Aonde o pediatra fixa o olhar quando diz que um recém-nascido tem dor durante a punção capilar?
Data
2022-09-08
Autores
Silva, Erica Souza [UNIFESP]
Orientadores
Barros, Marina Carvalho de Moraes [UNIFESP]
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A avaliação da dor do recém-nascido (RN) à beira do leito é fundamental para a decisão quanto ao seu tratamento, evitando as suas repercussões em curto e longo prazo. Não se conhece o foco de atenção visual do pediatra nessa avaliação. Objetivo: Avaliar o foco do olhar do pediatra em RN antes e após uma punção capilar de calcanhar. Método: Estudo observacional, analítico e transversal, com pediatras atuantes em unidade neonatal que avaliaram a dor de RN antes e após a punção do calcanhar, sendo o olhar rastreado por meio dos óculos de rastreamento. Os pediatras, cegos em relação ao momento do procedimento, falavam a palavra "punção" quando percebiam uma resposta de dor do RN. Ao término, os pediatras conferiram um escore relativo à sua percepção da intensidade da dor (0=ausência de dor; 10=dor máxima). Os desfechos do rastreamento visual - número de fixações e o tempo das fixações visuais foram avaliados em três áreas de interesse (AI) (face superior, face inferior e membros superiores), em dois períodos de 10 segundos, um após o início do experimento (PRÉ) e outro após a punção (PÓS). O percentual de pediatras que fixou o olhar nas AI foi comparado entre os períodos pelo teste do qui-quadrado. Os desfechos do rastreamento foram comparados entre os períodos PRÉ e PÓS para as três AI pelo Wilcoxon-Rank test. Aplicou-se o modelo linear geral para medidas repetidas (GLM) para os dois desfechos do rastreamento visual, considerando dois fatores, os períodos e as AI face superior e face inferior. Os desfechos do rastreamento visual foram comparados de acordo com a percepção de dor pelo pediatra ausente/leve (escore: 0-5) e moderada/intensa (escore: 6-10) pelo teste de Mann-Whitney. Resultados: Foram estudados 24 pediatras com 31 anos, 92% do sexo feminino, tendo concluído a residência médica em pediatria há 3 anos. Os RN tinham uma idade gestacional de 39,0±1,5 semanas e peso ao nascer de 3258±666 gramas. O escore mediano aferido pelos pediatras para a dor do RN foi sete (P25-75: 5-8). Maior número de pediatras fixou o olhar no período PÓS na face inferior, comparado ao período PRÉ (92% vs. 63%; p=0,036) sem diferença para as outras AI. Também foi maior número de fixações visuais na face inferior no período PÓS em relação ao PRÉ (5,00 vs. 2,00; p=0,018), sem diferença para as demais AI. Não se observou diferença no tempo das fixações visuais entre os dois períodos para nenhuma das três AI. No GLM, houve diferença entre o número de fixações visuais na face inferior entre os
períodos PRÉ e PÓS (2,96±1,08; p=0,012) e entre o número de fixações no período PRÉ entre a face superior e a face inferior a (3,67±1,70; p=0,041). Para o desfecho tempo das fixações visuais, não se observou diferença nas comparações entre os dois períodos ou entre as AI. Dor ausente/leve foi atribuída por 37% dos pediatras e moderada/intensa por 63%. Não houve diferença no número e no tempo das fixações visuais de acordo com a intensidade da dor referida pelos pediatras. Conclusões: Na avaliação da dor de RN à beira do leito, em uma punção de calcanhar, os pediatras focam a sua atenção visual na face superior e inferior, e menos nos membros superiores. Após a punção, os pediatras realizam maior número de fixações visuais na face inferior comparado ao período pré-punção. O conhecimento do processo de avaliação da dor de RN por pediatras pode contribuir para aprimorar o treinamento de profissionais de saúde, resultando em um melhor diagnóstico e tratamento da dor neonatal.
Introduction: The assessment of newborn (NB) pain at the bedside is essential for the decision regarding its treatment, avoiding its repercussions in the short and long term. The pediatrician's focus of visual attention in this assessment is not known. Objective: To evaluate the pediatrician's gaze on newborns before and after a heel puncture. Method: Observational, analytical and cross-sectional study, with pediatricians working in a neonatal unit who evaluated NB pain before and after a heel puncture, with the gaze being tracked through tracking glasses. Pediatricians, blind to the time of the procedure, spoke the word "puncture" when they perceived a pain response from the NB. At the end, pediatricians gave a score related to their perception of pain intensity (0=no pain; 10=maximum pain). Visual tracking outcomes - number of fixations and time of visual fixations were evaluated in three areas of interest (AI) (upper face, lower face and upper limbs), in two 10-second periods, one after the start of the experiment (PRE) and another after the puncture (POST). The percentage of pediatricians who fixed their gaze on the AI was compared between periods using the chi-square test. The visual tracking outcomes were compared between the PRE and POST periods for the three AI using the Wilcoxon-Rank test. The general linear model for repeated measures (GLM) was applied to the two visual tracking outcomes, considering two factors, the periods and the AI, upper face and lower face. Visual tracking outcomes were compared according to the pediatrician's perception of pain as absent/mild (score: 0-5) and moderate/severe (score: 6-10) by the Mann-Whitney test. Results: We studied 24 pediatricians aged 31 years, 92% female, having completed their medical residency in pediatrics 3 years ago. The newborns had a gestational age of 39.0±1.5 weeks and a birth weight of 3258±666 grams. The median score given by pediatricians for NB pain was seven (P25-75: 5-8). A greater number of pediatricians fixed their gaze in the POST period on the lower face, compared to the PRE period (92% vs. 63%; p=0.036) with no difference for the other AIs. There was also a greater number of visual fixations on the lower face in the POST period compared to PRE period (5.00 vs. 2.00; p=0.018), with no difference for the other AI. There was no difference in the time of visual fixations between the two periods for any of the three AI. In the GLM, there was a difference between the number of visual fixations on the lower face between the PRE and POST periods (2.96±1.08; p=0.012) and between the number of fixations in the PRE period between the upper face and the lower face a (3.67±1.70; p=0.041). For the time of visual fixations, no difference was observed in the comparisons between the two periods or between the AI. Absent/mild pain was attributed by 37% of pediatricians and moderate/severe by 63%. There was no difference in the number and time of visual fixations according to the intensity of pain reported by pediatricians. Conclusions: In assessing NB pain at the bedside, in a heel puncture, pediatricians focus their visual attention on the upper and lower face, and less on the upper limbs. After the puncture, pediatricians perform a greater number of visual fixations on the lower face compared to the pre-puncture period. Knowledge of the process of evaluating NB pain by pediatricians can contribute to improve the training of health professionals, resulting in a better diagnosis and treatment of neonatal pain.
Introduction: The assessment of newborn (NB) pain at the bedside is essential for the decision regarding its treatment, avoiding its repercussions in the short and long term. The pediatrician's focus of visual attention in this assessment is not known. Objective: To evaluate the pediatrician's gaze on newborns before and after a heel puncture. Method: Observational, analytical and cross-sectional study, with pediatricians working in a neonatal unit who evaluated NB pain before and after a heel puncture, with the gaze being tracked through tracking glasses. Pediatricians, blind to the time of the procedure, spoke the word "puncture" when they perceived a pain response from the NB. At the end, pediatricians gave a score related to their perception of pain intensity (0=no pain; 10=maximum pain). Visual tracking outcomes - number of fixations and time of visual fixations were evaluated in three areas of interest (AI) (upper face, lower face and upper limbs), in two 10-second periods, one after the start of the experiment (PRE) and another after the puncture (POST). The percentage of pediatricians who fixed their gaze on the AI was compared between periods using the chi-square test. The visual tracking outcomes were compared between the PRE and POST periods for the three AI using the Wilcoxon-Rank test. The general linear model for repeated measures (GLM) was applied to the two visual tracking outcomes, considering two factors, the periods and the AI, upper face and lower face. Visual tracking outcomes were compared according to the pediatrician's perception of pain as absent/mild (score: 0-5) and moderate/severe (score: 6-10) by the Mann-Whitney test. Results: We studied 24 pediatricians aged 31 years, 92% female, having completed their medical residency in pediatrics 3 years ago. The newborns had a gestational age of 39.0±1.5 weeks and a birth weight of 3258±666 grams. The median score given by pediatricians for NB pain was seven (P25-75: 5-8). A greater number of pediatricians fixed their gaze in the POST period on the lower face, compared to the PRE period (92% vs. 63%; p=0.036) with no difference for the other AIs. There was also a greater number of visual fixations on the lower face in the POST period compared to PRE period (5.00 vs. 2.00; p=0.018), with no difference for the other AI. There was no difference in the time of visual fixations between the two periods for any of the three AI. In the GLM, there was a difference between the number of visual fixations on the lower face between the PRE and POST periods (2.96±1.08; p=0.012) and between the number of fixations in the PRE period between the upper face and the lower face a (3.67±1.70; p=0.041). For the time of visual fixations, no difference was observed in the comparisons between the two periods or between the AI. Absent/mild pain was attributed by 37% of pediatricians and moderate/severe by 63%. There was no difference in the number and time of visual fixations according to the intensity of pain reported by pediatricians. Conclusions: In assessing NB pain at the bedside, in a heel puncture, pediatricians focus their visual attention on the upper and lower face, and less on the upper limbs. After the puncture, pediatricians perform a greater number of visual fixations on the lower face compared to the pre-puncture period. Knowledge of the process of evaluating NB pain by pediatricians can contribute to improve the training of health professionals, resulting in a better diagnosis and treatment of neonatal pain.