Validity of behavioral and physiologic parameters for acute pain assessment of term newborn infants
Palavras-chave:
Newborn-infant, Pain, Pain AssessmentResumo
CONTEXTO: A subjetividade da dor gera uma grande dificuldade para a elaboração de um método único de avaliação e de fácil aplicação na clínica diária. Os métodos para a avaliação da dor no período neonatal devem ser válidos, seguros, confiáveis, úteis e exeqüíveis.OBJETIVO: verificar a validade do Sistema de Codificação da Atividade Facial Neonatal (NFCS), Escala de Dor para o RN (NIPS), freqüência cardíaca (FC) e saturação de oxigênio (SatO2) para a avaliação da dor no recém-nascido (RN). TIPO DE ESTUDO: prospectivo, duplo-cego e randomizado. LOCAL: maternidade de nível secundário. PARTICIPANTES: 70 RN a termo saudáveis, com punção venosa para bilirrubina, divididos em dois grupos: P (n=33) recebeu um estímulo doloroso (punção) e F (n=37) um desagradável (fricção na mão). INTERVENÇÃO: observação do NFCS, da NIPS, da FC e da SatO2, antes (PRÉ), durante (T0) e 1(T1), 3(T3), 5(T5) e 10(T10) minutos após P ou F. MENSURAÇÃO: testes não paramétricos (significância: p<0.05). RESULTADOS: a mediana do NFCS e da NIPS foi maior no Grupo P em T0, T1 e T3. Mais RN do Grupo P apresentaram NFCS >2 e/ou NIPS >3 em T0, T1 e T3. A FC foi inferior no Grupo P em T1. A SatO2 manteve-se, em média, acima de 90% nos dois grupos. CONCLUSÕES : o NFCS e a NIPS são válidos para a avaliação da dor aguda no RN a termo. A FC e a SatO2 devem ser utilizadas como coadjuvantes.
Downloads
Referências
Stevens BJ, Johnston CC, Grunau RVE. Issues of assessment of pain and discomfort in neonates. J Obstet Gynecol Neonatal Nurs 1995;24:849-55.
Finley GA, McGrath PJ. Introduction: the roles of measurement in pain management and research. In: Finley GA, McGrath PJ, eds. Measurements of pain in infants and children. Seattle: IASP Press 1998:1-4.
Beyer JE, Knapp TR. Methodological issues in the measurement of childrens pain. CHC Spring 1986;14:233-41.
McGrath PA. An assessment of childrens pain: a review of behavioral, physiological and direct scaling techniques. Pain 1987;31:147-76.
Johnston CC. Psychometric issues in the measurement of pain. In: Finley GA, McGrath PJ, editors. Measurements of pain in infants and children. Seattle: IASP Press 1998:5-20.
Sweet SD, McGrath PJ. Physiological measures of pain. In: Finley GA, McGrath PJ, editors. Measurements of pain in infants and children. Seattle: IASP Press 1998:59-82.
McIntosh N, Van-Veen L, Brameyer H. The pain of heel prick and its measurement in preterm infants. Pain 1993;52:71-4.
Stevens B. Composite measures of pain. In: Finley GA, McGrath PJ, eds. Measurements of pain in infants and children. Seattle: IASP Press; 1998:161-78.
Grunau RVE, Craig KD. Pain expression in neonates: facial action and cry. Pain 1987;28:395-410.
Grunau RVE, Johnston CC, Craig KD. Neonatal facial responses to invasive and non-invasive procedures. Pain 1990;42:295-305.
Guinsburg R, Berenguel RC, Xavier RC, Almeida MFB, Kopelman BI. Are behavioral scales suitable for preterm and term neonatal pain assessment? In: Jensen TS, Turner JA, Wiesenfeld-Hallin Z, eds. Proceedings of the 8th World Congress on Pain. Seattle: IASP Press; 1997:893-902.
Lawrence J, Alcock D, McGrath P, Kay J, McMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Network 1993;12:59-66.
Hadjistavropoulos HD, Craig KD, Grunau RVE, Johnston CC. Judging pain in newborns: facial and cry determinants. J Pediatr Psychol 1994;19:485-91.
Levine JD, Gordon NC. Pain in prelingual children and its evaluation by pain-induced vocalization. Pain 1982;14:85-93.
Anand KJS, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med 1987;317:1321-9.
Murray AD. Infant crying as an elicitor of parental behavior: an examination of two models. Psychol Bull 1979;86:191-215.
Corwin MJ, Lester BM, Golub HL. The infant cry: what can it tell us? Curr Probl Pediatr 1996;26:325-34.
Golub HL, Corwin MJ. Infant cry: a clue to diagnosis. Pediatrics 1982;69:197-201.
Johnston CC, Strada ME. Acute pain response in infants: a multidimensional description. Pain 1986;24:373-82.
Johnston CC, Stevens B, Craig KD, Grunau RVE. Developmental changes in pain expression in premature, full-term, two- and four-month-old infants. Pain 1993;52:201-8.
McGrath PJ. Behavioral measures of pain. In: Finley GA, McGrath PJ, eds. Measurements of pain in infants and children. Seattle: IASP Press; 1998:83-102.
Owens ME. Pain in infancy: conceptual and methodological issues. Pain 1984;20:213-30.
Franck LS. A new method to quantitatively describe pain behavior in infants. Nurs Res 1986;35:28-31.
Craig KD, Whitfield MF, Grunau RVE, Linton J, Hadjistavropoulos HD. Pain in the preterm neonate: behavioural and physiological indices. Pain 1993;52:287-99.
Grunau RVE, Holsti L, Whitfield MF, Ling EY. Clinical bedside assessment of procedural pain in extremely low birth weight neonates: which body movements indicate distress? In: World Congress on Pain. Vancouver: Abstracts, 1996:180 (Abstract: 232).
Craig KD, Hadjistavropoulos HD, Grunau RVE, Whitfield MF. A comparison of two measures of facial activity during pain in the newborn child. J Pediatr Psychol 1994;19:305-18.
Lilley CM, Craig KD, Grunau RE. The expression of pain in infants and toddlers: developmental changes in facial action. Pain 1997;72:161-70.
International Association for the Study of Pain; Subcommittee on Taxonomy. Pain terms: a list with definitions and notes on usage. Pain 1979;6:249-52.
Stevens B, Johnston C, Petryshen P, Taddio A. Premature Infant Pain Profile: development and initial validation. Clin J Pain 1996;12:13-22.
Truog R, Anand KJS. Management of pain in the post-operative neonate. Clin Perinatol 1989;16:61-78.
Wardlaw SL, Stark RI, Baxi L, Frantz AG. Plasma beta-endorphin and beta-lipotropin in the human fetus at delivery: correlation with arterial pH and pO2 J Clin Endocrinol Metab 1979;49:888-91.
Maisels M, Gifford K. Normal serum bilirubin levels in the newborn and the effect of breast feeding. Pediatrics 1986;78:837.
Belsey EM, Rosenblatt DB, Lieberman BA. The influence of maternal analgesia on neonatal behaviour. I. Phetidine. Br J Obstet Gynaecol 1981;88:398-406.
Hodgkinson R. Double-blind comparison of maternal analgesia and neonatal neurobehaviour following intravenous butorphanol and meperidine. J Int Med Res 1979;7:224.
Apgar V. A proposal for a new method of evaluation of the newborn infant. Curr Res Anesth Analg 1953;32:260-7.
Volpe JJ. The neurological examination: normal and abnormal features. In: Volpe JJ, ed. Neurology of the Newborn. Philadelphia: W B Saunders 1995:95-124.
Edmonds LD, Layde PM, James LM, Flynt JW, Erickson JD, Oakley Jr. GP. Congenital malformations surveillance: two American systems. Int J Epidemiol 1981;10:247-52.
Chung CS, Myrianthopoulos NC. Congenital anomalies: mortality and morbidity, burden and classification. Am J Med Genet 1987;27:505-23.
Khoury MJ, Erickson JD, Cordero JF, McCarthy BJ. Congenital malformations and intrauterine growth retardation: a population study. Pediatrics 1988;82:83-90.
Ramos JLA. Avaliaçăo do crescimento intra-uterino por medidas antropométricas do recém-nascido. Săo Paulo 1983. 180 p. Tese Doutorado, Universidade de Săo Paulo.
Southall DP. Study of cardiac rhythm in health newborn infants. Br Heart J 1979;43:14-20.
Dudell G, Cornish JD, Bartlett RH. What constitutes adequate oxygenation? Pediatrics 1990;85:39-41.
Siegel S. Estatística năo paramétrica. México: Trillas; 1975:346.
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
