Abstract
Infants born preterm are at a high risk for repeated pain exposure in early life. Despite valid tools to assess pain in non-verbal infants and effective interventions to reduce pain associated with medical procedures required as part of their care, many infants receive little to no pain-relieving interventions. Moreover, parents remain significantly underutilized in provision of pain-relieving interventions, despite the known benefit of their involvement. This narrative review provides an overview of the consequences of early exposure to untreated pain in preterm infants, recommendations for a standardized approach to pain assessment in preterm infants, effectiveness of non-pharmacologic and pharmacologic pain-relieving interventions, and suggestions for greater active engagement of parents in the pain care for their preterm infant.
Highlights
Management of Pain in PretermUbiquitous exposure to acute pain is inevitable for all infants, for most within the initial hour and first day(s) after birth as part of recommended medical care [1]
Studies in this review reported that infants went without any form of analgesia during painful procedures ranging from 42–100% of the time, with the majority of studies reporting no pain treatment [12]
This paper provides a narrative review of the current best evidence regarding the assessment and management of pain for infants born preterm requiring neonatal intensive care
Summary
Ubiquitous exposure to acute pain is inevitable for all infants, for most within the initial hour and first day(s) after birth as part of recommended medical care [1]. Data from Canadian [7] and European [8,9,10,11] studies demonstrate that infants can undergo anywhere from one to 14 procedures per day when hospitalized in the neonatal intensive care unit (NICU). Studies in this review reported that infants went without any form of analgesia during painful procedures ranging from 42–100% of the time, with the majority of studies reporting no pain treatment [12] These findings are consistent with a prospective observational study over one week in 14 Canadian NICUs [7]. For infants delivered very preterm, controlling for gestational age, severity of illness and morbidity exposure to early pain-related distress is associated with both immediate physiologic instability and pain sensitivity as well as long-lasting deleterious impacts on cognition and behavior [13,14] and poor executive function and visual abilities [15]. This paper provides a narrative review of the current best evidence regarding the assessment and management of pain for infants born preterm requiring neonatal intensive care
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