Medidas Não Farmacológicas no Controle da Dor e Estresse em Recém–Nascido Prematuro em UTIN: Revisão Sistemática e Meta-Análise em Rede

Abstract

Background: Increasing knowledge about pain and stress control measures in preterm infants in neonatal intensive care units (NICU) is of interest to providers and health professionals, especially non-pharmacological measures, which can be cost-effective and safe. Objectives: To identify which non-pharmacological measures are most effective in controlling pain and stress in critically ill preterm infants in the NICU. Method: Systematic review and network meta-analysis of randomized clinical trials published in English, Portuguese, and Spanish. The search took place in the period from April 23, 2020, to April 11, 2022. The search was performed in MedLine via PubMed, Latin American and Caribbean Heal th Sciences Literature (LILACS), Excerpta Medica dataBASE (Embase), The Cochrane Central Register of Controlled Trials (CENTRAL) and Evidence Database in physical therapy (PEDro). The primary outcome of interest was pain and stress control. The risk of bias analysis was performed using the Revised Cochrane risk-of-bias tool for randomized trials (Rob 2) and the certainty of evidence and strength of recommendation using the Grading of Recommendations Assessment, Development and Evaluation system. Heterogeneity was assessed by the Higgins and Thompson I2 test, the classification of interventions by the P-score and inconsistencies by the Direct Evidence Plot. Results: Of the 210 publications identified, twelve studies were included in a qualitative analysis with 961 preterm infants and ten in quantitative analysis with 716 preterm infants. There were 12 different combinations of non-pharmacological measures. With moderate confidence, we demonstrated that sucrose or oral glucose, maternal heart sound, lullaby, breastmilk odor/taste, non-nutritive pacifier sucking, magnetic acupuncture, skin-to-skin contact, facilitated containment, and sensory saturation reduced pain and stress in critically ill preterm infants when compared to no intervention, placebo, proparacaine, or standard NICU routine, with multiple therapies (sensory saturation) and sugars having a larger effect size. Conclusion: Multiple therapies (sensory saturation) and sugars were the most effective measures to reduce pain and stress in preterm infants in NICU. It is strongly recommended that these non-pharmacological measures be considered for the management of pain and stress in preterm infants in the NICU. Discussion: Limitations were that not all non-pharmacological measures for pain and stress control in preterm infants were included in this review, and it was not possible to analyze whether gestational age or health conditions could alter the results.