects of analgesic and sedative treatment. Eur J Pain 2015;4:473-479. DOI: https://doi.org/10.1002/ejp.569. PMID: 25070754.
Walker SM. Neonatal pain. Pediatric Anesthesia 2013;24:39-48. DOI: https://doi.org/10.1111/pan.12293.
Shah V, Taddio A, Ohlsson A. Randomised controlled trial of paracetamol for heel prick pain in neonates. Arch Dis Child Fetal Neonatal Ed. 1998;79:F209–211. DOI: https://doi.org/10.1136/fn.79.3.f209. PMID: 10194994.
Badiee Z, Torcan N. Effects of high dose orally administered paracetamol for heel prick pain in premature infants. Saudi Med J. 2009;30:1450–1453. PMID: 19882059.
Roofthooft DWE, Simons SHP, van Lingen RA, Tibboel D, van den Anker JN, Reiss IKH, et al. Randomized controlled trial comparing different single doses of intravenous paracetamol for placement of peripherally inserted central catheters in preterm infants. Neonatology 2017;112:150–158. DOI: https://doi.org/10.1159/000468975.
Harrison D, Yamada J et Stevens B. Strategies for prevention and managment of neonatal and infant pain. Current Pain and Headache reports 2010;14:113-123. DOI: https://doi.org/10.1007/s11916-009-0091-0. PMID 20425200.
Lupien SJ, McEwen BS, Gunnar MR, Heim C. Effects of stress throughout the lifespan on the brain, behaviour and cognition. Nat Rev Neurosci. 2009;10:434–445. DOI: https://doi.org/10.1038/nrn2639. PMID: 19401723.
Heim C, Nemeroff CB. Neurobiology of early life stress: clinical studies. Semin Clin Neuropsychiatry 2002;7:147–159. DOI: https://doi.org/10.1053/scnp.2002.33127. PMID: 11953939.
Brummelte S, Grunau RE, Chau V, Poskitt KJ, Brant R, Vinall J et al. Procedural pain and brain development in premature newborns. Ann Neurol. 2012;71(3):385-396. DOI: https://doi.org/10.1002/ana.22267. PMID: 22374882.
Peters KL. Neonatal stress reactivity and cortisol. J Perinat Neonatal Nurs 1998;11:45–59. DOI: https://doi.org/10.1097/00005237-199803000-00007. PMID: 9592461.
Vinall, J., Miller, S., Chau, V. Neonatal pain in relation to postnatal growth in infants born very preterm, Pain 2002;153(7):1374–1381. DOI: https://doi.org/10.1016/j.pain.2012.02.007. PMID: 22704600.
Hohmeister J, Kroll A, Wollgarten-Hadamek I et al. Cerebralprocessing of pain in school-aged children with neonatal nociceptiveinput: an exploratory fMRI study, Pain 2010;150(2): 257–267. DOI: https://doi.org/10.1016/j.pain.2010.04.004. PMID: 20471751.
Duhrsen L, Simons SH, Dzietko M, et al. Effects of repetitive exposure to pain and morphine treatment on the neonatal rat brain. Neonatology 2013;103:35–43. DOI: https://doi.org/10.1159/000341769. PMID: 23037996.
Hatfield LA. Neonatal pain: What’s age got to do with it? Surg Neurol Int. 2014;5(Suppl 13):S479–489. DOI: https://dx.doi.org/10.4103%2F2152-7806.144630. PMID: 25506507.
Fitzgerald M. The development of nociceptive circuits. Nat Rev Neurosci 2005;6:507–520. DOI: https://doi.org/10.1038/nrn1701. PMID: 15995722.
Fitzgerald M, Anand K. Development of neuroanatomy and neurophysiology of pain. In:Schecther N, Berde C, Zaster M, (eds). Pain in Infants, Children and Adolescents. Baltimore: Williams and Wilkins ; 1993. pp 11-31.
