非药物干预对减轻早产儿疼痛的效果：系统回顾和网络荟萃分析

IF 4.9 2区医学 Q1 NURSING Intensive and Critical Care Nursing Pub Date : 2024-06-08 DOI:10.1016/j.iccn.2024.103742

Tainá Costa Pereira Lopes , Alexia Gabriela da Silva Vieira , Sarah Almeida Cordeiro , Alexandre Lopes Miralha , Edson de Oliveira Andrade , Raquel Lima de Lima , Marcello Facundo do Valle Filho , Antônio Luiz Boechat , Roberta Lins Gonçalves

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引用次数: 0

摘要

方法对 2020 年 4 月至 2023 年 12 月期间用英语、葡萄牙语和西班牙语发表的随机临床试验进行系统综述和网络荟萃分析。使用的数据来源包括通过 PubMed 进行的 MedLine、LILACS、EMBASE、Cochrane 对照试验中央注册中心和 Pedro。我们使用 Rob 2 进行了偏倚风险分析，并使用建议分级评估、制定和评价系统对证据的确定性和建议的力度进行了评估。我们使用 Higgins 和 Thompson I2 检验评估了异质性，使用 P 评分对干预措施进行了分类，并使用直接证据图谱评估了不一致性。结果从 210 篇已确定的出版物中，我们利用 12 项研究对 961 名早产儿进行了分析，并结合 10 项研究对 716 名早产儿进行了网络荟萃分析，同时结合了 12 种非药物措施。在中等可信度的情况下，与无干预、安慰剂、丙卡因或标准新生儿重症监护室常规相比，感觉饱和度、糖类、非营养性吸吮、母体心音、摇篮曲、母乳气味/味道、磁针灸、皮肤接触和促进性掖被均可减轻早产儿的疼痛：感觉饱和度[SMD 5,25 IC 95%：-8,98；-1,53]、糖[SMD 2,32 IC 95%：-3,86；-0,79]、奶嘴[SMD 3,74 IC 95%：-7,30；0,19]、糖和奶嘴SMD[3,88 IC 95%：-7,72；-0,04]。对临床实践的启示本研究结果对政策和实践具有重要意义。这是唯一一项对非药物治疗措施的有效性进行比较的系统性综述，因此可以确定哪种措施效果最好，并可作为临床决策的首选。

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Effectiveness of non-pharmacological interventions in reducing pain in preterm infants: A systematic review and network meta-analysis

Objective

To identify the most effective non-pharmacological measures for pain control in preterm infants in the Neonatal Intensive Care Unit (NICU).

Methods

A Systematic review and network meta-analysis of randomized clinical trials published in English, Portuguese, and Spanish from April 2020 to December 2023. The data sources used were MedLine via PubMed, LILACS, EMBASE, The Cochrane Central Register of Controlled Trials, and Pedro. We performed the risk of bias analysis with Rob 2 and the certainty of the evidence and strength of the recommendation using the Grading of Recommendations Assessment, Development, and Evaluation system. We assessed heterogeneity using the Higgins and Thompson I² test, the classification of interventions using the P-score, and inconsistencies using the Direct Evidence Plot.

Results

From 210 publications identified, we utilized 12 studies in analysis with 961 preterm infants, and we combined ten studies in network meta-analysis with 716 preterm infants, and 12 combinations of non-pharmacological measures. With moderate confidence, sensory saturation, sugars, non-nutritive sucking, maternal heart sound, lullaby, breast milk odor/taste, magnetic acupuncture, skin-to-skin contact, and facilitated tucking have been shown to reduce pain in preterm infants when compared to no intervention, placebo, proparacaine or standard NICU routine: sensory saturation [SMD 5,25 IC 95%: −8,98; −1,53], sugars [SMD 2,32 IC 95%: −3,86; −0,79], pacifier [SMD 3,74 IC 95%: −7,30; 0,19], and sugars and pacifier SMD [3,88 IC 95% −7,72; −0,04].

Conclusion

Non-pharmacological measures are strongly recommended for pain management in preterm infants in the NICU.

Implications for clinical practice

The findings of this study have important implications for policy and practice. This is the only systematic review that compared the effectiveness of non-pharmacological measures, thus making it possible to identify which measure presents the best results and could be the first choice in clinical decision making.

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来源期刊

Intensive and Critical Care Nursing NURSING-

CiteScore

6.30

自引率

15.10%

发文量

144

审稿时长

57 days

期刊介绍： The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues; to provide an international and interdisciplinary forum for the publication, dissemination and exchange of research findings, experience and ideas; to develop and enhance the knowledge, skills, attitudes and creative thinking essential to good critical care nursing practice. The journal publishes reviews, updates and feature articles in addition to original papers and significant preliminary communications. Articles may deal with any part of practice including relevant clinical, research, educational, psychological and technological aspects.