Epidemiology of painful procedures performed in neonates: A systematic review of observational studies

Procedural pain in neonates has been a concern in the last two decades. The purpose of this review was to provide a critical appraisal and a synthesis of the published epidemiological studies about procedural pain in neonates admitted to intensive care units. The aims were to determine the frequency of painful procedures and pain management interventions as well as to identify their predictors. Academic Search, CINAHL, LILACS, Medic Latina, MEDLINE and SciELO databases were searched for observational studies on procedural pain in neonates admitted to intensive care units. Studies in which neonatal data could not be extracted from the paediatric population were excluded. Eighteen studies were included in the review. Six studies with the same study duration, the first 14 days of the neonate life or admission in the unit of care, identified 6832 to 42,413 invasive procedures, with an average of 7.5-17.3 per neonate per day. The most frequent procedures were heel lance, suctioning, venepuncture and insertion of peripheral venous catheter. Pharmacological and nonpharmacological approaches were inconsistently applied. Predictors of the frequency of procedures and analgesic use included the neonate's clinical condition, day of unit stay, type of procedure, parental presence and pain assessment. The existence of pain protocols was not a predictor of analgesia. Painful procedures were performed frequently and often with inadequate pain management. Unlike neonate clinical factors, organizational factors may be modified to promote a context of care more favourable to pain management. © 2015 European Pain Federation - EFIC®

Cognitive Assessment System (CAS): Psychometric studies with Portuguese children from 7 to 15 years.

The Cognitive Assessment System (CAS) is a new measure of cognitive abilities based on the Planning, Attention, Simultaneous and Successive (PASS) Theory. This theory is derived from research in neuropsychological and cognitive Psychology with particular emphasis on the work of Luria (1973). According to Naglieri (1999) and Naglieri and Das (1997), the PASS cognitive processes are the basic building blocks of human intellectual functioning. Planning processes provide cognitive control, utilization of processes and knowledge, intentionality, and self-regulation to achieve a desired goal; Attention processes provide focused, selective cognitive activity and resistance to distraction; and, Simultaneous and Successive processes are the two forms of operating on information. The PASS theory has had a strong empirical base prior to the publication of the CAS (see Das, Naglieri & Kirby, 1994), and its research foundation remains strong (see Naglieri, 1999; Naglieri & Das, 1997). The four basic psychological processes can be used to (1) gain an understanding of how well a child thinks; (2) discover the child’s strengths and needs, which can then be used for effective differential diagnosis; (3) conduct fair assessment; and (4) select or design appropriate interventions. Compared to the traditional intelligence tests, including IQ tests, the Cognitive Assessment System (CAS) has the great advantage of relying on a modern theory of cognitive functioning, linking theory with practice.