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Biomedical subjects

B J Stevens

Publications and source records attributed to B J Stevens.

87 records · Page 5Linked to original sources
PubMedDate not supplied

Multidimensional pain assessment in premature neonates: a pilot study.

OBJECTIVE: To describe the physiologic and behavioral responses of premature neonates to a painful stimulus. DESIGN: Descriptive. SETTING: Secondary-level neonatal unit in a large metropolitan university teaching hospital. PARTICIPANTS: Forty neonates between 32 and 34 weeks' postconceptual age and less than 5 days' postnatal age. MAIN OUTCOME MEASURES: Physiologic (heart rate, oxygen saturation, and intracranial pressure) and behavioral (facial expression and cry) outcomes observed during a routine heel stick. RESULTS: Physiologic responses were significant, but were not specific to pain. Behavioral responses were more promising and indicated that premature neonates were capable of responding in a manner similar to full-term neonates. CONCLUSIONS: Premature neonates are capable of expressing their pain in a manner similar to healthy, full-term neonates. Factors that alter this response were not clearly delineated. Further research is needed to determine more precise patterns of response in this age group.

Age Factors↗
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Issues of assessment of pain and discomfort in neonates.

Pain assessment in neonates often presents problems. The problem of inadequate or inaccurate assessment is complicated by issues related to the nature, consistency, and variability of the infant's physiologic and behavioral responses; the reliability, validity, specificity, sensitivity, and practicality of existing neonatal pain measures or measurement approaches; ethical questions about pain research in infants; and uncertainty about the responsibilities of health care professionals in managing pain in clinical settings. Despite these many issues, neonates need to be comfortable and as free of pain as possible to grow and develop normally. Valid and reliable assessment of pain is the major prerequisite for attaining this goal. Issues embodied in neonatal pain responses, measurement, ethical, and clinical considerations are explored. Suggestions for resolving some of these problems are presented.

Ethics, Nursing↗
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Special needs of preterm infants in the management of pain and discomfort.

Most infants born preterm are admitted to hospital neonatal intensive care units, where they undergo repeated multiple diagnostic and therapeutic procedures that result in pain and discomfort. Although there is convincing evidence to support the preterm infant's neurologic capacity for pain, management of pain often is not optimal. Accurate and reliable assessment of the preterm infant's pain is an important prerequisite for effective pain management. Pain assessment is a challenge for health professionals because the preterm infant's responses are less vigorous, more variable, and less consistent than are the responses of term neonates and older infants. Few reliable and valid assessment measures exist for this age group. There also is uncertainty in implementing pain-relieving intervention because of inadequate information on their safety and effectiveness and preconceived attitudes and beliefs of health professionals. The special needs of preterm infants related to the assessment and management of pain are discussed.

Analgesics↗
PubMedDate not supplied

Factors explaining lack of response to heel stick in preterm newborns.

OBJECTIVE: To determine factors explaining lack of response by preterm newborns to heel stick for blood sampling. DESIGN: A cross-sectional design based on secondary analysis of the control session of a randomized crossover design. SETTING: Four Level III neonatal intensive-care units of university teaching hospitals. PARTICIPANTS: 120 preterm newborns with an average age of 28 weeks postconceptional age. INTERVENTION: 24 newborns who showed a "no change" response according the Premature Infant Pain Profile were compared to the remaining 96 newborns who had shown a pain response. MAIN OUTCOME MEASURES: Age (postconceptional age at birth, postnatal age at study), Apgar score at 5 minutes, severity of illness, sex, race, wake/sleep state, previous study sessions, total number of painful procedures since birth, and time since last painful procedure. RESULTS: After stepwise logistic regression analysis the variables remaining in the final model that explained the difference between the groups were postnatal age at time of study, postconceptional age at birth, time since last painful procedure, and wake/sleep state. CONCLUSIONS: Newborns who were younger, asleep, and had undergone a painful event more recently were less likely to demonstrate behavioral and physiologic indicators of pain.

Age Factors↗
PubMedDate not supplied

Physiological responses of premature infants to a painful stimulus.

The purpose of this study was to describe the physiological responses of premature infants to an acute tissue-damaging stimulus and to determine how severity of illness and behavioral state influenced these responses. The physiological responses (heart rate, oxygen saturation, and intracranial pressure) of a convenience sample of 124 premature infants between 32 and 34 weeks gestational age were described during four phases of a routine heel stick procedure. Analysis of the results showed a significant multivariate main effect of phase on the group of physiological responses. Behavioral state was found to influence the physiological responses, but severity of illness did not.

Behavior↗