Prevention and Management of Pain in the Neonate

Abstract

The prevention of pain in neonates should be the goal of all caregivers, because repeated painful exposures have the potential for deleterious consequences. Neonates at greatest risk of neurodevelopmental impairment as a result of preterm birth (ie, the smallest and sickest) are also those most likely to be exposed to the greatest number of painful stimuli in the NICU. Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underused for routine minor yet painful procedures. Every health care facility caring for neonates should implement an effective pain-prevention program, which includes strategies for routinely assessing pain, minimizing the number of painful procedures performed, effectively using pharmacologic and nonpharmacologic therapies for the prevention of pain associated with routine minor procedures, and eliminating pain associated with surgery and other major procedures.

The effect of the facilitated tucking position in reducing vaccination-induced pain in newborns

“…In this study, infants were held in the facilitated tucking position during HBV vaccination, their pain perceptions were evaluated, and the pain perceptions of newborns held in this position were significantly lower compared to those held in the classical holding position. When examined the literature, facilitated-tucking position has been proven in many studies to be an effective method for relieving many procedural pain (such as heelstick, suctioning, venipuncture) in the infants [ 13 , 15 , 17 – 24 ]. However, any work that examined the impact of facilitated-tucking position relieving the pain occurred in hepatitis B and other vaccine applications has not been found.…”

“…Although many studies are reported on procedural pain control and assessment in the infants [ 13 , 15 , 17 – 24 ], there are no studies on facilitated tucking position to alleviate the pain associated with the vaccination. Recent studies have focused on pain physiology, pain assessment, and pharmacological interventions [ 4 , 25 ].…”

Pain-Related Reactions among Premature Infants with Gestational Age Less than 26 Weeks: An Observational Cohort Study

“…The observers were initially provided with a list of all documented pain-related reactions of infants, in order to prepare a comprehensive map of additional pain reactions and movements. Using this list the observers evaluated videos of infants who did not belong to the study population, documenting any pain-related reactions that may not have been reported in any of the existing pain scales yet [4,14]. These reactions, which were deep breathing, chest wall indrawing and nasal flaring, were included in the evaluation sheet of reactions to be studied qualitatively, under the common variable ‘changes of breath pattern'.…”

“…Several instruments evaluating neonatal pain measurement have been developed [4]. The concept of premature infants experiencing pain is clear [5].…”

“…Therefore pain scales may only be applied with caution to infants with a gestational age of 25-26 weeks. There is no suitable instrument for infants with a lower gestational age [4]. …”