Changes in Physicians' Perceptions and Practices on Neonatal Pain Management Over the Past 20 Years. A Survey Conducted at Two Time-Points

Abstract

Intense research for more than three decades expelled the view that neonates do not experience pain. The aim of this survey was to investigate whether the Greek physicians involved in neonatal intensive care have changed their perceptions regarding neonatal pain, adapting their management practices to the knowledge that have emerged in the past 20-years. This study is a survey conducted at two time-points, 20 years apart. Anonymous questionnaires were distributed to 117 and 145 physicians working in neonatal intensive care units (NICUs) all over Greece in years 2000 and 2019, respectively. The response rate was 90.6 and 80.7% in 2000 and 2019, respectively. All respondents, at both time-points, believed that neonates experience pain, which has serious acute and long-term consequences, while the vast majority considered analgesia-sedation (A-S) during painful interventions as obligatory. Utilization of NICU protocols and pain assessment tools remained low although increased significantly between 2000 and 2019. The use of systemic A-S postoperatively was high at both time-points, while its implementation in infants subjected to prolonged pain, specifically mechanical ventilation, increased significantly by 2019. Systemic or local analgesia for acute procedural pain was used by lower proportions of physicians in 2019, except for the tracheal intubation. In contrast, the use of sweet solutions and non-pharmacological measures prior to or during bedside procedures significantly increased over time. Opioid administration significantly increased, while a shift from morphine to fentanyl was observed. International literature and perinatal–neonatal congresses were stated as the main sources of updating physicians' knowledge and improving management practice on neonatal pain prevention and treatment. In conclusion, Greek NICU-physicians' perceptions that neonates can experience pain with potentially serious acute and long-term consequences remained strong over the past 20 years. Although physicians' practices on neonatal pain management improved, they are still suboptimal, while significant differences exist among centers. Continuing education, globally accepted management protocols, and readily applied pain assessment tools would further improve the management of procedural pain and stress in neonates.

Dexmedetomidine: An Alternative to Pain Treatment in Neonatology

“…As mentioned before, scientific evidence demonstrates that neonatal pain has short and long-term adverse effects [ 1 , 2 , 3 ]. By 23–25 weeks, free nerve endings and spinal cord projections are fully mature, so pain sensation is theoretically possible at 24 weeks of gestation [ 4 ].…”

“…During the 80′s and 90′s, it was believed that neonates did not feel pain because of the immaturity of their nervous system. These wrong beliefs have influenced the neonatal pain assessment during decades [ 1 ]. Only 30 years ago, newborns underwent major surgical procedures without perioperative or postoperative analgesia [ 2 ].…”

“…As multiple studies have shown, neonates not only suffer pain, but is has short and long-term consequences such as metabolic and hormonal stress, even neurodevelopmental sequellae. There are many concerns about the side effects of pain treatment and there is still so much to study on how to assess neonatal pain and what treatment would be the best in a rapidly developing target organ [ 1 ].…”

Efficacy and safety of non‐pharmacological interventions for endotracheal suctioning pain in preterm infants: A systematic review

“…Over the last few decades, physicians have recognized that infants can be more sensitive to pain and suffer from severe acute and long‐term adverse effects of it. While physician practices in newborn pain management have improved, they remain shortcomings, and there are significant differences between medical centres (Agakidou et al, 2021). Currently, procedural pain in infants can be managed by non‐pharmacological and pharmacological interventions.…”

“…there are significant differences between medical centres (Agakidou et al, 2021). Currently, procedural pain in infants can be managed by non-pharmacological and pharmacological interventions.…”