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  • 1
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    Online Resource
    Eight Years Later, Are We Still Hurting Newborn Infants?
    S. Karger AG ; 2014
    In:  Neonatology Vol. 105, No. 3 ( 2014), p. 218-226
    Details
    In: Neonatology, S. Karger AG, Vol. 105, No. 3 ( 2014), p. 218-226
    Abstract: 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To study whether new pharmacological and nonpharmacological guidelines lowered numbers of painful procedures in neonates and changed the amount and frequency of analgesic therapy as compared to the results of our previous study in 2001. 〈 b 〉 〈 i 〉 Design: 〈 /i 〉 〈 /b 〉 A prospective observational study. 〈 b 〉 〈 i 〉 Setting: 〈 /i 〉 〈 /b 〉 Level III NICU of the Erasmus MC-Sophia Children's Hospital, Rotterdam. 〈 b 〉 〈 i 〉 Participants: 〈 /i 〉 〈 /b 〉 Neonates admitted at postnatal ages less than 3 days with length of stay at least 72 h. 〈 b 〉 〈 i 〉 Main Outcome Measures: 〈 /i 〉 〈 /b 〉 Number of all potentially painful procedures and analgesic therapy recorded at the bedside during the first 14 days of NICU stay. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total number of 21,076 procedures were performed in the 175 neonates studied during 1,730 patient-days (mean 12.2). The mean number of painful procedures per neonate per day was 11.4 (SD 5.7), significantly lower than the number of 14.3 (SD 4.0) in 2001 (p 〈 0.001). The use of analgesics was 36.6% compared to 60.3% in 2001. Sixty-three percent of all peripheral arterial line insertions failed versus 37.5% in 2001 and 9.1% venipunctures failed versus 21% in 2001. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The mean number of painful procedures per NICU patient per day declined. Nonpharmacological pain- or stress-reducing strategies like NIDCAP and sucrose were fully embedded in our pain management. As further reduction of the number of painful procedures is unlikely, we should apply more nonpharmacological interventions and explore newer pharmacological agents.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000357207
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
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  • 2
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    Online Resource
    Translation, Cross-Cultural Adaptation, and Validation of the Portuguese Version of the Rotterdam Elderly Pain Observation Scale
    S. Karger AG ; 2021
    In:  Dementia and Geriatric Cognitive Disorders Extra Vol. 11, No. 3 ( 2021-12-20), p. 314-323
    Details
    In: Dementia and Geriatric Cognitive Disorders Extra, S. Karger AG, Vol. 11, No. 3 ( 2021-12-20), p. 314-323
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 This study reports on the translation, cultural adaptation, and validation of a Portuguese version of the Rotterdam Elderly Pain Observation Scale (REPOS), a Dutch scale to assess pain in patients who cannot communicate, with or without dementia. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 This is a multicenter study in pain and neurological units involving Brazil (clinical phase) and the Netherlands (training phase). We performed a retrospective cross-sectional, 2-staged analysis, translating and culturally adapting the REPOS to a Portuguese version (REPOS-P) and evaluating its psychometric properties. Eight health professionals were trained to observe patients with low back pain. REPOS consists of 10 behavioral items scored as present or absent after a 2-min observation. The REPOS score of ≥3 in combination with the Numerical Rating Scale (NRS) of ≥4 indicated pain. The Content Validity Index (CVI) in all items and instructions showed CVI values at their maximum. According to the higher correlation coefficient found between NRS and REPOS-P, it may be suggested that there was an adequate convergent validity. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 The REPOS-P was administered to 80 patients with a mean age of 60 years (SD 11.5). Cronbach’s alpha coefficient showed a moderate internal consistency of REPOS-P (α = 0.62), which is compatible with the original study of REPOS. All health professionals reached high levels of interrater agreement within a median of 10 weeks of training, assuring reproducibility. Cohen’s kappa was 0.96 (SD 0.03), and the intraclass correlation coefficient was 0.98 (SD 0.02), showing high reliability of REPOS-P scores between the trainer (researcher) and the trainees (healthcare professionals). The Pearson correlation coefficient was 0.95 (95% confidence interval 0.94–0.97), showing a significant correlation between the total scores of REPOS-P and NRS. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 The REPOS-P was a valuable scale for assessing elderly patients with low back pain by different healthcare professionals. Short application time, ease of use, clear instructions, and the brief training required for application were essential characteristics of REPOS-P.
    Type of Medium: Online Resource
    ISSN: 1664-5464
    URL: Article
    DOI: 10.1159/000520455
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
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  • 3
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    Lung Function of Infants with Congenital Lung Lesions in the First Year of Life
    S. Karger AG ; 2013
    In:  Neonatology Vol. 103, No. 1 ( 2013), p. 60-66
    Details
    In: Neonatology, S. Karger AG, Vol. 103, No. 1 ( 2013), p. 60-66
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Several studies have evaluated short-term neonatal outcome in infants with congenital lung lesions (CLL) but clinical course and lung function in the longer term have not yet been documented. We hypothesized that clinical course and lung function would be negatively affected by surgical resection. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To evaluate respiratory symptoms and lung function longitudinally in the first year of life in infants with CLL, and to analyse differences herein between infants managed by observation only and infants whose affected lung parts were resected. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We evaluated respiratory symptoms and lung function at 6 and 12 months in 30 patients with CLL. Functional residual capacity (FRC 〈 sub 〉 p 〈 /sub 〉 ) and maximal expiratory flow at functional residual capacity (V′ 〈 sub 〉 max 〈 /sub 〉 〈 smlcap 〉 f 〈 /smlcap 〉 〈 smlcap 〉 r 〈 /smlcap 〉 〈 smlcap 〉 c 〈 /smlcap 〉 ) were measured with body plethysmography. SD scores were calculated for V′ 〈 sub 〉 max 〈 /sub 〉 〈 smlcap 〉 f 〈 /smlcap 〉 〈 smlcap 〉 r 〈 /smlcap 〉 〈 smlcap 〉 c 〈 /smlcap 〉 . 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Prevalence of respiratory symptoms did not differ between the groups. Mean FRC 〈 sub 〉 p 〈 /sub 〉 (95% CI) was 25.3 (23.3–27.3) in the group managed by observation versus 27.3 (25.1–29.6) in the group managed by surgery (p = 0.149). Mean (95% CI) SDS V′ 〈 sub 〉 max 〈 /sub 〉 〈 smlcap 〉 f 〈 /smlcap 〉 〈 smlcap 〉 r 〈 /smlcap 〉 〈 smlcap 〉 c 〈 /smlcap 〉 was –1.45 (–1.84 to –1.06) versus –1.41 (–1.90 to –0.91) (p = 0.892). Lung function did not change significantly over the 6-month period. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Surgical resection did not seem to have negatively affected the clinical course and lung function. We recommend pulmonary follow-up of all CLL patients into adulthood to further identify any long-term effects of CLL and observation or surgery.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000342224
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
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  • 4
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    Congenital Diaphragmatic Hernia: 10-Year Evaluation of Survival, Extracorporeal Membrane Oxygenation, and Foetoscopic Endotracheal Occlusion in Four High-Volume Centres
    S. Karger AG ; 2018
    In:  Neonatology Vol. 113, No. 1 ( 2018), p. 63-68
    Details
    In: Neonatology, S. Karger AG, Vol. 113, No. 1 ( 2018), p. 63-68
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Congenital diaphragmatic hernia (CDH) is a severe congenital anomaly with significant mortality. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 The aim of this study was to determine if there were trends in survival over the last decade and to compare patient populations, treatment options, and survival rates between 4 high-volume centres, and hence determine which factors were associated with survival. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 In 4 high-volume CDH centres from the CDH EURO Consortium, data from all CDH patients born between 2004 and 2013 were analysed. The predictive value of variables known at birth and the influence of centre-specific treatments (extracorporeal membrane oxygenation, ECMO, and foetoscopic endotracheal occlusion, FETO) on survival were evaluated in multivariable logistic regression analyses. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Nine hundred and seventy-five patients were included in the analysis, of whom 274 (28.1%) died. ECMO was performed in 259 patients, of whom 81 (31.3%) died. One hundred and forty-five patients (14.9%) underwent FETO, and from those 76 patients (52.4%) survived. Survival differed significantly between years ( 〈 i 〉 p 〈 /i 〉 = 0.006) and between the 4 centres ( 〈 i 〉 p 〈 /i 〉 〈 0.001). In the multivariable logistic regression analysis, lung-to-head ratio, gestational age at birth, ECMO, centre of birth, and year of birth were significantly associated with survival, whereas FETO was not. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 The patient populations were different between centres, which influenced outcomes. There was a significant variability in survival over time and between centres, which should be taken into consideration in the planning of future trials.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000480451
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
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  • 5
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    Online Resource
    Nationwide Evaluation of Congenital Hypothyroidism Screening during Neonatal Extracorporeal Membrane Oxygenation
    S. Karger AG ; 2017
    In:  Neonatology Vol. 111, No. 2 ( 2017), p. 93-99
    Details
    In: Neonatology, S. Karger AG, Vol. 111, No. 2 ( 2017), p. 93-99
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Thyroid hormone concentrations may deviate from normal values during critical illness. This condition is known as nonthyroidal illness syndrome (NTIS), and it can influence the results of screening for congenital hypothyroidism (CH) during neonatal extracorporeal membrane oxygenation (ECMO). 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 To determine the incidence of aberrant CH screening results in ECMO-treated neonates, to identify possible determinants, and to follow up patients with abnormal thyroid hormone concentrations. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 In this retrospective cohort study, we included 168 ECMO-treated neonates admitted from 2004 to 2014 and screened by protocol and divided them into the following 3 groups: group 1 (screened during ECMO, n = 107), group 2 (screened shortly before ECMO, n = 26), and group 3 (screened shortly after ECMO, n = 35). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 CH screening results were aberrant in 67.3% (72/107) of the neonates screened during ECMO, in 73.1% (19/26) of the neonates screened before ECMO, and in 31.4% (11/35) of the neonates screened after ECMO (p 〈 0.001). Of the neonates with an aberrant screening result, all but 2 (i.e. 98%) had a low thyroxine concentration with a normal thyrotropin concentration at screening, as is seen in NTIS. None was diagnosed with CH. Mortality did not significantly differ between neonates with an aberrant screening result (32.4%) and neonates with a normal screening result (22.7%; p = 0.18). Screening before ECMO (OR 5.92; 95% CI 1.93-18.20), screening during ECMO (OR 4.49; 95% CI 1.98-10.19), and a higher Pediatric Logistic Organ Dysfunction-2 score (OR 1.31; 95% CI 1.04-1.66) were associated with an aberrant screening result. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Aberrant CH screening results were found in most ECMO-treated neonates screened before or during ECMO, which is likely due to NTIS. Follow-up of thyroid hormone concentrations is best started after recovery from critical illness. Our results suggest that thyroxine therapy is not required during ECMO.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000448238
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
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  • 6
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    Is the Glass Half Full or Half Empty?
    S. Karger AG ; 2016
    In:  Neonatology Vol. 109, No. 2 ( 2016), p. 122-123
    Details
    In: Neonatology, S. Karger AG, Vol. 109, No. 2 ( 2016), p. 122-123
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000442098
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
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  • 7
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    Infants Operated on for Necrotizing Enterocolitis: Towards Evidence-Based Pain Guidelines
    S. Karger AG ; 2016
    In:  Neonatology Vol. 110, No. 3 ( 2016), p. 190-197
    Details
    In: Neonatology, S. Karger AG, Vol. 110, No. 3 ( 2016), p. 190-197
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Necrotizing enterocolitis (NEC) is known as an extremely painful childhood condition. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 The objective of this study was to explore pain management around NEC-related surgery in our neonatal intensive care unit (NICU) from a chart review of prospectively collected data on 60 operated NEC patients admitted between 2008 and 2013 with a median (IQR) gestational age of 28.3 (25.5-31.6) weeks. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Pain medication data and pain scores (i.e. COMFORTneo and Numerical Rating Scale pain and distress scores) from 72 h before until 72 h after surgery were collected. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Preoperatively, 95% of the patients received morphine versus 100% postoperatively, with a median dosage of 10.0 (IQR 9.7-14.5) and 16.9 (IQR 10.1-20.0) μg/kg/h, respectively. Postoperatively, 28 patients (46.7%) received additional fentanyl intermittently and 14 (23.3%) received midazolam, which was part of palliative treatment for 6 patients (42.9%). In patients receiving pain medication, median COMFORTneo scores were 10 (IQR 10-11) preoperatively and 11 (10-12) postoperatively. The pain scores were comparable with those of other patients admitted to the NICU in the same time period. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Continuous morphine of 10 μg/kg/h preoperatively, with an increase to 15 μg/kg/h postoperatively, seems to constitute a good starting dose for further individualized pain management guided by pain scores.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000445284
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
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  • 8
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    Effects of Repetitive Exposure to Pain and Morphine Treatment on the Neonatal Rat Brain
    S. Karger AG ; 2013
    In:  Neonatology Vol. 103, No. 1 ( 2013), p. 35-43
    Details
    In: Neonatology, S. Karger AG, Vol. 103, No. 1 ( 2013), p. 35-43
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Untreated exposure to pain in preterm neonates might damage the vulnerable premature brain and alter development. Pain treatment is limited because analgesic agents may also have adverse neurodevelopmental consequences in newborns. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 To study the effects of neonatal pain and morphine treatment on the developing brain in a neonatal rat model. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Newborn rats were randomly assigned to: treatment with formalin injections (group 1), saline injections (group 2) and controls receiving no injections (group 3). Treatment was given on postnatal days 1–3 (model A), 1–5 (model B) and 10–12 (model C). Brains were studied histologically and protein expression was evaluated (protein kinase C epsilon and doublecortin). Effects of preemptive morphine treatment were studied in the same models (models A+M and B+M). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Formalin injections resulted in increased apoptotic scores in models A and B. Saline injections increased the number of degenerative cells only in model B. Morphine showed protective effects in formalin-treated animals of model A+M and saline-treated animals of model B+M only. In model C, no neurodegenerative effects were detected. The protein expression of doublecortin showed a pain-related upregulation in the thalamus region, whereas protein kinase C epsilon expression was upregulated in the cortex. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Severe inflammatory pain and pain caused by repetitive injections in neonatal rats may cause major changes in the developing brain during the first week of life. Morphine may only protect the newborn brain against these changes in specific situations.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000341769
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
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  • 9
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    Effect of Oxygen on the Expression of Hypoxia-Inducible Factors in Human Fetal Lung Explants
    S. Karger AG ; 2010
    In:  Neonatology Vol. 97, No. 4 ( 2010), p. 346-354
    Details
    In: Neonatology, S. Karger AG, Vol. 97, No. 4 ( 2010), p. 346-354
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Fetal lung development requires proper coordination between lung epithelial and vascular morphogenesis. A major determinant in lung vascular development is vascular endothelial growth factor (VEGF), which is regulated by hypoxia-inducible factors (HIFs). VEGF is expressed in the airway epithelium, while its receptors (VEGFRs) are expressed in the pulmonary mesenchyme. The hypoxic environment in utero is beneficial for fetal organogenesis, especially vascular development. However, little is known about the expression of HIFs and VEGFR-2 in the human fetal lung in vitro. 〈 i 〉 Objectives: 〈 /i 〉 The purpose of this study was to investigate the effects of hypoxia on fetal lung morphology and mRNA expression of VEGF, VEGFR-2, HIF-2α, and HIF-3α. 〈 i 〉 Methods: 〈 /i 〉 An explant culture technique was used to study the effects of normoxic and hypoxic conditions on human fetal lung. 〈 i 〉 Results: 〈 /i 〉 The morphology remained largely unchanged in explants cultured under hypoxic or normoxic conditions. Quantitative RT-PCR showed that the mRNA expression of VEGF-A, but not VEGFR-2 is upregulated in explants cultured at 1.5% compared with 21% oxygen. We observed a nonsignificant increase in HIF-2α and HIF-3α mRNA expression in explants cultured at 1.5% oxygen. These data suggest that the mRNA expression of VEGF, and possibly HIF-2α and HIF-3α, is regulated by hypoxia in the developing human lung. 〈 i 〉 Conclusion: 〈 /i 〉 This lung explant culture model appears to be a valuable model to unravel the molecular mechanisms of human lung development.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000261018
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2010
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  • 10
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    Prematurity, Opioid Exposure and Neonatal Pain: Do They Affect the Developing Brain?
    S. Karger AG ; 2015
    In:  Neonatology Vol. 108, No. 1 ( 2015), p. 8-15
    Details
    In: Neonatology, S. Karger AG, Vol. 108, No. 1 ( 2015), p. 8-15
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Traditionally, 10 years ago, children born preterm often routinely received morphine, especially during mechanical ventilation. Studies in neonatal rats, whose stage of brain development roughly corresponds to that of children born preterm, found negative long-term effects after pain and opioid exposure. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 We studied possible effects of prematurity, procedural pain and opioids in humans 10 years later. We hypothesized that these factors would negatively influence neurobiological, neuropsychological and sensory development later in life. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We included 19 children born preterm who as neonates participated in an RCT on the short-term effects of morphine administration and who previously participated in our follow-up studies at ages 5 and 8/9 years. We assessed associations between brain morphology (n = 11), neuropsychological functioning (n = 19) and thermal sensitivity (n = 17) and prematurity, opioid exposure and neonatal pain. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Significant correlations (coefficients 0.60-0.85) of gestational age, number of painful procedures and morphine exposure with brain volumes were observed. Significant correlations between these factors and thermal sensitivity were not established. Neuropsychological outcome was significantly moderately correlated with morphine exposure in only two subtests, and children performed in general ‘average' by Dutch norms. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Although prematurity, opioid exposure and neonatal pain were significantly associated with brain volume, no major associations with neuropsychological functioning or thermal sensitivity were detected. Our findings suggest that morphine administration during neonatal life does not affect neurocognitive performance or thermal sensitivity during childhood in children born preterm without brain damage during early life. Future studies with larger sample sizes are needed to confirm these findings.
    Type of Medium: Online Resource
    ISSN: 1661-7800 , 1661-7819
    URL: Article
    DOI: 10.1159/000376566
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
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