Non-pharmacological measures in preterm newborns submitted to arterial puncture

to assess pain in preterm newborns and to compare the neonatal and therapeutic variables with the total scores of the Neonatal Facial Coding System of preterm newborns submitted to arterial puncture exposed to music and 25% oral glucose.

Method:

a comparative study with 48 recordings of preterm newborns - Group 1, music (26); Group 2, glucose 25% (22) - individually analyzed by three trained nurses, after Kappa of at least 80%.

Results:

the variables and the pain scores of the groups did not present statistical significance (p < 0.05) according to the Neonatal Facial Coding System. 80.8% of the preterm infants in Group 1 had a higher quantitative score ≥ 3 in the neonatal variables (gender, type of delivery), and therapeutic variables (type of oxygen therapy, place of hospitalization, type of puncture).

Conclusion:

There was no difference when comparing the music and glucose 25% groups and the variables studied.

Descriptors:
Newborn; Ache; Music, Glucose; Neonatal Nursing

Intervention	Variables	NFCS Pain Score^* * NFCS = Neonatal Facial Coding System;				Total		p^† † p = Pearson's Chi-square test or Fischer's exact test;
		< 3		≥ 3		Total
		n^‡ ‡ N = Number of newborn;	%	n	%	n	%
	Gender
Group 1^§ § Group 1 = Music; \|\|Group 2 = 25% Glucose.	Male	2	12.5	14	87.5	16	61.5
	Female	3	30.0	7	70.0	10	38.5	0.271
	Total	5	19.2	21	80.8	26	100.0
Group 2^\|\| \|\| Group 2 = 25% Glucose.	Male	10	66.7	5	33.3	15	68.2
	Female	2	28.6	5	71.4	7	31.8	0.095
	Total	12	54.5	10	45.5	22	100.0
	Type of delivery
Group 1	Normal	0	0.0	4	100.0	4	15.4
	Cesarean	4	21.1	15	78.9	19	73.1	0.502
	Forceps	1	33.3	2	66.7	3	11.5
	Total	5	19.2	21	80.8	26	100.0
Group 2	Normal	2	40.0	3	60.0	5	22.7
	Cesarean	10	58.8	7	41.2	17	77.3	0.457
	Forceps	0	0.0	0	0.0	0	0.0
	Total	12	54.5	10	45.5	22	100.0

Variables	NFCS Value^* * NFCS = Neonatal Facial Coding System;	Mean±DP^† † SD = standard deviation;	IC^‡ ‡ CI = Confidence Interval; 95%		Minimum	Maximum	p^§ § p = Student's t test or Mann-Whitney U test
Variables	NFCS Value^* * NFCS = Neonatal Facial Coding System;	Mean±DP^† † SD = standard deviation;	Inferior Limit	Superior Limit	Minimum	Maximum	p^§ § p = Student's t test or Mann-Whitney U test
Weight at delivery	< 3	2146.0±564.7	1444.8	2847.2	1336.0	2682.0
	≥ 3	2133.7±654.4	1835.8	2431.6	1226.0	3946.0	0.970
	Total	2136.1±627.4	1882.7	2389.5	1226.0	3946.0
Cephalic perimeter	< 3	31.9±2.0	29.4	34.4	29.5	34.0
	≥ 3	31.2±2.6	30.0	32.4	26.5	36.5	0.569
	Total	31.3±2.4	30.3	32.3	26.5	36.5
Thoracic perimeter	< 3	28.4±3.4	24.1	32.7	23.0	31.0
	≥ 3	27.9±3.1	26.5	29.3	22.0	34.5	0.742
	Total	28.0±3.1	26.7	29.2	22.0	34.5
Number of punctures	< 3	1.0±0.0	1.0	1.0	1.0	1.0
	≥ 3	1.2±0.7	0.9	1.6	1.0	4.0	0.461
	Total	1.2±0.6	0.9	1.4	1.0	4.0
Apgar 1st minute	< 3	8.0±0.0	8.0	8.0	8.0	8.0
	≥ 3	6.5±2.1	5.6	7.5	2.0	9.0	0.133
	Total	6.8±2.0	6.0	7.6	2.0	9.0
Apgar 5th minute	< 3	8.8±0.4	8.2	9.4	8.0	9.0
	≥ 3	8.4±0.9	8.0	8.8	6.0	10.0	0.309
	Total	8.5±0.8	8.1	8.8	6.0	10.0
Corrected gestational age (weeks)	< 3	34.8±1.7	32.8	36.9	32.6	36.3
	≥ 3	34.2±1.6	33.5	35.0	32.0	36.5	0.463
	Total	34.4±1.6	33.7	35.0	32.0	36.5
Corrected gestational age (days)	< 3	245.2±11.1	231.4	259.0	230.0	255.0
	≥ 3	241.3±10.9	236.4	246.3	224.0	257.0	0.483
	Total	242.1±10.8	237.7	246.4	224.0	257.0
Chronological age (days)	< 3	1.2±1.8	-1.0	3.4	0.0	4.0
	≥ 3	2.1±5.4	-0.3	4.6	0.0	23.0	0.705
	Total	2.0±4.9	0.0	3.9	0.0	23.0

Variables	NFCS Value^* * NFCS = Neonatal Facial Coding System;	Mean±DP^† † SD = standard deviation;	IC^‡ ‡ CI = Confidence Interval; 95%		Minimum	Maximum	p^§ § p = Student's t test or Mann-Whitney U test
Variables	NFCS Value^* * NFCS = Neonatal Facial Coding System;	Mean±DP^† † SD = standard deviation;	Inferior Limit Superior Limit		Minimum	Maximum	p^§ § p = Student's t test or Mann-Whitney U test
Weight at delivery	<3	1,882.0±536.3	1,541.3	2,222.7	918.0	2,999.0
	≥ 3	1,853.3±445.7	1,534.5	2,172.1	1350.0	2,578.0	0.894
	Total	1,869.0±485.8	1,653.6	2,084.3	918.0	2,999.0
Cephalic perimeter	< 3	29.3±3.8	26.9	31.7	20.0	35.5
	≥ 3	30.2±1.7	29.0	31.3	28.0	32.6	0.530
	Total	29.7±3.0	28.4	31.0	20.0	35.5
Thoracic perimeter	< 3	26.9±3.6	24.6	29.2	20.0	32.0
	≥ 3	27.9±3.2	25.6	30.1	23.0	34.0	0.529
	Total	27.3±3.4	25.9	28.8	20.0	34.0
Number of punctures	< 3	1.0±0.0	1.0	1.0	1.0	1.0
	≥ 3	1.2±0.4	0.9	1.5	1.0	2.0	0.114
	Total	1.1±0.3	1.0	1.2	1.0	2.0
Apgar 1st minute	< 3	6.6±1.5	5.6	7.5	4.0	9.0
	≥ 3	6.1±2.8	4.1	8.1	2.0	9.0	0.615
	Total	6.4±2.2	5.4	7.3	2.0	9.0
Apgar 5th minute	< 3	8.3±0.7	7.9	8.7	7.0	9.0
	≥ 3	8.2±1.0	7.5	8.9	7.0	9.0	0.716
	Total	8.3±0.8	7.9	8.6	7.0	9.0
Corrected gestational age (weeks)	< 3	33.4±1.8	32.3	34.5	32.0	36.6
	≥ 3	34.2±1.6	33.1	35.3	32.4	36.6	0.274
	Total	33.8±1.7	33.0	34.5	32.0	36.6
Corrected gestational age (days)	< 3	234.5±12.8	226.4	242.6	224.0	258.0
	≥ 3	240.4±11.6	233.1	248.7	228.0	258.0	0.275
	Total	237.2±12.3	231.7	242.7	224.0	258.0
Chronological age (days)	< 3	4.3±11.5	-3.0	11.5	0.0	40.0
	≥ 3	1.7±2.4	0.0	3.4	0.0	8.0	0.499
	Total	3.1±8.5	-0.7	6.9	0.0	40.0

Intervention	Variables	NFCS Pain Score^* * NFCS = Neonatal Facial Coding System;				Total		p^† † p = Pearson's Chi-square test or Fischer's exact test;
		< 3		≥ 3
		n^‡ ‡ N = Number of newborn;	%	n	%	n	%
	Type of oxygen therapy
Group 1^§ § Group 1 = Music;	Mechanical ventilation	1	16.7	5	83.3	6	23.1
	Continuous Positive Airway Pressure	2	20.0	8	80.0	10	38.5
	Oxi-Hood	2	28.6	5	71.4	7	26.9	0.888
	Ambient air	0	0.0	3	100.0	3	11.5
	Total	5	19.2	21	80.8	26	100.0
Group 2^\|\| \|\| Group 2 = 25% Glucose	Mechanical ventilation	3	75.0	1	25.0	4	18.2
	Continuous Positive Airway Pressure	4	50.0	4	50.0	8	36.4
	Oxi-Hood	4	66.7	2	33.3	6	27.2	0.474
	Ambient air	1	25.0	3	75.0	4	18.2
	Total	12	54.5	10	45.5	22	100.0
	Admission location
Group 1	High risk	4	16.7	20	83.3	24	100.0
	Medium risk	1	50.0	1	50.0	2	8.3	0.250
	Total	5	19.2	21	80.8	26	108.3
Group 2	High risk	10	58.8	7	41.2	17	77.3
	Medium risk	2	40.0	3	60.0	5	22.7	0.406
	Total	12	54.5	10	45.5	22	100.0
	Puncture location
Group 1	Right radial	2	16.7	10	83.3	12	46.2
	Left radial	3	25.0	9	75.0	12	46.2
	Right brachial	0	0.0	1	100.0	1	3.8	0.853
	Left brachial	0	0.0	1	100.0	1	3.8
	Total	5	19.2	21	80.8	26	100.0
Group 2	Right radial	6	50.0	6	50.0	12	54.5
	Left radial	5	55.6	4	44.4	9	41.0
	Right brachial	0	0.0	0	0.0	0	0.0	0.626
	Left brachial	1	100.0	0	0.0	1	4.5
	Total	12	54.5	10	45.5	22	100.0

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[1] CORRESPONDING AUTHOR: Maria Vera Lúcia Moreira Leitão Cardoso. E-mail: cardoso@ufc.br