Pain management is an integral focus of neonatal care. This article reviews the physiology and impact of neonatal pain and distress and pain assessment tools, as well as clinical interventions and current controversies in the management of pain and distress in neonates. Current guidelines to enhance the recognition and treatment of pain are highlighted.

Patients' knowledge of perioperative care is limited, with very little change during hospital stay. Novel educational approaches may be required to increase basic medical knowledge.

Indwelling UACs in sick infants may not carry an increased risk of thrombosis during the first 5 days of use.

SUMMARY Fatal haemopericardium occurred in a 14-year-old boy after rupture of a pulmonary artery aneurysm. Persistent ductus arteriosus with severe pulmonary hypertension was confirmed by cardiac catheterisation when he was 4 weeks old. Attempted closure of the ductus at 4 years had not been possible because of apparent high pulmonary resistance. Exercise tolerance had been good enough to permit competitive horse riding up to the day ofdeath. Light and electron microscopy showed widespread cystic medionecrosis of the elastic pulmonary arteries.