Search Results (49)

Background/Objectives: Neonatal pain must be treated due to its potential short- and long-term adverse effects. A frenotomy is a painful procedure where common strategies to relieve pain (oral sucrose solutions and sucking) cannot be used because the technique is performed on the tongue. Lavender essential oil (LEO) is useful in treating pain during blood sampling, heel punctures, vaccination, and frenotomies. We aimed to determine whether smelling colostrum had similar effects as inhaled LEO during frenotomies. Methods: A prospective, randomized clinical trial was carried out with neonates who underwent a frenotomy for ankyloglossia between September 2023 and June 2024. We assessed pain using the NIPS score, heart rate, oxygen saturation, and crying time. After obtaining parental informed consent, we randomized patients into experimental and control groups. In both groups, we performed swaddling, administered 1 mL of oral sucrose, and let the newborn suck for 2 min. In the experimental group, we placed a gauze pad with two drops of colostrum, whereas in the control group, we used one drop of LEO 2 cm under the neonate’s nose prior to and during the frenotomy. Results: We enrolled 142 patients (71 experimental cases and 71 controls). The experimental group showed lower crying times (28.0 vs. 40.2 s, p = 0.03). Both groups showed similar NIPS scores (1.4 vs. 1.5, p = 0.28). We observed no side effects in either of the groups. Conclusions: Inhaled colostrum and LEO help relieve pain in neonates who undergo a frenotomy for ankyloglossia and have no side effects. Aromatherapy with colostrum may decrease crying time during the frenotomy. Full article

Background: Polysubstance use, particularly combining opioids with stimulants such as cocaine, is rising among individuals with substance use disorders. This practice aims to balance cocaine’s stimulant effects with opioids’ sedative effect, potentially decreasing adverse outcomes. We hypothesized that concurrent exposure to cocaine and opioids would reduce the risk of neonatal opioid withdrawal syndrome (NOWS) compared to opioid use alone. Methods: This analysis draws from an ongoing prospective study of maternal substance use (SUD) at Regional One Health’s perinatal center in Memphis, TN, and included mothers and their infants born between 2018 and 2022. Maternal SUD was identified via screening questionnaires, urine toxicology, or umbilical cord tissue analysis. Participants were grouped into using (a) opioids with cocaine (OwC) and (b) opioids without cocaine (OwoC). Univariate and regression analyses were conducted to assess the risk of NOWS. Results: A total of 353 infants were born to 342 mothers, with 31% (110/353) of the infants born to women who used cocaine along with opioids. While maternal demographics were similar, the OwC group had significantly lower rates of prenatal care, chronic pain history, and MOUD enrollment (p = 0.03). Infants in the OwC group had significantly higher rates of NOWS (p < 0.01), longer hospital stays (p < 0.01), and 6.5 times greater odds of developing NOWS (p < 0.001). NOWS was associated with an average 15-day increase in the length of stay for term infants (95% CI: 11.2, 18.8; p < 0.001). Conclusions: Contrary to our hypothesis, our study highlights the significant impact of maternal cocaine use on the increased likelihood of NOWS and extended hospital stays for affected infants. Full article

Background: Over recent years, several pain management techniques have been proposed to control labour pain, including pharmacological and non-pharmacological interventions. Transcutaneous electrical nerve stimulation (TENS) is considered a safe, non-invasive, easily applicable, and inexpensive pain relief method. This study aimed to investigate the impact of TENS on consecutive labour stages and on maternal and neonatal outcomes. Methods: This retrospective, single-centre cohort study covered a two-year period (1 January 2022–31 December 2023). A total of 1451 women met the inclusion criteria. TENS was applied in 203 of them. In 54.67% of cases, TENS was combined with water immersion and, in 42.85%, with water immersion and Entonox (N₂O and O₂ mixture). Two groups of patients that either made use of TENS, or not, to reduce labour pain, were compared to assess the effect of TENS on the course of labour and the condition of the newborn. Results: The women in the TENS group experienced a significantly longer first stage of labour. There was no statistically significant difference between the groups in terms of oxytocin usage, perineal tearing, episiotomy, and umbilical cord blood pH. The simultaneous application of TENS and water immersion contributed to prolonging the first stage of labour relative to their independent effects. Conclusions: The application of TENS may prolong the first stage of labour, without increasing the rate of perineal tearing and episiotomy and without any adverse effects on the condition of the newborn. Full article

Background and Objectives: This study aimed to assess the impact of early epidural analgesia (EA) on the progression of labor and delivery outcomes among nulliparous women. Materials and Methods: A retrospective analysis was conducted utilizing data from the Birth Registry of the Department of Obstetrics and Gynecology at LUHS. The dataset encompassed women who underwent childbirth between 1 January 2021 and 31 December 2021 and who received EA for labor pain management. A total of 89 women with low-risk deliveries and EA were included in the study. The cohort was divided into two groups: Group I—parturients who underwent early EA with cervical dilatation ≤3 cm—and Group II—parturients who underwent EA with cervical dilatation >3 cm but <7 cm. The results were processed using IBM SPSS. Results: Group I consisted of 25 (28.1%) women and Group II consisted of 64 (71.9%). The prevalence of obesity was higher in Group II (p = 0.021). Bishop score was statistically elevated in Group II (p = 0.018). Upon hospital admission, Group II exhibited greater cervical dilation (p = 0.001). The rate of cervical dilation was higher in Group II at 1.54 cm/h (p = 0.033). Episiotomy was more frequently performed in Group II (p = 0.014). The average durations of the first stage of labor (p = 0.045), the second stage of labor (p = 0.033), and the overall labor (p = 0.023) were prolonged in Group I. Conclusions: The cervical dilation up to 10 cm occurs at a swifter pace when EA is administered following cervical dilation exceeding 3 cm. Notable associations were observed between EA and the incidence of episiotomy as well as the duration of labor stages. Early EA exhibited no impact on neonatal outcomes. Full article

Objective: The aim of this study was to assess the opinions of pregnant women living with HIV (PWLWHIV) about their positive childbirth experiences and the most important factors contributing to positive or negative experiences. Methods: A cross-sectional study was conducted with 82 PWLWHIV; semi-structured interviews were conducted in a public hospital in Rio de Janeiro. Results: A total of 65 (79.3%) PWLWHIV experienced a positive childbirth experience. Conversely, 14 (17.1%) PWLWHIV had a negative experience. The main reasons given by the PWLWHIV for positive experiences were the good health of the baby, their partner’s presence at the childbirth, and good healthcare professional support. The main reasons for negative childbirth experiences were poor healthcare professional support, excessive pain or medication, and the absence of a companion during childbirth. Conclusions: Our findings indicate that the health of the baby at birth was the main factor in positive childbirth experiences. On the other hand, poor healthcare professional support was the main cause of negative childbirth experiences. Increasing the incidence of positive childbirth experiences could reduce maternal depression and anxiety, and significantly impact neonatal outcomes (mainly low birth weights and preterm birth). Future studies should target reducing depressive symptoms in perinatal HIV-positive women, increasing partner involvement, and decreasing HIV stigma. Full article

Background/Objectives: Women’s experience plays an important role in the evaluation of different methods in obstetric practice with a patient-centered approach, especially for induction of labor (IOL). For IOL, cervical ripening seemed to be associated with a less positive experience of childbirth. More specific data regarding the different cervical ripening methods might help the obstetrician to better counsel and support women requiring cervical ripening to improve their experience of IOL. The aim of this study was therefore to assess whether the method is associated with altered experiences of cervical ripening and childbirth among nulliparous women. Methods: A prospective observational study included 340 nulliparous women with a singleton fetus in cephalic presentation and cervical ripening at term (≥37 weeks) for maternal and/or fetal disease using a cervical ripening balloon (CRB, 33.8%), dinoprostone vaginal insert (PG, 32.7%), oral misoprostol (M, 3.8%), or repeated methods (R, 29.7%). The cervical ripening method was left to the free discretion of the obstetrician responsible for the women. A self-developed questionnaire assessed women’s feelings and experience of cervical ripening and childbirth using Likert scales from 0 to 10 (very satisfied) according to the method in the immediate postpartum period. We compared the women’s experiences and feelings according to the cervical ripening method (CRB, PG, M, or R) and specifically studied the association (assessed by multivariate logistic regression analyses) between women’s experience in the immediate postpartum period and the cervical ripening method. Results: The overall vaginal rate was 79.1% and was similar between groups (CRB 77.4%, PG 87.4%, M 69.2%, and R 73.3%; p = 0.15). The experience of ripening was significantly better with CRB, M, or PG compared to R (CRB: 6.7 ± 2.5, PG: 7.2 ± 2.6, M: 6.8 ± 3.6, and R: 5.2 ± 2.8; p < 0.001). The maximum pain during ripening was significantly higher in PG (7.9 ± 2.5 vs. CRB 7.2 ± 2.4, M 7.0 ± 3.9, and R 7.8 ± 2.4; p = 0.02). The experience of childbirth was more negative in the R group (6.1 ± 2.7 vs. CRB 6.9 ± 2.6, PG 7.2 ± 2.4, and M 7.4 ± 3.1; p = 0.02). After multivariate analysis with adjustment for confounders (method for cervical ripening, pain during IOL, mode of birth, maternal morbidity, and neonatal morbidity), repeated methods were significantly associated with worse overall experiences of cervical ripening (aOR = −1.4, 95%CI −2.1–−0.67; p < 0.001) and childbirth (aOR = −0.75, 95% CI −1.6–−0.05; p = 0.03), compared to PG, CRB, or M used alone. After adjustment, maternal experience and childbirth were similar between methods used alone for cervical ripening. Conclusions: Nulliparous women who required repeated methods for cervical ripening at term had significantly worse experiences of ripening and childbirth in the immediate postpartum period compared to PG, CRB, or M used alone, regardless of the mode of delivery and maternal and neonatal morbidity. Full article

Background: Iatrogenic withdrawal syndrome (IWS) poses a significant clinical challenge in pediatric intensive care units (PICUs) within Japan. Despite the existing availability of tools to assess pain and delirium, a validated instrument specifically designed for IWS has been notably absent in Japanese clinical practice. The Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale is globally recognized as an effective tool for IWS evaluation. To bridge this gap, this study aimed to validate the Japanese version of the SOS-PD scale. Methods: A prospective, cohort, observational study was undertaken in a single-center PICU in Japan. Participants ranged from neonates to children aged 20 years, excluding those with pre-existing neurological conditions or coma. Criterion validity was evaluated by comparing Japanese SOS-PD scale scores between a Weaning Group (WEAN) undergoing sedative/opioid tapering and a Maintenance Group (MAIN) receiving stable medication. Correlation analysis was also conducted against pediatric intensivists’ observational NRS (NRSobs). Inter-rater reliability of the Japanese SOS-PD scale was assessed utilizing kappa statistics and intraclass correlation coefficient (ICC). Results: In support of criterion validity, the WEAN group demonstrated significantly higher scores in both NRSobs and the IWS component of the Japanese SOS-PD scale compared to the MAIN group (p < 0.001). A strong correlation was observed between the Japanese SOS-PD IWS component and NRSobs (r = 0.91, p < 0.001). Inter-rater reliability was also robust, with a kappa coefficient of 0.95 and an ICC of 0.98. Conclusions: The Japanese version of the SOS-PD scale exhibits strong validity and inter-rater reliability for IWS assessment within Japanese PICUs. This validated instrument can support the early detection and appropriate management of pediatric IWS in Japan, with the potential to enhance the quality of patient care. Full article

Background/Objectives: Effective infant cardiopulmonary resuscitation (CPR) relies on high-quality chest compressions, yet the optimal technique for single-rescuer scenarios remains debated. Although widely used, the two-finger technique (TFT) is associated with an inadequate compression depth and increased rescuer fatigue. While the two-thumb encircling hands technique (TTHT) provides a superior compression depth, its application in single-rescuer scenarios is impractical. This study evaluates a novel technique (nT) as a potential alternative, aiming to optimize both compression efficacy and rescuer endurance. Methods: This randomized crossover study assessed the efficacy of the TFT, TTHT, and nT in a simulated infant CPR setting. Medical students trained in newborn and infant resuscitation performed all three techniques in a controlled environment using a high-fidelity neonatal simulator. We objectively measured and compared key CPR performance metrics, rescuer fatigue, and hand pain among the techniques. Results: The nT and TTHT outperformed the TFT in compression depth, rescuer endurance, and overall CPR quality. The nT achieved the highest adequate compression rate (92.4% vs. 78.6% for TTHT and 65.2% for TFT) while minimizing fatigue (RPE: 3.1 vs. 4.5 for TTHT and 6.2 for TFT) and hand pain (NRS: 1.8 vs. 3.9 for TTHT and 5.4 for TFT). TTHT produced the deepest compressions (mean: 44.2 mm vs. 42.9 mm for nT and 38.6 mm for TFT, p < 0.001). Rescuer anthropometric factors (sex, weight, and height) affected all techniques similarly, suggesting no inherent advantage based on body characteristics. Conclusions: Both the nT and TTHT outperformed the TFT, with the nT demonstrating superior rescuer endurance while maintaining high-quality compressions. Given its ergonomic benefits and effectiveness, the nT emerges as a promising alternative for single-rescuer infant CPR and warrants consideration for future resuscitation guidelines. Full article

Background and Objectives: Inadequate pain treatment in pediatric patients can cause long-term physical and psychological issues. Accurate detection of pain presence and intensity is crucial, especially in Neonatal and Pediatric Sub-Intensive Care Units. Due to uncertainties about the best pain assessment tool in these settings, it is necessary to review the literature to identify the available evidence. Methods: A scoping review was performed to address the question: What tools are available for pain assessment in non-sedated, non-intubated pediatric patients in sub-intensive care? Searches were conducted in databases including PubMed, Scopus, Embase, CINAHL, Cochrane Library, Web of Science, Open Dissertation, as well as CENTRAL and ClinicalTrials.gov registries. Results: The review included 27 studies, revealing various tools for pain assessment in pediatric sub-intensive settings. All studies favored the use of multidimensional scales, combining physiological and behavioral indicators. Conclusions: This review offers a comprehensive overview of the tools for pain assessment in pediatric patients in sub-intensive care settings but does not determine a single best tool. Most studies focused on the validation, translation, and adaptation of these tools. Further research is needed on the practical application of these tools and the perceptions of those administering them. Full article

Background/Objectives: Prematurity is a leading cause of infant mortality and mechanical ventilation increases respiratory complication risk. The effects of secretion removal techniques in premature infants remain a topic of ongoing debate. The aim of the study is to compare two secretion removal techniques in premature infants on mechanical ventilation; Methods: The participants were randomized into conventional chest physiotherapy (CPT; n = 22) or expiratory flow increase technique (EFIT; n = 21) groups. Each participant completed four sessions on consecutive days with a minimum of one and a maximum of two sessions per day. We assessed peripheral oxygen saturation (SpO₂), heart (HR) and respiratory rates (RR), tidal volume (VT), and pain levels at specific time points: before the intervention, immediately after the intervention, 5 min after the intervention, and 10 min after the intervention. The partial Eta squared (ŋ_p²) was reported to measure the effect size; Results: HR and RR increased post-intervention in both groups (p < 0.001; HR ŋ_p² = 0.51; RR ŋ_p² = 0.38); post hoc comparisons showed EFIT group decreased RR from the first to last session (p = 0.045). Both groups exhibited increased VT and SpO₂ in all sessions (p < 0.001; VT ŋ_p² = 0.40; SpO₂ ŋ_p² = 0.50). The EFIT group had higher SpO₂ values (p = 0.013; ŋ_p² = 0.15) and lower pain scores (p < 0.001; ŋ_p² = 0.46) post-intervention compared to CPT; Conclusions: CPT and EFIT resulted in similar effects on short-term respiratory parameters and heart rate; however, EFIT had advantages, including lower RR, higher SpO₂, and reduced pain, suggesting it may be a more effective, comfortable neonatal respiratory treatment. Full article

Background: Obstetric brachial plexus injuries (OBPIs) not only lead to severe and life changing sequelae regarding motor impairment but can also be responsible for multi-characteristic pain. In everyday routine, questions regarding pain of the developing child with an OBPI are often overseen and neglected. We aimed to elucidate this specific question and analyzed all patients with OBPI treated in our center to unmask initially non-observed pain and ultimately put pain in correlation to the surgical reconstructive treatment performed. Methods: This single center retrospective study analyzes patients with OBPI treated in our center over the past 20 years. Patients were surveyed by the adolescent pediatric pain tool assessment to evaluate pain over their entire life span by excluding potential postoperative pain episodes. Results: A total of 95 patients were initially contacted of which 78 returned the questionnaire (53.8% female, 46.2% male). In our patient cohort, the vast majority constituting 84.6 percent did not experience pain in the affected upper extremity over the years up to the date of their examination. Most of the patients describing pain had not been microsurgically treated for brachial plexus reconstruction in their neonate period. Merely, 33.3 percent of all OBPI experiencing pain had been microsurgically reconstructed at a median age of 7 months. Conclusions: Pain interrogation in patients with OBPI is often overseen during daily clinical routine. Adequate age-appropriate analgesic therapy regimens adapted to the individual are highly recommended. Timely microsurgical brachial plexus reconstruction may result in reduced lifetime pain experiences. Full article

Background: While parent-delivered pain management has been demonstrated to effectively reduce neonatal procedural pain responses, little is known about to what extent it is utilized. Our aim was to explore the utilization of parents in neonatal pain management and investigate whether local guidelines promote parent-delivered interventions. Methods: A web-based survey was distributed to neonatal units worldwide. Results: The majority of the 303 responding neonatal intensive care units (NICUs) from 44 countries were situated in high-income countries from Europe and Central Asia. Of the responding units, 67% had local guidelines about neonatal pain management, and of these, 40% answered that parental involvement was recommended, 27% answered that the role of parents in pain management was mentioned as optional, and 32% responded that it was not mentioned in the guidelines. According to the free-text responses, parent-delivered interventions of skin-to-skin contact, breastfeeding, and parental live singing were the most frequently performed in the NICUs. Of the responding units, 65% answered that parents performed some form of pain management regularly or always. Conclusions: There appears to be some practice uptake of parent-delivered pain management to reduce neonatal pain in high-income countries. Additional incorporation of these interventions into NICU pain guidelines is needed, as well as a better understanding of the use of parent-delivered pain management in low- and middle-income countries. Full article

The COVID-19 pandemic has posed significant risks to pregnant women and those recently pregnant, leading to heightened mortality and morbidity rates. Vaccination has emerged as a pivotal strategy in reducing COVID-19-related deaths and illnesses worldwide. However, the initial exclusion of pregnant individuals from most clinical trials raised concerns about vaccine safety in this population, contributing to vaccine hesitancy. This review aims to consolidate the existing literature to assess the safety and efficacy of COVID-19 vaccination in pregnant populations and neonatal outcomes. Diverse studies were included evaluating various aspects of safety for women and their newborns, encompassing mild to severe symptoms across different vaccines. The findings indicate the overall safety and efficacy of COVID-19 vaccination, with minimal adverse outcomes observed, including mild side effects like pain and fever. Although most studies reported the absence of severe adverse outcomes, isolated case reports have raised concerns about potential associations between maternal COVID-19 vaccination and conditions such as fetal supraventricular tachycardia and immune-mediated diseases. Our review underscores the importance of ongoing surveillance and monitoring to ensure vaccine safety in pregnant women. Overall, COVID-19 vaccination during pregnancy remains a safe and effective strategy, emphasizing the need for continued research and vigilance to safeguard maternal and fetal health. Full article

Background and Aims: Efforts to humanize childbirth focus on promoting skin-to-skin contact, labor accompaniment, and breastfeeding. Despite these advancements, cesarean sections often lack a consideration of immediate mother–child contact, early breastfeeding initiation, and follow-up. This underscores the need for a ‘natural’ approach to cesarean sections, aiming to ‘humanize’ the procedure and emulate some aspects of vaginal birth. Materials and Methods: An observational longitudinal cohort study was conducted, involving pregnant women scheduled for a cesarean section. Two comparison groups were established: one undergoing conventional cesarean sections and the other receiving a humanization intervention. While in “conventional cesarean sections,” newborns are separated from mothers at birth, preventing actions such as early breastfeeding or skin-to-skin contact, and maternal companionship is lacking in the operating room, the intervention of cesarean section humanization was based on avoiding the separation of the mother and newborn, promoting skin-to-skin contact, early breastfeeding, and maternal accompaniment during surgery. Descriptive data on maternal and neonatal variables, including breastfeeding initiation, maintenance, and baby weight trends, were collected. Additionally, a validated survey assessed the pain, satisfaction, and anxiety among the 73 participating women. Results: Women undergoing natural cesarean sections reported higher satisfaction, lower anxiety, and reduced postoperative pain, requiring less analgesia. Although their exclusive breastfeeding rates at 10 days postpartum showed no significant difference, statistically significant differences favored natural cesarean sections at 3 months (67.5% vs. 25%) and 6 months (50% vs. 4.5%). Neonates in the natural cesarean group exhibited greater weight gain at 10 days postpartum compared to those delivered conventionally (+49.90 g vs. −39.52 g). No significant differences in blood counts were observed between the groups. Conclusions: This study underscores the manifold advantages offered by the natural cesarean procedure compared to the conventional cesarean approach. Notably, a NC demonstrates superior outcomes in terms of heightened maternal satisfaction with the obstetric process, the enhanced sustainability of exclusive breastfeeding, and augmented neonatal weight gain. Full article

Objective: Colorectal cancer (CRC) during pregnancy is a rare occurrence, with a reported incidence of 0.8 cases per 100,000 pregnancies. Managing CRC during pregnancy poses substantial challenges for clinicians: the diagnosis is often complicated and delayed due to symptom overlap with pregnancy-related manifestations, and medical imaging is constrained by safety concerns for the foetus. Methods: This article presents two cases of advanced CRC diagnosed and managed during pregnancy. Additionally, we conducted a systematic review of the literature to assess diagnostic and prognostic factors involved in CRC in pregnant individuals. The systematic review, with pre-registration and approval through Prospero, involved an extensive search of medical databases (Pubmed, Web of Science, Scopus and Scholar) and statistical analysis using t-test for continuous variables and chi square for dichotomous variables. Results: A total of 1058 studies were identified. After applying exclusion criteria, sixty-six studies were included. Women whose initial symptoms were severe abdominal pain not responsive to common medical treatments and constipation (acute abdomen) had a mean gestational age at delivery lower than those who presented with paucisymptomatic onset. In our study groups, women who underwent chemotherapy during pregnancy had a higher mean gestational age at delivery and did not experience worse neonatal outcomes compared to those who did not undergo chemotherapy. Conclusions: CRC during pregnancy poses unique diagnostic and therapeutic challenges. Collaborative efforts among various medical disciplines are essential to manage CRC during pregnancy. Full article