Background

The incidence of acute urinary retention (AUR) in children receiving intravenous (IV) opioids varies widely. Risk factors have been studied scarcely.

Objectives

To determine the incidence, risk factors and the time to event of AUR in children receiving IV opioids.

Methods

Prospective observational study at the Amsterdam UMC, The Netherlands, from January-November 2018. This is an interim-analysis.

Included were children 0-18 year admitted to a general ward or pediatric intensive care unit (PICU), receiving IV opioids >4h. Exclusion criteria: indication for IUC, per-operative AUR, urological pathology, epidural/ spinal/ caudal anaesthesia, neuro-muscle disease, receiving paralysing agents, prematurity.

AUR was defined as the inability to void >8h, with a bladder volume larger than expected for age, confirmed by ultrasound.

Univariable and multivariable logistic regression analysis were performed to study the association between potential risk factors and AUR.

Results

We included 207 participants, of which 31(15.0%) developed AUR, with 19/65(29.2%) in PICU and 12/142(8.5%) in non-PICU patients.

In univariable analysis PICU admission, sedation as indication for opioids, reason for admission and maximum daily fluid intake were significantly associated with AUR. After stepwise backward selection, PICU admission (adjusted OR=4.40,95%CI:1.75-11.19,p=0.002) and maximum daily fluid intake (10% deviation of normal intake, adjusted OR=0.78,95%CI:0.65-0.90,p=0.002) remained significantly associated.

Median time to AUR was 9h (IQR:7.14-13.3), 28/31(90,3%) occurred <24h.

Conclusion

Our preliminary results indicate that routinely IUC placement is not required in children receiving IV opioids, if strict observation of voiding and any necessary US and IUC placement is performed, which is at greatest importance in PICU patients and during the first 24h.

Background

Skin to skin care (SSC) and sucrose, both have been shown to be effective in providing pain relief for premature neonates. There is lack of strong evidence for choosing one over other because of limited comparison data

Objectives

To compare the effect of SSC and oral Sucrose on pain control of preterm neonates by premature infant pain profile (PIPP) scale.

Methods

This is an crossover RCT involving stable preterm neonates (28 - 36 wk GA at birth) conducted during Jan- Dec 2018. In group A, SSC was started 10 min before 1 heel-stick, SSC was continued post procedure as per the unit protocol and 0.2 ml 24% oral sucrose was given 2 min before the 2 heelstick. In group B, 0.2 ml 24% oral sucrose was given 2 min before the 1 heel-stick and SSC was started 10 min before 2 heel-stick.

Results

The study involved 100 neonates (45 female, 55 male). The mean (SD) total PIPP score at baseline was significantly lower in sucrose group [2.75(1.36) vs 3.4(1.01), p<0.001]. The mean (sd) total PIPP score at 5 min is significantly lower in the sucrose group than KMC group [3.1(1.27) vs 3.5(1.19) p<0.01]. This difference in sucrose group attribute to behavioural state of the neonate [2.1(1.09) vs 2.5(0.8) p<0.01] and brow bulge (facial expression) of neonate [0.05(0.2) vs 0.09(0.4) p<0.05].

Conclusion

SSC and oral sucrose have comparable efficacy in reducing premature neonatal pain. Given that SSC offers several additional bshould be the first preference for providing pain control in preterm neonates whenever possible.

Background

Children with cognitive impairment generally express their pain through idiosyncratic, subjective behavior. The Comfort Behavior Scale (CBS) is validated for the assessment of distress, pain and sedation in mechanically ventilated children in PICU. However it has not been validated yet in children with cognitive impairment.

Objectives

To explore the criterion validity of CBS comparing it with the Individualized Numeric Rating Scale(INRS) and revised FLACC scale (R-FLACC) for pain.

Methods

Observational validation pilot study from March to September 2018 in 3 PICU’s in a tertiary care pediatric hospital. Pain and sedation was assessed in 16 patients before and after tracheal suctioning by two independent clinicians, using the CBS, INRS and R-FLACC. Interrater reliability using linearly weighted kappa was evaluated at the beginning of the study. To evaluate the correlation between scales the Spearman rho correlation coefficient was applied.

Results

Results: 38 tracheal suctioning events were assessed on 16 cognitively impaired patients. Interrater reliability between nurses was evaluated on 11 events: interrater reliability was maximum for the R-FlACC (Cohen’s kappa = 1), and moderate for the CBS (Cohen’s kappa = 0.42): The correlation between R-FLACC and CBS was was 0.75 before and 0.80 after the procedure.

Conclusion

This is the first study to validate a standardized pain and sedation scale on a population of mechanically ventilated patients with cognitive impairment. Results seem promising for the use of CBS on this patient population.