Analgosedation in neonates: what we know and how we act

Abstract

Inadequate pain management in neonatal life impairs the neurodevelopmental outcome. It alters pain thresholds, pain and stress-related behavior, and physiologic responses in later life. At the same time, there are emerging animal experimental and human epidemiologic data on the impact of analgosedatives on neuroapoptosis and impaired neurodevelopmental outcome. As a consequence, the management of neonatal pain is in search of a new equilibrium since these conflicting (undertreatment versus overtreatment) observations are the main drivers of its current management. Such tailoring includes new treatment modalities, and also more effective implementation strategies. The search for tailored nonpharmacologic (ie, less invasive techniques, preventive strategies, complementary techniques) and pharmacologic (eg, dexmedetomidine, intravenous acetaminophen, remifentanil) treatment modalities are discussed and reflect the increased knowledge on neonatal pain management. Despite this increasing knowledge ("toolbox") regarding neonatal pain, there is still a major gap between knowledge ("what we know") and practice ("how we act"). Consequently, more research activity on methods for effective implementation of the available knowledge is needed. Illustrations of effective approaches, eg, the Evidence-Based Practice for Improving Quality (EPIQ) initiative, to bridge this gap are provided. This is followed by an intersubjective proposal on priorities for contemporary clinical management and a research agenda.

The Rotterdam Elderly Pain Observation Scale (REPOS) is reliable and valid for non-communicative end-of-life patients

“…However, this approach asks more from the caregivers: it is a dynamic approach requiring evaluation and adjustment at regular times and when indicated. As daily pain assessment itself was shown to be problematic [ 47 ], one can wonder if an individualized approach is feasible in a daily care situation [ 48 , 49 ].…”

The COMFORT behaviour scale detects clinically meaningful effects of analgesic and sedative treatment

“…A similar cut‐off score for all patients is easier to remember and can be included in a pain and sedation protocol. In the long run, an individualized cut‐off score is probably the best option but perhaps hardly feasible in daily practice (Stevens et al., ; Allegaert and Bellieni, ).…”