A amamentação e o leite materno para o alívio da dor de procedimentos em recém-nascidos pré-termo: revisão sistemática
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Universidade Federal de Goiás
Introduction: Preterm newborns in the Intensive Care Unit are exposed to different painful procedures. It is recommended that units providing care to the newborn should establish a pain management program, which includes non-pharmacological analgesic interventions. Breastfeeding in full-term newborns is effective in reducing pain responses, but the evidence for preterms is still inconclusive. Objective: To evaluate and synthesize the literature on the evidences of the effectiveness of breastfeeding or breast milk as non-pharmacological interventions for the management of acute procedural pain in preterm newborns. Methods: Systematic review of randomized clinical trials published between 2011 and 2018 in English, Spanish and Portuguese. Search performed according to the acronym PICO, with the research question: Are breastfeeding and breast milk effective in the management of acute pain of procedures in preterm newborns compared to other non-pharmacological methods. Pain was assessed as the predicted value, considering at least one of the following results: scoring of pain assessment scales and evaluation of physiological, behavioral pain indicators or other indicators. The search performed in the electronic databases of MEDLINE, CENTRAL and LILACS, using controlled terms for preterm newborn, pain, breastfeeding, breast milk and randomized clinical trial. Study methodological quality was assessed using the Cochrane Collaboration tool for bias risk assessment from randomized clinical trials. Results: Fifteen studies were included, and two evaluated the use of breastfeeding (128 preterms) and thirteen (1026 preterms) the use of breast milk as an analgesic intervention. The endpoint evaluated in most of the studies (n= 12, 80%) was the PIPP score. The painful procedures examined were heel puncture, ophthalmologic examination for retinopathy of prematurity, aspiration of the airways, removal of adhesive tape from dressing and venipuncture. Conclusion: Breastfeeding has an analgesic effect on heel puncture for late preterm newborns that demonstrate ability to breastfeed. It did not present significant differences in relation to then onnutritive suction and sucrose 24%. Breast milk has a superior effect in relation to water and no treatment, and it shows better results when combined with nonnutritive suction, kangaroo position and enrollement, and is recommended for pain reduction during heel puncture. Studies should be done to investigate other factors that interfere with the efficacy of breastfeeding, such as maternal factors and breastfeeding time, and in addition to investigate different dosages of milk that ensure the best dose / effect to promote analgesia.
FREITAS, R. R. A amamentação e o leite materno para o alívio da dor de procedimentos em recém-nascidos pré-termo: revisão sistemática. 2019. 132 f. Dissertação (Mestrado em Enfermagem) - Universidade Federal de Goiás, Goiânia, 2019.