Psychosocial and Neurobiological Vulnerabilities of the Hospitalized Preterm Infant and Relevant Non-pharmacological Pain Mitigation Strategies

Abstract

Background: Preterm pain is common in the Neonatal Intensive Care Unit (NICU), with multiple invasive procedures occurring daily.Objective: To review the psychosocial and neurobiological vulnerabilities of preterm infants and to provide an updated overview of non-pharmacological strategies for acute procedural pain in hospitalized preterm infants.Methods: We utilized a narrative review methodology, which also included a synthesis of key pieces of published systematic reviews that are relevant to the current work.Results and Conclusions: Preterm infants are uniquely susceptible to the impact of painful procedures and prolonged separation from caregivers that are often inherent in a NICU stay. Non-pharmacological interventions can be efficacious for mitigating procedural pain for preterm infants. Interventions should continue to be evaluated with high quality randomized controlled trials, and should endeavor to take into account the neurobiological and psychosocial aspects of preterm vulnerability for pain prevention and management strategies.

Effect of Non-Pharmacological Methods in the Reduction of Neonatal Pain: Systematic Review and Meta-Analysis

“…Studies show that unrelieved acute pain can affect the neurodevelopment of neonates, producing motor, cognitive, and behavioural alterations [ 9 , 10 ]. It is therefore necessary to modify clinical practice and attenuate stimuli in order to guarantee the comfort of these patients [ 11 , 12 ].…”

Effects of white noise on preterm infants in the neonatal intensive care unit: A meta‐analysis of randomised controlled trials

“…Preterm infants in the NICU are subjected to invasive medical therapies on a regular basis in order to prevent, diagnose, and treat severe illnesses (Coviello et al., 2018 ). Furthermore, it was demonstrated that they were exposed to an average of 12–17 procedures daily in the NICU (Shiff et al., 2021 ). Therefore, identifying interventions that minimise pain levels with minor side effects is extremely urgent for healthcare providers and researchers.…”

Effect of non-pharmacological interventions on pain in preterm infants in the neonatal intensive care unit: a network meta-analysis of randomized controlled trials

“…Research studies have indicated that multiple acute pain procedures in NICUs can result in “a chronically painful state” for preterm infants [ 64 , 65 ], which is detrimental to pain recovery, neurodevelopment, and psychosocial health [ 66 ]. Non-pharmacological interventions for managing pain have gained significant attention in recent years.…”

“…Non-pharmacological interventions for managing pain have gained significant attention in recent years. However, the effectiveness of these interventions has not yet been clear and remains an area of ongoing research [ 66 , 67 ]. Based on this, this meta-analysis compared their efficacy and found that OS + NNS, facilitated tucking and auditory intervention were relatively more effective.…”