Verbal Communication with the Patient Is Not Enough: The Six Languages of the Sick.

Evidence shows that verbal communication is just one of the ways patients indicate their wishes. For a sufficiently careful communication, we should also grasp other five unusual though evident languages: (a) body language, (b) the way patients manage their environment, (c) unconscious language, (d) lab-evidenced language, and (e) the way they master technology. So, we have six languages that should be intertwined to understand the real language of the sick.

Management of pain in newborn circumcision: a systematic review.

Male circumcision (MC) is one of the most common surgical procedures performed on neonates. In the last decades, there have been consistent advances in the understanding of pain mechanisms in newborns, and analgesia has become a fundamental part of neonatal care. MC is still often performed with inappropriate analgesic methods, and there is still great variability among the various centers about surgical and anesthethic techniques to do it.

Modified Sensory Stimulation Using Breastmilk for Reducing Pain Intensity in Neonates in Indonesia: A Randomized Controlled Trial.

Purpose: Several studies have shown that oral sucrose reduces pain in newborns. However, sucrose has no efficacy in eliminating pain and long-term effects remain unclear. Breast milk may be useful as an alternative, safe sweet solution.

Evidence-based clinical guidelines on analgesia and sedation in newborn infants undergoing assisted ventilation and endotracheal intubation.

Aim: This review informed pain control guidelines for clinicians performing mechanical ventilation, nasal continuous positive airway pressure and endotracheal intubation on term and preterm newborn infants.

Methods: We reviewed literature published between 1986 and June 2017 on analgesia and sedation during assisted ventilation and before endotracheal intubation in newborn infants admitted to neonatal intensive care units. The subsequent guidelines were developed using the Grading of Recommendations Assessment, Development and Evaluation approach.

Literature review informs clinical guidelines for pain management during screening and laser photocoagulation for retinopathy of prematurity.

Aim: The aim of this study was to carry out a literature review and develop clinical guidelines for pain prevention and control during screening and laser photocoagulation for retinopathy of prematurity (ROP) in neonatal intensive care units (NICUs).

Methods: The Italian Society of Neonatology assessed papers published between 1986 and June 2017 and used the Grading of Recommendations, Assessment, Development and Evaluation approach, to develop new guidelines on pain and ROP.

Results: The Society's pain experts assessed the full texts of 47 papers, including randomised or quasi-randomised controlled trials and case-control studies on nonpharmacological and pharmacological measures used in NICUs during the screening and laser photocoagulation of neonates for ROP.

Electromagnetic fields in neonatal incubators: the reasons for an alert.

Background: Neonatal incubators are important tools for sick newborns in the first few days of life. Nevertheless, their electric engine, often very close to the newborn's body, emits electromagnetic fields (EMF) to which newborns are exposed. Aim of this paper is to review the available literature on EMF exposure in incubators, and the effects of such exposures on newborns that have been investigated.

Sensorial saturation and neonatal pain: a review.

Aim: Sensorial saturation (SS) is an analgesic approach to babies' pain that includes three types of stimulations: oral sugar, massage and caregivers' voice. The aim of this review is to assess its efficacy.

Methods: We performed an analysis of scientific literature from 2001 to 2017, retrieving those clinical trials where SS had been compared with other analgesic treatments during procedural pain in babies.

Systematic review of nonpharmacological analgesic interventions for common needle-related procedure in newborn infants and development of evidence-based clinical guidelines.

Unlabelled: The aim of this literature review was to develop clinical guidelines for the prevention and control of needle-related pain in newborn infants. The guidelines were developed by the Italian Society of Neonatology, using the Grading of Recommendations, Assessment, Development and Evaluation approach, based on the assessment of 232 papers published between 1986 and 2015. The quality of the evidence was high or moderate for some behavioural and nonpharmacological interventions.

Cardiac Adaptation to Severe Congenital Diaphragmatic Hernia.

Objective: Prenatal heart adaptations to congenital diaphragmatic hernia (CDH) could help define postnatal outcome.

Methods: We retrospectively analyzed post-mortem tissues from fetuses with severe CDH (n = 7). Histology and immunohistochemical distribution of desmin, muscle actin [HHF35], endothelin-1 [ET-1] and TGF-β were evaluated.

Fetal surgery and maternal cortisol response to stress. The myelomeningocele sheep model.

Background: Prenatal surgery represents a multifactorial stressor event for mother and fetus. The stress response to fetal surgery was evaluated by measuring maternal plasma and amniotic fluid (AF) cortisol levels in the myelomeningocele (MMC) sheep model.

Subjects And Methods: Pregnant ewes (n = 8) underwent general anesthesia for MMC-induction (step 1: 75 d gestation), surgical defect repair (step 2: 110 d gestation), and delivery (step 3: 140 d gestation).

Should we assess pain in newborn infants using a scoring system or just a detection method?

Unlabelled: Newborn infants' pain should be scored indirectly using dedicated pain scales. Unfortunately, while some scales for prolonged pain have given good results, a gold standard to assess acute pain does not exist. Acute pain scales still have weak points, most are complex and are scarcely used in neonatal departments.

Music provided through a portable media player (iPod) blunts pain during physical therapy.

This research studied, 25 adult patients who underwent physical therapy to assess the analgesic effect of distraction with the use of music during physical therapy. Patients randomly underwent physical therapy once with music provided by an iPod and once without music. In both sessions patients underwent identical physical procedures.

Neonatal risks from in vitro fertilization and delayed motherhood.

Delayed childbearing (DC) is common in most Western countries. The average age of first-time mothers increased in United States from 21.4 years in 1970 to 25.

Pain assessment in human fetus and infants.

In humans, painful stimuli can arrive to the brain at 20-22 weeks of gestation. Therefore several researchers have devoted their efforts to study fetal analgesia during prenatal surgery, and during painful procedures in premature babies. Aim of this paper is to gather from scientific literature the available data on the signals that the human fetus and newborns produce, and that can be interpreted as signals of pain.

Is newborn melatonin production influenced by magnetic fields produced by incubators?

Background: During permanence in most incubators, newborns are very close to the electric engine, which represents a source of electromagnetic fields (EMF). Previous studies demonstrated a decrease in melatonin production in adults and animals exposed to EMF.

Aims: To assess melatonin production in a group of newborns exposed to EMF, and to evaluate whether removing the babies from the source of MF can affect melatonin production.

Sensorial saturation for infants' pain.

Introduction: Sensorial saturation (SS) is a multisensorial stimulation consisting of delicate tactile, gustative, auditory and visual stimuli. This procedure consists of simultaneously: attracting the infant's attention by massaging the infant's face; speaking to the infant gently, but firmly, and instilling a sweet solution on the infant's tongue.

Methods: We performed a systematic Medline search of for articles focusing on human neonatal studies related to SS.

Is fetal pain a real evidence?

Unlabelled: Due to the progress in fetal surgery, it is important to acquire data about fetal pain.

Material And Methods: We performed a Medline research from 1995, matching the following key words: "pain" and "fetus", with the following: "subplate", "thalamocortical", "myelination", "analgesia", "anesthesia", "brain", "behavioral states", "substance p". We focused on: (a) fetal development of nociceptive pathways; (b) fetal electrophysiological, endocrinological and behavioral reactions to stimuli and pain.

Ethical charter of Union of European Neonatal and Perinatal Societies.

The Union of European Neonatal and Perinatal Societies, worried for the lack of unanimous guidelines in the ethical domain, propose a 10-point charter about the ethical rights of the newborns. It is complementary to other charters, such as the United Nations charter of children's rights, but it adds some specific and debated points, to find a common denominator, hopefully useful to the ongoing debate.

Whole body hypothermia and oxidative stress in babies with hypoxic-ischemic brain injury.

According to increasing evidence, hypothermia can significantly improve outcomes in term neonates manifesting asphyxic insult and hypoxic-ischemic encephalopathy. Oxidative stress plays a key role in hypoxic-ischemic and inflammatory brain injuries. We investigated the impact of hypothermia on oxidative stress in babies with hypoxic-ischemic encephalopathy.

Guidelines for procedural pain in the newborn.

Unlabelled: Despite accumulating evidence that procedural pain experienced by newborn infants may have acute and even long-term detrimental effects on their subsequent behaviour and neurological outcome, pain control and prevention remain controversial issues. Our aim was to develop guidelines based on evidence and clinical practice for preventing and controlling neonatal procedural pain in the light of the evidence-based recommendations contained in the SIGN classification. A panel of expert neonatologists used systematic review, data synthesis and open discussion to reach a consensus on the level of evidence supported by the literature or customs in clinical practice and to describe a global analgesic management, considering pharmacological, non-pharmacological, behavioural and environmental measures for each invasive procedure.

Pain management in the neonatal intensive care unit: a national survey in Italy.

Background: This study assessed current medical practice in preventative analgesia and sedation for invasive procedures in neonatal intensive care units (NICU) in Italy.

Methods: A questionnaire was sent to level II and III Italian NICUs to investigate pain management, pharmacological treatment and the use of pain scores during invasive procedures. Main outcome measures were the extent to which analgesia and sedation are currently used for invasive procedures in Italian neonatal units.

Intracranial pressure during procedural pain.

Physiological changes provoked by pain may threaten the integrity of the CNS. In particular, intracranial pressure (ICP) regulates brain perfusion, and its sudden increase may trigger brain haemorrhage. We measured ICP in 51 healthy newborns (gestational age: 35-41 weeks) during blood sampling, by means of a tonometer applied to the anterior fontanelle.

Long-term effects of antepartum bed rest on offspring.

We studied the children of mothers who were confined to bed during pregnancy for more than 15 consecutive days (mean 3.69 months) in the years 1986-1990 (bed rest offspring; BRO). We studied 86 children: 43 BRO and 43 control children.

[Exposure of nursing personnel to electromagnetic fields in neonatal intensive care].

Electromagnetic fields (EMF) are recognised as a source of environmental pollution for workers and people resident in exposed areas. The level of exposure to EMFs of the nurses working in the Siena Neonatal Intensive Care Unit, during two workdays was recorded and peak levels > 10 mG (1 microT) were registered well above an almost permanence exposure at > 2 mg G. The application of existing standard, cautionary criteria and rules would suggest protective or restrictive measures against EMF exposure for these workers.