Heel-Lancing in Newborns: Behavioral and Spectral Analysis Assessment of Pain Control Methods.

Weissman, A., Aranovitch, M., Blazer, S., Zimmer, E. Z.
PEDIATRICS. Vol. 124 No. 5 November 2009, pp. e921-e926 doi:10.1542/peds.2009-0598

OBJECTIVE: Pain experience can alter clinical outcome, brain development, and subsequent behavior in newborns, primarily in preterm infants. The aims of this study were (1) to evaluate several simple, commonly used methods for pain control in newborns and (2) to evaluate the concordance between behavioral and autonomic cardiac reactivity to pain in term neonates during heel-lancing.

METHODS: A prospective study was conducted of 180 term newborn infants who were undergoing heel-lancing for routine neonatal screening of phenylketonuria and hypothyroidism. Newborns were assigned to 6 groups: (1) control (no pain relief intervention); (2) nonnutritive sucking; (3) holding by mother; (4) oral glucose solution; (5) oral formula feeding; or (6) breastfeeding. Outcome measures included the Neonatal Facial Coding System score; cry duration; and autonomic variables obtained from spectral analysis of heart rate variability before, during, and after heel-lancing.

RESULTS: Infants with no pain control showed the highest pain manifestation compared with newborns to whom pain control was provided. Infants who breastfed or received an oral formula showed the lowest increase in heart rate (21 and 23 beats per minute, respectively, vs 36; P < .01), lowest neonatal facial score (2.3 and 2.9, respectively, vs 7.1; P < .001), lowest cry duration (5 and 13 seconds, respectively, vs 49; P < .001), and lowest decrease in parasympathetic tone (–2 and –2.4, respectively, vs 1.2; P < .02) compared with the other groups.

CONCLUSIONS: Any method of pain control is better than none. Feeding and breastfeeding during heel-lancing were found to be the most effective methods of pain relief.

A school-based program to prevent adolescent dating violence: a cluster randomized trial

A school-based program to prevent adolescent dating violence: a cluster randomized trial.Wolfe DA, Crooks C, Jaffe P, et al. Arch Pediatr Adolesc Med. 2009 Aug;163(8):692-9.
OBJECTIVE: To determine whether an interactive curriculum that integrates dating violence prevention with lessons on healthy relationships, sexual health, and substance use reduces physical dating violence (PDV). DESIGN: Cluster randomized trial with 2.5-year follow-up; prespecified subgroup analyses by sex. SETTING: Grade 9 health classes. PARTICIPANTS: A total of 1722 students aged 14-15 from 20 public schools (52.8% girls). Intervention A 21-lesson curriculum delivered during 28 hours by teachers with additional training in the dynamics of dating violence and healthy relationships. Dating violence prevention was integrated with core lessons about healthy relationships, sexual health, and substance use prevention using interactive exercises. Relationship skills to promote safer decision making with peers and dating partners were emphasized. Control schools targeted similar objectives without training or materials. MAIN OUTCOME MEASURES: The primary outcome at 2.5 years was self-reported PDV during the previous year. Secondary outcomes were physical peer violence, substance use, and condom use. Analysis was by intention-to-treat.
RESULTS: The PDV was greater in control vs intervention students (9.8% vs 7.4%; adjusted odds ratio, 2.42; 95% confidence interval, 1.00-6.02; P = .05). A significant group x sex interaction effect indicated that the intervention effect was greater in boys (PDV: 7.1% in controls vs 2.7% in intervention students) than in girls (12.1% vs 11.9%). Main effects for secondary outcomes were not statistically significant; however, sex x group analyses showed a significant difference in condom use in sexually active boys who received the intervention (114 of 168; 67.9%) vs controls (65 of 111 [58.6%]) (P < .01). The cost of training and materials averaged CA$16 per student.
CONCLUSION: The teaching of youths about healthy relationships as part of their required health curriculum reduced PDV and increased condom use 2.5 years later at a low per-student cost.

Efficacy of Interventions to Improve Motor Development in Young Children: A Systematic Review. Riethmuller AM, Jones RA, Okely AD.Pediatrics. 2009 Sep 7. (Review) PMID: 19736263.

Objective: The objective of this study was to systematically review evidence from controlled trials on the efficacy of motor development interventions in young children.
Methods: A literature search of interventions was conducted of 14 electronic databases. Three reviewers independently evaluated studies to determine whether they met the inclusion criteria. Studies were compared on 5 components: design, methodologic quality, intervention components, efficacy, and alignment with the Consolidated Standard of Reporting Trials (CONSORT) and Transparent Reporting of Evaluation with Nonrandomized Designs (TREND) statements.
Results: Seventeen studies met the inclusion criteria. More than half (65%) were controlled trials and delivered at child care settings or schools (65%). Three studies had high methodologic quality. Studies were approximately 12 weeks in duration and delivered by teachers, researchers, and students. Parents were involved in only 3 studies. Nearly 60% of the studies reported statistically significant improvements at follow-up. Three studies aligned with the CONSORT and TREND statements.
Conclusions: This review highlights the limited quantity and quality of interventions to improve motor development in young children. The following recommendations are made: (1) both teachers and researchers should be involved in the implementation of an intervention; (2) parental involvement is critical to ensuring transfer of knowledge from the intervention setting to the home environment; and (3) interventions should be methodologically sound and follow guidelines detailed in the CONSORT or TREND statement.