Long-term effects of neonatal pain

Abstract

Pain experienced during neonatal intensive care management can influence neurodevelopmental outcome and the somatosensory and/or emotional components of pain response in later life. Alterations in biological factors (e.g. peripheral and central somatosensory function and modulation, brain structure and connectivity) and psychosocial factors (e.g. gender, coping style, mood, parental response) that influence pain have been identified in children and young adults born very preterm or extremely preterm. Earlier gestational age at birth and cumulative pain exposure from tissuebreaking procedures and/or neonatal surgery influence the degree of change. In neonatal rodents, repeated needle insertion or hindpaw incision identify developmentally-regulated and activitydependent long term alterations in nociceptive processing, and the efficacy of novel or current analgesic interventions can be compared. As prior neonatal experience and sex may influence current pain experience or the risk of persistent pain, these factors should be considered within the biopsychosocial assessment and formulation of pain in later life.

A systematic review of outcomes reported in pediatric perioperative research: A report from the Pediatric Perioperative Outcomes Group

“…In the vast majority of studies, outcomes were measured in the immediate perioperative period, with the duration often restricted to the postanesthesia care unit or the first 24 postoperative hours. However, more prolonged follow‐up in specific age‐based populations is required for outcomes‐related to emergent research priorities, 7 such as potential effects of general anesthesia on the developing brain, 60,61 or factors associated with an increased risk of persistent postsurgical pain 42,62 . While neonatal mortality is declining, 63 the rate of preterm birth continues to increase, 64 and neonatal comorbidities make significant contributions to years of life lost and years lived with disability 65 .…”

“…Of the 599 outcomes extracted, the top three outcome domains were patient comfort (49%), clinical indicators (16%), and (19) 136 (47) 1353 (62) 293 (49) 1805 57Patient-centered outcomes (%) 6 (5) 35 (12) 251 (12) 86 (14) 378 (12) Bleeding/transfusion (%) 3 318 (6) 57(3) 32 (5) 110 3Healthcare utilization (%) 10 (8) 21 7189 (9) 60 (10) 280 (9) Clinical indicators (%) 44 3761 (21) 245 (11) 93 (16) 443 14Other (%) 34 2821 786 4 Table 6).…”

“…However, more prolonged follow-up in specific age-based populations is required for outcomes-related to emergent research priorities, 7 such as potential effects of general anesthesia on the developing brain, 60,61 or factors associated with an increased risk of persistent postsurgical pain. 42,62 While neonatal mortality is declining, 63 the rate of preterm birth continues to increase, 64 and neonatal comorbidities make significant contributions to years of life lost and years lived with disability. 65 While the need for surgery at early gestational ages can be associated with persistent effects on health and cognitive outcome, [66][67][68] the potential impact of anesthesia drugs and management requires ongoing evaluation.…”

A cluster randomized clinical trial to evaluate the effectiveness of the Implementation of Infant Pain Practice Change (ImPaC) Resource to improve pain practices in hospitalized infants: a study protocol

“…Step 5: Select appropriate implementation strategies that will support the target evidence-based pain management or assessment practice change during The extent to which the Resource was successfully implemented in terms of ease of use and time [10,15] Focus group. A semi-structured interview guide was developed according to CFIR constructs on intervention characteristics [9] and has been pre-tested in a usability study [12] T2 (for INT group)…”

“…Although abundant and high-quality evidence on reliable pain assessment measures [2] and effective and safe analgesic strategies [3][4][5][6] exist, neonates continue to experience procedural pain with suboptimal management in the Neonatal Intensive Care Unit (NICU) [1,7,8]. Repetitive and untreated pain from procedures is associated with early [9,10] and later changes in various health outcomes [11][12][13][14]. The increasing complexity of care in the NICU and the potential burden of negative growth and development in the early years of life signal an imperative to translate high-quality evidence for minimizing procedural pain and its effects into practice and to improve outcomes.…”