Pain and distress management in palliative neonatal care

End-of-Life Care for Neonates: Assessing and Addressing Pain and Distressing Symptoms

“…In comparison to adults, neonates experience pain that is more severe, diffuse, and prolonged (16). Several different pain assessment tools are validated for neonates; however, one has not been found superior over the others (5,16,17). These assessment tools do not evaluate for distress from other etiologies such as hunger, and interpretation must be completed in proper clinical context (5).…”

“…Each of these methods has been shown to increase comfort or decrease oxidative stress markers of neonates in situations of acute pain. In fact, combining measures enhances comfort over using a single method alone (5,27).…”

“…Efficacious administration routes include enteral, intravenous (IV), mucosal (buccal, lingual, or rectal), intranasal, transdermal, and subcutaneous depending on the agent. Agents may need to be combined for optimal comfort (5,16). See Table 1 for initial dosing guidelines and Figure 1 for a general guide to stepwise approach for providers.…”

“…Sucrose is effective in reduction of pain behavior during acute procedures and noted to have increased efficacy when used in combination with nonnutritive sucking (5,16,30).…”

“…Neonatal intensive care units (NICUs) are generally competent in EOL care of neonates; however, evidence shows there are wide variations in methods for evaluating and addressing symptoms (1,12). This variation likely stems from limited evidence regarding neonatal EOL symptom management given the lack of on-label neonatal pharmacologic treatments (5,10). A 2016 survey showed only 55% of NICUs in the United States have a neonatal EOL guideline, and 45% do not have access to a palliative care team, showing there is much room for improvement regarding neonatal EOL care (1).…”