I think the most vulnerable set of patients in our health system are our sick preterm babies.
Several years ago, I spent some time in a Neonatal Intensive Care Unit (NICU) during a sabbatical in England. I was amazed by the complexity of the care that is needed and provided to these tiny patients. Those who care for sick neonates in the NICU are my heroes.
Research is the only way to improve care in the NICU. It is only with research that we can develop and carefully evaluate new ways to diagnose and treat babies that spend time in the NICU. In the last 20 years there have been significant advances in survival of neonates. Babies who would have died 20 years ago such as those delivered as young as 25 weeks gestation, and babies weighing 500 grams (a smidge over a pound), now routinely survive.
Unfortunately, these babies require many painful procedures to monitor how they are doing and also for treatment. And unfortunately, medications don’t work all that well for procedural pain in neonates.
We have a Researcher Super Hero in the NICU at the IWK Health Centre. Dr. Marsha Campbell-Yeo is a Neonatal Nurse Practitioner who received her PhD in Nursing from McGill University in 2012. She has focused her attention on how to help parents contribute to the care of their babies. Much of her work has been on non pharmacological ways to reduce pain and distress in neonates but she also leads a large research project on medications to help with neonate breastfeeding for moms who have not been able to produce enough milk. Marsha recently won a REAL Award for her work. She was the only Canadian honoured. The tag line for REAL Awards, “Some people entertain us, some people enlighten us, some people save our lives”. Marsha has enlightened us through her research and saved lives.
Marsha is a clinician scientist at the IWK and an Assistant Professor of Nursing at Dalhousie.
Marsha is one of several pediatric pain researchers in Halifax that makes the IWK a world leader in this area. Please note, I have done research on pediatric pain and Marsha worked with me as a post-doc for a few months.
Her PhD was on the effects of putting twins in the same incubator to see if this would reduce their stress response to the many needle procedures that neonates experience. The thought behind this process, called co-bedding, was that it may be helpful for the twins who might be face-to-face, back-to-back or in the spooning position and could provide comfort because of the human contact, the familiar smell or just the company. She was the first to examine the effect of co-bedding on the pain response of preterm twins having routine medically indicated procedures in the NICU. In a randomized trial, she found that co-bedded preterm twins recovered more quickly and had a more stable stress response than twins cared for in separate incubators. She also found co-bedding had no adverse effects on either the twin who had the painful procedure or the other twin.
Marsha has also helped make major discoveries in the use of skin-to-skin contact sometimes called Kangaroo Care for pain. Kangaroo Care began in Bogota, Columbia because there was a shortage of incubators in the NICU and the neonates had to be kept warm and safe. The babies were kept skin-to- skin on the chest of their mother. Amazingly, these babies did as well, or better, than babies in the regular incubators. Kangaroo Care is now used in many NICU’s across the world. Dr. Campbell-Yeo and her colleagues (including Celeste Johnston who was her PhD supervisor and is now Professor Emeritus at McGill and a consultant scientist at the IWK) thought it might also help with pain from needle procedures. They tried it and later conducted several randomized controlled trials to see if it really works in very preterm infants. The infant is placed skin-to-skin and settled before a painful procedure. This comforting process significantly diminishes pain in the neonate. She and her colleagues also found that other loved ones such as fathers or another female could help lower pain using skin-to-skin contact too. To assist others in gaining this information, Dr. Campbell-Yeo and her colleagues recently published a systematic review of all of the studies (19) related skin-to-skin contact and pain, with findings all in favour of the pain relieving effects of skin contact. Marsha is also examining the sustained effects of mothers contact provided during pain and impact on development.
The third area she has investigated is the use of small amounts of sugar-water to reduce pain from needle procedures. A small amount of sugar-water given by mouth just before the procedure is an effective analgesic in babies. Marsha is interested in exploring the relationship between infants receiving sugar water, Kangaroo Care, or both, and how infants respond to painful procedures while in the NICU. Her hope is to identify the best methods for reducing pain in preterm infants in order to help infants have the best possible outcomes in life.
Marsha also volunteers in Africa and India teaching other professionals about neonatal care. We are lucky to have her here in Halifax.
Dr. Marsha Campbell-Yeo
~ Dr. Patrick McGrath