目的:确定新生儿重症监护病房(NICU)早产儿疼痛控制的最有效的非药物措施。
方法:以英文发表的随机临床试验的系统评价和网络荟萃分析,葡萄牙语,和西班牙语从2020年4月到2023年12月。使用的数据源是MedLine通过PubMed,LILACS,EMBASE,Cochrane中央控制试验登记册,还有佩德罗.我们使用Rob2进行了偏倚风险分析,并使用建议分级评估对建议的证据和强度进行了确定性分析,发展,和评价体系。我们使用希金斯和汤普森I2检验评估异质性,使用P评分对干预措施进行分类,和使用直接证据图的不一致。
结果:从确定的210种出版物中,我们利用12项研究对961名早产儿进行分析,我们结合了716名早产儿的10项网络荟萃分析研究,和12种组合的非药理措施。有了适度的信心,感觉饱和度,糖,糖非营养性吸吮,母亲的心音,摇篮曲,母乳气味/味道,磁针,皮肤与皮肤的接触,与没有干预相比,促进塞入已被证明可以减轻早产儿的疼痛,安慰剂,丙美卡因或标准NICU常规:感觉饱和度[SMD5,25IC95%:-8,98;-1,53],糖[SMD2,32IC95%:-3,86;-0,79],安抚奶嘴[SMD3,74IC95%:-7,30;0,19],和糖和安抚奶嘴SMD[3,88IC95%-7,72;-0,04]。
结论:强烈建议非药物治疗措施用于NICU早产儿的疼痛管理。
结论:这项研究的结果对政策和实践具有重要意义。这是唯一的系统评价,比较非药物措施的有效性,因此,可以确定哪种措施可提供最佳结果,并可能成为临床决策的首选。
OBJECTIVE: To identify the most effective non-pharmacological measures for pain control in preterm infants in the Neonatal Intensive Care Unit (NICU).
METHODS: A Systematic review and network meta-analysis of randomized clinical trials published in English, Portuguese, and Spanish from April 2020 to December 2023. The data sources used were MedLine via PubMed, LILACS, EMBASE, The Cochrane Central Register of Controlled Trials, and Pedro. We performed the risk of bias analysis with Rob 2 and the certainty of the evidence and strength of the recommendation using the Grading of Recommendations Assessment, Development, and Evaluation system. We assessed heterogeneity using the Higgins and Thompson I2 test, the classification of interventions using the P-score, and inconsistencies using the Direct Evidence Plot.
RESULTS: From 210 publications identified, we utilized 12 studies in analysis with 961 preterm infants, and we combined ten studies in network meta-analysis with 716 preterm infants, and 12 combinations of non-pharmacological measures. With moderate confidence, sensory saturation, sugars, non-nutritive sucking, maternal heart sound, lullaby, breast milk odor/taste, magnetic acupuncture, skin-to-skin contact, and facilitated tucking have been shown to reduce pain in preterm infants when compared to no intervention, placebo, proparacaine or standard NICU routine: sensory saturation [SMD 5,25 IC 95%: -8,98; -1,53], sugars [SMD 2,32 IC 95%: -3,86; -0,79], pacifier [SMD 3,74 IC 95%: -7,30; 0,19], and sugars and pacifier SMD [3,88 IC 95% -7,72; -0,04].
CONCLUSIONS: Non-pharmacological measures are strongly recommended for pain management in preterm infants in the NICU.
CONCLUSIONS: The findings of this study have important implications for policy and practice. This is the only systematic review that compared the effectiveness of non-pharmacological measures, thus making it possible to identify which measure presents the best results and could be the first choice in clinical decision making.