Can the human neonate mount an endocrine and metabolic response to surgery?

Anand, K.J.S.; Brown, Morris J.; Causon, R. C.; Christofides, Nicos; Bloom, Stephen R.; Aynsley-Green, A

doi:10.1016/s0022-3468(85)80390-0

Cited by 243 publications

(44 citation statements)

References 20 publications

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“…This popular precept was challenged by accumulating data on hormonal-metabolic responses to surgical procedures performed under minimal anesthesia 9,10 , which were effectively reduced by giving potent anesthesia 11-13 , the identification of a “pain system” and initial data on its early development, rich observations on crying activity and other behaviors of newborns subjected to painful stimuli in the NICU – all of which contributed to a scientific rationale for neonatal pain perception and its clinical implications 3 . Once the existence of neonatal pain was acknowledged and methods for clinical assessment had been validated 14,15 , the stage was set for advances in neonatal pain management.…”

Section: Introductionmentioning

confidence: 99%

Pain Management in Newborns

Hall¹,

Anand

2014

Clinics in Perinatology

208

126

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Effective pain management is a desirable standard of care for preterm and term newborns and may potentially improve their clinical and neurodevelopmental outcomes. Neonatal pain should be assessed routinely using context-specific, validated and objective pain methods, despite the limitations of currently available tools. Reducing invasive procedures, and using pharmacological, behavioral or environmental measures can be used to manage neonatal pain. Non-pharmacologic approaches include kangaroo care, facilitated tucking, non-nutritive sucking, sucrose and other sweeteners, massage and acupuncture therapy. They are used for procedures causing acute, transient, or mild pain, or as adjunctive therapy for moderate or severe pain. Local and topical anesthetics can reduce the acute pain caused by skin-breaking or mucosa-injuring procedures. Opioids form the mainstay for treatment of severe pain; morphine and fentanyl are the most commonly used drugs, although other opioids are also available. Non-opioid drugs include various sedatives and anesthetic agents, mostly used as adjunctive therapy in ventilated neonates. Acetaminophen, ibuprofen and other drugs are used for neonates, although their efficacy and safety remains unproven. Approaches for implementing an effective pain management program in the Neonatal ICU are summarized, together with practical protocols for procedural, postoperative, and mechanical ventilation-associated neonatal pain and stress.

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Section: Introductionmentioning

confidence: 99%

Pain Management in Newborns

Hall¹,

Anand

2014

Clinics in Perinatology

208

126

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“…found increased catecholamine, cortisol and glucagon levels immediately after surgery in children which, in turn, may affect the microcirculation and lactate tissue concentration. These early increases in stress hormone levels tend to normalize approximately 6 h postoperatively ( 17). Such initial hormonal responses might explain why no significant difference was found during the first 8 h in the dialysate lactate concentrations in the present study.…”

Section: Discussionmentioning

confidence: 99%

Age‐dependent variations in white adipose tissue glycerol and lactate production after surgery measured by microdialysis in neonates and children

Hildingsson

Lönnqvist

Selldén

et al. 2000

Pediatric Anesthesia

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In previous studies, we observed that lactate concentrations in interstitial white adipose tissue are higher in small infants than in adults. Moreover, no lipolysis following catecholamine challenge has been reported in neonates and small infants. Our aim was to determine with microdialysis whether the above mentioned age-dependent changes could be detected in situ after surgery. A microdialysis catheter was introduced into the abdominal subcutaneous tissue in 13 neonates and 12 children undergoing surgery. Interstitial concentrations of glucose, lactate and glycerol were measured hourly during the first 20 postoperative hours. The concentrations of lactate in interstitial white adipose tissue were consistently higher in neonates compared to older children, with a significant difference during the 9-18 h postoperative period (P < 0.05). A significant difference in the lactate:glucose ratio was observed at 1-2, 8-10, 15 and 18 h postoperatively (P < 0.05). No significant differences were observed between the two groups with respect to glycerol and glucose concentrations. Interstitial lactate concentrations in white adipose tissue were higher in neonates compared with children in the early postoperative period. No age-dependent difference in postoperative lipolysis, measured as interstitial glycerol concentrations, was observed. Thus, an age-dependent difference in interstitial lactate production, but not lipolysis, was detected in the early postoperative period.

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“…Fifth, third order neurons within the cerebral cortex perceive the nociceptive signal as pain. Each step is mediated by a distinct set of receptor proteins [8] .…”

Section: Physiology Of Infant Pain Unique Structures and Processesmentioning

confidence: 99%

“…The pain pathway, transduction, transmission and perception of noxious stimuli and the cortical, subcortical anatomic and endorphin substrates necessary for pain transmission are well developed as early as 23 weeks gestation [8,9] . However, in contrast to adults, a preterm infant's afferent pain pathway has a higher density of high threshold Aδ and low threshold Aβ mechanoreceptors that respond with lower firing frequency [10] and the neurotransmitters in the inhibitory arm, found within the descending pathway, are immature and will not develop until 4 -8 weeks later in postnatal life [11,12] .…”

Section: Physiology Of Infant Pain Unique Structures and Processesmentioning

confidence: 99%

A systematic review of the effects of repeated painful procedures in infants: Is there a potential to mitigate future pain responsivity?

Hatfield

Meyers

Messing

2013

JNEP

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Background: Multiple lines of evidence suggest repeated painful procedures early in life may permanently disrupt the developing central nervous system. Painful diagnostic, medical, and minor surgical procedures performed in the neonatal intensive care unit such as venipunctures, heel lances, immunizations, and central venous catheter insertion are a significant portion of painful events experienced by infants. The objective of this systematic review is to synthesize findings from published clinical trials evaluating the effect of repeated painful procedures experienced during the plasticity of the developing peripheral and central nervous system and their influence on future pain responsivity. Methodology/Principal Findings:A systematic review of peer-refereed clinical trials was conducted. Clinical trials examining the effect of repeated painful procedures experienced during the plasticity of the developing peripheral and central nervous system and their influence on future pain responsivity were identified from electronic databases PUBMED, MEDLINE and CINAHL. Application of inclusion/exclusion criteria and limitations identified five clinical trials for critical reviewed. Findings suggest that repetitive pain experienced during a critical window of neurodevelopment alters the structure and function of an infant's nervous system, influences subsequent pain responses through childhood and may contribute to the development of chronic pain.Conclusions: Current research asserts that inadequate relief of infant pain and distress during tissue-damaging procedures may permanently decrease an individual's pain tolerance, and increase pain responses later in life.

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Can the human neonate mount an endocrine and metabolic response to surgery?

Cited by 243 publications

References 20 publications

Pain Management in Newborns

Pain Management in Newborns

Age‐dependent variations in white adipose tissue glycerol and lactate production after surgery measured by microdialysis in neonates and children

A systematic review of the effects of repeated painful procedures in infants: Is there a potential to mitigate future pain responsivity?

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