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BMC Pediatr 2019 Jan 15;19(1):20. Epub 2019 Jan 15.

Division of Midwifery, Department of Health Professions, Bern University of Applied Sciences, Murtenstrasse 10, 3008, Bern, Switzerland.

Background: Assessing pain in neonates is challenging because full-term and preterm neonates of different gestational ages (GAs) have widely varied reactions to pain. We validated the Bernese Pain Scale for Neonates (BPSN) by testing its use among a large sample of neonates that represented all GAs.

Methods: In this prospective multisite validation study, we assessed 154 neonates between 24 2/7 and 41 4/7 weeks GA, based on the results of 1-5 capillary heel sticks in their first 14 days of life. Read More

Z Orthop Unfall 2018 Nov 27. Epub 2018 Nov 27.

Centrum für Muskuloskeletale Chirurgie, Abteilung für Kinder- und Neuroorthopädie, Charité - Universitätsmedizin Berlin, gemeinsames Mitglied der Freien Universität Berlin, Humboldt-Universität zu Berlin, und Berlin Institute of Health.

This manuscript evaluates the recent standard concept for clubfoot treatment. With regard to the history of clubfoot therapy and the return to conservative methods, the focus is laid on Ponseti's treatment concept. Due to its development according to the precise analysis of the pathoanatomy, the practical principle is simple and easy to learn and consists basically of two redression maneuvers, percutaneous achillotenotomy, and boots and bar abduction treatment. Read More

Birth 2018 12 27;45(4):432-439. Epub 2018 May 27.

Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Background: Rooming-in, or keeping mothers and infants together throughout the birth hospitalization, increases breastfeeding initiation and duration, and is one of the Ten Steps to Successful Breastfeeding.

Methods: The Centers for Disease Control and Prevention's (CDC) Maternity Practices in Infant Nutrition and Care (mPINC) survey is a biennial census of all birth facilities in the United States and its territories. Data from the 2007-2015 mPINC surveys were used to assess trends in the prevalence of hospitals with most (≥90%) infants rooming-in more than 23 hours per day (ideal practice). Read More

Int J Nurs Stud 2018 Jul 7;83:25-33. Epub 2018 Apr 7.

Children's Hospital of Nanjing Medical University, China.

Background: Sucrose combined with non-nutritive sucking provided better pain relief than sucrose or non-nutritive sucking alone in a single painful procedure. However, whether the combination of non-nutritive sucking with sucrose could obtain a significant difference in analgesic effect of the repeated procedural pain than any single intervention has not been established.

Objective: To compare the effect of non-nutritive sucking and sucrose alone and in combination of repeated procedural pain in preterm infants. Read More

Environ Health Perspect 2018 02 27;126(2):027013. Epub 2018 Feb 27.

Center for Environmental Research and Children's Health, University of California , Berkeley School of Public Health, Berkeley, California, USA.

Background: Prenatal exposure to some per- and polyfluoroalkyl substances (PFASs) may disrupt maternal and neonatal thyroid function, which is critical for normal growth and neurodevelopment.

Objectives: We examined associations of PFAS exposure during early pregnancy with maternal and neonatal thyroid hormone levels.

Methods: We studied 732 mothers and 480 neonates in Project Viva, a longitudinal prebirth cohort in Boston, Massachusetts. Read More

Int J Nurs Stud 2018 Jan 8;77:162-170. Epub 2017 Oct 8.

School of Nursing, National Defense Medical Center, Taipei, Taiwan. Electronic address:

Background: Preterm infant pain can be relieved by combining non-nutritive sucking (sucking), oral sucrose, and facilitated tucking (tucking), but the pain-relief effects of oral expressed breast milk (breast milk) are ambiguous.

Aims: We compared the effects of combined sucking+ breast milk, sucking+breast milk+tucking, and routine care on preterm infant pain during and after heel-stick procedures.

Design: A prospective, randomized controlled trial. Read More

BMC Pediatr 2017 Jul 19;17(1):171. Epub 2017 Jul 19.

Department of Neonatology, Children's University Hospital, Bern, Switzerland.

Background: The Bernese Pain Scale for Neonates (BPSN) is a multidimensional pain assessment tool that is already widely used in clinical settings in the German speaking areas of Europe. Recent findings indicate that pain responses in preterm neonates are influenced by individual contextual factors, such as gestational age (GA), gender and the number of painful procedures experienced. Currently, the BPSN does not consider individual contextual factors. Read More

Int J Nurs Stud 2017 Jul 11;72:24-29. Epub 2017 Apr 11.

Nursing coordinator S.I.T.R.A. Basic Education Sector - Neonatology and Neonatal Intensive Care, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.

Background: The heel stick is the method of choice in most neonatal units for capillary blood sampling, and it represents the most common event among all painful procedures performed on newborns. The type and design of heel stick device and the clinical procedure to collect a blood sample may have an impact on newborn pain response as well.

Objective: To compare the pain response and efficiency of different automated devices for capillary blood collection in newborns. Read More

Ital J Pediatr 2016 Mar 9;42:29. Epub 2016 Mar 9.

Division of Neonatology, Department of Pediatrics, UniversityHospital "A.Gemelli" CatholicUniversity of the Sacred Heart, Rome, Italy.

Background: Continuous glucose monitoring using subcutaneous sensors has been validated in adults and children with diabetes, and was found to be useful in the management of glucose control. We aimed to assess feasibility and reliability of a new continuous glucose monitoring system (CGMS) in a population of preterm neonates using a Clarke error grid (CEG) specifically modified for preterm infants.

Methods: Preterm infants were recruited within 24 h from delivery. Read More

J Trop Pediatr 2016 06 10;62(3):246-9. Epub 2016 Feb 10.

College of Nursing, Eulji University, Daejeon, 301-746 South Korea

Blood sampling for a newborn screening test is necessary for all neonates in South Korea. During the heel stick, an appropriate intervention should be implemented to reduce neonatal pain. This study was conducted to identify the effectiveness of kangaroo care (KC), skin contact with the mother, on pain relief during the neonatal heel stick. Read More

Cochrane Database Syst Rev 2015 Dec 2(12):CD006275. Epub 2015 Dec 2.

Department of Psychology, York University, 4700 Keele Street, OUCH Laboratory, 2004/6 Sherman Health Sciences Building, Toronto, ON, Canada, M3J 1P3.

Background: Infant acute pain and distress is commonplace. Infancy is a period of exponential development. Unrelieved pain and distress can have implications across the lifespan. Read More

Iran J Nurs Midwifery Res 2015 May-Jun;20(3):405-8

Department of Pediatric Nursing School and Midwifery, Isfahan University of Medical Science, Isfahan, Iran.

Background: During health care in the neonatal intensive care unit (NICU), infants undergo extremely painful procedures, which may cause problems, if not controlled, such as changes in the pattern of respiratory rate, heart rate, and blood oxygen saturation. The present study aimed to find the effect of melody on the physiological responses of neonates' heel stick pain.

Materials And Methods: This quasi-experimental study was conducted in Alzahra Hospital (Isfahan, Iran) for 5 months. Read More

Int J Nurs Stud 2015 Aug 23;52(8):1288-99. Epub 2015 Apr 23.

School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC. Electronic address:

Background: Preterm infants manifest pain and stress by behavioural agitation and state change. Few studies have explored the effects of combining nonpharmacological interventions, i.e. Read More

Int J Nurs Stud 2015 Jul 9;52(7):1157-65. Epub 2015 Apr 9.

School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China.

Background: Preterm infants' repeated exposure to painful procedures may lead to negative consequences. Thus, non-pharmacological pain management is essential due to medication side effects. Kangaroo Mother Care, which aims at offering human care to neonates, has been established for the treatment of a single painful procedure, but the effectiveness of Kangaroo Mother Care across repeated painful procedures is unknown. Read More

Med Acupunct 2013 Aug;25(4):285-290

Department of Neurobiology, Center for Translational Neuroscience, University of Arkansas for Medical Sciences , Little Rock, AR. ; Department of Pediatrics and Neonatology, College of Medicine, University of Arkansas for Medical Sciences , Little Rock, AR.

Background: Hospitalized infants may undergo frequent painful procedures with inadequate pain relief. Alternative pain relief interventions are needed.

Objective: The aim of this research was to determine the safety of noninvasive electrical stimulation of acupuncture points (NESAP) in neonates who were receiving routine heel sticks. Read More

Zhonghua Shi Yan He Lin Chuang Bing Du Xue Za Zhi 2013 Oct;27(5):392-4

Objective: This study compared two newborn Cytomegalovirus (CMV) IgG antibody screening ELISA kits and evaluated the detection effectiveness of Abnova kit.

Methods: CMV IgG antibodies were detected by both SeraQuest and Abnova kits from dried blood spot (DBS) samples of 488 newborn heel sticks. The detection abilities of these two kits were compared in different sample dilution concentrations. Read More

Neonatal Netw 2013 Sep-Oct;32(5):353-7

University of Connecticut School of Nursing, 231 Glenbrook Road, Unit 2026, Storrs, CT 06269-2026, USA.

Kangaroo Care (KC) has been recommended as a pain-reducing strategy in neonates; however, KC has not been widely used to minimize procedural pain caused in part by nurses'/phlebotomists' discomfort when positioning themselves and the infant for blood drawing and injections. Therefore, an ergonomically designed setup incorporating the use of KC was introduced into clinical practice to facilitate blood draws and injections. The step-by-step procedure used for heel sticks and injections is presented in this manuscript. Read More

Eur J Pain 2013 Feb 2;17(2):255-63. Epub 2012 Jul 2.

Institute of Nursing Science, University of Basel, Basel, Switzerland.

Background: Evidence indicates that medical and demographic contextual factors (cFs) impact pain responses in preterm neonates, but the existing evidence is very heterogeneous.

Aim: To explore the effect of cFs on pain responses to heel-stick procedures of preterm infants.

Methods: This study was a secondary analysis of data collected during a randomized controlled trial examining pain response to non-pharmacological interventions across repeated heel sticks. Read More

Int J Nurs Stud 2013 Jul 12;50(7):883-94. Epub 2012 Oct 12.

School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC.

Background: Pain and stress agitate preterm infants, interrupting their sleep. Frequent high arousal states may affect infants' brain development and illness recovery. Preserving infants' sleep and relieving their pain during painful procedures are both important for their health. Read More

Pediatrics 2012 Feb 9;129(2):299-308. Epub 2012 Jan 9.

Institute of Nursing Science, University of Basel, Basel, Switzerland.

Objectives: To test the comparative effectiveness of 2 nonpharmacologic pain-relieving interventions administered alone or in combination across time for repeated heel sticks in preterm infants.

Methods: A multicenter randomized controlled trial in 3 NICUs in Switzerland compared the effectiveness of oral sucrose, facilitated tucking (FT), and a combination of both interventions in preterm infants between 24 and 32 weeks of gestation. Data were collected during the first 14 days of their NICU stay. Read More

Int J Nurs Stud 2012 Mar 14;49(3):300-9. Epub 2011 Oct 14.

School of Nursing, National Defense Medical Center, Taipei, Taiwan, ROC.

Background: Preterm infants' repeated exposure to painful procedures may contribute to negative consequences. Thus, improving preterm infants' neurodevelopmental outcomes requires prioritising their pain management.

Objectives: To compare the effectiveness of two non-pharmacological pain-relief strategies (non-nutritive sucking and facilitated tucking) with routine care on preterm infants' pain, behavioural, and physiological responses before, during, and after heel-stick procedures. Read More

Cochrane Database Syst Rev 2011 Oct 5(10):CD006275. Epub 2011 Oct 5.

Department of Psychology, York University, 4700 Keele Street, OUCH Laboratory, Atkinson College, Toronto, Ontario, Canada, M3J 1P3.

Background: Infant acute pain and distress is commonplace. Infancy is a period of exponential development. Unrelieved pain and distress can have implications across the lifespan. Read More

J Clin Nurs 2011 Apr 10;20(7-8):1054-9. Epub 2011 Feb 10.

Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.

Aim: The aim of this study was to determine whether oral glucose could have a pain-relieving effect during the eye examinations that premature neonates undergo in the screening for retinopathy of prematurity.

Background: Studies have shown that orally administered sweet-tasting solutions reduce signs of pain during painful procedures such as venepuncture and heel sticks on premature and full-term infants. This effect has not yet been proven during the eye examinations for the screening of retinopathy of prematurity. Read More

MCN Am J Matern Child Nurs 2010 Nov-Dec;35(6):346-54; quiz 354-6

Texas Health Harris Methodist Hospital Cleburne, Cleburne, TX, USA.

Purpose: To measure the difference in pain scores for newborns who were held and swaddled while undergoing routine heel lance procedures compared to newborns who were lying on their backs and not swaddled during heel lance. Additionally, we sought to compare the total amount of time it took to collect the specimens in each group.

Design And Methods: A total of 42 neonates recruited from a large tertiary hospital were enrolled in a randomized controlled trial. Read More

J Perinat Neonatal Nurs 2010 Jul-Sep;24(3):274-83

Nursing Faculty, Department of Nursing, Mesa Community College, Mesa, Arizona 85202, USA.

Background: Hospitalized infants are often exposed to many painful procedures as a result of their illness or disease process. Untreated or poorly treated pain can have deleterious effects on normal nociceptive pain development as well as future development of pain pathways. Mechanical vibration has been found to be efficacious in adult and pediatric populations for the relief of mild-to-moderate acute and chronic pain. Read More

Pediatr Nurs 2010 May-Jun;36(3):129-36

Azusa Pacific University Azusa, CA, USA.

The exposure of premature infants to stressors, such as pain intended to ensure their survival, may instead alter their brain development and contribute to several learning and behavioral difficulties observed in later childhood. The objective of this descriptive, cross-sectional study was to compare the pain responses of 72 preterm infants to a heel stick procedure taking into consideration a variety of factors, including the use of opioids and sedatives. The pain scores assessed on the Preterm Infant Pain Profile (PIPP) scale were highest for the lowest gestational age (GA) group. Read More

Am Fam Physician 2009 Apr;79(8):681-5

Georgetown University School of Medicine, Georgetown University Medical Center, Washington, District of Columbia 20007, USA.

Physicians are often asked for guidance about pacifier use in children, especially regarding the benefits and risks, and when to appropriately wean a child. The benefits of pacifier use include analgesic effects, shorter hospital stays for preterm infants, and a reduction in the risk of sudden infant death syndrome. Pacifiers have been studied and recommended for pain relief in newborns and infants undergoing common, minor procedures in the emergency department (e. Read More

Acta Paediatr 2009 May 13;98(5):842-6. Epub 2009 Jan 13.

Institute of Nursing Science, University of Basel, Basel, Switzerland.

Aim: To explore the variability in pain response in preterm infants across time who received sucrose during routine heel stick.

Method: Single group, exploratory repeated measures design.

Setting: Two tertiary level neonatal intensive care units (NICU) in Switzerland. Read More

Adv Neonatal Care 2007 Oct;7(5):222-9

Clinical Education, Obstetrics/Gynecology Program, Kingston General Hospital, Ontario, Canada.

Venipuncture is now the standard method of phlebotomy for well newborn infants at Kingston General Hospital (KGH), Canada. Newborn infants require at least one blood sample for mandatory genetic screening. Some will require additional samples for monitoring of hyperbilirubinemia or other laboratory tests. Read More

Pediatrics 2006 Nov;118 Suppl 2:S78-86

Department of Pediatrics, Stanford University School of Medicine, Lucile Packard Children's Hospital, Palo Alto, CA 94304, USA.

Objective: Despite increased knowledge, improved options, and regulatory mandates, pain management of neonates remains inadequate, promoted by the ineffective translation of research data into clinical practice. The Neonatal Intensive Care Quality Improvement Collaborative 2002 was created to provide participating NICUs the tools necessary to translate research, related to prevention and treatment of neonatal pain, into practice. The objective for this study was to use proven quality improvement methods to develop a process to improve neonatal pain management collaboratively. Read More

Arch Pediatr Adolesc Med 2006 Jun;160(6):645

School of Medicine, University of California-Davis, Davis, CA, USA.

Ambul Pediatr 2005 Nov-Dec;5(6):359-64

Loma Linda University Children's Hospital, Loma Linda, CA, USA.

Objectives: First, to compare analgesic effects of breast-feeding versus pacifier use in newborn infants undergoing blood collection via heel sticks. Second, to compare analgesic effects of pacifier use with maternal holding versus nonmaternal holding.

Design: A prospective, randomized, controlled trial. Read More

Pediatrics 2005 Jun;115(6):1494-500

Neonatal Intensive Care Unit, Poissy Saint Germain Hospital, Poissy, France.

Background: Morphine alleviates prolonged pain, reduces behavioral and hormonal stress responses induced by surgery among term neonates, and improves ventilator synchrony and sedation among ventilated preterm neonates, but its analgesic effects on the acute pain caused by invasive procedures remain unclear.

Objective: To investigate the analgesic efficacy of intravenously administered morphine on heel stick-induced acute pain among preterm neonates.

Design: This study was nested within a prospective, randomized, double-blind, multicenter, placebo-controlled trial (the NEOPAIN Trial). Read More

Pain Manag Nurs 2004 Dec;5(4):160-8

University of Louisiana at Monroe, 68 Quail Ridge Drive, Monroe, LA 71203, USA.

Oral sucrose reduces pain during heel sticks and venipunctures in preterm infants, but no studies have been done to determine the effectiveness of sucrose during eye examinations for retinopathy of prematurity. Therefore, the purpose of this study was to determine the effectiveness of local anesthetic eye drops and a pacifier, plus repeated doses of 24% sucrose, to relieve pain associated with eye examinations for retinopathy of prematurity. In this double-blind randomized controlled trial, 30 preterm infants were randomly assigned to one of two treatments, in which they received either local anesthetic eye drops, a pacifier, plus three doses of sterile water or local anesthetic eye drops, a pacifier, plus three doses of 24% sucrose during the eye examination. Read More

J Midwifery Womens Health 2004 Nov-Dec;49(6):514-9

The Children's Hospital of Philadelphia, NICU, PA 19104, USA.

A baseline assessment of pain should occur as part of a newborn's health assessment within the first few hours of life. Validation and assessment of pain in the term newborn is important for providing care because newborns may experience pain from a multitude of procedures, ranging from heel sticks to circumcisions. Current assessment tools evaluate both behavioral and physiologic parameters. Read More

Clin Exp Dermatol 2003 Sep;28(5):502-3

Department of Dermatology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

Dystrophic cutaneous calcification may arise at sites of local trauma or in association with various disorders. Calcified nodules of the heel have been reported in high-risk neonates following repeated heel sticks to draw blood. We present a healthy 2-year-old boy with a calcified nodule on the heel secondary to a single heel stick in the neonatal period. Read More

J Obstet Gynecol Neonatal Nurs 2002 Sep-Oct;31(5):563-9

School of Nursing, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada.

Newborn care in the first 24 hours of life has been based on tradition for many years. Nurses recognize that many practices are not based on good scientific evidence and are not individualized. Instead, all newborns are treated as though they acquire potential pathogens during birth and are oblivious to noxious interventions such as intramuscular injections and heel sticks. Read More

Vojnosanit Pregl 2002 Jul-Aug;59(4):399-404

Vojnomedicinska akademija, Klinika za plasticnu hirurgiju i opekotine, Beograd.

The soft tissue cover in the calcaneal region represents one of the great problems in the reconstructive surgery. The distant skin, muscle and musculocutaneous flaps are subjected to ulcers even with the orthopedic shoes. The island fasciocutaneus mid sole neurocutaneous flap can be a good substitute for the soft tissue cover due to its anatomic structure. Read More

J Am Podiatr Med Assoc 2002 Feb;92(2):112-3

Podiatric Medicine, Temple University School of Podiatric Medicine, Philadelphia, PA, USA.

Calcified nodules of the heel have been reported in high-risk neonates following multiple needle sticks to draw blood. Previous reports suggest that the needle stick trauma causes dystrophic calcification. A case of multiple discrete firm heel lesions, which began shortly after birth in an immature-birth weight neonate who had sustained multiple needle sticks of the heel, is presented. Read More

J Dev Behav Pediatr 2001 Dec;22(6):418-24

Department of Psychology, Gettysburg College, Pennsylvania 17325, USA.

The first goal of the study was to explore whether preterm newborns can learn to predict painful stimulation. The second goal was to provide a description of physiological and behavioral responses to repeated heel-sticks over days. Preterm newborns, born between 28 and 32 weeks gestational age, were observed five times over a period of 2 weeks while undergoing heel-sticks. Read More

Pediatr Dermatol 2001 Mar-Apr;18(2):138-40

Department of Dermatology, University Hospital of Wales, Heath Park, Cardiff, Wales.

We report the presence of calcified nodules on the heels secondary to heel sticks in healthy monozygotic twins in childhood. The subjects were born preterm at 34 weeks. The heels were normal at birth. Read More

Arch Dis Child Fetal Neonatal Ed 2001 Jan;84(1):F53-5

Department of Clinical Chemistry, Helsinki University Central Hospital, Helsinki, Finland.

Objectives: To evaluate in a randomised blind study the effect on puncture site lesions of two different incision devices used to obtain blood samples from preterm infants by repeated heel sticks.

Setting: The neonatal intensive care unit at the Hospital for Children and Adolescents and Laboratory, Helsinki University Central Hospital.

Patients: A total of 100 preterm infants (birth weight below 2500 g) not previously subjected to heel stick sampling. Read More

Pediatrics 2000 Apr;105(4):E49

Pamela Youde Nethersole Hospital, Hong Kong, China.

Objective: To test the effect of nonnutritive sucking (NNS), music therapy (MT), and combined NNS and MT (NNS + MT), versus no intervention, on heart rate, transcutaneous oxygen (TcPaO(2)) levels, and pain behavior of neonates in intensive care units having blood taken by a heel-stick procedure.

Methodology: A within-subjects, counter-balancing, repeated-measures design conducted in a government-funded hospital in Hong Kong, comparing TcPaO(2) levels, heart rate, and pain behavior outcomes in 27 neonates.

Results: Repeated-measures multivariate analysis of variance revealed statistically significant differences in outcomes across all interventions (Wilk's lambda =. Read More

An Esp Pediatr 1999 Apr;50(4):389-92

Servicio de Neonatología, Universitat de Barcelona.

Objective: Nowadays economical criteria lead to early maternal hospital discharge, even before 48 hours after labor, producing an increase in neonatal readmissions for hyperbilirubinemia. We tried to predict the healthy term newborns that may develop a significant hyperbilirubinemia (> or = 17 mg/dl in the first 4 days of life).

Methods: Bilirubin in umbilical cord blood, transcutaneous measurements of bilirubin at 24, 48 and between 60 and 96 hours of life and bilirubin in blood obtained from heel-sticks at 96 hours was analyzed in 610 newborns. Read More

Pediatr Med Chir 1998 Nov-Dec;20(6):411-3

Clinica Pediatrica, Università degli Studi di Verona.

When an infant presents severe cyanosis which is not associated with respiratory distress, methaemoglobinemia should always be suspected. In children its main inducers are contaminated water or vegetable broths with high nitrate levels (especially spinach and carrots) used to prepare powdered formula or soups. Children affected with methaemoglobinemia have a peculiar lavender colour. Read More

Pediatrics 1998 Apr;101(4 Pt 1):583-90

Bureau of Laboratories, Texas Department of Health, Austin, Texas 78756, USA.

Objective: To assess results of newborn screening for 21-hydroxylase-deficient congenital adrenal hyperplasia (CAH) in Texas over 6 years of screening 1.9 million infants.

Methods: In 1989, CAH was incorporated into the ongoing Texas Newborn Screening Program, which requires two screens on each newborn. Read More

Am J Clin Pathol 1993 Aug;100(2):116-8

Hurley Medical Center, Flint, MI 48502.

The authors retrospectively reviewed complete blood counts in the medical records of all babies admitted to a normal newborn nursery from January through December 1989. The subjects consisted of 326 babies who were delivered vaginally (VgD) and 138 who were delivered by Cesarean section (CS). All blood samples were drawn by warmed or unwarmed heel sticks or by venipuncture. Read More

Child Dev 1989 Aug;60(4):781-92

College of Nursing, University of Illinois, Urbana 61801.

The effectiveness of pacifiers and swaddling in reducing pain-induced distress was compared in 2-week-old infants who underwent heel-sticks and 2-month-old infants who received injections. Crying, state, and heart rate were measured on 32 infants at each age during baseline, the stress of heel-stick or injection, and during 3-min soothing intervention and postintervention periods. At 2 weeks, infants' HR levels and crying declined significantly more rapidly in the pacifier than in the swaddling condition. Read More

Am J Med 1985 Jun;78(6B):206-12

An approach that is useful in classifying the risk factors for the development of acute osteomyelitis is the same as one commonly employed to discuss the mechanisms responsible for pathogenesis: hematogenous dissemination, direct inoculation, and contiguous spread from an adjacent area of soft tissue infection. Acute hematogenous osteomyelitis is predominantly a disease of children. Factors that favor the development of acute bone infection are those that predispose to bacteremia. Read More

J Pediatr 1985 Jan;106(1):168