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Infants, unlike adults, are at a disadvantage
All newborns undergo routine invasive procedures the first days and weeks after birth. Babies in the intensive care often undergo numerous medical procedures, yet pain in newborn babies is often unrecognized and undertreated, according to the International Consensus Group for Neonatal Pain, a collaborative of pediatric pain experts from around the world.
Because babies cannot talk or respond like adults, it is difficult for health care professionals to understand the type or degree of pain the baby is experiencing, contend these experts. Lack of understanding contributes to inadequate assessment, prevention, and management of pain.
To help health care providers manage pain in newborn babies, the group developed a set of guidelines. "Our recommendations are mainly applicable in established neonatal intensive care units that provide advanced medical and nursing care for critically ill babies. However, we are working toward adapting them for the management of neonatal pain in other clinical settings," says K.J.S. Anand, MD, chairman of the virtual group consisting of 25 physicians and nurses from 12 countries.
The guidelines, which were published in the February issue of the Archives of Pediatrics and Adolescent Medicine, consist of safe and effective treatment approaches for preventing and relieving pain, as well as principles for pain relief in neonates.
Treatment approaches include:
• Environmental. Producing a soothing atmosphere by reducing light and noise surrounding the baby.
• Behavioral. Providing comfort by swaddling the baby and using pacifiers.
• Pharmacological. Using analgesia as a pre-emptive comfort measure including oral sucrose, topical anesthetic creams such as EMLA cream, morphine and other opioids, and acetaminophen.
Principles for pain relief include:
• If a procedure is painful in adults, it should be considered painful in newborn infants, even if they are preterm.
• Adequate treatment of pain may be associated with decreased clinical complications and decreased mortality.
• The appropriate use of environmental, behavioral, and pharmacological interventions can prevent, reduce, or eliminate neonatal pain
in many clinical situations.
The guidelines are based on the latest research developments in an effort in an effort to link research and clinical practice. "We hope our work will stimulate further research by clearly outlining the areas where current evidence is not available with regard to specific therapeutic approaches," says Anand.
(Editor’s note: To help manage pediatric pain, look for an overview of pain assessment scales in the May issue of Patient Education Management.) n
For more information, or to obtain a copy of the guidelines, contact:
• K.J.S. Anand, MD, Chairman, International Consensus Group for Neonatal Pain, c/o Arkansas Children’s Hospital, 800 Marshall St., Little Rock, AR 72202. Telephone: (501) 320-1100.