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Decrease Pain in Neonates
Topic: In neonates needing ostomy pouching, how can pain caused by removal of adhesives be decreased?
Purpose: The purpose of this neonatal pilot study was to measure outcomes related to neonatal pain and ostomy appliance effectiveness when traditional pouching was compared to use of a silicone product as a base layer with a traditional pouch.
Methods: This IRB-approved comparative descriptive study was conducted in a Level III regional Midwestern Neonatal ICU. A convenience sample was recruited of 10 neonates with an ostomy requiring pouching. Data collection occurred during wafer changes and included demographics, pain levels (NPASS scores), wafer duration time, wafer change reason, wafer leakage & skin irritation scores, stool output volumes, and peristomal skin interventions. Since each neonate had both traditional and silicone+traditional wafers applied, outcome comparisons could be made. Study participation concluded once 6 silicone+traditional wafer changes were completed. Descriptive statistics were calculated on all variables. N-PASS pain scores and wafer duration were compared using independent t-test; leakage and skin irritation scores compared using Mann-Whitney u; neonate demographic variables and stool output scores were tested as possible covariates.
Results: Observations of 153 wafer changes were made. In comparison to traditional products, use of a silicone-based wound product significantly decreased the pain of the neonate during ostomy wafer changes (t(140)= 2.146,p =0.034). Wafer duration minutes were not significantly different (t (151) = - 0.691, p = 0.491); neither were leakage scores (p = 0.857) or skin irritation scores (p = 0.890). There was a significant correlation between Wafer Duration and Stool Output (r = 0.441, p < 0.001), but not between Stool Output and Skin Irritation (r = - 0.126, p = 0.192).
Conclusion: Silicone use significantly decreased neonatal pain during ostomy wafer changes.