Abstract
Background:The neurobiology of neonatal pain processing, especially in preterm infants, differs significantly from older infants, children, adolescence, and adults. Research suggests that strong painful procedures or repeated mild procedures may permanently modify individual pain processing. Acute injuries at critical developmental periods are risk factors for persistent altered neurodevelopment. The purpose of this narrative review is to present the seminal and current literature describing the unique physiological aspects of neonatal pain processing.Methods:Articles describing the structures and physiological processes that influence neonatal pain were identified from electronic databases Medline, PubMed, and CINAHL.Results:The representation of neonatal pain physiology is described in three processes: Local peripheral nervous system processes, referred to as transduction; spinal cord processing, referred to as transmission and modulation; and supraspinal processing and integration or perception of pain. The consequences of undermanaged pain in preterm infants and neonates are discussed.Conclusion:Although the process and pain responses in neonates bear some similarity to processes and pain responses in older infants, children, adolescence, and adults; there are some pain processes and responses that are unique to neonates rendering them at risk for inadequate pain treatment. Moreover, exposure to repeated painful stimuli contributes to adverse long-term physiologic and behavioral sequelae. With the emergence of studies showing that painful experiences are capable of rewiring the adult brain, it is imperative that we treat neonatal pain effectively.
Highlights
The neurobiology of neonatal pain processing, especially in preterm infants, differs significantly from older infants, children, adolescence, and adults
It has been nearly 27 years since Anand and Hickey’s[9] seminal article on neonatal pain established that nociceptive activity constitutes an overwhelming physiologic stress for infants, in some neonatal intensive care units (NICUs), 79.2% of painful procedures are performed without analgesia
Pain responses in neonates bear some similarity to pain responses in older infants, children, adolescence, and adults; there are some pain responses that are unique to neonates rendering them at risk for inadequate pain treatment.[11,17,35,36,49,52,89,145]
Summary
The neurobiology of neonatal pain processing, especially in preterm infants, differs significantly from older infants, children, adolescence, and adults. Acute injury at critical developmental periods are risk factors for persistent altered neurodevelopment.[42] During normal development, infant pain transmission and pain modulation undergo rapid growth beginning at 22 weeks gestation; achieving mature functioning at approximately 2 months of age.[4,120,142] Noxious stimuli during this vulnerable period of neuronal plasticity may trigger unpredicted long‐term epigenetic changes, which affect the brain, neurodevelopment, pain modulation, and pain reactivity into adulthood.[67,68,91,94,107]
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