Parents as Pain killers in the Pain ManageMent of PreterM infants

The aim of this study was to develop a new pain management method called facilitated tucking by parents (FTP) to alleviate procedural pain in preterm infants in the Neonatal Intensive Care Unit (NICU). In two randomized controlled crossover trials, the effectiveness of FTP was compared to a non-pharmacological evidence-based practice (oral glucose), a pharmacological method (intravenous oxycodone) and a placebo (oral water) or control care in the context of heel lance and endotracheal or pharyngeal suctioning. In addition, the short-term adverse effects (desaturation, bradycardia) and the prolonged effects of pain management on sleep were measured. The gestational age of the infants was a median of 28 weeks (n=20) in Study I and a mean of 28 1/7 (n=20) in Study II. The primary outcome measure for procedural pain was the Premature infant pain profile (PIPP). After interventions, sleep structure was analysed from 13-hour polysomnographic recordings. In the third study, the mothers (n = 23) who had used FTP from 2-4 weeks in the NICU were interviewed using the Clinical interview for parents of high-risk infants with additional questions related to the infants’ pain care. During heel lance, the PIPP scores were significantly lower with oral glucose (mean 4.85 ± 1.73, p≤0.001) and FTP (mean 5.20 ± 1.70, p=0.004) when compared to the placebo (mean 7.05 ± 2.16). During pharyngeal suctioning, the scores were lower with oral glucose (mean 11.05 ± 2.31, p=0.014) and FTP (mean 11.25 ± 2.47, p=0.034) compared to the placebo (mean 12.40 ± 2.06). Opioid equalled placebo during both procedures. Significantly more short-term adverse effects were related to the administration of oral glucose (21.3%) and oral water (12.5%) compared to opioid (5%) or FTP (5%). Oxycodone treatment altered the sleep structure by significantly decreasing the amount of REM sleep. The FTP was positively perceived by all participating parents. In the mothers, three different styles of involvement in pain care were identified. The differences found in the involvement of pain care were related to maternal attachment and NICUrelated stress of the mothers. The FTP was preferable to oral glucose and intravenous oxycodone when efficacy, safety and family issues were considered in treating short-term procedural pain in preterm infants.