Abstract
Effective management of pain remains an important indicator of the quality of care provided to neonates. Since the review of McIntosh in this journal over a decade ago, an extensive number of papers on assessment, prevention, and treatment of pain have been reported. In addition, preclinical insights into neurodevelopmental aspects of pain processing and the neuro-apoptotic effects of analgesics and sedatives were unveiled. Based on the newly collected evidence, the practice of “one-drug, one dose and one treatment fits all” became obsolete, necessitating a more individualized analgesia, based on non-pharmacological and pharmacological therapies and preventive strategies for effective management of neonatal pain. The progress made is impressive, but the current major challenge is to implement the available knowledge in clinical care. Future research should therefore focus on the evaluation of the effectiveness of non-opioid and moderately potent opioids compared to morphine and should also describe the methods to facilitate effective implementation. Finally, there is an extensive field of procedural techniques that need to be evaluated on their pain related response.
Similar content being viewed by others
References
Allegaert K, Tibboel D (2007) Shouldn’t we reconsider procedural techniques to prevent neonatal pain? Eur J Pain 11:910–912. doi:10.1016/j.ejpain.2007.01.007
Allegaert K, Daniels H, Naulaers G et al (2005) Pharmacodynamics of chloral hydrate in former preterm neonates. Eur J Pediatr 164:403–407. doi:10.1007/s00431-005-1648-5
Allegaert K, Tibboel D, Naulaers G et al (2003) Systematic evaluation of pain in neonates: effect on the number of intravenous analgesics prescribed. Eur J Clin Pharmacol 59:87–90
Allegaert K, de Hoon J, Van Overmeire B, Devlieger H (2005) Clinical pharmacology of non opioid analgesics in neonates. Verh K Acad Geneeskd Belg 67:289–315
Allegaert K, van den Anker JN, de Hoon JN et al (2008) Covariates of tramadol disposition in the first months of life. Br J Anaesth 100:525–532. doi:10.1093/bja/aen019
Anand KJ (1998) Clinical importance of pain and stress in preterm neonates. Biol Neonate 73:1–9. doi:10.1159/000013953
Anand KJ, International Evidence-Based Group for Neonatal Pain (2001) Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 155:173–180
Anand KJ, Hall RW, Desai N et al (2004) Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet 63:1673–1682. doi:10.1016/S0140-6736(04)16251-X
Anand KJ, Aranda JV, Berde CB et al (2006) Summary proceedings from the neonatal pain-control Group. Pediatrics 117:S9–S22. doi:10.1542/peds.2005-2250
Anderson BJ, van Lingen RA, Hansen TG et al (2002) Acetaminophen developmental pharmacokinetics in premature neonates and infants: a poolde population analysis. Anesthesiology 96:1336–1345. doi:10.1097/00000542-200206000-00012
Bartocci M, Bergqivst LL, Lagercrantz H, Anand KJ (2006) Pain activates cortical areas in the preterm newborn brain. Pain 122:109–117. doi:10.1016/j.pain.2006.01.015
Bouwmeester NJ, Hop WC, van Dijk M et al (2003) Postoperative pain in the neonate: age-related difference in morphine requirements and metabolism. Intensive Care Med 29:2009–2015. doi:10.1007/s00134-003-1899-4
Carbajal R, Rousset A, Danan C et al (2008) Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA 300:60–70. doi:10.1001/jama.300.1.60
Cignacco E, Hamers JP, Stoffel L et al (2007) The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates. A systematic literature review. Eur J Pain 11:139–152. doi:10.1016/j.ejpain.2006.02.010
Debillon T, Zupan V, Ravault N, Magny JF, Dehan M (2001) Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch Dis Child Fetal Neonatal Ed 85:F36–F41. doi:10.1136/fn.85.1.F36
Fitzgerald M (2005) The development of nociceptive circuits. Nat Rev Neurosci 6:507–520. doi:10.1038/nrn1701
Gjerstad AC, Wagner K, Henrichsen T, Storm H (2008) Skin conductance versus the modified COMFORT score as a measure of discomfort in artificially ventilated children. Pediatrics 122:848–853. doi:10.1542/peds.2007-2545
Howard R, Carter B, Curry J et al (2008) Special issue: good practice in postoperative and procedural pain management. Paediatr Anaesth 18(S1):1–81. doi:10.1111/j.1155-5645.2008.02423.x
Ivani G, Mossetti V (2008) Regional anesthesia for postoperative pain control in children: focus on continuous central and perineural infusions. Paediatr Drugs 10:107–114. doi:10.2165/00148581-200810020-00005
McIntosh N (1997) Pain in the newborn, a possible new starting point. Eur J Pediatr 156:173–177. doi:10.1007/s004310050576
Müller C, Kremer W, Harlfinger S et al (2006) Pharmacokinetics of piritramide in newborns, infants and young children in intensive care units. Eur J Pediatr 165:229–239. doi:10.1007/s00431-005-0021-z
Okan F, Coban A, Ince Z et al (2007) Analgesia in preterm newborns: the comparative effects of sucrose and glucose. Eur J Pediatr 166:1017–1024. doi:10.1007/s00431-006-0373-z
Peters JW, Schouw R, Anand KJ et al (2005) Does neonatal surgery lead to increased pain sensitivity in later childhood. Pain 114:444–454. doi:10.1016/j.pain.2005.01.014
Ranger M, Johnston CC, Anand KJ (2007) Current controversies regarding pain assessment in neonates. Semin Perinatol 31:283–288. doi:10.1053/j.semperi.2007.07.003
Sanders RD, Ma D, Brooks P, Maze M (2008) Balancing paediatric anaesthesia: preclinical insights into analgesia, hypnosis, neuroprotection, and neurotoxicity. Br J Anaesth 101:597–609. doi:10.1093/bja/aen263
Sharek PJ, Powers R, Koehn A, Anand KJ (2006) Evaluation and development of potentially better practices to improve pain management of neonates. Pediatrics 118:S78–S86. doi:10.1542/peds.2006-0913D
Simons SH, van Dijk M, Anand KS et al (2003) Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med 157:1058–1064. doi:10.1001/archpedi.157.11.1058
Simons SH, van Dijk M, van Lingen RA et al (2003) Routine morphine infusion in preterm newborns who received ventilatory support: a randomized controlled trial. JAMA 290:2419–2427. doi:10.1001/jama.290.18.2419
Taddio A, Shah V, Hancock R et al (2008) Effectiveness of sucrose analgesia in newborns undergoing painful medical procedures. CMAJ 179:37–43. doi:10.1503/cmaj.071734
Van Dijk M, Peters JW, Bouwmeester NJ, Tibboel D (2002) Are postoperative pain instruments useful for specific groups of vulnerable infants? Clin Perinatol 29:469–491. doi:10.1016/S0095-5108(02)00015-5
Westrup B (2007) Newborn Individualized Developmental Care and Assessment Program (NIDCAP)—family-centered developmentally supportive care. Early Hum Dev 83:443–449. doi:10.1016/j.earlhumdev.2007.03.006
Acknowledgments
The clinical research of Karel Allegaert is supported by the Fund for Scientific Research, Flanders (Belgium) and F.W.O. Vlaanderen by a Fundamental Clinical Investigatorship (1800209 N).
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Allegaert, K., Veyckemans, F. & Tibboel, D. Clinical practice: analgesia in neonates. Eur J Pediatr 168, 765–770 (2009). https://doi.org/10.1007/s00431-009-0932-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00431-009-0932-1