Pain management for placement of peripherally inserted central catheters in neonates: A systematic review and meta-analysis
Notice bibliographique
Résumé
Abstract Background Placement of a peripherally inserted central catheter (PICC) is a clinically essential but painful procedure commonly performed in neonates. Early exposure to pain is associated with negative sequelae and therefore pain should be managed. Various non-pharmacological and/or pharmacological interventions have been used in clinical practice. However, the optimal pain management strategy is unclear. The primary objective of this systematic review and meta-analysis is to evaluate the benefits and harms of pain management interventions in neonates undergoing PICC placement. Methods Databases were searched for randomized controlled trials (RCTs) from inception to March 2024. The literature search was updated in June 2025 and no additional eligible articles were identified for inclusion. Title and abstract screening, full-text screening and data extraction were performed in duplicate. Risk of bias was assessed using Cochrane’s risk of bias (RoB) 2.0 tool. The critically important outcome was pain measured using validated tools including unidimensional behaviour and multidimensional (comprising combinations of contextual, behavioural and/or physiological components) tools. Secondary outcomes included procedure success and adverse events. Pooled effect estimates were standardized mean difference (SMD) and relative risk (RR) with 95% confidence intervals (CI) using random effects models. A GRADE assessment of the overall certainty of the evidence for each outcome was completed. Results Six included studies reported pain scores for between-group comparisons of pain management interventions among 324 neonates. The interventions included intravenous opioids (morphine, remifentanil), topical anesthetics (tetracaine) and intravenous acetaminophen. Morphine was effective in reducing acute pain compared to control (SMD −0.65 [95% CI −1.17, −0.13]) using a unidimensional tool (brow bulge) in one study. Using two different multidimensional tools, remifentanil was effective in reducing acute pain compared to control (SMD −1.59 [95% CI −2.21, −0.97] using the premature infant pain profile [PIPP] and SMD −1.21 [95% CI −1.79, −0.62] using the neonatal infant pain scale). In a meta-analysis of two RCTs comparing tetracaine to placebo, there was no difference in acute pain (SMD −0.05 [95% CI −1.70, 1.59], I2 = 0%) or overall procedural pain (SMD −0.19 [95% CI −2.07, 1.69], I2 = 0%) using PIPP scores. For acetaminophen, there was no difference in pain scores across three dosing regimens. Across all intervention comparisons, there was no difference in procedure success and no serious adverse events attributed to pharmacological interventions. There was moderate certainty of evidence for all critical and important outcomes. Discussion Based on available evidence, opioids probably reduce pain associated with PICC placement in neonates. Topical anesthetics and acetaminophen were not demonstrated to be effective. Further research is necessary to guide healthcare professionals in implementing optimal pain management for this procedure.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,012 | 0,033 |
| Méta-épidémiologie (sens strict) | 0,003 | 0,001 |
| Méta-épidémiologie (sens large) | 0,020 | 0,036 |
| Bibliométrie | 0,006 | 0,006 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,003 | 0,002 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,002 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,004 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».