Newborn predictors of infant irritability.

OBJECTIVE: To identify newborn infant behaviors that may predict infant irritability, commonly referred to as colic. DESIGN: A prospective, correlational design, with data collection occurring the first 4 days of life and again at 1 month of age. SETTING: This study was conducted in a private hospital in a large metropolitan city in the Midwest. PARTICIPANTS: Sixty infants who were at low risk and full term and whose weight was appropriate for gestational age were recruited during their postpartum hospital stay. Infants with congenital anomalies, signs of illness, or high-risk factors were excluded from the study. MAIN OUTCOME MEASURES: During infants' 1-4-day hospital stays, their crying was assessed and reported by the nurses, and a Neonatal Behavioral Assessment Scale was completed on each infant. At 1 month of age, irritability was measured using the Fussiness Rating Scale. RESULTS: Only two components of the Neonatal Behavioral Assessment Scale were related to development of colic or infant irritability at 1 month of age. These were the cluster of variables representing motor activity and the Neonatal Behavioral Assessment Scale supplemental item measuring the persistence necessary on the part of the examiner to get the infant to attend to stimuli presented. The infants who were classified by parents as irritable at 1 month of age were more active and more attentive to stimuli in the first few days of life. CONCLUSIONS: Of interest was that the newborn nursery nurses cry ratings were not related to the later development of colic in these infants. Active infants who are sensitive to stimuli may be predisposed to infant irritability; however, further work is needed to understand the relationships of these infant characteristics to the human interactions and physical environments they encounter

Factors predicting postoperative pain in children and adolescents following spine fusion.

Despite advances in research and technology, investigators around the world acknowledge the continued undertreatment and unnecessary suffering of children in pain. The dilemma of inadequate relief of children's pain may relate to the complexity of the pain phenomenon. Using the Gate Control Theory as the foundation for this work, the purpose of my study was to determine the extent to which selected variables (severity of operative procedure, postoperative use of pharmacological agents, prior experience with pain, pain tolerance, gender, and age) predicted children's and adolescents' pain following spine fusion. Using a descriptive correlational design, data were collected from 93 children (ages 8 to 21 years) who had undergone spine fusion. For four consecutive postoperative days, children were asked to rate the intensity of their pain using the Adolescent Pediatric Pain Tool and observed pain behaviors were recorded using the Child Pain Scale. Repeated measures MANOVA revealed that children continued to experience moderate to severe pain throughout the four days. Stepwise multiple regression analyses were conducted for each postoperative day on each of the dependent variables. A modest amount of variance in children's pain was explained by the variables studied. R square values suggested that age, pain tolerance, and severity of operative procedure have the greatest potential as predictors of children's postoperative pain and warrant future research.

Children's use of PCA following spinal fusion.

PURPOSE: The purpose of this study was to examine the effectiveness of patient-controlled analgesia (PCA) in relieving postoperative pain for children and adolescents following spinal fusion. DESIGN/SAMPLE: A one-group, descriptive design was used with a convenience sample of 93 children (ages 8 to 21 years) who had undergone spinal fusion over a 2-year period. METHODS: All of the patients were using PCA postoperatively with morphine sulfate, the most common opioid analgesic prescribed for use in the infusion pump. Data were collected for the first 4 postoperative days on four outcome variables: use of PCA, self-report of pain, observed pain-related behaviors, and satisfaction with PCA. FINDINGS: Despite aggressive pain management, findings showed that neither children's pain nor their analgesic use diminished significantly over time. Children continued to report moderate-to-severe pain over the 4-day measurement period. Likewise, children reported their satisfaction with PCA for pain relieve as "fair" to "good." CONCLUSION: The use of high technology and aggressive pharmacologic treatment alone may not be adequate for managing severe pain following spinal fusion. As proposed by the Gate Control Theory, pain stimuli produce not only physiologic, but also psychologic and emotional responses. Relief for severe pain, therefore, may require multidimensional therapies that include nonpharmacologic approaches together with precise titration of available pharmacologic agents.

Creative strategies for pediatric nursing research: data collection.

As the researcher contemplates the design and methodology of a study involving children, the age and maturity of the child are key factors for consideration. A good understanding of the child's cognitive and developmental level of functioning will greatly facilitate the explanation to the child and the process of obtaining data from the child. The successful outcome of a study may depend on how well the investigator uses this knowledge and is able to make appropriate adaptations in data collection to meet the requirements of the study design.

The effectiveness of a standardized educational program for children using patient-controlled analgesia.

PURPOSE: To examine the effectiveness of two types of preoperative education (routine education and a standardized educational program) for children undergoing spinal fusion. DESIGN: Two group, phase-lag design. SETTING: Tertiary pediatric hospital. PARTICIPANTS: Children ages 8-18 years (N = 93). MAIN OUTCOME MEASURES: Adolescent Pediatric Pain Tool, Child Pain Scale, Post-PCA Satisfaction Interview, and PCA infusion pump data. RESULTS: No statistically significant differences between the groups on any of the main outcome variables. Children and parents reported, however, that the SEP provided them with invaluable information regarding the use of PCA and alleviated their concerns about getting "hooked on drugs," overdosing, side effects, and being able to get pain relief when needed. CONCLUSION: Children having spine fusion surgery experienced severe postoperative pain that was not ameliorated by optimizing use of PCA through standardized education. Further testing of the SEP with other populations is needed in order to more fully realize its potential for influencing pain outcomes.

A longitudinal comparison of irritable and nonirritable infants.

Infantile colic is characterized by persistent crying, diminished soothability, and excessive activity or restlessness. The purpose of this study was to explore the processes underlying the persistent, recurrent irritability by investigating behavioral and interactional differences in irritable and nonirritable infants. In this two-group longitudinal study, 40 infants and their mothers were followed over the first 4 months of life. Statistically significant differences between the two groups were found, with the irritable infants demonstrating an increase in the amount and intensity of crying, more disruption in sleep-wake states, and less synchrony in mother-infant interaction.

Pitfalls in diagnosing galactosemia: false negative newborn screening following red blood cell transfusion.

Newborn galactosemia screening programs using the fluorescence spot test to detect red cell galactose-1-phosphate uridyltransferase activity are prone to inaccuracy if the screened infants have received blood transfusions. We describe an infant with galactosemia who received packed red cell transfusions in the first few days of life and was misdiagnosed after an initial positive screening test result. Although the patient was thought to have cytomegaloviral hepatitis, a percutaneous liver biopsy helped direct the evaluation toward identifying the galactosemia carrier state in both parents. This case report illustrates the need for careful consideration of the patient's history of transfusion of blood products when evaluating newborn screening results.

Development of a system for monitoring infant state behavior.

The concept of infant state refers to patterns of behavior that comprise the sleep-wake cycle. The infant's ability to organize state behavior rhythmically is indicative of central nervous system maturation and predictive of later development. This article describes the development of a noninvasive, computerized infant monitoring system that can be used to categorize the infant's sleep-wake behavior into states. Development of the system occurred in two phases: In the first phase of the study, reliability and validity of the infant monitoring system for recording continuous behavioral and physiological data were assessed. These results were then used in the second phase to develop a rule-based computer program to interpret the signal data stored on a micro-diskette and to characterize the infant's state throughout the period of monitoring. The capability of computerized data collection and analysis of infant state behavior has expanded the application of this infant monitoring system. Its use as an investigative tool in clinical research is discussed.