Nonpharmacological Pain Management in Neonates

NCT ID: NCT06155825

Last Updated: 2023-12-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

NOT_YET_RECRUITING

Clinical Phase

NA

Total Enrollment

164 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-12-01

Study Completion Date

2025-02-01

Brief Summary

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This is A randomized controlled study which aim to:

The primary aim in this study is assessment of non-pharmacological pain management in neonate and determine the most effective.

The secondary aim of this study is to introduce idea of neonatal pain management. and record its effect on hospital stay and Duration to reach full enteral feeding. This prospective study will be conducted at NICU unit of Assiut University pediatrician hospital, Duration of study 1 year from 1/12/2023 to 1/12/2024.

one hundred sixty-four children will be divided into 4 groups each group will have 41 patients. Groups 1-3 will be intervention groups, patients of which received a non-pharmacological intervention during mild regular painful maneuvers as cannula insertion, venipuncture, arterial puncture, heel prick, Group 1 will receive nonnutritive suckling. Group 2 will receive oral glucose 25% Group 3 will undergo facilitated tuckling Group 4 will be a control group (receive no nonpharmacological intervention). The pain response in each group will be assessed by CRIES score CRIES comes from (Crying, requires oxygen, Increased vital signs, Expression, Sleep). The scale may be taken over time to monitor the infant's (32 to 60 weeks' gestational age) recovery or response to interventions.

Minimum score is 0 whilst maximum score is 10. The higher the score, the greater the expression of pain. If the CRIES score is greater than 4, further pain assessment should be undertaken, and analgesic administration is indicated for a score of 6 or higher.

Detailed Description

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Pain is defined as unpleasant sensory and emotional experience associated with tissue damage. Newborns are especially vulnerable to pain and its deleterious effects, as they have larger receptive fields for nociceptive impulses and possibly a higher density of nerve endings and concentration of substance P receptors 1) . The density of proprioceptive nerve ending is equal to the adult, also they have a lower threshold for excitation and sensitization.

In neonates the harmful effects of pain include irritability, fear, sense of mistrust towards caregiver, disturbed sleep and wakefulness cycle, delayed wound healing, altered immunological functions, biochemical alterations in energy metabolism2), negative effects on the developing brain and behavior. Neonates requiring intensive care admission exposed to various types of painful stimuli such as venipuncture, arterial puncture, suction, catheterization or invasive procedures as, lumbar puncture, CVC and bronchoscopy.

The responses to pain in a newborn are nonverbal and include physiological and autonomic manifestations as changes in heart rate, respiratory rate, blood pressure and oxygen saturation3), also behavioral changes as crying, change in facial expressions and body movement. These parameters are used for pain assessment in various scales4). For example, total facial activity and cluster of specific facial findings (brow bulge, eye squeeze, nasolabial furrow, open mouth) were associated with acute and postoperative pain5\*6).

Example of most commonly used scales in assessment of pain7), the Premature Infant Pain Profile (PIPP)8), Neonatal Pain Agitation and Sedation Scale (N-PASS)9), Neonatal Infant Pain Scale (NIPS) and the CRIES scale (Crying, Requires Oxygen Saturation, Increased Vital Signs, Expression, Sleeplessness).12)

Conditions

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Pain Management Neonates Pain Management

Keywords

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pain management in neonates nonpharmacological neonatal pain management

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group 4 (placebo)

this group will be A control group receive no intervention.

Group Type PLACEBO_COMPARATOR

no intervention

Intervention Type BEHAVIORAL

Group 4 will receive no intervention

group 1 (interventional group)

Intervention groups which will receive nonnutritive suckling.

Group Type EXPERIMENTAL

nonnutritive suckling

Intervention Type DRUG

Group 1 will receive nonnutritive suckling

group 2 (interventional group )

Group 2 will receive oral glucose 25%

Group Type EXPERIMENTAL

oral glucose 25%

Intervention Type DRUG

Group 2 will receive oral glucose 25%

Group 3 (interventional group)

Group 3 will undergo facilitated tuckling

Group Type EXPERIMENTAL

facilitated tuckling

Intervention Type BEHAVIORAL

Group 3 will undergo facilitated tuckling

Interventions

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no intervention

Group 4 will receive no intervention

Intervention Type BEHAVIORAL

nonnutritive suckling

Group 1 will receive nonnutritive suckling

Intervention Type DRUG

oral glucose 25%

Group 2 will receive oral glucose 25%

Intervention Type DRUG

facilitated tuckling

Group 3 will undergo facilitated tuckling

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

1. Healthy term newborn 32 week or more.
2. Newborn during routine painful maneuvers as venipuncture and arterial puncture

Exclusion Criteria

* 1\) Preterm \< 32 week 2) Newborn with neurological impairment 3) Sedated newborn 4) Newborn with metabolic diseases 5) Newborn with congenital anomalies 6) Newborn undergoing operative intervention
Minimum Eligible Age

32 Weeks

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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Assiut University

OTHER

Sponsor Role lead

Responsible Party

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Safaa Mustafaa Abu Zaid

pediatric resident

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Safaa Mustafaa Abo Zaid, pediatric resident

Role: PRINCIPAL_INVESTIGATOR

Assiut University

Zeinab Mohie Eldeen, professor

Role: STUDY_DIRECTOR

Assiut University

Amira Mohamed shalaby, Assistant Professor

Role: STUDY_DIRECTOR

Assiut University

Randa AbdAlbadea Abdelaleem, Lecturer of Pediatrics

Role: STUDY_DIRECTOR

Assiut University

Central Contacts

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Safaa Mustafaa Abu Zaid, Resident of Pediatrics

Role: CONTACT

Phone: 01098067714

Email: [email protected]

Randa AbdAlbadea Abdelaleem, Lecturer of Pediatrics

Role: CONTACT

Phone: 01003895236

Email: [email protected]

References

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Krechel SW, Bildner J. CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability. Paediatr Anaesth. 1995;5(1):53-61. doi: 10.1111/j.1460-9592.1995.tb00242.x.

Reference Type BACKGROUND
PMID: 8521311 (View on PubMed)

Castagno E, Fabiano G, Carmellino V, Cerchio R, De Vito B, Lauria B, Mercurio G, Coscia A, Ponte G, Bondone C. Neonatal pain assessment scales: review of the literature. Prof Inferm. 2022 Apr 1;75(1):17-28. doi: 10.7429/pi.2022.751017. English, Italian.

Reference Type BACKGROUND
PMID: 36962062 (View on PubMed)

Bucsea O, Pillai Riddell R. Non-pharmacological pain management in the neonatal intensive care unit: Managing neonatal pain without drugs. Semin Fetal Neonatal Med. 2019 Aug;24(4):101017. doi: 10.1016/j.siny.2019.05.009. Epub 2019 Jun 5.

Reference Type BACKGROUND
PMID: 31326301 (View on PubMed)

Shukla VV, Bansal S, Nimbalkar A, Chapla A, Phatak A, Patel D, Nimbalkar S. Pain Control Interventions in Preterm Neonates: A Randomized Controlled Trial. Indian Pediatr. 2018 Apr 15;55(4):292-296. Epub 2018 Feb 9.

Reference Type BACKGROUND
PMID: 29428919 (View on PubMed)

Maxwell LG, Fraga MV, Malavolta CP. Assessment of Pain in the Newborn: An Update. Clin Perinatol. 2019 Dec;46(4):693-707. doi: 10.1016/j.clp.2019.08.005. Epub 2019 Aug 19.

Reference Type BACKGROUND
PMID: 31653303 (View on PubMed)

Other Identifiers

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pain management in neonate

Identifier Type: -

Identifier Source: org_study_id