Prevention and management of pain in the neonatal intensive care unit

Abstract

Variable degrees of neonatal discomfort, stress, or pain re sulting from mild to moderate procedures may occur during routine neonatal intensive care. 1) Health care providers are also expected to prevent or treat pain. Preventing and relieving pain in neonates is important because it is a moral obligation and exposure to repeated pain experiences during the neonatal period is known to have short and longterm adverse effects, including alterations in pain sensitivity and reactivity and the generalized stress arousal system. 2) Nociceptive pathways are active and functional in the fetus by 25 weeks of gestation and may provoke a generalized or overstated response to harmful stimuli in newborns. 2) Assessing pain in newborns is challenging because of the infants' inability to communicate with the health care providers. 3) Therefore, neonatal intensive care units must adopt effective pain assessment tools that consider multiple factors (gestational age and physiological and behavioral responses to pain). Thus, health care professionals face the dilemma of balancing the need for proper monitoring, testing, and treatment with the need to minimize patient pain and stress. Certain nonpharma cological methods can efficiently decrease pain and discomfort due to routine care measures and minor procedures (e.g., heel stick and phlebotomy) in preterm and term neonates. 4) These methods include breastfeeding, nonnutritive sucking, swaddling, or facilitated tucking (gently maintaining the arms and legs in a flexed position), skintoskin contact (e.g., kangaroo care), and sensorial saturation through massage, touch, voice, and smell. Pharmacological therapies for neonatal pain control include oral sucrose and other sweet liquids, local analgesia includ ing topical anesthetics and lidocaine, and systematic analgesia including opioid therapy (morphine and fentanyl). 5) When sucrose is used, it should be prescribed and tracked as a medication, and the neonate should be monitored for changes in vital signs as well as any clinical signs of aspiration. Whenever pharmacological therapyespecially systematic analgesia-is used, the balance between the benefits and the adverse effects of the intervention must be considered. Opioid therapy, in parti cular, can have numerous adverse effects including respira tory depression, hypotension, urinary retention, and reduced gut motility. 5)

Effectiveness of Gentle Human Touch for Pain Control During Examination for Retinopathy of Pre-maturity: A Randomized Controlled Trial

“…Therefore, prevention and alleviation of pain in newborns, particularly pre-mature babies, are important. The Guide to Neonatal Pain indicates that analgesic treatment mainly includes environmental measures, non-pharmacological measures, and drug-based treatment (12). For any procedure in newborns, clinicians should try and operate in a quiet and relaxed environment with minimum noxious stimuli such as light and noise (8).…”

“…The degree of pain before and during the examination were quantified using the Pre-mature Infant Pain Profile (PIPP) (12). The PIPP assessment items include the gestational age, increased HR, decreased blood oxygen saturation (SaO 2 ), a state of arousal, and the proportion of painful expressions throughout the examination (frowning, blinking, and wrinkling the nose and sulcus).…”

Itemreduktion zur Verbesserung der Praktikabilität neonatologischer Schmerzmesssysteme

“…Es wurde festgestellt, dass täglich im Durchschnitt zwei bis zehn potenziell schmerzhafte Prozeduren im Rahmen der medizinischen Versorgung von Frühgeborenen auf der neonatologischen Intensivstation durchgeführt werden [3]. Auch wenn das oberste Ziel die Schmerzprävention ist, können Schmerzen nie vollständig vermieden werden [16,24].…”

Scoping review of systematic reviews of nursing interventions in a neonatal intensive care unit or special care nursery

“…Their role is multifaceted, attending to and supporting the complex needs of the infant and family in the neonatal unit (Kenner & McGrath, 2004). NICU and SCN nurses provide various treatments and nursing care to newborns, including oxygen therapy, mechanical ventilation, maintenance of vital signs, nutritional supplementation, infection prevention (Lee et al., 2020) and pain prevention and management (Kim, 2020). Key roles for neonatal nurses include providing direct care to newborns and families through education, advocacy, research, participation in shaping neonatal health policy and inpatient and health systems management.…”