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Biomedical subjects

Pat Hummel

Publications and source records attributed to Pat Hummel.

7 recordsLinked to original sources
PubMed2006

Pain assessment: current status and challenges.

Neonatal pain assessment has received much attention over the past decade. Behavioural indicators of pain include facial action, body movement and tone, cry, state/sleep, and consolability. Physiological indicators of pain include increased heart rate, respiratory rate, and blood pressure, as well as decreased heart rate variability and oxygen desaturation. Pain assessment in neonates is difficult in neurologically compromised, chemically paralyzed, and non-responsive infants. Multiple pain assessment tools are summarized. Pain assessment and management protocols are delineated.

Biomarkers↗
PubMed2005

Impacting infant head shapes.

Infant sleep position impacts the development of head shape. Changes in infant sleep position, specifically the movement toward supine sleep, have led to a redefinition of normal head shape for infants in the United States. Historically, a dolichocephalic (elongated) head shape was the norm. Currently the norm has changed to a more brachycephalic (shorter and broader) shape. Since the American Academy of Pediatrics' Back to Sleep Campaign, the incidence of positional plagiocephaly has increased dramatically with a concurrent rise in the incidence of torticollis. Infants who require newborn intensive care, particularly premature infants, are more prone to positional plagiocephaly and dolichocephaly. Both can be prevented or minimized by proper positioning. The infant with an abnormal head shape requires careful evaluation; treatment varies according to the etiology. Craniosynostosis, a less common but pathological etiology for plagiocephaly, should be considered in the diagnostic process. Successful treatment of positional plagiocephaly and dolichocephaly includes systematic positioning changes to overcome the mechanical forces of repetitive positioning, physical and/or occupational therapy to treat underlying muscle or developmental challenges, and in some cases, molding helmet therapy.

Craniofacial Abnormalities↗
PubMed2005

Analgesia and sedation during mechanical ventilation in neonates.

BACKGROUND: Endotracheal intubation and mechanical ventilation are major components of routine intensive care for very low birth weight newborns and sick full-term newborns. These procedures are associated with physiologic, biochemical, and clinical responses indicating pain and stress in the newborn. Most neonates receive some form of analgesia and sedation during mechanical ventilation, although there are marked variations in clinical practice. Clinical guidelines for pharmacologic analgesia and sedation in newborns based on robust scientific data are lacking, as are measures of clinical efficacy. OBJECTIVE: This article represents a preliminary attempt to develop a scientific rationale for analgesia sedation in mechanically ventilated newborns based on a systematic analysis of published clinical trials. METHODS: The current literature was reviewed with regard to the use of opioids (fentanyl, morphine, diamorphine), sedative-hypnotics (midazolam), nonsteroidal anti-inflammatory drugs (ibuprofen, indomethacin), and acetaminophen in ventilated neonates. Original meta-analyses were conducted that collated the data from randomized clinical comparisons of morphine or fentanyl with placebo, or morphine with fentanyl. RESULTS: The results of randomized trials comparing fentanyl, morphine, or midazolam with placebo, and fentanyl with morphine were inconclusive because of small sample sizes. Meta-analyses of the randomized controlled trials indicated that morphine and fentanyl can reduce behavioral and physiologic measures of pain and stress in mechanically ventilated preterm neonates but may prolong the duration of ventilation or produce other adverse effects. Randomized trials of midazolam compared with placebo reported significant adverse effects (P < 0.05) and no apparent clinical benefit; the findings of a meta-analysis suggest that there are insufficient data to justify use of IV midazolam for sedation in ventilated neonates. CONCLUSIONS: Despite ongoing research in this area, huge gaps in our knowledge remain. Well-designed and adequately powered clinical trials are needed to establish the safety, efficacy, and short- and long-term outcomes of analgesia and sedation in the mechanically ventilated newborn.

Analgesia↗
PubMed2004

Home care of the high-risk infant.

Increasingly, infants are discharged from the neonatal intensive care unit (NICU) with unresolved healthcare issues and ongoing technology needs. A well-planned discharge of a medically stable infant is important to assure safe and effective care in the home and to minimize avoidable hospital readmissions. This article addresses the discharge of and home care options for 3 groups of infants who have traditionally been cared for in the hospital. These include infants requiring palliative care, infants who are technology dependent, and those stable premature infants requiring intensive home support. Intermittent and continuous home nursing care options are defined, and the goals of home care nursing are outlined. The importance of objective discharge criteria and medical stability is discussed along with practical tips and strategies to assure success. A teaching tool to assist parents in choosing a home care provider is included.

Equipment and Supplies↗
PubMed2002

The reality of neonatal pain.

Pain has been unrecognized and undertreated throughout the history of neonatal care. Misconceptions about the infant's ability to feel, remember, and express pain contribute to this long-standing problem. These misconceptions include beliefs that infants are unable to feel pain like adults or to remember it. This article describes the embryology of pain and includes a discussion of emerging evidence that infants do remember pain and consequently react differently to subsequent painful experiences. In addition, the adverse long-term effects of pain on the developing infant are identified and discussed. Permanent structural and function changes in the brain and spinal cord occur with repeated painful experiences, and adverse outcomes are described. An enhanced understanding of the infant's ability to experience pain and the long-term effects of unrelieved pain are essential to avoid harm and to maximize short- and long-term neurodevelopmental outcomes in this vulnerable population.

Adaptation, Psychological↗