Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Strengthens the clinical practice
- Dr saroj kumar Patnaik (3 January 2003)
-
Methodology casts doubt on validity of findings
- George Hill (4 January 2003)
-
Breast is the best: is it the best analgesic for newborn?
- Roy K Philip (14 January 2003)
-
I'm a newborn
- Sergio Conti Nibali (23 January 2003)
-
Newborns are very demanding patiens
- Carlo V. Bellieni, Duccio M Cordelli, Franco Bagnoli and Giuseppe Buonocore (2 February 2003)
-
the effects is probably due to melatonin in milk
- James M. Howard (16 April 2003)
|
|
|||
|
Dr saroj kumar Patnaik, Postgraduate Resident (Paediatrics) AFMC,Pune-411040, India
Send response to journal:
|
EDITOR- The study of Carbajal et al strengthens the evidence base of our neonatal and postnatal ward practices (1). In numerous babies, the only analgesic ever used by me and my colleagues during sampling has been concurrent breastfeeding - its remarkable to see the soothing effect of this procedure against the wishfully avoidable trauma incurred by us during venepunctures or heelpricks. It would have been interesting to look at the differences in pain percetion and modulating influences of breastfeeding in relation to the preprocedure state of awareness as per Brazelton scale. Differences in an wide alert neonate versus the sleepy baby are likely. In setups with poor confidence levels about the environmental sterility especially in poor developing countreies or primary care setups, perhaps its prudent to avoid an external source of infection like oral sucrose solutions or pacifiers. Admittedly poor maternal hygiene and subsequent breastfeeding is also a potent source of transmission . Yet I surmise it is better to resort to breastfeeding alone as an analgesic ( with its known share of commensals, to which the neonate is likely to be accustomed to and hence less likely to progress to sepsis )rather than the undoubtedly efficacious oral analgesic solutions. ---------------------------------------------------------- 1. Ricardo Carbajal, Soocramanien Veerapen, Sophie Couderc, Myriam Jugie, and Yves Ville. Analgesic effect of breast feeding in term neonates: randomised controlled trial BMJ 2003; 326: 13 Competing interests: None declared |
|||
|
|
|||
|
George Hill, Executive Secretary Doctors Opposing Circumcision, Suite 42, 2442 NW Market Street, Seattle, Washington 98107, USA,
Send response to journal:
|
Competing interests: None declared |
|||
|
|
|||
|
Roy K Philip, Consultant Paediatrician Mid-Western Regional Hospital, Limerick, Republic of Ireland
Send response to journal:
|
Editor Caberjal et al. reported that breastfeeding reduced pain during neonatal procedures like venepuncture1. This article sends the message that in the name of randomised trials one could readily convert a social concept to level two evidence. Planned methods could lead to planned results. How? 1.Exclusion of a group of newborns held by mother during the procedure and given formula the same way as their breastfed counterparts. Perhaps it is the skin-to-skin contact2 and sucking of milk (not necessarily breastfeed) that reduced pain. 2.Types of devices for neonatal venepuncture or number of attempts per blood sample were not considered. As common devices like venous cannula, ‘broken needle’, scalp vein (butterfly) needle, vacutte needle, fixed wing Philip’s needle, vary in their ease and efficacy, perceived pain could have been influenced. Review3 of existing neonatal venepuncture methods showed benefits of single wing needle over the modified devices. 3.Two groups of newborns were ‘laid on the table’ and given 1 ml each of water (as placebo) or 30% glucose solution (sweet, hypertonic, hygroscopic and possibly not very pleasant to newborn taste buds!) for a few seconds followed by dry pacifier. Breastfed group had their feeds continued throughout the procedure while ‘held in mother’s arms’. Perhaps authors set the scene for widening pain scores among study groups. BMJ’s contribution - ‘what the study adds is analgesic properties of breastfeeding’ – a generous summary from the evidence presented. I am not a bottle-feed activist and rest my case. References 1.Caberjal R, Veerapen S, Couderc S, et al. Analgesic effect of breast feeding in term neonates: randomised controlled trial. BMJ 2003; 326:13 2.Gray L, Watt L, Blass EM. Skin-to-skin contact is analgesic in healthy newborns. Paediatrics 2000; 105(1):E14 3.Philip RK, Beckett M. Neonatal Blood Sampling: time for safer devices. J Neonatal Nursing 2000; 6:88-89. Competing interests: Invented the concept of a purpose-built neonatal venepuncture needle(Philip's needle). The developed product is marketed by Vygon Ltd. and is currently used in the majority of neonatal units in UK&Ireland and many Hospitals in continental Europe. |
|||
|
|
|||
|
Sergio Conti Nibali, family pediatrician Messina (ITALY) 98123
Send response to journal:
|
I cannot speak, but I’ve always used my body movements, my facial expressions, my beckoning and my cries to make me understand. I’d like to say that for the past few years (about ten), I’ve been bothered more and more by all those people who continuously try to separate me from my mother as soon as I am born. They do not allow me to stay with her more than a few hours during the day. They do not allow me to suckle that delicious creamy fluid that they call colostrum. And if they do allow me, it’s only when they decide. They advise my mother on when and how much I should eat. Often they do not allow me to drink my mother’s milk, but rather a liquid that I dare to swallow only because I’m starving. I know that there are some people out there who try to protect me (1,2), but let me tell you that they are few, too few! The worst came when many people round the world started to think that they had to find proof that my desire to stay close to my mother and to suckle her milk as I wished, just as any puppy would do, was truly legitimate, in other words “effective”. They started to carry out the best possible research, what they call RCT, according to “evidence based medicine”. It is impossible for me to list all the RCTs they imposed upon me, because the Editor of the BMJ wouldn’t let me add more than five references. But if you want, you can type "Breast Feeding" [MESH] in something called PubMed, you can limit the publication date from 1993 to 2003 and age to newborn, and search only the RCTs you will count 187 papers! I’d like to ask you to please stop wasting your time trying to demonstrate that doing what mother nature does is better than doing something else. Acknowledgement: I’d like to give many thanks to Sergio Conti Nibali, family paediatrician, who allowed me to speak out. 1. Editorial. A warm chain for breastfeeding. The Lancet 1994;344:1239-41 2. American Academy of Pediatrics Work Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 1997;100(6):1035-1039 Competing interests: None declared |
|||
|
|
|||
|
Carlo V. Bellieni, M.D., Neonatal Intensive Care Unit Policlinico Le scotte. 53100 SIENA- ITALY, Duccio M Cordelli, Franco Bagnoli and Giuseppe Buonocore
Send response to journal:
|
Sir, Carbajal's paper (1) demonstrates the importance of newborn-mother interaction even as an analgesic. This is a further demonstration of what we described in our papers (2,3): multisensorial stimulation, offered by an attentive caregiver, is analgesic in newborns. We gave this phenomenon a dual explanation: 1. multisensorial stimulation activates gate control (4) of pain transmission to the brain, creating competition between painful and non painful stimuli: according with the gate control theory the brain is not a passive receiver of nociceptive input, but can influence the information received, deciding whether it is important enough to record. 2. Newborns are very demanding and want to be reassured, soothed and calmed [they also need to relate and interact]. We concluded that we cannot continue considering pain only from the technical point of view, treating heel-prick or venepuncture only with oral sugar, sucking and topical analgesics, which only provide partial analgesia and not almost complete disappearance of pain signs as does multisensorial stimulation that we showed to be more effective than oral sugar. Furthermore the technical approach is not ethical because it ignores the needs of newborns for human presence, preferably the mother. Carbajal's work is a further demonstration that newborns, including premature babies, look for a reassuring presence when experiencing pain. This might be surprising, but to the attentive observer they reveal an unsuspected emotional world. Not only do they feel pain, but they are also capable of suffering, distress, anxiety and fear. This needs to be considered in neonatal analgesic treatment, even for extremely premature children, where mothers are not always allowed to stay by them: it is mandatory for caregivers to guarantee a reassuring presence during painful procedures: newborns are exacting patients. They not only feel pain, they even suffer; they request not only sugar or drugs, but a human presence nearby. References: 1. Carbajal R, Soocramanien V, Couderc S, Ville Y: Analgesic effect of breast feeding in term neonates: randomised controlled trial. BMJ 2003;326:13 2. Bellieni CV, Buonocore G, Nenci A, Franci N, Cordelli DM, Bagnoli F: Sensorial saturation: an effective tool for heel-prick in preterm infants. Biol Neonate 2001;80:15-18 3. Bellieni CV, Bagnoli F, Perrone S, Nenci A, Cordelli DM, Fusi M, Ceccarelli S, Buonocore G: The effect of multi-sensory stimulation on analgesia in term neonates: a randomized controlled trial. Pediatr Res. 2002 Apr;51(4):460-3 4. Melzack R, Wall PD: Pain mechanisms: a new theory. Science 1965;150(699):971-9 Carlo V Bellieni, MD Competing interests: None declared |
|||
|
|
|||
|
James M. Howard, biologist 1037 North Woolsey Avenue, Fayetteville, Arkansas 72701-2046, U.S.A.
Send response to journal:
|
Melatonin is in breast milk and melatonin stimulates beta-endorphin release. Competing interests: None declared |
|||