{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T15:19:27Z","timestamp":1790695167999,"version":"4.1.0"},"reference-count":32,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T00:00:00Z","timestamp":1675987200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: Ultrasonography is widely used in neonatological practice and studies investigating the hemodynamic effects of various treatment protocols or clinical situations. On the other hand, pain causes changes in the cardiovascular system; so, in the case of ultrasonography leading to pain in neonates, it may cause hemodynamic alterations. In this prospective study, we evaluate whether ultrasonographic application causes pain and changes in the hemodynamic system. Methods: Newborns undergoing ultrasonographic examination were enrolled in the study. Vital signs, cerebral and mesenteric tissue oxygenation (StO2) levels, and middle cerebral artery (MCA) Doppler measurements were recorded, and NPASS scores were calculated before and after ultrasonography. Results: We enrolled 39 patients in the study. After ultrasonography, Neonatal Pain, Agitation, and Sedation Scale (NPASS) scores were significantly higher (p &lt; 0.01), and all vital signs (heart rate, respiratory rate, SpO2, diastolic and systolic blood pressure; p = 0.03; p &lt; 0.01, p &lt; 0.01, p &lt; 0.01, p = 0.02, p = 0.03, respectively) were altered. Cerebral (p = 0.008) and mesenteric (p = 0.039) StO2 levels were significantly lower in the whole study group, MCA end-diastolic velocity decreased (p = 0.02), and the resistive index (p = 0.03) increased in patients whose NPASS score was &gt;7 after ultrasonography. Conclusions: This study is the first to show that ultrasonography may cause pain in newborn patients, and alters vital signs and hemodynamic parameters. Therefore, precautions should be taken to protect newborn babies from pain during ultrasound applications, as they are already exposed to many noxious stimuli. Furthermore, pain scores should be considered in studies using ultrasonography and evaluating hemodynamic parameters to increase the reliability of the studies.<\/jats:p>","DOI":"10.3390\/children10020347","type":"journal-article","created":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T02:56:13Z","timestamp":1675997773000},"page":"347","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Ultrasonography Causes Agitation and Pain Leading to Hemodynamic Disturbance in Neonates: A Prospective Observational Study"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1429-3206","authenticated-orcid":false,"given":"Emre","family":"Dincer","sequence":"first","affiliation":[{"name":"Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children\u2019s Research and Training Hospital, Op. Dr. Burhanettin \u00d6ncel Cad No. 10, \u00dcsk\u00fcdar, Istanbul 34668, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3210-4544","authenticated-orcid":false,"given":"Hamza","family":"\u00d6zer","sequence":"additional","affiliation":[{"name":"Department of Radiology, Bolu Abant \u0130zzet Baysal University Medical Faculty, Bolu 14030, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevilay","family":"Top\u00e7uo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children\u2019s Research and Training Hospital, Op. Dr. Burhanettin \u00d6ncel Cad No. 10, \u00dcsk\u00fcdar, Istanbul 34668, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G\u00fcner","family":"Karatekin","sequence":"additional","affiliation":[{"name":"Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children\u2019s Research and Training Hospital, Op. Dr. Burhanettin \u00d6ncel Cad No. 10, \u00dcsk\u00fcdar, Istanbul 34668, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/MOP.0000000000000863","article-title":"Point-of-care ultrasound in the neonatal ICU","volume":"32","author":"Miller","year":"2020","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1097\/MOP.0000000000000887","article-title":"Neonatal functional echocardiography","volume":"32","author":"Tissot","year":"2020","journal-title":"Curr. Opin. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1739","DOI":"10.1007\/s00431-021-04353-z","article-title":"A new intestinal ultrasound integrated approach for the management of neonatal gut injury","volume":"181","author":"Elsayed","year":"2022","journal-title":"Eur. J. Pediatr."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"124","DOI":"10.11152\/mu-3018","article-title":"Advances in the application of Doppler ultrasonography in the newborn","volume":"23","author":"Johnson","year":"2021","journal-title":"Med. Ultrason."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1080\/14767058.2017.1281905","article-title":"Echocardiography may cause significant pain response in preterm infants","volume":"31","author":"Aktas","year":"2018","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"89","DOI":"10.3233\/NPM-210782","article-title":"Evaluation of pain and physiological stress during targeted neonatal echocardiography","volume":"15","author":"Ahsan","year":"2022","journal-title":"J. Neonatal Perinatal. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1007\/s13312-015-0663-5","article-title":"Oral sucrose for pain in neonates during echocardiography: A randomized controlled trial","volume":"52","author":"Potana","year":"2015","journal-title":"Indian Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1001\/jama.300.1.60","article-title":"Epidemiology and treatment of painful procedures in neonates in intensive care units","volume":"300","author":"Carbajal","year":"2008","journal-title":"JAMA"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1177\/1054773817744324","article-title":"Number and Frequency of Routinely Applied Painful Procedures in University Neonatal Intensive Care Unit","volume":"28","author":"Kassab","year":"2019","journal-title":"Clin. Nurs. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.earlhumdev.2017.03.003","article-title":"The impact of cumulative pain\/stress on neurobehavioral development of preterm infants in the NICU","volume":"108","author":"Cong","year":"2017","journal-title":"Early Hum. Dev."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1111\/dmcn.13663","article-title":"Infants born preterm, stress, and neurodevelopment in the neonatal intensive care unit: Might music have an impact?","volume":"60","author":"Anderson","year":"2018","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"101005","DOI":"10.1016\/j.siny.2019.04.005","article-title":"Long-term effects of neonatal pain","volume":"24","author":"Walker","year":"2019","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1374","DOI":"10.1016\/j.pain.2012.02.007","article-title":"Neonatal pain in relation to postnatal growth in infants born very preterm","volume":"153","author":"Vinall","year":"2012","journal-title":"Pain"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1016\/j.clp.2019.08.005","article-title":"Assessment of Pain in the Newborn: An Update","volume":"46","author":"Maxwell","year":"2019","journal-title":"Clin. Perinatol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/S0885-3924(97)00222-4","article-title":"Measurement of neonatal responses to painful stimuli: A research review","volume":"14","author":"Franck","year":"1997","journal-title":"J. Pain Symptom Manag."},{"key":"ref_16","first-page":"S161","article-title":"Turkish Neonatal Society guideline on the neonatal pain and its management","volume":"53","author":"Ecevit","year":"2018","journal-title":"Turk Pediatri Ars."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1038\/s41372-020-00840-7","article-title":"Neonatal Pain, Agitation, and Sedation Scale\u2019s use, reliability, and validity: A systematic review","volume":"40","author":"Morgan","year":"2020","journal-title":"J. Perinatol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1097\/ANC.0000000000000521","article-title":"Comparing N-PASS and NIPS: Improving Pain Measurement in the Neonate","volume":"18","author":"Desai","year":"2018","journal-title":"Adv. Neonatal Care"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1080\/14767058.2019.1639661","article-title":"The association between NIRS and Doppler ultrasonography in preterm infants with patent ductus arteriosus","volume":"33","author":"Arman","year":"2020","journal-title":"J. Matern. Fetal Neonatal Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"940915","DOI":"10.3389\/fped.2022.940915","article-title":"Peripheral fractional oxygen extraction measured with near-infrared spectroscopy in neonates-A systematic qualitative review","volume":"10","author":"Wolfsberger","year":"2022","journal-title":"Front. Pediatr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1093\/tropej\/fmy044","article-title":"Acute hemodynamic effects of methylxanthine therapy in preterm neonates: Effect of variations in subgroups","volume":"65","author":"Nayak","year":"2019","journal-title":"J. Trop. Pediatr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1016\/j.siny.2015.03.008","article-title":"Near-infrared spectroscopy: Applications in neonates","volume":"20","author":"Sood","year":"2015","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1221","DOI":"10.1001\/jama.2018.1896","article-title":"Association of Placebo, Indomethacin, Ibuprofen, and Acetaminophen with Closure of Hemodynamically Significant Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-analysis","volume":"319","author":"Mitra","year":"2018","journal-title":"JAMA"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/j.pain.2012.01.030","article-title":"Autonomic reactions in pain","volume":"153","year":"2012","journal-title":"Pain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"268","DOI":"10.3389\/fped.2020.00268","article-title":"The Cerebral Hemodynamic Response to Pain in Preterm Infants with Fetal Growth Restriction","volume":"8","author":"Dix","year":"2020","journal-title":"Front. Pediatr."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1097\/JPN.0000000000000138","article-title":"Cerebral Oxygenation and Pain of Heel Blood Sampling Using Manual and Automatic Lancets in Premature Infants","volume":"29","author":"Hwang","year":"2015","journal-title":"J. Perinat. Neonatal Nurs."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1097\/AJP.0000000000000774","article-title":"Does Repeated Painful Stimuli Change Cerebral Near-Infrared Spectroscopy Response in Healthy, Term, Large for Gestational Age Newborns?","volume":"36","author":"Ozdemir","year":"2020","journal-title":"Clin. J. Pain"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1016\/j.pain.2011.11.002","article-title":"Effects of acute postoperative pain on catecholamine plasma levels, hemodynamic parameters, and cardiac autonomic control","volume":"153","author":"Ledowski","year":"2012","journal-title":"Pain"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1038\/s41390-019-0744-6","article-title":"The influence of pain, agitation, and their management on the immature brain","volume":"88","author":"McPherson","year":"2020","journal-title":"Pediatr. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s00431-020-03603-w","article-title":"Introduction of point-of-care neonatal lung ultrasound in a developing country","volume":"179","author":"Mazmanyan","year":"2020","journal-title":"Eur. J. Pediatr."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"101017","DOI":"10.1016\/j.siny.2019.05.009","article-title":"Non-pharmacological pain management in the neonatal intensive care unit: Managing neonatal pain without drugs","volume":"24","author":"Bucsea","year":"2019","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_32","first-page":"CD001069","article-title":"Sucrose for analgesia in newborn infants undergoing painful procedures","volume":"7","author":"Stevens","year":"2016","journal-title":"Cochrane Database Syst. Rev."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/2\/347\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:29:42Z","timestamp":1760120982000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/10\/2\/347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,10]]},"references-count":32,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["children10020347"],"URL":"https:\/\/doi.org\/10.3390\/children10020347","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,10]]}}}