The Effect of Therapeutic Play on Children's Pain, Anxiety and Mothers' Anxiety during Pre- and Postcircumcision Period.

PURPOSE: The study was conducted to determine the effect of the therapeutic play method implemented on the pre- and postcircumcision pain and anxiety levels of children and mothers' anxiety levels in the pediatric surgery clinic. DESIGN: Prospective, randomized clinical trial. METHODS: The study consisted of children between the ages of 3 to 6 admitted to the pediatric surgery clinic and their mothers (N = 120; Therapeutic playgroup = 60, Control group = 60). As a therapeutic play method the children and their mothers used play dough during the structured conversation for about 10 minutes before and after the operation. A questionnaire, the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, the Children's Emotional Manifestation Scale (CEMS) anxiety scale, and State-Trait Anxiety Inventory-S (STAI-S) anxiety scale for parents were used to collect data. FINDINGS: In the pre- and postcircumcision period, the pain and anxiety levels of children and mothers' anxiety levels in the therapeutic playgroup were statistically lower compared to the control group (P < .05). In the postoperative period, a positive and significance correlation was found between anxiety levels of the mothers and pain and anxiety levels of children in the control group (P < .05). CONCLUSIONS: The therapeutic play method was effective in reducing the pain and anxiety levels of children and mothers' anxiety in the pre- and postcircumcision period.

Effects of Topical Oils on Neonatal Skin: A Systematic Review.

OBJECTIVE: To identify studies that aimed to determine the effects of topical oils on neonatal skin. DATA SOURCES: Authors searched PubMed, Cochrane Central Register of Controlled Trials, and Science Direct databases. STUDY SELECTION: The databases were searched for studies published through February 2022 (when the search was conducted) using the keywords "skin", "neonatal", "infant", and "oil". Fourteen randomized controlled trials that met the eligibility criteria were included in the review. DATA EXTRACTION: Researchers used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) reporting guidelines to guide this systematic review. Two authors reviewed and evaluated the articles independently. DATA SYNTHESIS: The 14 studies included in this review were conducted with a total of 5,683 neonates, most of whom were preterm. The included studies used blended sunflower (n = 8), coconut (n = 5), almond (n = 2), olive (n = 1), mustard (n = 1), and vegetable (n = 1) oils. These studies investigated the effects of topical oils on the skin's barrier functions and skin integrity. Most studies used noninvasive measurement devices to evaluate the skin's barrier functions; they used a variety of scoring systems to evaluate skin integrity. Eleven of the studies concluded that the oils used in the skincare of neonates effectively improve the skin condition and barrier functions of the skin. However, three studies found equivocal, negative, or mixed findings. CONCLUSION: Although current evidence indicates a potential benefit, more studies with a high level of evidence on the subject are required.

Effectiveness of active video games in overweight and obese adolescents: a systematic review and meta-analysis of randomized controlled trials.

PURPOSE: The purpose of this review was to assess the effect of active video games among overweight and obese adolescents. METHODS: A systematic review and meta-analysis were conducted using records from the English-language electronic databases MEDLINE, the Web of Science, and PubMed. These databases were searched from January 2010 to December 2020 using the keywords (adolescent*) AND (overweight OR obese *) AND (active video games OR exergaming * OR video game*). RESULTS: Five articles met the inclusion criteria. Four studies were conducted in the United States of America and 1 study was conducted in Canada. In addition, all included articles had a randomized controlled trial study design. It was determined that the sample size of the studies was 30-46 participants and there were a total of 195 overweight and obese adolescents across the included studies. Active video gaming was negatively associated with changes in body mass index percentile (mean difference [MD], -1.77; 95% confidence interval [CI], -2.55 to -0.99; p<0.001) and total cholesterol (MD, -11.16; 95% CI, -16.64 to -5.68; p<0.001). CONCLUSION: Playing active video games can reduce both the body mass index percentile and total cholesterol in overweight and obese adolescents. Active video games can provide a different method for combating childhood obesity. High-quality randomized controlled trials are recommended to assess the impact of game-based interventions.

The Effect of Parental Presence on Pain Levels of Children During Invasive Procedures: A Systematic Review.

AIM: This systematic review was conducted to determine the effect of parental presence on the child's pain intensity during invasive procedures. DESIGN: A systematic review. METHOD: The systematic review was conducted in July 2019 and updated in December 2020 to include the latest research published during the publication process by scanning the articles in English. Scopus, Pubmed, Cochrane, Science Direct, MedLine databases were used for scanning. The keywords "parental presence", "family presence", "parent involvement", "invasive procedures", "venipuncture", "painful procedures", "child", "children", "pediatric" were used in the scanning. Preferred Reporting Items for Systematic reviews and Meta-Analyses protocol was followed to prepare the study and the report, and the systematic review was created according to the patient, intervention, comparison, outcomes (PICOS) strategy. RESULTS: A total of 248 articles were reached, and the full texts of 18 articles were evaluated for eligibility. After the articles excluded by the full-text search were eliminated, six studies, involving 730 children with a sample aged between 0-12 years, were included in the analysis. In 4 studies, it was determined that having a parent with the child during the invasive procedure significantly decreased the pain level, and in 2 studies, there was no statistically significant decrease in the pain level of the children. CONCLUSIONS: Parental presence and parental involvement during invasive procedures effectively reduced the children's pain levels. Since the number of studies with a high level of evidence regarding the effect of family participation on pain level is limited, it is recommended to conduct more randomized controlled studies.

An alternative supplemental feeding method for preterm infants: the supplemental feeding tube device

Background/aim: The purpose of this study was to determine the effects of the supplemental feeding tube device (SFTD) and bottle methods on weight gain, transition to full breastfeeding, breastfeeding success, and duration of discharge in preterm infants. Materials and methods: This randomized controlled trial was conducted with a total of 46 preterm infants including 23 infants in study (SFTD) and control (bottle) groups. An information form, an infant follow-up form for feeding, and LATCH breastfeeding assessment instrument were used to collect the data. Results: The gestation week of the infants in the study group was 31.22 ± 2.76, and in the control group it was 30.52 ± 2.47. The birth weight of the infants in the study group was 1586.3 ± 525.35 g and 1506.09 ± 454.77 g in the control group. The daily weight gain of the infants was 24.09 ± 15.21 g in the study group and 27.17 ± 17.63 g in the control group. The infants in the study group (4.70 ± 2.44 days) transitioned to full breastfeeding earlier than those in the control group (6.00 ± 4.10 days). LATCH 2nd measurement scores were significantly higher in both groups than LATCH 1st measurement scores (p < 0.01). Although it was not statistically significant (p > 0.05), the infants in the study group (10.22 ± 5.20 days) were discharged earlier than those in the control group (13.48 ± 8.78 days). Conclusion: The SFTD and bottle methods were determined to be similar in terms of daily weight gain, transition to full breastfeeding, breastfeeding success, and duration of hospitalization.

Effect of Intravenous Infiltration Management Program on Peripheral Intravenous Catheter Success and Infiltration in Hospitalized Infants.

BACKGROUND: Peripheral intravenous catheter (PIVC) insertion is the most frequently used method for intravenous (IV) treatment in pediatric patients. PURPOSE: The aim of this study was to determine the effect of the Intravenous Infiltration Management Program on the success of PIVC insertion and infiltration in infants. METHODS: The study was carried out using a quasi-experimental design with pretest-posttest control groups and included 750 PIVC procedures for 218 infants between 28 days and 12 months of age. RESULTS: The program decreased the number of PIVC insertions per patient, although it was not statistically significant (P = .076) and had an impact on the success of the PIVC attempt (P < .001), first PIVC attempt (P < .001), PIVC dwell time, and early detection of infiltration (P < .001). CONCLUSION: The program is effective in the success of the PIVC insertion process and early detection of infiltration.

The effect of Yakson and Gentle Human Touch methods on pain and physiological parameters in preterm infants during heel lancing.

BACKGROUND: Various non-pharmacologic methods are used to alleviate pain in preterm infants who spend their first days in neonatal intensive care units (NICU) because they are exposed to numerous painful interventions. OBJECTIVE: To determine the effects of Yakson and Gentle Human Touch (GHT) methods on pain and physiologic parameters during heel lancing procedures in preterm infants. DESIGN AND METHODS: This was a randomised controlled trial. The study was conducted in a NICU between June 2018 and June 2019. A total of 90 preterm infants were divided into three groups: 30 infants in the Yakson group, 30 infants in the GHT group, and 30 infants in the control group. All preterm infants were randomly divided into groups. Pain responses were evaluated using the Neonatal Infant Pain Scale. RESULTS: It was found that pain scores and heart rates were significantly lower during and after heel lancing in preterm infants in the Yakson and GHT groups than in the control group, the difference was statistically significant (p < .001). PRACTICAL IMPLICATIONS: Yakson and GHT applied to preterm infants during heel lancing has positive effects on pain and physiologic parameters.

The Effect of Sunflower Seed and Almond Oil on Preterm Infant Skin: A Randomized Controlled Trial.

OBJECTIVE: To investigate the effect of sunflower seed oil (SSO) and almond oil (AO) on stratum corneum hydration and Neonatal Skin Condition Scores (NSCSs) of preterm infants. METHODS: This randomized controlled trial recruited 90 preterm infants whose gestational ages were between 32 and 37 weeks in the neonatal ICU. Infants were randomly assigned to three groups (SSO, AO, or control). The oils were applied to the whole body of each infant except for the head and face by a nurse researcher four times a day (4 mL/kg) for 5 days. MAIN OUTCOME MEASURES: Skin condition of the infants as evaluated with the NSCS; hydration as measured by a skin moisture meter before and after application. MAIN RESULTS: When average stratum corneum hydration was compared, infants in the SSO and AO groups had better hydration than infants in the control group. The NSCS scores in the control group were significantly higher than in the intervention groups, but there was no difference between the SSO and AO groups. CONCLUSIONS: Neither SSO nor AO has harmful effects on the skin, and their use may improve stratum corneum hydration. These oils can be used by nurses to hydrate the skin of preterm infants. Further studies are needed to evaluate the efficacy of natural oils on infant skin.

Effectiveness of an Intravenous Protection Device in Pediatric Patients on Catheter Dwell Time and Phlebitis Score.

PURPOSE: The study aimed to examine the efficacy of the I.V. House UltraDressing for protecting peripheral intravenous catheters (PIVCs) in pediatric patients. METHODS: This randomized controlled trial comprised 60 pediatric patients (aged 2-24 months): 30 in the experimental group and 30 in the control group. The PIVC dwell time and phlebitis scores were also reported for both groups. The degree of phlebitis was determined using the Visual Infusion Phlebitis Scale (VIPS) and was recorded every 8 hours from the start of antibiotic therapy until catheter removal. RESULTS: The mean catheter dwell time in the experimental group (2.10 ± 1.55 days) was significantly longer than that in the control group (1.27 ± 0.45 days) (p < .01). However, there were no significant differences between the scores and signs of phlebitis in both groups (p > .05). CONCLUSION: The I.V. House UltraDressing is a useful device that can be used to increase catheter dwell time and protect and stabilize PIVCs in pediatric patients.

Efficacy of Vein Visualization Devices for Peripheral Intravenous Catheter Placement in Preterm Infants: A Randomized Clinical Trial.

The aim of this randomized controlled trial was to examine the efficacy of vein visualization devices and the routine method for insertion of peripheral intravenous catheters (PIVCs) in preterm infants. The study was conducted between June 2016 and April 2017 in the neonatal intensive care unit of Bakirköy Dr Sadi Konuk Education and Research Hospital. Participants (N = 90) were randomly assigned to the infrared group (n = 30), the transilluminator group (n = 30), or the control group (n = 30). Time to successful cannulation was significantly lower for the infrared group (8.70 ± 2.56 seconds) than for the transilluminator group (45.27 ± 30.83 seconds) and the control group (17.30 ± 8.40 seconds) (P ≤ .001). Success of the first attempt was significantly higher in the infrared and transilluminator groups than in the control group (P ≤ .05). Dwell time of the PIVC in place was significantly higher in the infrared group than in the transilluminator and control groups (P ≤ .05). Neonatal Infant Pain Scale scores were significantly higher in the transilluminator group (0.60 ± 0.855) than in the infrared (0.33 ± 0.182) and control groups (0.33 ± 0.182) while seeking an appropriate vein (P ≤ .001). The use of an infrared device provides efficacy in time to successful cannulation, success of the first attempt, length of the time the catheter is in place, and technique-related pain.

The Effect of Parental Presence on Pain and Anxiety Levels During Invasive Procedures in the Pediatric Emergency Department.

INTRODUCTION: Parental presence during invasive procedures is important in family-centered-care. Family-centered-care is a basic principle of pediatric nursing. METHODS: This randomized controlled trial included data from 111 cases in the Pediatric Emergency Department of Istanbul University, Istanbul Medical Faculty, during October 2016-January 2017 (parental involvement group, n = 40; parental presence group, n = 40; parental absence group, n = 31). Information form, State-Trait Anxiety Inventory, State-Trait Anxiety Inventory for Children and Visual Analogue Scale were used to collect data. RESULTS: When children's pain levels before invasive procedures were compared, there was no significant difference between the groups (P > 0.05). Significant difference was found between pain levels of the groups during the process (P < 0.001). It was found that the pain levels of the children in the parental absence group (6.00 ± 2.88) were significantly higher than those in the parental involvement group (3.15 ± 2.79) and the parental presence group (3.70 ± 2.92) (P < 0.05). There was a weak, positive, and significant relationship between parents' trait anxiety levels and the preprocedural pain and trait anxiety levels of children in all groups (P < 0.05). DISCUSSION: Parental involvement is effective in reducing the pain felt during invasive procedures. Moreover, anxiety levels of children during the procedure were not affected in all groups; however, the children of parents with high trait anxiety levels had higher preprocedural pain and trait anxiety levels.

Effectiveness of ShotBlocker for Immunization Pain in Full-Term Neonates: A Randomized Controlled Trial.

Nonpharmacologic strategies exist to manage procedural pain in healthy newborn infants. The aim of this prospective randomized controlled trial (RCT) was to examine the efficacy of ShotBlocker for managing injection pain associated with the first intramuscular hepatitis B vaccine given to healthy full-term neonates. This randomized controlled trial study was conducted in a private university hospital in Istanbul, Turkey, in which 100 healthy term neonates were randomly assigned to either a ShotBlocker (n = 50) or control group (n = 50). The Neonatal Infant Pain Scale scores of the neonates in the ShotBlocker and control groups were compared before, during, and after the injections, and the physiological parameters were compared before and after the procedure. The pain scores of the neonates during (ShotBlocker group: 1.64 ± 0.80; control group: 2.96 ± 0.73) and after (ShotBlocker group: 0.74 ± 0.66; control group: 1.42 ± 0.76) the injection procedure were lower in the ShotBlocker group than in the control group (P = .000). The postinjection heart rate in the infants in the ShotBlocker group (145.02 ± 13.50) was found to be lower than in those for whom ShotBlocker was not used (150.24 ± 13.36) (P = .05). The use of ShotBlocker during the hepatitis B vaccine in term neonates is effective in reducing the acute pain.

Heat loss prevention (help) after birth in preterm infants using vinyl isolation bag or polyethylene wrap.

OBJECTIVE: To examine the effects of using vinyl isolation bags or polyethylene wrap for the prevention of postnatal hypothermia in preterm infants at ≤ 32 weeks gestation. DESIGN: A prospective, randomized controlled trial. SETTING: The neonatal intensive care unit (NICU) of the Istanbul Faculty of Medicine in Turkey. PARTICIPANTS: Fifty-nine preterm infants. METHODS: Participants were randomly assigned to either the vinyl isolation-bag experimental group (n = 22) or the polyethylene-wrap control group (n = 37). Infant body temperature was measured at four time points after birth. RESULTS: Loss of body temperature was significantly less in the vinyl isolation-bag group during the first 60 minutes after birth (p = .041). Body temperature decreased by 1.41 ± 1.65 °C in the vinyl isolation-bag group and 2.75 ± 1.68 °C in the polyethylene wrap group. Body temperature was significantly less in the polyethylene wrap group compared to the vinyl isolation-bag group at birth to 60 minutes (p = .004). CONCLUSION: Wrapping preterm infants of gestational age ≤ 32 weeks in vinyl bags immediately after birth is associated with lower incidences of hypothermia.

Diaper dermatitis care of newborns human breast milk or barrier cream.

AIMS AND OBJECTIVES: To establish the effectiveness of human breast milk and barrier cream (40% zinc oxide with cod liver oil formulation) applied for the skincare of newborns in the neonatal intensive care unit on the healing process of diaper dermatitis. BACKGROUND: Diaper dermatitis is the most common dermatological condition in newborns who are cared for in the neonatal intensive care unit. Recently, there are several kinds of complementary skincare methods suggested for newborns, such as sunflower oil, human breast milk, etc. Also, some chemical formulations are still being used in many neonatal intensive care units. DESIGN: Randomised controlled, prospective, experimental. METHODS: This study was carried out with a population including term and preterm newborns who developed diaper rash while being treated in the neonatal intensive care unit of a university hospital in Istanbul between February-October 2010. On completion of the research, a total of 63 newborns from human breast milk (n = 30) and barrier cream (n = 33) groups were contacted. RESULTS: Genders, mean gestation weeks, feeding method, antibiotic use, diaper area cleansing methods, diaper brands and prelesion scores of newborns in both groups were found to be comparable (p > 0·05). There was no statistically significant difference (p = 0.294) between the groups in terms of mean number of clinical improvement days, but postlesion score of the barrier cream group was statistically significantly lower (p = 0·002) than the human breast milk group. CONCLUSION: Barrier cream delivers more effective results than treatment with human breast milk, particularly in the treatment of newborns with moderate to severe dermatitis in the result of the study. RELEVANCE TO CLINICAL PRACTICE: This study will shed light on nursing care of skin for newborns who are treated in neonatal intensive care unit.

Observation results of handwashing by health-care workers in a neonatal intensive care unit.

This research was conducted as a descriptive study to determine the status of handwashing, which is important and an effective method of preventing and controlling hospital infections, by health-care workers in a neonatal intensive care unit and to make recommendations based on the results. The research sample included 28 health-care workers (physicians and nurses) who agreed to participate voluntarily in the study. A total of 344 observations were made of situations requiring handwashing. The health-care workers' handwashing compliance rate was 58.14% and no statistically significant difference between physicians and nurses was found in whether or not handwashing was done. However the percentage of handwashing compliance was higher for the nurses (62.50%) than for the physicians (52.63%). In the analysis of handwashing technique and duration, the physicians (23.75%) had a higher percentage of correct technique and duration than the nurses (13.33%), but the difference was not statistically significant.