A Guide to Pain Assessment and Management in the Neonate

Abstract

Newborn infants experience acute pain with various medical procedures. Evidence demonstrates that controlling pain in the newborn period is beneficial, improving physiologic, behavioral, and hormonal outcomes. Multiple validated scoring systems exist to assess pain in a neonate; however, there is no standardized or universal approach for pain management. Healthcare facilities should establish a neonatal pain control program. The first step is to minimize the total number of painful iatrogenic events when possible. If a procedure cannot be avoided, a tiered approach to manage pain using environmental, non-pharmacologic, and pharmacologic modalities is recommended. This systematic approach should decrease acute neonatal pain, poor outcomes, and provider and parent dissatisfaction.

Anesthetic Management of the Newborn Surgical Patient

“…Biological markers for pain such as emotional sweating (palm or sole, measured by skin conductance or galvanic skin response) or increased stress hormones (serum or saliva cortisol) are used in research but have limited clinical utility. Among the validated neonatal pain scales, premature infant pain profile (PIPP) assesses procedural pain, and neonatal pain, agitation, and sedation scale (N-PASS) assesses ongoing pain and sedation in both term and preterm neonates, providing an advantage over other available neonatal pain assessment tools ( Table 9) [62][63][64][65].…”

“…Systemic opioid analgesics are utilized to treat moderate to severe pain in conjunction with the above therapies (Table 10) [66,67]. Analgesic medications are most reliable when given intravenously, as oral absorption is unpredictable in the neonate [64,68].…”

Infants' Pain Recognition Based on Facial Expression: Dynamic Hybrid Descriptions

“…For infants or individuals with communicative impairment, pain assessment is measured by physiological and/or behavioral indicators such as facial movements and body postures. NIPS (Neonatal Infant Pain Scale) and NPASS (Neonatal Pain, Agitation and Sedation Scale) [10] are two popular indicator-based scales for infants' pain assessment for acute pain and chronic pain respectively. The indicatorbased scales are utilized by trained nurses at different time intervals for adequate pain monitoring.…”

Pain Scale: When the Training Influences Its Use

“…Six of the indicators are behavioral ones (alertness, calmness, muscle tone, movement, facial tension, and respiratory response/crying), and two are physiological indicators: heart rate and mean arterial pressure [9].…”