Parents in Neonatal Pain Management—An International Survey of Parent-Delivered Interventions and Parental Pain Assessment

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

The topic is current and relevant to the field, primarily because the family-centered principle is being implemented in more and more NICUs. However, there is limited information about the utilization of parent-delivered pain-reducing interventions or the inclusion of recommendations for such interventions in the guidelines/protocols. The study may be considered representative because it includes participants from 44 different countries.

In the introduction, the authors highlighted the importance of studying parent-delivered pain-reducing interventions in current scientific literature. This study aimed to explore the role of parents in neonatal pain management and investigate their involvement and the promotion of parent-delivered interventions in NICUs worldwide.

 

The Material and Methods section is structured and clear. The authors describe the construction and distribution of the web survey.

 

The statistical analysis utilized Latent Class Analysis to identify qualitatively different subgroups within populations, explained by patterns of classes across survey questions. The steps of the analysis, especially the Bayesian information criterion (BIC), can be detailed.

The conclusions are consistent with the results, and the references are appropriate.

The tables and figures are clear.

 

Overall, the study revealed that parent-delivered interventions are utilized more in clinical practice than local guidelines dictate, highlighting the need to prioritize their implementation in clinical settings.

In my opinion, the paper can be published in its current version.

 

Author Response

Comment 1: The topic is current and relevant to the field, primarily because the family-centered principle is being implemented in more and more NICUs. However, there is limited information about the utilization of parent-delivered pain-reducing interventions or the inclusion of recommendations for such interventions in the guidelines/protocols. The study may be considered representative because it includes participants from 44 different countries.

In the introduction, the authors highlighted the importance of studying parent-delivered pain-reducing interventions in current scientific literature. This study aimed to explore the role of parents in neonatal pain management and investigate their involvement and the promotion of parent-delivered interventions in NICUs worldwide.

The Material and Methods section is structured and clear. The authors describe the construction and distribution of the web survey.

The statistical analysis utilized Latent Class Analysis to identify qualitatively different subgroups within populations, explained by patterns of classes across survey questions. The steps of the analysis, especially the Bayesian information criterion (BIC), can be detailed.

The conclusions are consistent with the results, and the references are appropriate.

The tables and figures are clear.

Overall, the study revealed that parent-delivered interventions are utilized more in clinical practice than local guidelines dictate, highlighting the need to prioritize their implementation in clinical settings.

In my opinion, the paper can be published in its current version.

Response 1: Thank you for your positive view of the manuscript.

Reviewer 2 Report

Comments and Suggestions for Authors

This paper reports an international survey regarding parent-delivered interventions for neonatal pain delivered from the response of 303 major neonatal intensive care units (NICUs) from 44 countries in high-income countries from Europe and Central Asia. Neonatal pain management is important yet easily neglected in clinical practice. This survey investigates an interesting topic that to what extent parent-delivered interventions are used in clinical practice, where parent-delivered interventions where it has been proven to be an effective means of neonatal pain management in clinical basic research. We have some concerns:

 

1. Since only one person per NICU provided a response, there is indeed high risk of bias towards the results of the survey. Although the authors stated this point in the limitation, we recommend that the conclusions of this manuscript be used with caution in the validity of clinical guidelines. Meanwhile, it is necessary to introduce more relevant literature to support the results, or to provide the model relationship and significance level of level of parental participation in pain management and associated factors based on appropriate statistical methods.

 

2. Unlike ordinary neonatal wards, the management of NICU is more stringent. Besides, the density of beds in neonatal wards varies from country to country. These factors could limit parents' participation in neonatal pain management. These issues should be mentioned in the discussion, especially when this study only examined higher-income countries.

Author Response

Comment 1. Since only one person per NICU provided a response, there is indeed high risk of bias towards the results of the survey. Although the authors stated this point in the limitation, we recommend that the conclusions of this manuscript be used with caution in the validity of clinical guidelines. Meanwhile, it is necessary to introduce more relevant literature to support the results, or to provide the model relationship and significance level of level of parental participation in pain management and associated factors based on appropriate statistical methods.

Response 1: Thank you for this comment. We agree that the method we used for data collection with one respondent per unit has a risk of bias towards positive answers. We have added to the discussion about this, and modified the conclusion to be more cautious.

2. Unlike ordinary neonatal wards, the management of NICU is more stringent. Besides, the density of beds in neonatal wards varies from country to country. These factors could limit parents' participation in neonatal pain management. These issues should be mentioned in the discussion, especially when this study only examined higher-income countries.

Response 2: This is an important issue, and we have expanded the discussion about such barriers.

Round 2

Reviewer 2 Report

Comments and Suggestions for Authors

The authors have diligently addressed our concerns raised in the revised manuscript.