Paeds Vivas · fetal-neonatal-and-perinatal
Neonatal pain assessment and procedural comfort - branching viva
Branching viva from the neuroscience that neonates feel pain, through the validated pain scores and the comfort ladder, to the boundary of routine opioid analgesia and the preterm heel-lance scenario.
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Study tools
Target exams
RACP General PaediatricsRACP DCEMRCPCH ClinicalRCPSC Pediatrics
Prompt
You are the neonatal registrar. A bedside nurse asks whether the preterm infant grimacing through a heel lance is 'really in pain'. The examiner releases information in stages about the neuroscience, the assessment tools, the comfort ladder, and the ventilated preterm infant and the question of routine opioids.
Station opening
Examiner: "A preterm infant grimaces and desaturates with a heel lance. Is the baby really in pain? Defend your answer with the neuroscience." [7]
Strong candidate (must-hit)
- Yes. The nociceptive system matures early - free nerve endings by six to eight weeks, spinothalamic myelination from around twenty weeks, functional thalamo-cortical connections by term - so the pathway that carries a noxious signal to consciousness is working in a preterm infant. Slater recorded cortical pain-evoked potentials over the infant cortex after a heel lance, proving the signal reaches the brain and not merely a spinal reflex; Goksan then showed on fMRI that infant and adult brains activate overlapping pain networks. The preterm brain is hyper-excitable, with predominant excitatory over immature inhibitory tone, so the infant feels more pain per stimulus, not less. [7] [8]
Weak candidate
- "Babies this small can't really feel pain - it's just a reflex." [7]
References6ShowHide
- [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; et al 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; et al Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev, 2016.PMID 27420164
- [7]Slater R; Cantarella A; Gallella S; et al Cortical pain responses in human infants. J Neurosci, 2006.PMID 16597720
- [8]Goksan S; Hartley C; Emery F; et al fMRI reveals neural activity overlap between adult and infant pain. Elife, 2015.PMID 25895592