Abstract
Pain is a major problem in sick newborn infants, especially for those needing intensive care. Pharmacological pain relief is the most commonly used, but might be ineffective and has side effects, including long-term neurodevelopmental sequelae. The effectiveness and safety of alternative analgesic methods are ambiguous. The objective was to review the effectiveness and safety of non-pharmacological methods of pain relief in newborn infants and to identify those that are the most effective. PubMed and Google Scholar were searched using the terms: “infant”, “premature”, “pain”, “acupuncture”, “skin-to-skin contact”, “sucrose”, “massage”, “musical therapy” and ‘breastfeeding’. We included 24 studies assessing different methods of non-pharmacological analgesic techniques. Most resulted in some degree of analgesia but many were ineffective and some were even detrimental. Sucrose, for example, was often ineffective but was more effective than music therapy, massage, breast milk (for extremely premature infants) or non-invasive electrical stimulation acupuncture. There were also conflicting results for acupuncture, skin-to-skin care and musical therapy. Most non-pharmacological methods of analgesia provide a modicum of relief for preterm infants, but none are completely effective and there is no clearly superior method. Study is also required to assess potential long-term consequences of any of these methods.
Highlights
Newborn infants admitted to an Neonatal Intensive Care Unit (NICU) undergo an average of 134 painful procedures within the first two weeks [1,2]
Articles were included if they described non-pharmacological techniques in preterm or term infants and excluded if they compared pharmacological and non-pharmacological intervention or there was no behavioral measurement of pain (e.g., PIPP (Premature Infant Pain Profile), or NIPS (Neonatal Infant Pain Scale))
A total of 10 studies were done in preterm infants, 12 studies were in term infants and four studies were done in preterm and term infants
Summary
Newborn infants admitted to an Neonatal Intensive Care Unit (NICU) undergo an average of 134 painful procedures within the first two weeks [1,2]. Some infants might experience more than 3000 painful procedures during the entire course of their NICU stay [3]. These procedures are often necessary to ensure best care, such as heel pricks for blood sampling or endotracheal suctioning. Some of these procedures are performed repeatedly on the same infant and have been shown to cause adverse physiological consequences, such as hypoxemia, bradycardia and hypertension [1]. Apart from acute discomfort, there is growing evidence, that painful (and repetitive) procedures may have adverse consequences on long-term neurological development.
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