Navegando por Palavras-chave "avaliação da dor"

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    Diferenças na expressão de dor entre recém-nascidos a termo do sexo feminino e masculino diante de estímulo nociceptivo agudo
    (Universidade Federal de São Paulo (UNIFESP), 2014-12-16) Arias, Maria Carmenza Cuenca [UNIFESP]; Guinsburg, Ruth Guinsburg [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Neonatal exposure to noxious stimuli during their stay in intensive care unit has the potential to alter neurodevelopment and cause permanent changes in somatosensory processing of pain. The consequences of nociception in both the short and long term are known to be affected by variables such as gestational age and newborn morbidity. Furthermore, sex-related differences in the structure and functionality of the brain can also affect its susceptibility to nociceptive stimulus during the neonatal period. However, the impact of sex in the response to an acute nociceptive stimulus in newborn infants remains to be elucidated. In this context the objective of this study was to analyze the differences in the expression of pain in newborns (NB) females and males in response to acute noxious stimulation in the first hours of life. For this purpose, we performed a cross-sectional and blinded study with prospective data collection of 400 infants (200 / sex) healthy, full-term, in the first 6 hours of life, who underwent intramuscular injection of Vitamin K. Heart rate (HR), oxygen saturation (SpO2) and three validated scales for assessing neonatal pain (neonatal Facial Coding System (NFCS), Behavioral Indicators of Infant Pain (BIPP) and Premature Infant pain Profile (PIPP)) were assessed before the procedure, during antisepsis, during injection and two minutes afterwards. The results for both sexes were compared with repeated measures (RM) ANOVA adjusted for gestational age (GA), hours of age, 5-minute Apgar. p <0.05 was considered significant. The studied population had an average or mean GA 39 ± 1 week, birth weight 3169 ± 316g, postnatal age 67 ± 45 minutes, 65% were born by cesarean section and the median Apgar score at 5 minutes was 10. RM-ANOVA adjusted HR, SpO2, BIPP and PIPP were significant for time effect, but not for sex or for the interaction of time and sex. NFCS as to the time effects (p <0.001), gender (p <0.05) and time and sex interaction (p <.03) were significant. Further, construction of contrasts analysis showed that this difference occurred during injection. Therefore, our findings indicate that the newborn full-term healthy females express more facial movements related to pain during an acute nociceptive stimulus in the first 6 hours of life, compared to males.
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    Discordância entre pais e profissionais de saúde quanto à intensidade da dor no recém-nascido criticamente doente
    (Sociedade Brasileira de Pediatria, 2008-02-01) Elias, Luciana Sabatini Doto Tannous [UNIFESP]; Guinsburg, Ruth [UNIFESP]; Peres, Clovis de Araujo [UNIFESP]; Balda, Rita de Cássia Xavier [UNIFESP]; Dos Santos, Amelia Miyashiro [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE: To verify whether parents and health professionals homogeneously evaluate presence and intensity of neonatal pain. METHODS: This cross-sectional study enrolled 52 neonates and 154 adults. Inclusion criteria for neonates were admission to neonatal intensive care unit, presence of gastric tube, tracheal tube, and venous lines. Each newborn was observed by a different group of three adults (parent, nurse assistant and pediatrician) for 1 minute at the same time to evaluate presence and intensity of infant's pain. Homogeneity of pain evaluation was analyzed by a modified Bland-Altman plot and by intraclass correlation coefficient (ICC). Multiple linear regression analysis was used to evaluate association of neonatal characteristics and heterogeneity of pain scores for adults. RESULTS: ICC showed disagreement of the pain scores given by the three groups of adults (ICC 0.066, agreement > 0.75). Bland-Altman analysis showed agreement among adults when they thought pain was absent. When they thought pain was present, there was heterogeneity of opinions regarding intensity of neonatal pain. Multiple regression analysis indicated that 10% of this disagreement could be explained by infant's gender and mode of delivery. CONCLUSIONS: Disagreement among adults about intensity of neonatal pain is a marker of the difficulty in deciding the need for analgesia in preverbal patients.