Brazilian Journal of Pain
https://brjp.org.br/article/doi/10.5935/2595-0118.20200021
Brazilian Journal of Pain
Original Article

Evaluation of pain in vaginal and caesarean section birth newborns before and after intramuscular injection

Avaliação da dor em recém-nascidos de parto vaginal e cesariana antes e após injeção intramuscular

Esther Angélica Luiz Ferreira; Damaris Souza Nassif; Matheus Jordão Danza Silva; Silvia Maria de Macedo Barbosa; Norma Sueli Pinheiro Módolo; Guilherme Antônio Moreira Barros

Downloads: 0
Views: 569

Abstract

BACKGROUND AND OBJECTIVES: It is already known that the painful experiences to which the newborn is subjected may be related to future reactions and differences in the behavioral response to pain in newborns from different birth routes. This study aimed to evaluate the response to pain in infants born by cesarean section and vaginal delivery routes.

METHODS: This is a prospective cohort study. Newborns born at full term were allocated into two groups: cesarean section and vaginal delivery. The intramuscular vitamin K injection was performed as an acute pain stimulus because it is a routine injection at birth. The newborns were evaluated for pain on two scales, a one-dimensional, the Neonatal Facial Coding System, and a multidimensional, the COMFORT Behavior Scale (Comfort b), in addition to heart rate counting, moments before, immediately after and 10 minutes after the stimuli. Students t-test was used for statistical analyzes, and the level of significance was 5%.

RESULTS: Eighty-three children were evaluated. The pain intensity assessed by both scales before the pain stimulus was higher in the cesarean section group, but not statistically significant. Heart rate values after the stimulus showed a statistically significant difference (p<0.05), higher in the cesarean section group than in the vaginal delivery.

CONCLUSION: The results did not suggest that there are differences in the perception of pain among newborns born vaginally and cesarean section.

Keywords

Acute pain, Cesarean section, Newborn, Obstetric delivery

Resumo

JUSTIFICATIVA E OBJETIVOS: As experiências dolorosas as quais o recém-nascido é submetido podem ter relação com reações futuras e que existem diferenças no comportamento de resposta à dor nos recém-nascidos oriundos de diferentes vias de parto. O estudo teve como objetivo avaliar a resposta à dor em bebês nascidos por cesariana e parto vaginal.

MÉTODOS: Estudo coorte prospectivo que incluiu recém-nascidos nascidos a termo, de cesariana e parto vaginal. Utilizou-se, como estímulo doloroso agudo, a injeção intramuscular de vitamina K rotineira ao nascimento. Os recém-nascidos foram avaliados quanto à dor pela escala unidimensional Neonatal Facial Coding System e pela multidimensional COMFORT Behavior Scale (Comfort b), além da frequência cardíaca nos momentos antes, imediatamente após e 10 minutos após o estímulo. Foi utilizado teste t de Student para a análise estatística com significância de 5%.

RESULTADOS: Foram avaliadas 83 crianças. A intensidade da dor avaliada por ambas as escalas antes do estímulo doloroso foi maior no grupo de recém-nascidos de cesariana, porém não foi estatisticamente significativa. Os valores da frequência cardíaca após o estímulo mostraram diferença estatisticamente significativa (p<0,05) maiores no grupo cesariana que no parto vaginal.

CONCLUSÃO: Os dados obtidos não evidenciaram diferenças na percepção da dor entre recém-nascidos de parto vaginal e cesariana.

Palavras-chave

Cesariana, Dor aguda, Parto obstétrico, Recém-nascido

References

Anand KJ, Hickley PR. Pain and its effects in the human neonate and fetus. New Engl J Med. 1987;317(21):1321-9.

Anand KJ, Carr DB. The neuroanatomy, neurophysiology, and neurochemistry of pain, stress, and analgesia in newborns and children. Pediatr Clin North Am. 1989;36(4):795-822.

Goksan S, Hartley C, Emery F, Cockrill N, Poorun R, Moultrie F. fMRI reveals neural activity overlap between adult and infant pain. Elife. 2015;4:1-13.

Taddio A, Katz J, Ilersich AL, Koren G. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet. 1997;349(9052):599-603.

Moriarty O, Harrington L, Beggs S, Walker SM. Opioid analgesia and the somatosensory memory of neonatal surgical injury in the adult rat. Br J Anaesth. 2018;121(1):314-24.

Bergqvist LL, Katz-Salamon M, Hertegard S, Anand KJ, Lagercrantz H. Mode of delivery modulates physiological and behavioral responses to neonatal pain. J Perinatol. 2009;29(1):44-50.

Schuller C, Känel N, Müller O, Kind AB, Tinner EM, Hösli I. Stress and pain response of neonates after spontaneous birth and vacuum-assisted and cesarean delivery. Am J Obstet Gynecol. 2012;207(5):415.e1-6.

Chis A, Vulturar R, Andreica S, Prodan A, Mil AC. Behavioral and cortisol responses to stress in newborn infants: effects of mode of delivery. Psychoneuroendocrinology. 2017;86:203-8.

Lagercrantz H, Slotkin TA. The "stress" of being born. Sci Am. 1986;254(4):100-7.

Facchinetti F, Bagnoli F, Sardelli S, Petraglia F, De Leo V, Bracci R. Plasma opioids in the newborn in relation to the mode of delivery. Gynecol Obstet Invest. 1986;21(1):6-11.

Räisänen I, Paatero H, Salminen K, Laatikainen T. Beta-endorphin in maternal and umbilical cord plasma at elective cesarean section and in spontaneous labor. Obstet Gynecol. 1986;67(3):384-7.

Bacigalupo G, Langner K, Schmidt S, Saling E. Plasma immunoreactive beta-endorphin, ACTH and cortisol concentrations in mothers and their neonates immediately after delivery-their relationship to the duration of labor. J Perinat Med. 1987;15(1):45-52.

Braga AA, Frias JA, Braga FS, Potério GB, Hirata ES, Torres NA. Spinal anesthesia for cesarean section. Use of hyperbaric bupivacaine (10mg) combined with different adjuvants. Rev Bras Anestesiol. 2012;62(6):775-87.

Santos AP, da Silva M de L, de Souza NL, Mota GB, de França DF. Nursing diagnoses of newborns with sepsis in a Neonatal Intensive Care Unit. Rev Lat Am Enfermagem. 2014;22(2):255-61.

de Melo GM, Lélis AL, de Moura AF, Cardoso MV, da Silva VM. Pain assessment scales in newborns: integrative review. Rev Paul Pediatr. 2014;32(4):395-402.

Haynes SR, Lawler PG. An assessment of the consistency of ASA physical status classification allocation. Anaesthesia. 1995;50(3):195-9.

Almeida MFB, Guinsburg R. Reanimação do recém-nascido = 34 semanas em sala de parto: Diretrizes 2016 da Sociedade Brasileira de Pediatria. 2016.

Amoretti CF, Rodrigues GO, Carvalho PR, Trott Ede A. Validation of sedation scores in mechanically ventilated children admitted to a tertiary pediatric intensive care unit. Rev Bras Ter Intensiva. 2008;20(4):325-30.

Guinsburg R. Avaliação e tratamento da dor no recém-nascido. J Pediatr. 1999;75(3):149-60.

Atenção à saúde do recém-nascido: guia para os profissionais de saúde. 2012:48-153p.

Guerreiro MM, Montenegro AM. Desenvolvimento neuropsicomotor de lactentes filhos de mãe que apresentaram hipertensão arterial na gestação. Arq Neuropsiquiatr. 2005;63(3-A):632-6.

Battaglia FC, Lubchenco LO. A practical classification of newborn infants by weight and gestational age. J Pediatr. 1967;71(2):159-63.

Rodrigues YT, Rodrigues PPB. Semiologia Pediátrica. 2013:296p-308p.

WHO Child Growth Standards: Head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age and subscapular skinfold-for-age: Methods and development. 2007:217 pages.

Student B. The probable error of a mean. Biometrika. 1908;6:1-25.

Fisher RA. Statistical Methods for Research Workers. 1934.

Shah PS, Herbozo C, Aliwalas LL, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev. 2012;12:CD004950.

Nicolau CM, Modesto K, Nunes P, Araújo K, Amaral H, Falcão MC. Avaliação da dor no recém-nascido prematuro: parâmetros fisiológicos versus comportamentais. Arq Bras Ciênc Saúde. 2008;33(3):146-50.


Submitted date:
11/06/2019

Accepted date:
03/05/2020

5f2877d80e88257a130e4938 brjp Articles

BrJP

Share this page
Page Sections