Skip to main content
SpringerLink
Log in

Schmerz- und Symptomkontrolle

  • Chapter
  • First Online:
Palliativversorgung und Trauerbegleitung in der Neonatologie

  • 2518 Accesses

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 44.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 59.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

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

    Article  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  PubMed Central  Google Scholar 

  • 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • van Dijk M, Tibboel D (2012) Update on pain assessment in sick neonates and infants. Pediatr Clin N Am 59:1167–1181

    Article  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Edwards MJ (2005) Opioids and benzodiazepines appear paradoxically to delay inevitable death after ventilator withdrawal. J Palliat Care 21:299–302

    Article  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Flaskerud JH, Winslow BJ (1998) Conceptualizing vulnerable populations health-related research. Nurs Res 47:69–78

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Garten L, Bührer C (2012) Reversal of morphine-induced urinary retention after methylnaltrexone. Arch Dis Child Fetal Neonatal Ed 97:F151–F153

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  CAS  Google Scholar 

  • Härmä A, Aikio O, Hallman M, Saarela T (2016) Intravenous paracetamol decreases requirements of morphine in very preterm infants. J Pediatr 168:36–40

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Johnston CC, Stevens BJ (1996) Experience in a neonatal intensive care unit affects pain response. Pediatrics 98:925–930

    CAS  PubMed  Google Scholar 

  • 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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Liu M, Wittbrodt E (2002) Low-dose oral naloxone reverses opioid-induced constipation and analgesia. J Pain Symptom Manag 23:48–53

    Article  Google Scholar 

  • Miraie ED (1988) Withholding nutrition from serious ill newborn infants: a Partners Perspektive. J Pediatr 113:262–265

    Article  CAS  PubMed  Google Scholar 

  • Mitchell A, Smith HS (2010) Applying partially occluded fentanyl transdermal patches to manage pain in pediatric patients. J Opioid Manag 6:290–294

    Article  PubMed  Google Scholar 

  • Moffett S, Wann TI, Carberry KE, Mott AR (2006) Safety of ketorolac in neonates and infants after cardiac surgery. Pediatr Anesth 16:424–428

    Article  Google Scholar 

  • Mudd S (2011) Intranasal fentanyl for pain management in children: a systematic review of the literature. J Pediatr Health Care 25:316–322

    Article  PubMed  Google Scholar 

  • 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

    PubMed  PubMed Central  Google Scholar 

  • 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

    Google Scholar 

  • 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

    PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • 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

    Google Scholar 

  • 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

    Article  PubMed  Google Scholar 

  • Stevens B, Yamada J, Lee GY, Ohlsson A (2016) Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 1:CD001069

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Neonatologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland

    Lars Garten

Authors
  1. Lars Garten
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lars Garten .

Editor information

Editors and Affiliations

  1. Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Berlin, Germany

    Lars Garten

  2. Klinik für Neonatologie, Charité Universitätsmedizin Berlin, Berlin, Germany

    Kerstin von der Hude

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer-Verlag Berlin Heidelberg

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

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)

Publish with us

Policies and ethics

Search

Navigation