Zusammenfassung
Neben vielen anderen Faktoren sind Schmerzen und Unruhezustände die führende Ursache einer körperlichen und psychischen Stressbelastung für ein palliativ betreutes Neugeborenes. Die konsequente Behandlung von Schmerzen und Unruhezuständen ist eine Grundvoraussetzung für eine gelungene Begleitung des Kindes in der Sterbephase und die spätere Trauerverarbeitung der Eltern. Sie muss integraler Bestandteil jedes individuellen, palliativen Pflegekonzeptes sein. In diesem Kapitel wird detailliert auf die Möglichkeiten nicht-pharmakologischer und pharmakologischer Maßnahmen zur Schmerz- und Symptomkontrolle eingegangen. Abschließend werden spezielle Aspekte der Symptomkontrolle bei Abbruch einer maschinellen Beatmung bzw. bei Abbruch einer parenteralen Ernährung und Flüssigkeitszufuhr dargestellt.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Literatur
Aldrink JH, Ma M, Wang W, Caniano DA, Wispe J, Puthoff T (2011) Safety of ketorolac in surgical neonates and infants 0 to 3 months old. J Ped Surgery 46:1081–1085
Bellieni CV, Buonocore G, Nenci A, Franci N, Cordelli DM, Bagnoli F (2001) Sensorial saturation: an effective analgesic tool for heel-prick in preterm infants: a prospective randomized trial. Biol Neonate 80:15–18
Breau LM, McGrath PJ, Stevens B, Beyene J, Camfield C, Finley GA, Franck L, Gibbins S, Howlett A, McKeever P, O’Brien K, Ohlsson A (2006) Judgments of pain in the neonatal intensive care setting: a survey of direct care staffs’ perceptions of pain in infants at risk for neurological impairment. Clin J Pain 22:122–129
Campbell-Yeo M, Fernandes A, Johnston C (2011) Procedural pain management for neonates using nonpharmacological strategies: part 2: mother-driven interventions. Adv Neonatal Care 11:312–318
Carbajal R, Lenclen R, Jugie M, Paupe A, Barton BA, Anand KJ (2005) Morphine does not provide adequate analgesia for acute procedural pain among preterm neonates. Pediatrics 115:1494–1500
Ceelie I, de Wildt SN, van Dijk M, van den Berg MM, van den Bosch GE, Duivenvoorden HJ, de Leeuw TG, Mathôt R, Knibbe CA, Tibboel D (2013) Effect of intravenous paracetamol on postoperative morphine requirements in neonates and infants undergoing major noncardiac surgery: a randomized controlled trial. JAMA 309:149–154
Cignacco E, Hamers JP, van Lingen RA, Zimmermann LJ, Müller R, Gessler P, Nelle M (2008) Pain relief in ventilated preterms during endotracheal suctioning: a randomized controlled trial. Swiss Med Wkly 138:635–645
Cignacco EL, Sellam G, Stoffel L, Gerull R, Nelle M, Anand KJ, Engberg S (2012) Oral sucrose and „facilitated tucking“ for repeated pain relief in preterms: a randomized controlled trial. Pediatrics 129:299–308
Curtis SJ, Jou H, Ali S, Vandermeer B, Klassen T (2007) A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venipuncture in a pediatric emergency department. BMC Pediatr 7:27
Debillon T, Zupan V, Ravault N, Magny JF, Dehan M (2001) Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch Dis Child Fetal Neonatal Ed 85:F36–F41
van Dijk M, Tibboel D (2012) Update on pain assessment in sick neonates and infants. Pediatr Clin N Am 59:1167–1181
van Dijk M, Roofthooft DWE, Anand KJS, Guldemond F, de Graaf J, Simons S et al (2009) Taking up the challenge of measuring prolonged pain in (premature) neonates: the COMFORTneo scale seems promising. Clin J Pain 25(7):607–616
Edwards MJ (2005) Opioids and benzodiazepines appear paradoxically to delay inevitable death after ventilator withdrawal. J Palliat Care 21:299–302
Feltman DM, Du H, Leuthner SR (2012) Survey of neonatologists’ attitudes toward limiting life-sustaining treatments in the neonatal intensive care unit. J Perinatol 32:886–892
Fernandes A, Campbell-Yeo M, Johnston CC (2011) Procedural pain management for neonates using nonpharmacological strategies: part 1: sensorial interventions. Adv Neonatal Care 11:235–241
Flaskerud JH, Winslow BJ (1998) Conceptualizing vulnerable populations health-related research. Nurs Res 47:69–78
Ganzini L, Goy ER, Miller LL, Harvath TA, Jackson A, Delorit MA (2003) Nurses’ experiences with hospice patients who refuse food and fluids to hasten death. N Engl J Med 349:359–365
Garten L, Bührer C (2012) Reversal of morphine-induced urinary retention after methylnaltrexone. Arch Dis Child Fetal Neonatal Ed 97:F151–F153
Garten L, Daehmlow S, Reindl T, Wendt A, Münch A, Bührer C (2011a) End-of-life opioid administration on neonatal and pediatric intensive care units: nurses’ attitudes and practice. Eur J Pain 15:958–965
Garten L, Degenhardt P, Bührer C (2011b) Resolution of opioid-induced postoperative ileus in a newborn infant after methylnaltrexone. J Pediatr Surg 46:e13–e15
Garten L, Demirakca S, Harth I, Huth R, Kumpf M, Schindler M, Weißhaar GF, Roth B, Trieschmann U (2015) Analgesie, Sedierung und Delirmanagement bei Kindern und Neugeborenen – Die aktuelle Version der DAS-Leitlinie 2015. Anasthesiol Intensivmed Notfallmed Schmerzther 50(11–12):712–722
de Graeff A, Dean M (2007) Palliative sedation therapy in the last weeks of life: a literature review and recommendations for standards. J Palliat Med 10:67–85
Harlos MS, Stenekes S, Lambert D, Hohl C, Chochinov HM (2013) Intranasal fentanyl in the palliative care of newborns and infants. J Pain Symptom Manag 46:265–274
Härmä A, Aikio O, Hallman M, Saarela T (2016) Intravenous paracetamol decreases requirements of morphine in very preterm infants. J Pediatr 168:36–40
Hellmann J, Williams C, Ives-Baien L, Shah PS (2013) Withdrawal of artificial nutrition and hydration in the Neonatal intensive care unit: parental perspectives. Arch Dis Child Fetal Neonatal Ed 98:F21–F25
Hummel P, Puchalski M, Creech SD, Weiss MG (2008) Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain. J Perinatol 28:55–60
Hummel P, Lawlor-Klean P, Weiss MG (2010) Validity and reliability of the N-PASS assessment tool with acute pain. J Perinatol 30:474–478
Hünseler C, Balling G, Röhlig C, Blickheuser R, Trieschmann U, Lieser U et al (2014) Continuous infusion of clonidine in ventilated newborns and infants: a randomized controlled trial. Pediatr Crit Care Med 15(6):511–522
Johnston CC, Stevens BJ (1996) Experience in a neonatal intensive care unit affects pain response. Pediatrics 98:925–930
Kompanje EJ, van der Hoven B, Bakker J (2008) Anticipation of distress after discontinuation of mechanical ventilation in the ICU at the end of life. Intensive Care Med 34:1593–1599
de Leeuw TG, Dirckx M, Gonzalez Candel A, Scoones GP, Huygen FJPM, de Wildt SN (2017) The use of dipyrone (metamizol) as an analgesic in children: What is the evidence? A review Paediatr Anaesth 27(12):1193–1201
Liu M, Wittbrodt E (2002) Low-dose oral naloxone reverses opioid-induced constipation and analgesia. J Pain Symptom Manag 23:48–53
Miraie ED (1988) Withholding nutrition from serious ill newborn infants: a Partners Perspektive. J Pediatr 113:262–265
Mitchell A, Smith HS (2010) Applying partially occluded fentanyl transdermal patches to manage pain in pediatric patients. J Opioid Manag 6:290–294
Moffett S, Wann TI, Carberry KE, Mott AR (2006) Safety of ketorolac in neonates and infants after cardiac surgery. Pediatr Anesth 16:424–428
Mudd S (2011) Intranasal fentanyl for pain management in children: a systematic review of the literature. J Pediatr Health Care 25:316–322
O’Mara K, Gal P, Wimmer J, Ransom JL, Carlos RQ, Dimaguila MA, Davanzo CC, Smith M (2012) Dexmedetomidine versus standard therapy with fentanyl for sedation in mechanically ventilated premature neonates. J Pediatr Pharmacol Ther 17:252–261
Ohlsson A, Shah PS (2015) Paracetamol (acetaminophen) for patent ductus arteriosus in preterm or low-birth-weight infants. Cochrane Database Syst Rev 11(3):CD010061
Ohlsson A, Walia R, Shah SS (2018) Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants. Cochrane Database Syst Rev 9:CD003481
Papacci P, De Francisci G, Iacobucci T, Giannantonio C, De Carolis MP, Zecca E, Romagnoli C (2004) Use of intravenous ketorolac in the neonate and premature babies. Paediatr Anaesth 14:487–492
Pasman HR, Onwuteaka-Philipsen BD, Kriegsman DM, Ooms ME, Ribbe MW, van der Wal G (2005) Discomfort in nursing home patients with severe dementia in whom artificial nutrition and hydration is forgone. Arch Intern Med 165:1729–1735
Pillai Riddell RR, Racine NM, Turcotte K, Uman LS, Horton RE, Din Osmun L, Ahola Kohut S, Hillgrove Stuart J, Stevens B, Gerwitz-Stern A (2015) Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev 10:CD006275
Róka A, Melinda KT, Vásárhelyi B, Machay T, Azzopardi D, Szabó M (2008) Elevated morphine concentrations in neonates treated with morphine and prolonged hypothermia for hypoxic ischemic encephalopathy. Pediatrics 121:e844–e849
Sandkühler J, Benrath J (2015) Das nozizeptive System von Früh- und Neugeborenen. In: Zernikow B (Hrsg) Schmerztherapie bei Kindern, Jugendlichen und jungen Erwachsenen. Springer, Berlin/Heidelberg/New York
Stevens B, McGrath P, Gibbins S, Beyene J, Breau L, Camfield C, Finley A, Franck L, Howlett A, Johnston C, McKeever P, O’Brien K, Ohlsson A, Yamada J (2003) Procedural pain in newborns at risk for neurologic impairment. Pain 105:27–35
Stevens B, Yamada J, Lee GY, Ohlsson A (2016) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 1:CD001069
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Garten, L. (2019). Schmerz- und Symptomkontrolle. In: Garten, L., von der Hude, K. (eds) Palliativversorgung und Trauerbegleitung in der Neonatologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-58945-8_4
Download citation
DOI: https://doi.org/10.1007/978-3-662-58945-8_4
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-662-58944-1
Online ISBN: 978-3-662-58945-8
eBook Packages: Medicine (German Language)