新生兒的疼痛控制建議

作者：Laurie Barclay, MD  
出處：WebMD醫學新聞

　　November 11, 2009 — 根據發表於11月小兒科(Pediatrics)期刊的前瞻性研究結果，哺乳和餵母奶是緩解新生兒腳後跟扎血時疼痛最有效的方法。
　　
　　以色列Technion-Israel科技研究中心的Amir Weissman醫師等人寫道，疼痛經驗會改變新生兒的臨床結果、腦部發育與後續的行為，特別是早產兒。研究目標是，(1)評估多種簡單、一般使用的新生兒疼痛控制方法，(2)評估周產新生兒在腳後跟扎血時對於疼痛的行為和自律心臟活性之間的協同性。
　　
　　以腳後跟扎血進行新生兒的苯酮尿症和甲狀腺低功能症篩檢時，180名周產新生兒被隨機分到以下六組之一：(1)控制組(沒有緩解疼痛的介入方式)；(2)吸吮但不哺餵；(3)由母親抱住；(4)給予口服葡萄糖溶液；(5)餵配方奶；(6)餵母奶。測量「新生兒臉部辨識系統量表(Neonatal Facial Coding System score)」；哭泣時間；腳後針扎血前中後之心律變化的頻譜分析，確認自律神經變項等評估疼痛反應。
　　
　　相較於五個介入組中的任一組，沒有疼痛介入之控制組的疼痛表現程度最大。與其他各組相比，餵母奶或餵配方奶最有效，心律增加最少(每分鐘分別是21下和23下，其他組為每分鐘36下；P < .01)、新生兒臉部分數(分別是2.3 和2.9，其他組為7.1；P < .001)、哭泣時間(分別是5秒和13秒，其他組為49秒；P < .001)、副交感神經緊張分數降低最少(分別是–2 和 –2.4，其他組為1.2；P < .02)。
　　
　　研究作者寫道，任何疼痛控制方法都勝過沒有控制，腳後跟扎血時哺乳和哺餵母乳是緩解疼痛最有效的方法。
　　
　　研究限制包括，疼痛評估方法的敏感度低、新生兒對於疼痛刺激的反應變化大、詮釋資料的主觀偏見等。
　　
　　研究作者結論表示，新生兒疼痛預防是父母的期待，也應是醫療人員的目標；因此，家屬或醫療人員應在這些檢查進行時互助合作，鼓勵哺乳婦女在這些檢查時餵母乳；如果家人認為她們無法忍受檢查過程、無法忍受聽到嬰兒哭泣、或不敢看見進行腳後跟扎血，可以考慮用奶瓶哺餵。
　　
　　研究作者皆宣告沒有相關財務關係。


Pain Control Recommended for Newborns

By Laurie Barclay, MD
Medscape Medical News

November 11, 2009 — Feeding and breast-feeding newborns are found to be the most effective methods of pain relief during heel-lancing, according to the results of a prospective study reported in the November issue of Pediatrics.

"Pain experience can alter clinical outcome, brain development, and subsequent behavior in newborns, primarily in preterm infants," write Amir Weissman, MD, from Technion-Israel Institute of Technology in Haifa, Israel, and colleagues. "The aims of this study were (1) to evaluate several simple, commonly used methods for pain control in newborns and (2) to evaluate the concordance between behavioral and autonomic cardiac reactivity to pain in term neonates during heel-lancing."

During heel-lancing for routine neonatal screening of phenylketonuria and hypothyroidism, 180 term newborn infants were randomly selected to 1 of 6 groups: (1) control (no intervention for pain relief); (2) sucking without feeding; (3) holding by mother; (4) ingestion of oral glucose solution; (5) feeding with oral formula; or (6) breast-feeding. Response to pain was assessed with the Neonatal Facial Coding System score; duration of crying; and autonomic variables determined from spectral analysis of heart rate variability before, during, and after heel-lancing.

Compared with newborns in any of the 5 intervention groups, those in the control group with no pain intervention had the greatest levels of pain manifestation. Breast-feeding or feeding with oral formula appeared to be most effective vs all other groups, based on the lowest increase in heart rate (21 and 23 beats per minute, respectively, vs 36 beats per minute; P < .01), neonatal facial score (2.3 and 2.9, respectively, vs 7.1; P < .001), cry duration (5 and 13 seconds, respectively, vs 49 seconds; P < .001), and the lowest decrease in parasympathetic tone (–2 and –2.4, respectively, vs 1.2; P < .02).

"Any method of pain control is better than none," the study authors write. "Feeding and breast-feeding during heel-lancing were found to be the most effective methods of pain relief."

Limitations of this study include low sensitivity of the pain assessment methods, large variability of newborn response to painful stimuli, and the subjective nature of interpreting these data.

"Neonatal pain prevention is the expectation of the parents and should be the goal of the medical staff; therefore, family members or staff may be recruited to help during these procedures, and nursing mothers should be encouraged to breastfeed during the procedure," the study authors conclude. "If family members believe that they cannot withstand the procedure, hear their infant crying, or see the heel-lancing, then bottle-feeding seems to be a good alternative."

The study authors have disclosed no relevant financial relationships.

Pediatrics. 2009;124:e921-e926.