We have developed a neonatal pain assessment tool CRIES. The tool is a ten point scale similar to the APGAR score (Apgar 1953). It is an acronym of five physiological and behavioural variables previously shown to be associated with neonatal pain. C--Crying; R--Requires increased oxygen administration; I--Increased vital signs; E--Expression; S--Sleeplessness. We have tested CRIES for validity and reliability. This report is the result of that testing. We have found CRIES to be valid, reliable and well accepted by neonatal nurses.

This is a retrospective study covering the ten-year period 1984-1993. Single shot spinal morphine (ITM) is compared with PCA nalbuphine for postoperative pain relief in children having abdominal or thoracic procedures. The records of 52 patients meeting selection criteria were examined. Nursing and physician notations were reviewed for hourly pain assessments, evidence of associated complications, respiratory depression, nausea and or vomiting, pruritus, and urinary retention. ITM provided significantly better pain relief (2.2 h in pain) during the first 24 h postoperatively than PCA nalbuphine (9.2 h in pain). With the exception of urinary retention which was significantly more frequent following ITM (58.6%) compared to PCA nalbuphine (8.7%), narcotic related complications were not different between the two groups. No difference in duration of hospital stay or ICU stay could be demonstrated. We conclude that ITM provides better pain relief, without more serious complications, than PCA nalbuphine. We recommend it as a safe, effective technique to treat postoperative pain in children following thoracic or upper abdominal procedures.

We present a case of severe bronchopulmonary dysplasia in which intrathecal morphine was successfully used for analgesia after a Nissen fundoplication and gastrostomy. Various options for anaesthesia are discussed with the knowledge that two previous procedures had been complicated by congestive cardiac failure and increased respiratory failure.

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