Neonatal pain

Abstract

Effective management of procedural and postoperative pain in neonates is required to minimize acute physiological and behavioral distress and may also improve acute and long-term outcomes. Painful stimuli activate nociceptive pathways, from the periphery to the cortex, in neonates and behavioral responses form the basis for validated pain assessment tools. However, there is an increasing awareness of the need to not only reduce acute behavioral responses to pain in neonates, but also to protect the developing nervous system from persistent sensitization of pain pathways and potential damaging effects of altered neural activity on central nervous system development. Analgesic requirements are influenced by age-related changes in both pharmacokinetic and pharmacodynamic response, and increasing data are available to guide safe and effective dosing with opioids and paracetamol. Regional analgesic techniques provide effective perioperative analgesia, but higher complication rates in neonates emphasize the importance of monitoring and choice of the most appropriate drug and dose. There have been significant improvements in the understanding and management of neonatal pain, but additional research evidence will further reduce the need to extrapolate data from older age groups. Translation into improved clinical care will continue to depend on an integrated approach to implementation that encompasses assessment and titration against individual response, education and training, and audit and feedback.

Behavioral effects of perinatal opioid exposure

“…Adequate intra-and postoperative analgesia not only modifies the stress response but also has been shown to reduce morbidity and mortality (Lonnqvist and Morton, 2005). Repetitive untreated pain and distress may impair the premature brain and have short-and long-term negative consequences (Duhrsen et al, 2013;Walker, 2014). For example, the effects of neonatal inflammatory pain resulted in decreased locomotor activity in adult rats, and this effect was reduced by morphine pretreatment (Bhutta et al, 2001).…”

“…For example, the effects of neonatal inflammatory pain resulted in decreased locomotor activity in adult rats, and this effect was reduced by morphine pretreatment (Bhutta et al, 2001). Therefore, pain management is increasingly recognized as an integral part of the effective management of vulnerable babies in the neonatal intensive care unit (NICU) (Walker, 2014;Hall, 2012). Beyond the most common non-pharmacologic techniques (sucking, maternal contact and massage), the drugs used to treat neonatal pain include opiates.…”

Sedation in the Neonatal Intensive Care Unit: International Practice

“…This exaggerated brain response was pain-specific since this was not observed during non-painful warmth stimulation [11]. Similar, and using a term matched-control design in 43 former extreme preterm neonates, Walker et al documented that there were differences in somatosensory perception in childhood [12]. Interestingly, these differences were in part local (e.g., thermal and mechanical hyposensitivity around a thoracotomy scar) and in part more general (thermal hyposensitivity).…”

Editorial: Neonatal Pain

“…Parents are also supportive for usage of environmental strategies for managing pain and stress in their neonates. Currently sucrose is one of the most widely used nonpharmacological methods to reduce neonatal pain [18]. Kangaroo Care or skin-to-skin contact between mother and neonate is another method that has proven its clinical efficacy in reducing neonatal pain [19].…”

“…Among twin neonates, positive effects of cobedding are seen while managing procedural pain like pain after heel lance [20]. Positive parent interaction is yet another effective measure that is found to be helpful in comforting neonates from procedural pain and stress [18].…”