Biomedical subjects

Janet Pinelli

Publications and source records attributed to Janet Pinelli.

17 recordsLinked to original sources

PubMed2007

Parent as proxy reporting: implications and recommendations for quality of life research.

Improved disease management in children has resulted in an increased interest in the quality of life in children. Quality of life research in children may enlist either the substitute or complementary perspective. Much of the quality of life literature has been guided by the substitute perspective, which infers that parents may best report their child's quality of life. However, the complementary perspective values both parent and child perspectives equally. The purpose of this article was to critically review the quality of life literature with respect to children with diabetes. Limitations in the literature were addressed as conceptual and methodological, demographic, and underlying proxy perspectives. Benefits and limitations of quality of life measurements and perspectives were also discussed. Recommendations and future implications for quality of life research in children extend current understanding from both substitute and complementary perspectives.

Adaptation, Psychological↗

PubMed2006

Growth trajectories of extremely low birth weight infants from birth to young adulthood: a longitudinal, population-based study.

We compared sex-specific growth attainment of a population-based cohort of 147/166 (89%) extremely low birthweight (ELBW < 1000 g) and 131/145 (90%) sociodemographically comparable normal birthweight (NBW) cohort at young adulthood, and examined the pattern of growth trajectories and correlates of growth at ages 1, 2, 3, and 8 y, and teen and young adulthood (mean age, 23.3 versus 23.6 y). The proportion considered small for gestational age was ELBW 25% versus NBW 3%; and 26% versus 2% had neurosensory impairments. Weight for age z-scores for ELBW showed substantial decline to age 3 y, with subsequent significant catch-up to adolescence and smaller gains to adulthood. Height for age z-scores showed both sexes of ELBW were disadvantaged at every age compared with NBW and their expected mid-parental height. The BMI z-scores for ELBW showed a sustained incline from age 3 to adulthood, where both sexes normalized to above zero, and were comparable to their peers. ELBW children showed growth failure during infancy, followed by accelerated weight gain and crossing of BMI percentiles at adolescence, a pattern that may increase the risk of insulin resistance and coronary heart disease. However, normalization of BMI for both sexes at adulthood suggests that final growth was proportionate.

Adult↗

PubMed2006

Transition of extremely low-birth-weight infants from adolescence to young adulthood: comparison with normal birth-weight controls.

CONTEXT: Traditionally, educational attainment, getting a job, living independently, getting married, and parenthood have been considered as markers of successful transition to adulthood. OBJECTIVE: To describe and compare the achievement and the age at attainment of the above markers between extremely low-birth-weight (ELBW) and normal birth-weight (NBW) young adults. DESIGN, SETTING, AND PARTICIPANTS: A prospective, longitudinal, population-based study in central-west Ontario, Canada, of 166 ELBW participants who weighed 501 to 1000 g at birth (1977-1982) and 145 sociodemographically comparable NBW participants assessed at young adulthood (22-25 years). Interviewers masked to participant status administered validated questionnaires via face-to-face interviews between January 1, 2002, and April 30, 2004. MAIN OUTCOME MEASURES: Markers of successful transition to adulthood, including educational attainment, student and/or worker role, independent living, getting married, and parenthood. RESULTS: At young adulthood, 149 (90%) of 166 ELBW participants and 133 (92%) of 145 NBW participants completed the assessments at mean (SD) age of 23.3 (1.2) years and 23.6 (1.1) years, respectively. We included participants with neurosensory impairments (ELBW vs NBW: 40 [27%] vs 3 [2%]) and 7 proxy respondents. The proportion who graduated from high school was similar (82% vs 87%, P = .21). Overall, no statistically significant differences were observed in the education achieved to date. A substantial proportion of both groups were still pursuing postsecondary education (47 [32%] vs 44 [33%]). No significant differences were observed in employment/school status; 71 (48%) ELBW vs 76 (57%) NBW young adults were permanently employed (P = .09). In a subanalysis, a higher proportion of ELBW young adults were neither employed nor in school (39 [26%] vs 20 [15%], P = .02 by Holm's correction); these differences did not persist when participants with disabilities were excluded. No significant differences were found in the proportion living independently (63 [42%] vs 70 [53%], P = .19), married/cohabitating (34 [23%] vs 33 [25%], P = .69), or who were parents (16 [11%] vs 19 [14%], P = .36). The age at attainment of the above markers was similar for both cohorts. CONCLUSION: Our study results indicate that a significant majority of former ELBW infants have overcome their earlier difficulties to become functional young adults.

Achievement↗

PubMed2006

Self-perceived health-related quality of life of former extremely low birth weight infants at young adulthood.

OBJECTIVES: The goals were to compare the self-reported, health-related quality of life of former extremely low birth weight and normal birth weight infants at young adulthood and to determine whether there were any changes over time. METHODS: A prospective, longitudinal, population-based study with concurrent control subjects was performed. We interviewed 143 of 166 extremely low birth weight survivors (birth weight: 501-1000 g; 1977-1982 births) and 130 of 145 sociodemographically comparable, normal birth weight, reference subjects. Neurosensory impairments were present for 27% extremely low birth weight and 2% normal birth weight young adults. Health Utilities Index 2 was used to assess health status, and standard gamble technique was used to measure directly the self-reported, health-related, quality of life and 4 hypothetical health states. RESULTS: Extremely low birth weight young adults reported more functional limitations in cognition, sensation, mobility, and self-care, compared with control subjects. There were no differences between groups in the mean self-reported, health-related, quality of life or between impaired (n = 38) and nonimpaired (n = 105) extremely low birth weight subjects. However, with a conservative approach of assigning a score of 0 for 10 severely disabled, extremely low birth weight subjects, the mean health-related quality of life was significantly lower than control values. Repeated-measures analysis of variance to compare health-related quality-of-life measurements obtained for young adults and teens showed the same decline in scores over time for both groups. There were no differences between groups in the ratings provided for the hypothetical health states. CONCLUSIONS: At young adulthood, health-related quality of life was not related to size at birth or to the presence of disability. There was a small decrease in health-related quality-of-life scores over time for both groups.

Adult↗

PubMed2005

A review of the literature examining the benefits and challenges, incidence and duration, and barriers to breastfeeding in preterm infants.

Breastfeeding benefits preterm infants from a nutritional, gastrointestinal, immunological, developmental, and psychological perspective. Despite the benefits, the incidence and duration of breastfeeding preterm infants continues to be less than that of full-term infants. The lower incidence is probably related to breastfeeding challenges that preterm infants and parents face, including establishing and maintaining a milk supply and transitioning from gavage feeding to breastfeeding. In order to increase the incidence and duration of breastfeeding preterm infants, researchers must examine breastfeeding experiences longitudinally. This way, researchers and clinicians can begin to understand the barriers to breastfeeding at various time periods in the breastfeeding experience and begin implementing strategies to remove these barriers.

Breast Feeding↗

PubMed2005

Qualitative analysis of barriers to breastfeeding in very-low-birthweight infants in the hospital and postdischarge.

PURPOSE: To determine barriers to the successful establishment and maintenance of breastfeeding in very-low-birthweight (VLBW) infants, both in the hospital and after discharge, and changes in barriers over time. SUBJECTS: Sixty-four mothers of infants <1500 g birth weight who planned to breastfeed and were in the supplementary structured breastfeeding counseling intervention group. DESIGN: This qualitative, longitudinal study is a secondary analysis of a previously reported randomized controlled trial of a breastfeeding support intervention that examined infants weighing <1500 g at birth. METHODS: A qualitative technique, content analysis, was used to review, analyze, interpret, and categorize data for the current study. Data were extracted from the research records of the research lactation consultant that addressed all aspects of mothers' reported breastfeeding experiences. The principal investigator identified the main issues of the conversations, entered these into a summary chart, and then assigned appropriate categories. All categories are a reflection of maternal perception. Categorical data were analyzed descriptively using the crosstabs function. MAIN OUTCOME MEASURES: Barriers to the successful establishment and maintenance of breastfeeding during discharge from the neonatal intensive care unit (NICU), at discharge home, and at 1, 3, 6, and 12 months corrected age, or until weaning from breastfeeding. Changes in breastfeeding barriers across the 6 time periods were also determined. PRINCIPAL RESULTS: At NICU discharge, low milk volume was the greatest breastfeeding barrier. During the period from discharge home and at 1 month and 3 months, the infants' compromised physical status was the largest barrier to breastfeeding. Data from the 6- and 12-month time periods indicated that the provision of complementary feeding was the greatest barrier to breastfeeding; it was most prevalent in the period following NICU discharge and before discharge home. Across all time periods, nipple and breast problems were most prevalent at NICU discharge, whereas poor technique was a barrier at 1 month. Mothers' compromised emotional status was greatest at discharge from the NICU and diminished thereafter. CONCLUSIONS: Results from this study indicate the need to address time-period-specific barriers encountered during the breastfeeding experience of mothers of VLBW infants.

Breast Feeding↗

PubMed2004

The effects of family resources, coping, and strains on family adjustment 18 to 24 months after the NICU experience.

PURPOSE: To examine the relationship of family coping, resources, and strains on family adjustment over time following the NICU experience. DESIGN: Longitudinal, correlational study based on the Resiliency Model of Family Stress, Adjustment and Adaptation. SAMPLE: Data were collected, through mailed questionnaires, from 71 couples, 18 to 24 months following the birth of their infant. The data are a follow-up from a previous study conducted at the time of the infant's birth. MAIN OUTCOME VARIABLES: The dependent variable in the study was family adjustment, measured by the McMaster Family Assessment Device. The independent variables were family resources, as measured by the Family Inventory of Resource Management; family coping, as measured by the Family Crisis Oriented Evaluation Scales; family strain, as measured by the Family Inventory of Life Events and Changes; and parent gender, family system (first-time parent or not), and the child's health, as measured by the Demographic Information Questionnaire. RESULTS: Family adjustment improved over time for mothers but decreased for fathers. Fathers of infants with ongoing health problems reported significantly poorer family adjustment. Family resources were related to family adjustment and decreased over time for both parents. Families used more coping mechanisms and different coping patterns over time.

Adaptation, Psychological↗

PubMed2004

Incidence and duration of breastfeeding for term infants in Canada, United States, Europe, and Australia: a literature review.

BACKGROUND: Analysis of differences in the incidence and duration of breastfeeding across countries may provide information about practices that encourage breastfeeding. This comparative review examines variation in the incidence and duration of breastfeeding for term infants that has been reported in studies from Canada, the United States, Europe, and Australia. METHODS: Searches were conducted in PubMed, MEDLINE (from 1966), CINHAL (from 1982), and the Cochrane Database of Systematic Reviews. Studies were limited to nonexperimental and observational research that addressed term infants (>37 weeks gestational age), performed in developed countries, written in the English language, and published since 1990. Additional studies were located from reference lists of meta-analyses, systematic reviews, and previous articles. All studies that met study criteria were included in the review, regardless of the quality of methodology. RESULTS: Although studies had methodological limitations that precluded conducting a formal systematic review or meta-analysis, this comparative review revealed consistent differences among countries. For example, Europe and Australia reported a higher initiation and duration of breastfeeding term infants compared with Canada and the United States. CONCLUSIONS: Studies that examined reasons for a higher incidence and duration of breastfeeding term infants consistently document that women who initiate and continue to breastfeed are older, married, better educated, and have higher family incomes than women who do not breastfeed.

Australia↗

PubMed2004

Advanced practice nursing roles: development, implementation and evaluation.

AIM: The aim of this paper is to discuss six issues influencing the introduction of advanced practice nursing (APN) roles: confusion about APN terminology, failure to define clearly the roles and goals, role emphasis on physician replacement/support, underutilization of all APN role domains, failure to address environmental factors that undermine the roles, and limited use of evidence-based approaches to guide their development, implementation and evaluation. BACKGROUND: Health care restructuring in many countries has led to substantial increases in the different types and number of APN roles. The extent to which these roles truly reflect advanced nursing practice is often unclear. The misuse of APN terminology, inconsistent titling and educational preparation, and misguided interpretations regarding the purpose of these roles pose barriers to realizing their full potential and impact on health. Role conflict, role overload, and variable stakeholder acceptance are frequently reported problems associated with the introduction of APN roles. DISCUSSION: Challenges associated with the introduction of APN roles suggests that greater attention to and consistent use of the terms of the terms advanced nursing practice, advancement and advanced practice nursing is required. Advanced nursing practice refers to the work or what nurses do in the role and is important for defining the specific nature and goals for introducing new APN roles. The concept of advancement further defines the multi-dimensional scope and mandate of advanced nursing practice and distinguishes differences from other types of nursing roles. Advanced practice nursing refers to the whole field, involving a variety of such roles and the environments in which they exist. Many barriers to realizing the full potential of these roles could be avoided through better planning and efforts to address environmental factors, structures, and resources that are necessary for advanced nursing practice to take place. CONCLUSIONS: Recommendations for the future introduction of APN roles can be drawn from this paper. These include the need for a collaborative, systematic and evidence-based process designed to provide data to support the need and goals for a clearly defined APN role, support a nursing orientation to advanced practice, promote full utilization of all the role domains, create environments that support role development, and provide ongoing evaluation of these roles related to predetermined goals.

Humans↗

PubMed2004

Dancing to our own tune: understandings of advanced nursing practice in British Columbia.

There has been ongoing confusion about the meaning of advanced nursing practice (ANP) and the nature of ANP roles in Canada and elsewhere. A broad range of roles and titles have been adopted throughout Canada in an attempt to delineate specialized and/or advanced roles within nursing. One key objective in a recent three-phase study of ANP in British Columbia was to clarify the role and understanding of advanced nursing practice and related roles within the larger healthcare system. Our intent in this paper is to describe the understandings of ANP that emerged in Phase I of this recent study and to compare registered nurses' understandings of ANP to the characteristics and competencies identified by the Canadian Nurses Association (2002) framework. (Note: The term "nurse," as used in this paper, refers to "registered nurse.") We conclude by identifying future directions for development of advanced practice roles.

Attitude of Health Personnel↗

PubMed2003

Kangaroo care is effective in diminishing pain response in preterm neonates.

OBJECTIVE: To test the efficacy of maternal skin-to-skin contact, or kangaroo care (KC), on diminishing the pain response of preterm neonates to heel lancing. DESIGN: A crossover design was used, in which the neonates served as their own controls. Subjects Preterm neonates (n = 74), between 32 and 36 weeks' postmenstrual age and within 10 days of birth, who were breathing without assistance and who were not receiving sedatives or analgesics in 3 level II to III neonatal intensive care units in Canada. INTERVENTIONS: In the experimental condition, the neonate was held in KC for 30 minutes before the heel-lancing procedure and remained in KC for the duration of the procedure. In the control condition, the neonate was in the prone position in the isolette. The ordering of conditions was random. MAIN OUTCOME MEASURES: The primary outcome was the Premature Infant Pain Profile, which is composed of 3 facial actions, maximum heart rate, and minimum oxygen saturation changes from baseline in 30-second blocks. Videotapes, taken with the camera positioned on the neonate's face so that an observer could not tell whether the neonate was being held or was in the isolette, were coded by research assistants who were naïve to the purpose of the study. Heart rate and oxygen levels were continuously monitored into a computer for later analysis. A repeated-measures analysis of covariance was used, with order of condition and site as factors and severity of illness as a covariate. RESULTS: Premature Infant Pain Profile scores across the first 90 seconds from the heel-lancing procedure were significantly (.002<P<.04) lower by 2 points in the KC condition. CONCLUSIONS: For preterm neonates who are 32 weeks' postmenstrual age or older, KC seems to effectively decrease pain from heel lancing. Further study is needed to determine if younger neonates or those requiring assistance in breathing, or older infants or toddlers, would benefit from KC, or if it would remain effective over several procedures. Given its effectiveness, and that parents of neonates in critical care units want to participate more in comforting their children, KC is a potentially beneficial strategy for promoting family health.

Blood Specimen Collection↗

PubMed2003

Effect of breastmilk consumption on neurodevelopmental outcomes at 6 and 12 months of age in VLBW infants.

PURPOSE: To determine the influence of breastmilk consumption, as a dose response, in very low-birth-weight (VLBW) infants (< 1,500 g) on neurodevelopmental outcomes at 6 and 12 months corrected age, and to determine the influence of selected sociodemographic and infant variables on neurodevelopmental outcomes. SUBJECTS: VLBW infants (n = 148) who were fed mother's milk or formula by parental choice. DESIGN: Prospective cohort with longitudinal follow-up at 6 and 12 months corrected age. METHODS: Self-administered questionnaires given to mothers at study entry, before discharge, and at 3-, 6-, and 12-month follow-up visits. During hospitalization, mothers recorded the 24-hour volume of expressed milk once per week. At each follow-up visit, the volume of a single feeding was assessed by pre- and postbreastfeeding test weights of infants measured on an electronic scale accurate to 1.0 g. The amount of breastfeeding was also assessed by feeding records and mother's report. MAIN OUTCOME MEASURES: The Bayley Scales of Infant Development (2nd Edition), the Mental Developmental Index (MDI), and the Psychomotor Developmental Index (PDI). PRINCIPAL RESULTS: After controlling for specific sociodemographic and infant variables, this study of VLBW infants showed no statistically significant effect of predominantly breastfeeding compared with predominantly formula feeding on neurodevelopmental outcomes to 12 months corrected age. The most significant predictor of MDI scores at 6 and 12 months corrected age was birth weight, in which higher birth weights predicted higher MDI scores. CONCLUSIONS: Despite the lack of statistically significant differences, the findings suggest a small but consistent advantage in developmental scores in infants who were fed their mother's milk compared with those who were predominantly formula fed. Supporting parents to breastfeed preterm infants may maximize the potential advantages of early nutrition in the neurodevelopmental outcome of VLBW infants.

Breast Feeding↗

PubMed2003

Psychopathology and social competencies of adolescents who were extremely low birth weight.

BACKGROUND: We have previously shown that infants who were extremely low birth weight (ELBW) are particularly vulnerable to problems related to inattention and hyperactivity at school age. It is not known whether these problems persist to adolescence. OBJECTIVE: To explore and compare the levels of psychopathology in a regional cohort of ELBW infants and sociodemographically matched term controls as reported by teens and their parents. DESIGN/METHODS: Cross-sectional cohort study/geographically defined region. PARTICIPANTS: TEENS: ELBW 141/169 (83%) and control 122/145 (84%), aged 12 to 16 years. PARENTS: ELBW 143/169 (85%) and control 123/145 (85%). Both cohorts and their parents completed the Ontario Child Health Study-Revised questionnaire with 6 behavioral subsca1es: conduct disorder, oppositional defiant disorder, attention-deficit/hyperactivity disorder (ADHD), overanxious, separation anxiety, and depression. RESULTS: By teen self-report, there were no significant differences between ELBW and control teens on any of the 6 subscale scores. However, parents of ELBW teens reported significantly higher scores than parents of control for depression and ADHD based on 2-way analysis of variance (group x gender). Comparison within teen/parent dyads showed that both cohorts of teens reported significantly higher scores than their parents. Multivariable analyses on behavioral subscale scores demonstrated a number of variables that were significant predictors by parent report: group (ELBW vs control), gender, family function, developmental quotient, maternal mood, and socioeconomic status; no predictors were significant by teen report. There were no statistically significant interaction effects for any of the models. These models explained a greater percent of the variance in behavioral scores for parents than for teens (12.5%-22.0% vs 3.4%-8.2%). Results were similar when teens with neurosensory impairment were excluded. CONCLUSIONS: This study is unique in the inclusion of both parent and teen self-report of behaviors. Significant differences were apparent only by parent report for ADHD and depression among ELBW teens. Significant predictors of behavioral scores for parents include group, gender, family function, developmental quotient, maternal mood, and socioeconomic status.

Adaptation, Psychological↗

PubMed2002

Comparison of capillary blood sampling using an automated incision device with and without warming the heel.

OBJECTIVE: To determine if heel warming prior to heelstick increases the volume of blood collected compared to no warming. STUDY DESIGN: Randomized controlled trial involving 100 preterm and term infants requiring capillary blood sampling (CBS), randomized to receive warming (Control) (n=50) or nonwarming (Experimental) (n=50). RESULTS: This sample of infants showed no benefit of warming the heel prior to CBS. Volume of blood, collection time, crying time, and repeat procedures were not different between groups. More infants in the Control group received squeezing during the procedure compared to the Experimental group. CONCLUSION: Heel warming prior to CBS may be an unnecessary technique in preterm and term infants that expends nursing time and hospital financial cost.

Automation↗

PubMed2002

A matched cohort study of feeding practice guidelines for infants weighing less than 1,500 g.

PURPOSE: To evaluate the efficacy and safety of clinical practice guidelines (CPG) for the nutritional management of infants weighing < 1,500 g. SUBJECTS: Infants weighing < 1,500 g (n = 200) admitted to the NICU who had no major congenital anomalies were enrolled. DESIGN AND METHODS: A before-and-after matched cohort study was conducted during 1996/1997 and 1998/1999 enrolling infants in a Standard Practice (SP) group and CPG group, respectively. Weight-stratified CPG were introduced between these 2 study periods. Data on the first 100 babies who could be matched for birth weight and gestational age were analyzed. Data collection continued until full feedings were established and tolerated for 48 hours or the infant was discharged from the hospital, whichever came first. PRIMARY OUTCOME MEASURE: Of the 200 infants in the study (median gestational age 28 weeks), 142 infants attained full feedings. The median time to full feedings was 15 days in both groups, and a paired sample t test showed no significant difference between the 2 groups (P = 0.35). PRINCIPAL RESULTS: No statistically significant differences in the age of feeding commencement, number of feeding interruptions, days on total parenteral nutrition, days to regain birth weight, age at discharge, incidence of sepsis, necrotizing enterocolitis, or use of erythromycin were found. CONCLUSIONS: The CPG was a safe alternative to standardize nutritional practices in the NICU. The lack of differences between groups shown in this study is likely related to gut immaturity limiting the infant's response to changes in feeding practices, inconsistent use of the guidelines, confounding factors, the small sample size, or the similarity between SP and the CPG.

Body Weight↗

PubMedDate not supplied

Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates.

BACKGROUND: Preterm and acutely ill term neonates who are hospitalized in a neonatal intensive care unit are subjected to multiple frequent invasive and painful procedures aimed at improving their outcome. Although several trials to determine the efficacy of sucrose for managing procedural pain in preterm and acutely ill term neonates have been developed, these have generally lacked methodological rigor and have not provided clinicians with clear practice guidelines. OBJECTIVES: To compare the efficacy and safety of three interventions for relieving procedural pain associated with heel lances in preterm and term neonates, and to explore the influence of contextual factors including sex, severity of illness, and prior painful procedures on pain responses. METHODS: In a randomized controlled trial, 190 neonates were stratified by gestational age and then randomized to receive (a) sucrose and nonnutritive sucking (n = 64), (b) sucrose alone (n = 62), or (c) sterile water and nonnutritive sucking (control) (n = 64) to evaluate the efficacy (pain response as measured using the Premature Infant Pain Profile) (Stevens, Johnson, Petryshen, & Taddio, 1996) and safety (adverse events) following a scheduled heel lance during the first week of life. Stratification was used to control for the effects of age on pain response. RESULTS: Significant differences in pain response existed among treatment groups (F = 22.49, p <.001), with the lowest mean Premature Infant Pain Profile scores in the sucrose and nonnutritive sucking group. Efficacy of sucrose following a heel lance was not affected by severity of illness, postnatal age, or number of painful procedures. Intervention group and sex explained 12% of the variance in Premature Infant Pain Profile scores. Few adverse events occurred (n = 6), and none of them required medical or nursing interventions. CONCLUSIONS: The combination of sucrose and nonnutritive sucking is the most efficacious intervention for single heel lances. Research on the effects of gestational age on the efficacy and safety of repeated doses of sucrose is required.

Analysis of Variance↗

PubMedDate not supplied

Nonnutritive sucking in high-risk infants: benign intervention or legitimate therapy?

OBJECTIVE: To review the available research evidence on the effects of nonnutritive sucking (NNS) in high-risk full-term and preterm infants in neonatal nurseries. DATA SOURCES: Electronic searches of MEDLINE (1976-2001) and CINAHL (1982-2001) databases, as well as the Cochrane Library. Reference lists of all relevant articles were also reviewed. STUDY SELECTION: Experimental and quasi-experimental studies that included hospitalized full-term and preterm infants, where NNS by pacifier was compared to no pacifier. DATA EXTRACTION: Results of studies were reviewed by two of the authors. DATA SYNTHESIS: As an intervention to promote behavioral outcomes and gastrointestinal function or feeding, there is little evidence to support the use of NNS in preterm and high-risk full-term infants. NNS has been linked to reduced length of hospital stay and improved pain management. CONCLUSIONS: Although harmful effects have not been specifically studied, NNS in preterm and high-risk full-term infants does not appear to have any short-term negative effects. No long-term data on the effects of NNS in high-risk full-term and preterm infants are presently available. Based on the results of this review, it would seem reasonable for nurses to utilize pacifiers for pain management in high-risk full-term and preterm infants.

Evidence-Based Medicine↗