Paeds · fetal-neonatal-and-perinatal
Neonatal pain assessment and procedural comfort
Also known as Neonatal pain assessment and procedural comfort · Neonatal procedural pain management · Neonatal analgesia and comfort care · Pain assessment in the newborn · Sucrose and non-pharmacological analgesia in neonates
Fellowship guide to neonatal pain assessment and procedural comfort: the neuroscience proving neonates feel pain (Slater EEG, Goksan fMRI), the hyper-excitable preterm brain, the validated pain scores (PIPP/PIPP-R, N-PASS, NFCS, CRIES), and the stepwise comfort ladder from environmental measures through sucrose, breast milk, topical anaesthesia, paracetamol and titrated opioids.
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- A normal heart rate does not exclude pain in a neonate - pain is a clinical diagnosis from behaviour, physiology and context, never excluded by one normal vital sign
- Preterm infants feel MORE pain per stimulus, not less - their excitatory tone dominates while descending inhibition is immature, so the smallest infant is the most vulnerable, not the most protected
- Sucrose is for brief procedural pain only - it is not a substitute for opioid analgesia in major pain, surgery or ventilation
- Routine morphine infusion in ventilated preterm infants did not improve outcome in the NEOPAIN trial (Simons 2003) - opioids are titrated to the patient, not infused as routine
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- Neonatal pain assessment and procedural comfort
- Long case: neonatal pain assessment and procedural comfort in the preterm infant
- Communication: explaining procedural comfort to parents in the NICU
- Patient Care: neonatal pain assessment and procedural comfort
- Medical Expert: neonatal pain assessment and procedural comfort
Overview & Definition
A two-day-old preterm infant grimaces, desaturates and goes rigid moment heel-lance device fires. That response is pain. Until the 1980s the dogma held that the immature brain could not feel pain, and neonatal surgery was performed with little or no analgesia; modern neuroscience has refuted that dogma completely, and neonatal pain assessment is now a core standard of care in every nursery and intensive care unit. [1] [8]
Neonatal pain is the subjective sensory and emotional experience of a noxious event in an infant who cannot report it. At bedside clinician works with two linked ideas: nociception, the neural processing of a damaging stimulus, and pain, the experience it produces. Because the neonate cannot speak, both are operationally bundled and inferred from behaviour, physiology and context, and graded with a validated score. The task is to recognise the pain, match the comfort to the procedure, and prove the treatment worked by re-scoring. [1]
References10ShowHide
- [1]Anand KJ; International Evidence-Based Group for Neonatal Pain Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med, 2001.PMID 11177093
- [2]Stevens B; Johnston C; Petryshen P; Taddio A Premature Infant Pain Profile: development and initial validation. Clin J Pain, 1996.PMID 8722730
- [3]Simons SH; van Dijk M; van Lingen RA; Roofthooft D; Duivenvoorden HJ; Jongeneel N; Bunkers C; Smink E; Anand KJ; van den Anker JN; Tibboel D Routine morphine infusion in preterm newborns who received ventilatory support: a randomized controlled trial. JAMA, 2003.PMID 14612478
- [4]Stevens B; Yamada J; Ohlsson A; Haliburton S; Shorkey A Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev, 2016.PMID 27420164
- [5]Shah PS; Torgalkar R; Shah VS Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev, 2023.PMID 37643989
- [6]Pillai Riddell RR; Racine NM; Gennis HG; Turcotte K; Uman LS; Horton RE; Ahola Kohut S; Hillgrove Stuart J; Stevens B; Lisi DM Non-pharmacological management of infant and young child procedural pain. Cochrane Database Syst Rev, 2015.PMID 26630545
- [7]Slater R; Cantarella A; Gallella S; Worley A; Boyd S; Meek J; Fitzgerald M Cortical pain responses in human infants. J Neurosci, 2006.PMID 16597720
- [8]Goksan S; Hartley C; Emery F; Cockrill N; Poorun R; Moultrie F; Rogers R; Campbell J; Sanders M; Adams E; Clare S; Jenkinson M; Tracey I; Slater R fMRI reveals neural activity overlap between adult and infant pain. Elife, 2015.PMID 25895592
- [9]Gibbins S; Stevens B; Hodnett E; Pinelli J; Ohlsson A; Darlington G Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nurs Res, 2002.PMID 12464757
- [10]Ohlsson A; Shah PS Paracetamol (acetaminophen) for prevention or treatment of pain in newborns. Cochrane Database Syst Rev, 2020.PMID 31985830