Neonatal Pain: Perceptions and Current Practice

Mallory Perry, Zewen Tan, Jie Chen, Tessa Weidig, Wanli Xu, Xiaomei S Cong, Mallory Perry, Zewen Tan, Jie Chen, Tessa Weidig, Wanli Xu, Xiaomei S Cong

Abstract

Neonates may experience more than 300 painful procedures throughout their hospitalizations. Prior to 1980, there was a longstanding misconception that neonates do not experience pain. Current studies demonstrate that not only do neonates experience pain but also, due to their immature nervous systems, they are hypersensitive to painful stimuli. Poorly treated pain may lead to negative long-term consequences. Proper assessment of neonate pain is vital. The use of nonpharmacologic treatments may be beneficial in alleviating neonate pain. Pharmacologic treatments in the neonate have been well established. Pharmacologic and nonpharmacologic interventions can be used in conjunction to increase the efficacy of analgesia.

Keywords: Barriers; Neonatal care; Nonpharmacologic intervention; Pain; Pharmacologic intervention.

Conflict of interest statement

DISCLOSURE STATEMENT:

The authors have nothing to disclose.

Copyright © 2018 Elsevier Inc. All rights reserved.

References

    1. Anand KJ, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med. 1987;317(21):1321–1329.
    1. Fitzgerald M, Beggs S. The neurobiology of pain: developmental aspects. Neuroscientist. 2001;7(3):246–257.
    1. Grunau RE, Holsti L, Haley D, et al. Neonatal procedural pain exposure predicts lower cortisol and behavioral reactivity in preterm infants in the NICU. Pain. 2005;113(3):293–300.
    1. Committee On F, Newborn Section, On A, Pain M. Prevention and Management of Procedural Pain in the Neonate: An Update. Pediatrics. 2016;137(2):e20154271.
    1. Goksan S, Hartley C, Emery F, et al. fMRI reveals neural activity overlap between adult and infant pain. Elife. 2015;4
    1. Lippmann M, Nelson RJ, Emmanouilides GC, Diskin J, Thibeault DW. Ligation of patent ductus arteriosus in premature infants. Br J Anaesth. 1976;48(4):365–369.
    1. Holsti L, Grunau RE, Shany E. Assessing pain in preterm infants in the neonatal intensive care unit: moving to a ‘brain-oriented’ approach. Pain Manag. 2011;1(2):171–179.
    1. Cong X, Wu J, Vittner D, et al. The impact of cumulative pain/stress on neurobehavioral development of preterm infants in the NICU. Early Hum Dev. 2017;108:9–16.
    1. Osterweis M, Kleinman A, Mechanic D, editors. Pain and Disability: Clinical, Behavioral, and Public Policy Perspectives. Washington (DC): 1987.
    1. Brown AG. The dorsal horn of the spinal cord. Q J Exp Physiol. 1982;67(2):193–212.
    1. Ab Aziz CB, Ahmad AH. The role of the thalamus in modulating pain. Malays J Med Sci. 2006;13(2):11–18.
    1. Hatfield LA. Neonatal pain: What’s age got to do with it? Surg Neurol Int. 2014;5(Suppl 13):S479–489.
    1. Kostovic I, Rakic P. Developmental history of the transient subplate zone in the visual and somatosensory cortex of the macaque monkey and human brain. J Comp Neurol. 1990;297(3):441–470.
    1. Hasegawa M, Houdou S, Mito T, Takashima S, Asanuma K, Ohno T. Development of myelination in the human fetal and infant cerebrum: a myelin basic protein immunohistochemical study. Brain Dev. 1992;14(1):1–6.
    1. Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest. 2010;120(11):3760–3772.
    1. Fitzgerald M, Walker SM. Infant pain management: a developmental neurobiological approach. Nat Clin Pract Neurol. 2009;5(1):35–50.
    1. Slater R, Fabrizi L, Worley A, Meek J, Boyd S, Fitzgerald M. Premature infants display increased noxious-evoked neuronal activity in the brain compared to healthy age-matched term-born infants. Neuroimage. 2010;52(2):583–589.
    1. Cong X, McGrath JM, Cusson RM, Zhang D. Pain assessment and measurement in neonates: an updated review. Adv Neonatal Care. 2013;13(6):379–395.
    1. Ranger M, Grunau RE. Early repetitive pain in preterm infants in relation to the developing brain. Pain Manag. 2014;4(1):57–67.
    1. Xu W, Walsh S, Cong XS. Development of Accumulated Pain/Stressor Scale (APSS) in NICUs: A National Survey. Pain Manag Nurs. 2016
    1. Grunau RE, Craig KD. Pain expression in neonates: facial action and cry. Pain. 1987;28(3):395–410.
    1. Hummel P, Puchalski M, Creech SD, Weiss MG. Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain. J Perinatol. 2008;28(1):55–60.
    1. van Dijk M, Roofthooft DW, Anand KJ, et al. Taking up the challenge of measuring prolonged pain in (premature) neonates: the COMFORTneo scale seems promising. Clin J Pain. 2009;25(7):607–616.
    1. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993;12(6):59–66.
    1. Crellin DJ, Harrison D, Santamaria N, Babl FE. Systematic review of the Face, Legs, Activity, Cry and Consolability scale for assessing pain in infants and children: is it reliable, valid, and feasible for use? Pain. 2015;156(11):2132–2151.
    1. Stevens BJ, Gibbins S, Yamada J, et al. The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. Clin J Pain. 2014;30(3):238–243.
    1. Cong X, Cusson RM, Walsh S, Hussain N, Ludington-Hoe SM, Zhang D. Effects of skin-to-skin contact on autonomic pain responses in preterm infants. J Pain. 2012;13(7):636–645.
    1. Tristao RM, Garcia NV, de Jesus JA, Tomaz C. COMFORT behaviour scale and skin conductance activity: what are they really measuring? Acta Paediatr. 2013;102(9):e402–406.
    1. Hartley C, Slater R. Neurophysiological measures of nociceptive brain activity in the newborn infant--the next steps. Acta Paediatr. 2014;103(3):238–242.
    1. IASP IAftSoP. Acute pain management in newborn infants. Pain Clinical Updates. 2011 .
    1. Gao H, Gao H, Xu G, et al. Efficacy and safety of repeated oral sucrose for repeated procedural pain in neonates: A systematic review. Int J Nurs Stud. 2016;62:118–125.
    1. Stevens B, Yamada J, Ohlsson A, Haliburton S, Shorkey A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2016(7):CD001069.
    1. Gibbins S, Stevens B. Mechanisms of sucrose and non-nutritive sucking in procedural pain management in infants. Pain Res Manag. 2001;6(1):21–28.
    1. Cong X, Ludington-Hoe SM, Walsh S. Randomized crossover trial of kangaroo care to reduce biobehavioral pain responses in preterm infants: a pilot study. Biol Res Nurs. 2011;13(2):204–216.
    1. Boundy EO, Dastjerdi R, Spiegelman D, et al. Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis. Pediatrics. 2016;137(1)
    1. Johnston CC, Filion F, Campbell-Yeo M, et al. Kangaroo mother care diminishes pain from heel lance in very preterm neonates: a crossover trial. BMC Pediatr. 2008(8):13.
    1. Cong X, Ludington-Hoe SM, McCain G, Fu P. Kangaroo Care modifies preterm infant heart rate variability in response to heel stick pain: pilot study. Early Hum Dev. 2009;85(9):561–567.
    1. Ludington-Hoe S, Hosseini R, Torowicz DL. Skin-to-skin contact (Kangaroo Care) analgesia for preterm infant heel stick. AACN Clin Issues. 2005;16(3):373–387.
    1. Vittner D, McGrath J, Robinson J, et al. Increase in Oxytocin From Skin-to-Skin Contact Enhances Development of Parent-Infant Relationship. Biol Res Nurs. 2018;20(1):54–62.
    1. Golianu B, Krane E, Seybold J, Almgren C, Anand KJ. Non-pharmacological techniques for pain management in neonates. Semin Perinatol. 2007;31(5):318–322.
    1. Liaw JJ, Yang L, Katherine Wang KW, Chen CM, Chang YC, Yin T. Non-nutritive sucking and facilitated tucking relieve preterm infant pain during heel-stick procedures: a prospective, randomised controlled crossover trial. Int J Nurs Stud. 2012;49(3):300–309.
    1. Collados-Gomez L, Ferrera-Camacho P, Fernandez-Serrano E, et al. Randomised crossover trial showed that using breast milk or sucrose provided the same analgesic effect in preterm infants of at least 28 weeks. Acta Paediatr. 2017
    1. Blass EM. Milk-induced hypoalgesia in human newborns. Pediatrics. 1997;99(6):825–829.
    1. Ou-Yang MC, Chen IL, Chen CC, Chung MY, Chen FS, Huang HC. Expressed breast milk for procedural pain in preterm neonates: a randomized, double-blind, placebo-controlled trial. Acta Paediatr. 2013;102(1):15–21.
    1. Shah PS, Herbozo C, Aliwalas LL, Shah VS. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev. 2012(12):CD004950.
    1. Hartley KA, Miller CS, Gephart SM. Facilitated tucking to reduce pain in neonates: evidence for best practice. Adv Neonatal Care. 2015;15(3):201–208.
    1. Huang CM, Tung WS, Kuo LL, Ying-Ju C. Comparison of pain responses of premature infants to the heelstick between containment and swaddling. J Nurs Res. 2004;12(1):31–40.
    1. Cignacco E, Hamers JP, Stoffel L, et al. The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain. 2007;11(2):139–152.
    1. Barker DP, Willetts B, Cappendijk VC, Rutter N. Capillary blood sampling: should the heel be warmed? Arch Dis Child Fetal Neonatal Ed. 1996;74(2):F139–140.
    1. Shu SH, Lee YL, Hayter M, Wang RH. Efficacy of swaddling and heel warming on pain response to heel stick in neonates: a randomised control trial. J Clin Nurs. 2014;23(21–22):3107–3114.
    1. Krishnan L. Pain relief in neonates. J Neonatal Surg. 2013;2(2):19.
    1. Liaw JJ, Yang L, Lee CM, Fan HC, Chang YC, Cheng LP. Effects of combined use of non-nutritive sucking, oral sucrose, and facilitated tucking on infant behavioural states across heel-stick procedures: a prospective, randomised controlled trial. Int J Nurs Stud. 2013;50(7):883–894.
    1. Hall RW, Shbarou RM. Drugs of choice for sedation and analgesia in the neonatal ICU. Clin Perinatol. 2009;36(2):215–226. vii.
    1. Bhalla T, Shepherd E, Tobias JD. Neonatal pain management. Saudi J Anaesth. 2014;8(Suppl 1):S89–97.
    1. Hall RW. Anesthesia and analgesia in the NICU. Clinics in Perinatology. 2012;39(1):239–254.
    1. Haidon JL, Cunliffe M. Analgesia for neonates. Continuing Education in Anaesthesia Critical Care and Pain. 2010;10(4):123–127.
    1. PA L. Regional anesthesia and analgesia in the neonate. Best Pract Res Clin Anaesthesiol. 2010;24(3):309–321.
    1. Anand K, Johnston C, Oberlander T, Taddio A, Lehr V, Walco G. Analgesia and local anesthesia during invasive procedures in the neonate. Clin Ther. 2005;27(6):844–876.
    1. Anand K, Hall W. Controversies in neonatal pain: an introduction. Seminars in Perinatology. 2007;31(5):273–274.
    1. Byrd PJ, Gonzales I, Parsons V. Exploring barriers to pain management in newborn intensive care units: a pilot survey of NICU nurses. Adv Neonatal Care. 2009;9(6):299–306.
    1. Cong X, Delaney C, Vazquez V. Neonatal nurses’ perceptions of pain assessment and management in NICUs: a national survey. Adv Neonatal Care. 2013;13(5):353–360.
    1. Akuma AO, Jordan S. Pain management in neonates: a survey of nurses and doctors. J Adv Nurs. 2012;68(6):1288–1301.
    1. Cong X, McGrath JM, Delaney C, et al. Neonatal nurses’ perceptions of pain management: survey of the United States and China. Pain Manag Nurs. 2014;15(4):834–844.
    1. Franck LS. A pain in the act: musings on the meaning for critical care nurses of the pain management standards of the joint commission on accreditation of healthcare organizations. Crit Care Nurse. 2001;21(3):8, 10, 12. passim.
    1. National Association of Neonatal Nurses. Position statement on pain management in infants. Central Lines. 2000;16(1):4–6.
    1. Baker DW. Statement on Pain Management: Understanding How Joint Commission Standards Address Pain. Jt Comm Perspect. 2016;36(6):10–12.

Source: PubMed

Sponsor e collaboratori

Condizioni mediche

Interventi farmacologici

3
Sottoscrivi