This study examined the rates and risks of premature neonates >2500grams developing intraoperative non-euglycemia events (IONEE). A retrospective chart review of 26 premature neonates >2500 grams who underwent surgical procedures between January 1 and December 31, 2009 was conducted. Statistical analysis was done using Chi square and t-tests. Ten of the 26 subjects (38%) experienced an IONEE. Hyperglycemia was the primary IONEE that was noted in the neonates. (Mean: 143.19; sd: 56.041) Length of surgery was significantly longer in those premature neonates with IONEE than those with euglycemia (71.7 0± 27.03 vs. 45.62 ± 17.98 minutes). All IONEE subjects received general anesthesia (n=10) while none of those with only intravenous anesthesia had an IONEE (X2 (1) = 4.875, p=.027). Subjects with IONEE had a higher mean preoperative glucose level (127.11 gm/dL ± 31.66) than those who did not experienced IONEE (86.36 gm/dL ± 29.39; t(21) = 3.151, p=.005). A higher proportion of subjects who developed IONEE had the capillary heel (60%) as opposed to an arterial (40%) site for blood collection (X2 (1) = 6.518, p =.001). Also, subjects free of preoperative pulmonary complications were more prone to develop IONEE (X2 (1)= 8.60, p = .003). The presence of IONEE was associated with development of metabolic acidosis (X2 (1)= 5.426, p=.020) and lower postoperative pH values (7.19 ± 0.20 vs. 7.35 ± 0.11). Anesthesia providers need to establish intraoperative guidelines for the monitoring and treatment of IONEE to protect these premature neonates from having complications such as developmental delay.

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Introduction. L’exposition à la douleur répétée pendant la période néonatale a des effets nocifs sur le développement neurologique des nouveau-nés prématurés et peut contribuer à une douleur prolongée. Une taxonomie précise de la douleur néonatale est absente due à l’existence d’une terminologie ambigüe qui persiste en néonatologie. Par conséquent, l’évaluation et la gestion de ce type de douleur dans le milieu clinique sont sous-optimales. Objectif. Établir la portée, l'étendue et la nature des écrits scientifiques liées à la douleur prolongée des nouveau-nés prématurés hospitalisés dans l’unité de soins intensifs néonatals (USIN), par le biais d’une revue de la portée. Méthodologie. La revue de la portée suit les lignes directrices du Joanna Briggs Institute (JBI). Une stratégie de recherche a été effectuée dans les bases de données CINAHL, PubMed, Medline, Web of Science, Google Scholar, GeryLit.org et Grey Source Index. Résultats. La revue de la portée a identifié 78 articles pertinents qui abordaient des définitions (n=25), des indicateurs (n=37), des contextes de soins (n=47), des outils d’évaluation (n=49), des conséquences (n=29) et des interventions (n=21) pour soulager la douleur prolongée néonatale. La revue soutien que les contextes de soins des nouveau-nés prématurés devraient toujours être considérés indépendamment de la présence ou non d’indicateurs de la douleur prolongée afin de guider l’évaluation et le soulagement de la douleur prolongée. Conclusion. Ce mémoire a recensé les éléments essentiels de la douleur prolongée et a permis d’émettre des recommandations pour la pratique, la formation, la gestion et le recherche infirmière, guidé par le cadre théorique de Huth et Moore (1998). / Introduction. Exposure to repetitive pain during the neonatal period has been shown to have important long-term effects on the neurodevelopment of the premature neonate and can contribute to experienced prolonged pain. Since a uniform taxonomy of neonatal prolonged pain is still lacking to this day in neonatology, prolonged pain management remains suboptimal in neonatal intensive care units (NICU). Aim. This master’s thesis aims to determine the scope, extent, and nature of the available literature on prolonged pain in premature neonates hospitalized in the NICU by way of a scoping review. Methodology. An electronic search was conducted in the databases of CINAHL, PubMed, Medline, Web of Science, GeryLit.org and Grey Source Index. This scoping review follows the JBI guidelines for scoping reviews. Results. A total of 78 articles were included in the scoping review which identified key elements of neonatal prolonged pain such as definitions (n=25), indicators (n=37), contexts (n=47), pain scales (n=49), consequences (n=29) and possible interventions (n=21) for prolonged pain management. The contexts of care were identified as being more indicative of prolonged pain and should guide pain evaluation and management. Conclusion. This master’s thesis contributes to the foundation of growing knowledge in neonatal prolonged pain and sheds light on the ambiguity that currently exists on this topic in the scientific literature and informs nursing prolonged pain management in NICU with the ultimate goal of improving developmental outcomes of premature neonates.