Dolor en pediatría

Guías para el manejo del dolor por procedimientos en el recién nacido Guidelines for procedural pain in the newborn. Lago P, Garetti E, Merazzi D, Pieragostini L, Ancora G, Pirelli A, Bellieni CV; Pain Study Group of the Italian Society of Neonatology. Collaborators (6) Allegro A, Cavazza A, Cocchi G, Giusti F, Guadagni A, Memo L. Neonatal Intensive Care Unit, Department of Paediatrics, University of Padova, Via Giustiniani 3, Padua, Italy. lago@pediatria.unipd.it Acta Paediatr. 2009 Jun;98(6):932-9. Abstract Despite accumulating evidence that procedural pain experienced by newborn infants may have acute and even long-term detrimental effects on their subsequent behaviour and neurological outcome, pain control and prevention remain controversial issues. Our aim was to develop guidelines based on evidence and clinical practice for preventing and controlling neonatal procedural pain in the light of the evidence-based recommendations contained in the SIGN classification. A panel of expert neonatologists used systematic review, data synthesis and open discussion to reach a consensus on the level of evidence supported by the literature or customs in clinical practice and to describe a global analgesic management, considering pharmacological, non-pharmacological, behavioural and environmental measures for each invasive procedure. There is strong evidence to support some analgesic measures, e.g. sucrose or breast milk for minor invasive procedures, and combinations of drugs for tracheal intubation. Many other pain control measures used during chest tube placement and removal, screening and treatment for ROP, or for postoperative pain, are still based not on evidence, but on good practice or expert opinions. CONCLUSION: These guidelines should help improving the health care professional's awareness of the need to adequately manage procedural pain in neonates, based on the strongest evidence currently available. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2688676/pdf/apa0098-0932.pdf  ¿Aun estamos lesionando a los recién nacidos? Estudio prospectivo sobre el dolor secundario a procedimientos en los neonatos Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Simons SH, van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D.Arch Pediatr Adolesc Med. 2003;157:1058-1064. BACKGROUND: Despite an increasing awareness regarding pain management in neonates and the availability of published guidelines for the treatment of procedural pain, preterm neonates experience pain leading to short- and long-term detrimental effects. OBJECTIVE: To assess the frequency of use of analgesics in invasive procedures in neonates and the associated pain burden in this population. METHODS: For 151 neonates, we prospectively recorded all painful procedures, including the number of attempts required, and analgesic therapy used during the first 14 days of neonatal intensive care unit admission. These data were linked to estimates of the pain of each procedure, obtained from the opinions of experienced clinicians.RESULTS: On average, each neonate was subjected to a mean +/- SD of 14 +/- 4 procedures per day. The highest exposure to painful procedures occurred during the first day of admission, and most procedures (63.6%) consisted of suctioning. Many procedures (26 of 31 listed on a questionnaire) were estimated to be painful (pain scores >4 on a 10-point scale). Preemptive analgesic therapy was provided to fewer than 35% of neonates per study day, while 39.7% of the neonates did not receive any analgesic therapy in the neonatal intensive care unit.CONCLUSIONS: Clinicians estimated that most neonatal intensive care unit procedures are painful, but only a third of the neonates received appropriate analgesic therapy. Despite the accumulating evidence that neonatal procedural pain is harmful, analgesic treatment for painful procedures is limited. Systematic approaches are required to reduce the occurrence of pain and to improve the analgesic treatment of repetitive pain in neonates http://archpedi.ama-assn.org/cgi/reprint/157/11/1058

Atentamente Dr. Enrique Hernández-Cortez Anestesiología y Medicina del Dolor www.anestesia-dolor.org