Hélène Darretain, François-Xavier Laborne, Steven Lagadec, Bruno Garrigue, Frédéric Maillard, Faiza Harbi, Paul Waszak, Michele Granier, Nathalie Galand, Elizabeth Walter-Nicolet, Hasinirina Razafimahefa
{"title":"新生儿逆胃管插入镇痛技术:DOLATSONG,一项多中心随机对照试验。","authors":"Hélène Darretain, François-Xavier Laborne, Steven Lagadec, Bruno Garrigue, Frédéric Maillard, Faiza Harbi, Paul Waszak, Michele Granier, Nathalie Galand, Elizabeth Walter-Nicolet, Hasinirina Razafimahefa","doi":"10.1097/JPN.0000000000000746","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Gastric tube insertion is necessary to support early enteral feeding of newborns during their neonatal intensive care stay. This frequent and invasive procedure is known to be painful. Very few analgesic techniques (sweet solutions, sucking, swaddling, and skin-to-skin contact) are available to reduce the pain caused by orogastric tube insertion procedure.</p><p><strong>Objective: </strong>To determine whether a new orogastric tube insertion technique modifies the pain response in newborns, we hypothesize that inserting an orogastric tube through the nipple of a bottle reduces pain caused by this procedure.</p><p><strong>Design: </strong>Prospective, controlled, randomized, multicentered and open label study.</p><p><strong>Settings: </strong>Three neonatal intensive care units in France (2 level 3 units and 1 level 2B).</p><p><strong>Participants: </strong>Full-term or premature newborns at 32 weeks of gestation or more, postnatal age between 48 hours and 21 days, not ventilated and requiring enteral feeding, were randomized into 2 groups: usual technique (n = 36) and experimental technique (n = 35).</p><p><strong>Methods: </strong>Our experimental technique was to insert the orogastric tube through a modified nipple of a bottle. This method was compared with the usual technique of inserting the tube directly into the newborn's mouth without a support to guide it accompanied by a nipple encouraging sucking with a nonnutritive solution. An association of nonnutritive sucking and orally administered 30% glucose was given to all children for analgesic purposes. Pain during the orogastric tube insertion was assessed on video recordings by 2 independent experts, using a heteroassessment behavioral scale for pain (DAN-Douleur Aiguë du Nouveau-né; APN-Acute Pain in Newborns). The primary outcome was an Acute Pain in Newborns score of less than 3 at the time of the procedure. Comparisons were made using Fisher exact test or Mann-Whitney U test. Factors associated with an Acute Pain in Newborns score of 3 and greater were explored using univariable and multivariable regression models.</p><p><strong>Results: </strong>All but 1 video recording in each group were analyzed. Among the 34 neonates in the experimental group, 71.4% (95% CI: [53.7-85.4]) had an Acute Pain in Newborns score of less than 3 during orogastric tube insertion versus 41% (95% CI: [27.9-61.9]) in the control group (P = .031). Gagging was frequent and nonsignificantly different between the 2 groups (69% in the control group, 51% in the experimental group, P = .13). In multivariable analysis, the experimental technique was an independent factor of pain prevention compared with the usual technique (odds ratio = 0.21 [0.06-0.71], P = .015).</p><p><strong>Conclusions: </strong>This study suggests that a simple, inexpensive, and feasible technique of orogastric tube insertion through the nipple of a bottle limits pain associated with this procedure in newborns.</p>","PeriodicalId":54773,"journal":{"name":"Journal of Perinatal & Neonatal Nursing","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"An Analgesic Technique for Orogastric Tube Insertion in Newborns: DOLATSONG, a Randomized Multicentric Controlled Trial.\",\"authors\":\"Hélène Darretain, François-Xavier Laborne, Steven Lagadec, Bruno Garrigue, Frédéric Maillard, Faiza Harbi, Paul Waszak, Michele Granier, Nathalie Galand, Elizabeth Walter-Nicolet, Hasinirina Razafimahefa\",\"doi\":\"10.1097/JPN.0000000000000746\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Gastric tube insertion is necessary to support early enteral feeding of newborns during their neonatal intensive care stay. This frequent and invasive procedure is known to be painful. Very few analgesic techniques (sweet solutions, sucking, swaddling, and skin-to-skin contact) are available to reduce the pain caused by orogastric tube insertion procedure.</p><p><strong>Objective: </strong>To determine whether a new orogastric tube insertion technique modifies the pain response in newborns, we hypothesize that inserting an orogastric tube through the nipple of a bottle reduces pain caused by this procedure.</p><p><strong>Design: </strong>Prospective, controlled, randomized, multicentered and open label study.</p><p><strong>Settings: </strong>Three neonatal intensive care units in France (2 level 3 units and 1 level 2B).</p><p><strong>Participants: </strong>Full-term or premature newborns at 32 weeks of gestation or more, postnatal age between 48 hours and 21 days, not ventilated and requiring enteral feeding, were randomized into 2 groups: usual technique (n = 36) and experimental technique (n = 35).</p><p><strong>Methods: </strong>Our experimental technique was to insert the orogastric tube through a modified nipple of a bottle. This method was compared with the usual technique of inserting the tube directly into the newborn's mouth without a support to guide it accompanied by a nipple encouraging sucking with a nonnutritive solution. An association of nonnutritive sucking and orally administered 30% glucose was given to all children for analgesic purposes. Pain during the orogastric tube insertion was assessed on video recordings by 2 independent experts, using a heteroassessment behavioral scale for pain (DAN-Douleur Aiguë du Nouveau-né; APN-Acute Pain in Newborns). The primary outcome was an Acute Pain in Newborns score of less than 3 at the time of the procedure. Comparisons were made using Fisher exact test or Mann-Whitney U test. Factors associated with an Acute Pain in Newborns score of 3 and greater were explored using univariable and multivariable regression models.</p><p><strong>Results: </strong>All but 1 video recording in each group were analyzed. Among the 34 neonates in the experimental group, 71.4% (95% CI: [53.7-85.4]) had an Acute Pain in Newborns score of less than 3 during orogastric tube insertion versus 41% (95% CI: [27.9-61.9]) in the control group (P = .031). Gagging was frequent and nonsignificantly different between the 2 groups (69% in the control group, 51% in the experimental group, P = .13). In multivariable analysis, the experimental technique was an independent factor of pain prevention compared with the usual technique (odds ratio = 0.21 [0.06-0.71], P = .015).</p><p><strong>Conclusions: </strong>This study suggests that a simple, inexpensive, and feasible technique of orogastric tube insertion through the nipple of a bottle limits pain associated with this procedure in newborns.</p>\",\"PeriodicalId\":54773,\"journal\":{\"name\":\"Journal of Perinatal & Neonatal Nursing\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-01-10\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Perinatal & Neonatal Nursing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/JPN.0000000000000746\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"NURSING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Perinatal & Neonatal Nursing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/JPN.0000000000000746","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"NURSING","Score":null,"Total":0}
An Analgesic Technique for Orogastric Tube Insertion in Newborns: DOLATSONG, a Randomized Multicentric Controlled Trial.
Background: Gastric tube insertion is necessary to support early enteral feeding of newborns during their neonatal intensive care stay. This frequent and invasive procedure is known to be painful. Very few analgesic techniques (sweet solutions, sucking, swaddling, and skin-to-skin contact) are available to reduce the pain caused by orogastric tube insertion procedure.
Objective: To determine whether a new orogastric tube insertion technique modifies the pain response in newborns, we hypothesize that inserting an orogastric tube through the nipple of a bottle reduces pain caused by this procedure.
Design: Prospective, controlled, randomized, multicentered and open label study.
Settings: Three neonatal intensive care units in France (2 level 3 units and 1 level 2B).
Participants: Full-term or premature newborns at 32 weeks of gestation or more, postnatal age between 48 hours and 21 days, not ventilated and requiring enteral feeding, were randomized into 2 groups: usual technique (n = 36) and experimental technique (n = 35).
Methods: Our experimental technique was to insert the orogastric tube through a modified nipple of a bottle. This method was compared with the usual technique of inserting the tube directly into the newborn's mouth without a support to guide it accompanied by a nipple encouraging sucking with a nonnutritive solution. An association of nonnutritive sucking and orally administered 30% glucose was given to all children for analgesic purposes. Pain during the orogastric tube insertion was assessed on video recordings by 2 independent experts, using a heteroassessment behavioral scale for pain (DAN-Douleur Aiguë du Nouveau-né; APN-Acute Pain in Newborns). The primary outcome was an Acute Pain in Newborns score of less than 3 at the time of the procedure. Comparisons were made using Fisher exact test or Mann-Whitney U test. Factors associated with an Acute Pain in Newborns score of 3 and greater were explored using univariable and multivariable regression models.
Results: All but 1 video recording in each group were analyzed. Among the 34 neonates in the experimental group, 71.4% (95% CI: [53.7-85.4]) had an Acute Pain in Newborns score of less than 3 during orogastric tube insertion versus 41% (95% CI: [27.9-61.9]) in the control group (P = .031). Gagging was frequent and nonsignificantly different between the 2 groups (69% in the control group, 51% in the experimental group, P = .13). In multivariable analysis, the experimental technique was an independent factor of pain prevention compared with the usual technique (odds ratio = 0.21 [0.06-0.71], P = .015).
Conclusions: This study suggests that a simple, inexpensive, and feasible technique of orogastric tube insertion through the nipple of a bottle limits pain associated with this procedure in newborns.
期刊介绍:
The Journal of Perinatal and Neonatal Nursing (JPNN) strives to advance the practice of evidence-based perinatal and neonatal nursing through peer-reviewed articles in a topic-oriented format. Each issue features scholarly manuscripts, continuing education options, and columns on expert opinions, legal and risk management, and education resources. The perinatal focus of JPNN centers around labor and delivery and intrapartum services specifically and overall perinatal services broadly. The neonatal focus emphasizes neonatal intensive care and includes the spectrum of neonatal and infant care outcomes. Featured articles for JPNN include evidence-based reviews, innovative clinical programs and projects, clinical updates and education and research-related articles appropriate for registered and advanced practice nurses.
The primary objective of The Journal of Perinatal & Neonatal Nursing is to provide practicing nurses with useful information on perinatal and neonatal nursing. Each issue is PEER REVIEWED and will feature one topic, to be covered in depth. JPNN is a refereed journal. All manuscripts submitted for publication are peer reviewed by a minimum of three members of the editorial board. Manuscripts are evaluated on the basis of accuracy and relevance of content, fit with the journal purpose and upcoming issue topics, and writing style. Both clinical and research manuscripts applicable to perinatal and neonatal care are welcomed.