Pain Assessment among African Neonates

Desire Aime Nshimirimana; Donald Kokonya; Jeanne Marie Claude Uwurukundo; Phocas Biraboneye; Fred Were; Cyprien Baribwira

doi:doi:10.11648/j.ajp.20160202.11

Pain Assessment among African Neonates

Desire Aime Nshimirimana, Donald Kokonya, Jeanne Marie Claude Uwurukundo, Phocas Biraboneye, Fred Were, Cyprien Baribwira

Published in American Journal of Pediatrics (Volume 2, Issue 2)

Received: 11 August 2016 Accepted: 29 August 2016 Published: 11 October 2016

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Abstract

Neonates who require treatment and venous drawing of blood samples in the newborn units are subjected to acute and painfully invasive procedures. Several tools to assess pain among newborns have been developed and are widely used in developed countries, but in Africa, there is limited experience in the assessment pain among newborns. This study assessed physiological and behavioral responses to pain among neonates during invasive procedures performed in a newborn unit in Rwanda. A total of 60 neonates born at gestational age of 28-42 weeks at the National University of Rwanda Teaching and Referral Hospital in the year 2005 were enrolled into this study. Blood pressures, heart and respiratory rates, oxygen saturation levels, the Neonatal Facing Coding System (NFCS) and Neonatal Acute Pain (APN) pain tools were and scores recorded before, immediately and 5, 10, 15 and 20 minutes after procedures were recorded. Physiological parameters were compared using the Wilcoxon Signed Ranks Test while the NFCS and APN were compared using the McNemar Test. All (100%) neonates experienced acutely peak pain in the first 5 minutes of the invasive procedures with peak responses recorded at 2.5 minutes and no pain (resolution) after 15 minutes among 81% of the neonates and only 6% experienced pain after 20 minutes. The increases in systolic blood pressures immediately after inflicting pain, 5, 10, 15 and 20 minutes were statistically significant (p<0.001, p<0.001, p<0.005 and p<0.046) respectively compared to the diastolic blood pressures whose significant increases were at 5 and 10 minutes, (p<0.001 and p<0.001) respectively. Respiratory rates were significantly high at the onset (p<0.001), 5 minutes (p<0.001) and 10 minutes later (p<0.002). Heart rates significantly increased at the onset of the procedures (p<0.000), 5 minutes (p<0.001) and after 10 minutes (p<0.033). Decrease in oxygen saturation immediately after the procedures was significant (p<0.001). Oxygen saturation immediately after the procedures significantly increased up to 5 minutes (p<0.001) and 10 minutes (p<0.001). Invasive procedures caused acute pain among neonates in the African settings but to date, neonatal practice had not been given its due consideration with the aim of reducing pain among African neonates.

Published in	American Journal of Pediatrics (Volume 2, Issue 2)
DOI	10.11648/j.ajp.20160202.11
Page(s)	4-9
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2016. Published by Science Publishing Group

Keywords

Pain, Assessment, Neonates, Physiological, APN, NFCS, Africa

References

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APA Style

Desire Aime Nshimirimana, Donald Kokonya, Jeanne Marie Claude Uwurukundo, Phocas Biraboneye, Fred Were, et al. (2016). Pain Assessment among African Neonates. American Journal of Pediatrics, 2(2), 4-9. https://doi.org/10.11648/j.ajp.20160202.11

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ACS Style

Desire Aime Nshimirimana; Donald Kokonya; Jeanne Marie Claude Uwurukundo; Phocas Biraboneye; Fred Were, et al. Pain Assessment among African Neonates. Am. J. Pediatr. 2016, 2(2), 4-9. doi: 10.11648/j.ajp.20160202.11

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AMA Style

Desire Aime Nshimirimana, Donald Kokonya, Jeanne Marie Claude Uwurukundo, Phocas Biraboneye, Fred Were, et al. Pain Assessment among African Neonates. Am J Pediatr. 2016;2(2):4-9. doi: 10.11648/j.ajp.20160202.11

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@article{10.11648/j.ajp.20160202.11,
  author = {Desire Aime Nshimirimana and Donald Kokonya and Jeanne Marie Claude Uwurukundo and Phocas Biraboneye and Fred Were and Cyprien Baribwira},
  title = {Pain Assessment among African Neonates},
  journal = {American Journal of Pediatrics},
  volume = {2},
  number = {2},
  pages = {4-9},
  doi = {10.11648/j.ajp.20160202.11},
  url = {https://doi.org/10.11648/j.ajp.20160202.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20160202.11},
  abstract = {Neonates who require treatment and venous drawing of blood samples in the newborn units are subjected to acute and painfully invasive procedures. Several tools to assess pain among newborns have been developed and are widely used in developed countries, but in Africa, there is limited experience in the assessment pain among newborns. This study assessed physiological and behavioral responses to pain among neonates during invasive procedures performed in a newborn unit in Rwanda. A total of 60 neonates born at gestational age of 28-42 weeks at the National University of Rwanda Teaching and Referral Hospital in the year 2005 were enrolled into this study. Blood pressures, heart and respiratory rates, oxygen saturation levels, the Neonatal Facing Coding System (NFCS) and Neonatal Acute Pain (APN) pain tools were and scores recorded before, immediately and 5, 10, 15 and 20 minutes after procedures were recorded. Physiological parameters were compared using the Wilcoxon Signed Ranks Test while the NFCS and APN were compared using the McNemar Test. All (100%) neonates experienced acutely peak pain in the first 5 minutes of the invasive procedures with peak responses recorded at 2.5 minutes and no pain (resolution) after 15 minutes among 81% of the neonates and only 6% experienced pain after 20 minutes. The increases in systolic blood pressures immediately after inflicting pain, 5, 10, 15 and 20 minutes were statistically significant (p<0.001, p<0.001, p<0.005 and p<0.046) respectively compared to the diastolic blood pressures whose significant increases were at 5 and 10 minutes, (p<0.001 and p<0.001) respectively. Respiratory rates were significantly high at the onset (p<0.001), 5 minutes (p<0.001) and 10 minutes later (p<0.002). Heart rates significantly increased at the onset of the procedures (p<0.000), 5 minutes (p<0.001) and after 10 minutes (p<0.033). Decrease in oxygen saturation immediately after the procedures was significant (p<0.001). Oxygen saturation immediately after the procedures significantly increased up to 5 minutes (p<0.001) and 10 minutes (p<0.001). Invasive procedures caused acute pain among neonates in the African settings but to date, neonatal practice had not been given its due consideration with the aim of reducing pain among African neonates.},
 year = {2016}
}

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TY  - JOUR
T1  - Pain Assessment among African Neonates
AU  - Desire Aime Nshimirimana
AU  - Donald Kokonya
AU  - Jeanne Marie Claude Uwurukundo
AU  - Phocas Biraboneye
AU  - Fred Were
AU  - Cyprien Baribwira
Y1  - 2016/10/11
PY  - 2016
N1  - https://doi.org/10.11648/j.ajp.20160202.11
DO  - 10.11648/j.ajp.20160202.11
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 4
EP  - 9
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20160202.11
AB  - Neonates who require treatment and venous drawing of blood samples in the newborn units are subjected to acute and painfully invasive procedures. Several tools to assess pain among newborns have been developed and are widely used in developed countries, but in Africa, there is limited experience in the assessment pain among newborns. This study assessed physiological and behavioral responses to pain among neonates during invasive procedures performed in a newborn unit in Rwanda. A total of 60 neonates born at gestational age of 28-42 weeks at the National University of Rwanda Teaching and Referral Hospital in the year 2005 were enrolled into this study. Blood pressures, heart and respiratory rates, oxygen saturation levels, the Neonatal Facing Coding System (NFCS) and Neonatal Acute Pain (APN) pain tools were and scores recorded before, immediately and 5, 10, 15 and 20 minutes after procedures were recorded. Physiological parameters were compared using the Wilcoxon Signed Ranks Test while the NFCS and APN were compared using the McNemar Test. All (100%) neonates experienced acutely peak pain in the first 5 minutes of the invasive procedures with peak responses recorded at 2.5 minutes and no pain (resolution) after 15 minutes among 81% of the neonates and only 6% experienced pain after 20 minutes. The increases in systolic blood pressures immediately after inflicting pain, 5, 10, 15 and 20 minutes were statistically significant (p<0.001, p<0.001, p<0.005 and p<0.046) respectively compared to the diastolic blood pressures whose significant increases were at 5 and 10 minutes, (p<0.001 and p<0.001) respectively. Respiratory rates were significantly high at the onset (p<0.001), 5 minutes (p<0.001) and 10 minutes later (p<0.002). Heart rates significantly increased at the onset of the procedures (p<0.000), 5 minutes (p<0.001) and after 10 minutes (p<0.033). Decrease in oxygen saturation immediately after the procedures was significant (p<0.001). Oxygen saturation immediately after the procedures significantly increased up to 5 minutes (p<0.001) and 10 minutes (p<0.001). Invasive procedures caused acute pain among neonates in the African settings but to date, neonatal practice had not been given its due consideration with the aim of reducing pain among African neonates.
VL  - 2
IS  - 2
ER  -

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Author Information

Desire Aime Nshimirimana

Department of Health Systems Management, School of Medicine & Health Sciences, Kenya Methodist University, Nairobi, Kenya
Donald Kokonya

Department of Mental Health, School of Medicine, Masinde Muliro University of Science & Technology, Kakamega, Kenya
Jeanne Marie Claude Uwurukundo

Department of Pediatrics & Neonatology, School of Medicine, National University of Rwanda, Butare, Rwanda
Phocas Biraboneye

Department of Obstetrics and Gynecology, School of Medicine, University of Nairobi, Nairobi, Kenya
Fred Were

Department of Paediatrics & Child Health, School of Medicine, College of Health Sciences, University of Nairobi, Nairobi, Kenya
Cyprien Baribwira

Department of Pediatrics & Neonatology, School of Medicine, National University of Rwanda, Butare, Rwanda

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Plain Text BibTeX RIS

APA Style

Desire Aime Nshimirimana, Donald Kokonya, Jeanne Marie Claude Uwurukundo, Phocas Biraboneye, Fred Were, et al. (2016). Pain Assessment among African Neonates. American Journal of Pediatrics, 2(2), 4-9. https://doi.org/10.11648/j.ajp.20160202.11

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ACS Style

Desire Aime Nshimirimana; Donald Kokonya; Jeanne Marie Claude Uwurukundo; Phocas Biraboneye; Fred Were, et al. Pain Assessment among African Neonates. Am. J. Pediatr. 2016, 2(2), 4-9. doi: 10.11648/j.ajp.20160202.11

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AMA Style

Desire Aime Nshimirimana, Donald Kokonya, Jeanne Marie Claude Uwurukundo, Phocas Biraboneye, Fred Were, et al. Pain Assessment among African Neonates. Am J Pediatr. 2016;2(2):4-9. doi: 10.11648/j.ajp.20160202.11

Copy | Download

@article{10.11648/j.ajp.20160202.11,
  author = {Desire Aime Nshimirimana and Donald Kokonya and Jeanne Marie Claude Uwurukundo and Phocas Biraboneye and Fred Were and Cyprien Baribwira},
  title = {Pain Assessment among African Neonates},
  journal = {American Journal of Pediatrics},
  volume = {2},
  number = {2},
  pages = {4-9},
  doi = {10.11648/j.ajp.20160202.11},
  url = {https://doi.org/10.11648/j.ajp.20160202.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ajp.20160202.11},
  abstract = {Neonates who require treatment and venous drawing of blood samples in the newborn units are subjected to acute and painfully invasive procedures. Several tools to assess pain among newborns have been developed and are widely used in developed countries, but in Africa, there is limited experience in the assessment pain among newborns. This study assessed physiological and behavioral responses to pain among neonates during invasive procedures performed in a newborn unit in Rwanda. A total of 60 neonates born at gestational age of 28-42 weeks at the National University of Rwanda Teaching and Referral Hospital in the year 2005 were enrolled into this study. Blood pressures, heart and respiratory rates, oxygen saturation levels, the Neonatal Facing Coding System (NFCS) and Neonatal Acute Pain (APN) pain tools were and scores recorded before, immediately and 5, 10, 15 and 20 minutes after procedures were recorded. Physiological parameters were compared using the Wilcoxon Signed Ranks Test while the NFCS and APN were compared using the McNemar Test. All (100%) neonates experienced acutely peak pain in the first 5 minutes of the invasive procedures with peak responses recorded at 2.5 minutes and no pain (resolution) after 15 minutes among 81% of the neonates and only 6% experienced pain after 20 minutes. The increases in systolic blood pressures immediately after inflicting pain, 5, 10, 15 and 20 minutes were statistically significant (p<0.001, p<0.001, p<0.005 and p<0.046) respectively compared to the diastolic blood pressures whose significant increases were at 5 and 10 minutes, (p<0.001 and p<0.001) respectively. Respiratory rates were significantly high at the onset (p<0.001), 5 minutes (p<0.001) and 10 minutes later (p<0.002). Heart rates significantly increased at the onset of the procedures (p<0.000), 5 minutes (p<0.001) and after 10 minutes (p<0.033). Decrease in oxygen saturation immediately after the procedures was significant (p<0.001). Oxygen saturation immediately after the procedures significantly increased up to 5 minutes (p<0.001) and 10 minutes (p<0.001). Invasive procedures caused acute pain among neonates in the African settings but to date, neonatal practice had not been given its due consideration with the aim of reducing pain among African neonates.},
 year = {2016}
}

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TY  - JOUR
T1  - Pain Assessment among African Neonates
AU  - Desire Aime Nshimirimana
AU  - Donald Kokonya
AU  - Jeanne Marie Claude Uwurukundo
AU  - Phocas Biraboneye
AU  - Fred Were
AU  - Cyprien Baribwira
Y1  - 2016/10/11
PY  - 2016
N1  - https://doi.org/10.11648/j.ajp.20160202.11
DO  - 10.11648/j.ajp.20160202.11
T2  - American Journal of Pediatrics
JF  - American Journal of Pediatrics
JO  - American Journal of Pediatrics
SP  - 4
EP  - 9
PB  - Science Publishing Group
SN  - 2472-0909
UR  - https://doi.org/10.11648/j.ajp.20160202.11
AB  - Neonates who require treatment and venous drawing of blood samples in the newborn units are subjected to acute and painfully invasive procedures. Several tools to assess pain among newborns have been developed and are widely used in developed countries, but in Africa, there is limited experience in the assessment pain among newborns. This study assessed physiological and behavioral responses to pain among neonates during invasive procedures performed in a newborn unit in Rwanda. A total of 60 neonates born at gestational age of 28-42 weeks at the National University of Rwanda Teaching and Referral Hospital in the year 2005 were enrolled into this study. Blood pressures, heart and respiratory rates, oxygen saturation levels, the Neonatal Facing Coding System (NFCS) and Neonatal Acute Pain (APN) pain tools were and scores recorded before, immediately and 5, 10, 15 and 20 minutes after procedures were recorded. Physiological parameters were compared using the Wilcoxon Signed Ranks Test while the NFCS and APN were compared using the McNemar Test. All (100%) neonates experienced acutely peak pain in the first 5 minutes of the invasive procedures with peak responses recorded at 2.5 minutes and no pain (resolution) after 15 minutes among 81% of the neonates and only 6% experienced pain after 20 minutes. The increases in systolic blood pressures immediately after inflicting pain, 5, 10, 15 and 20 minutes were statistically significant (p<0.001, p<0.001, p<0.005 and p<0.046) respectively compared to the diastolic blood pressures whose significant increases were at 5 and 10 minutes, (p<0.001 and p<0.001) respectively. Respiratory rates were significantly high at the onset (p<0.001), 5 minutes (p<0.001) and 10 minutes later (p<0.002). Heart rates significantly increased at the onset of the procedures (p<0.000), 5 minutes (p<0.001) and after 10 minutes (p<0.033). Decrease in oxygen saturation immediately after the procedures was significant (p<0.001). Oxygen saturation immediately after the procedures significantly increased up to 5 minutes (p<0.001) and 10 minutes (p<0.001). Invasive procedures caused acute pain among neonates in the African settings but to date, neonatal practice had not been given its due consideration with the aim of reducing pain among African neonates.
VL  - 2
IS  - 2
ER  -

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