Pain management for children: the OPBG experience – newborn pain

Abstract

Abstract Pain in neonatology is still barely unexplored since until a few years ago, it was erroneously believed that premature newborns could not feel pain. Today, however, scientific investigation reveals that neuro-anatomical and neuro-endocrine substrates, responsible for pain perception and pain stimulus transmission, are fully developed in newborns, as well as in preterm infants. It means the newborn is able to feel and remember the pain as the process being stored in both the short and the long term memory. This determines immediate and/or later consequences (neurological, behavioural damages, sleep and feeding disorders) noticed during follow-ups. In neonatology wards the newborn becomes acquainted with physical, but also mental pain, both because of diagnosis and cure. He undergoes from minor procedures (hygiene, weight, heel puncture, naso-oral gastric tube insertion, etc) to major procedures (intubation, mechanic ventilation, surgery etc) and stressful situations (mother-child and father-child separation, blinding lights, noises, touched by many hands ect.) Neonatal intensive care units have been transformed according to the newborn's and his family's needs; They aim at providing a wider perspective of physical cures, changing the word “cure” into “care”, and not purely addressed to reach physical survival but also take care of affective relations and environment. It is important to assess neonatal pain and intervene with non-pharmacological procedures. Pain assessment scales allow quantifying pain by physiological (cardiac rate increase, blood pressure decrease etc) and behavioural (crying, body movements, facial expressions) parameters. In our Surgical Medical Department of Neonatology, we use PIPP (Premature Infant Pain Profile), CRIES (Crying, Requires Oxigeno, Increased vital signs, expression, Sleepless), NIPS (Neonatal Infant Pain Scale) and FLACC (Face, Legs, Activity, Cry, Consolability) pain assessment scales.