The Campaign Against the Docking of Dogs' Tails

In the Sunday Times - NEONATES  27/2/3005 :-

'A study of 200 preterm babies found they were subjected to a total of 20,000 procedures in the first 14 days of life in intensive care.  Add to this inappropriate stimulation and continuous bright light and you have a model for chronic stress.  In most neonatal units preterm babies lie on their backs on mats, naked apart from a nappy.  Grossly immature reflexes mean that their arms and legs tend to wave or flap which is distressing for the baby, whose every instinct is to curl and ball, seeking safe boundaries to contain him.  Now the impact of this kind of stark environment on the growth and development of premature babies is being challenged.  New evidence seems to suggest that a far gentler form of care is likely to result in babies with fewer long-term disabilities.  Some even argue that failure to minimise the impact of pain and stress on these children constitues a breach of their human rights.  .....Twenty years ago the notion of stress in preterm infants hadn't even been considered.  Tbe pioneering work of of Al Aynsley-Green and Sunny Anand during the 1980s overturned the widely held belief that babies couldn't feel pain, or if they could, their experience if it somehow wasn't like ours.  Before this time preterm babies regularly underwent surgery without anaesthesia.  "Many of them died from shock" says Anand, now Professor of Paediatrics and Anaesthesiology at Arkansas Children's Hospital.  "Others were returned to the ward, grey and shut-down, and it would take nurses to stabilise them.  Their hormonal stress responses were five times what we expected.  We proved that prolonged elevation of cortisol was incredibly damaging."  After 48 hours in intensive care, preterm babies have learnt what noxious stimuli are.  When a foot is grabbed for a routine heel prick, they desaturate (oxygen levels go down) and they become unstable, because they anticipate pain......A host of published studies shows that pain and stress affect brain development and yet the message still isn't getting across...."The collective ego of the medical profession will have to face the fact that their clinical approach is seriously limited" says Anand.  "Do we have a choice? No we don't.  It is our duty to practise what is best for the baby."........Where scientists agree that the preterm brain is very plastic; it develops more between 23 ane 40 weeks' gestation than at any other time throughout life, so sensory experience at this state is incredibly important....."Research has shown that a mother rocking her baby in her arms has a therapeutic effect on pain management and growth but rocking a baby mechanically doesn't have the same effect.  Why? Because the baby however tiny craves a relationship", explains Anand

Otwin Linderkamp, Prof of Neonatology at the University of Heidleberg Medical School, practises the minimisation of intensive-care medicine.  "Very early on I noticed how tiny babies always tried to get themselves into a corner in an incubator.  The nurses took them back to the middle then the babies tried again.  It was very sad this desperate search for boundaries.  When I first came to Heidelberg I found a typical intensive care unit babies lying on mats under bright lights, and because they were agitated and moved around they were given sedation."

Sunny Anand claims to have the first objective proof that there is conscious processing of painful stimuli by even the most premature babies, found by looking at responses within the cortex.  His paper has been submitted to the New England Journal of Medicine.  As the study contains unpublished information, he is reluctant to reveal the results, but he says this is the definitive study that the developmental care lobby has been waiting for.  "We can now show that repeated painful stimuli produce an increase in the number of cells that die during brain development and also alter a child's cognitive processing for life.  I'm not saying pain is the only problem but we think it is responsible for the long term cognitive outcomes of premature children."


The Campaign Against the Docking of Dogs' Tails


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