PEDIATRIC CARE
Painful Procedures in Infants
Weise KL, Nahata MC: EMLA for painful procedures in infants. J Pediatr Health Care 2005;19(1):42-7.
Infants in neonatal intensive care units can receive over 400 painful procedures during their stay in the unit. The Joint Commission on Accreditation of Healthcare Organizations has mandated pain management as the fifth vital sign to be checked on every patient. This article reviews several double-blind, randomized, placebo-controlled studies using eutectic mixture of local anesthetics (EMLA) for painful procedures on infants. The use of EMLA for heel lancing has not been effective and is not recommended. Study results vary, but EMLA is not recommended for venipuncture in neonates. For infants over 3 months of age, EMLA has been effective in pain reduction for intramuscular injections and oral glucose enhances the relief. The EMLA is a viable alternative to penile nerve block or ring block for infants undergoing circumcision. The EMLA reduces pain associated with lumbar punctures. Infants receiving multiple applications of EMLA need to be monitored for methemoglobin concentrations.
Olfactory Stimulation and Premature Newborns
Marlier L, Gaugler C, Messer J: Olfactory stimulation prevents apnea in premature newborns. Pediatrics 2005; 115(1):83-8.
Over 80% of premature infants (less than 30 weeks gestation) experience recurrent apnea, especially during sleep. Some respond to methylxanthines and doxapram, but others continue the apnea spells. By introducing a pleasant odor (vanillin) into the incubator, this study was able to reduce the incidence by 36%. Fourteen preterm infants (24 to 28 weeks gestation) were monitored and observed for 3 days. The first day was observational and baseline. The second day, 15 drops of saturated solution of vanillin were applied to the periphery of the infant's bed. On the third day, all bedding was changed and the infant was observed. Results showed a reduction in frequency of all apneas from 34.7 to 22.2. Once the odor was stopped, the frequency of apnea returned to the baseline value of 33.2. The reduction of apnea episodes without bradycardia fell 44%. There were no apparent side effects-daily weight was maintained, daily respiratory rates and cardiac rates were stable, gastrointestinal tolerance was unaffected, and there were no behavioral changes such as excitability or hyperactivity.