Plans to reduce pain in the neonatal intensive care

Abstract

Prolonged pain influences behaviour and physiological regulation in preterm infants undergoing intensive care. Insufficient pain treatment results in increased morbidity and mortality. Long-term consequences of stress and pain yet are not clear, but associations with neurobehavioral and developmental sequelae are discussed. A number of psychometric constructs (pain scales) are available to identify pain indicators. These pain scales represent the basis to consider treatment strategies. Main indications are painful interventional procedures, analgesia during mechanical ventilation and the reduction of pain following surgery. Supporting approaches to reduce pain and stress relate to infant's behaviour, care of the professionals and improvement of "infant's world". Pharmacologic interventions are practicable with acetaminophen in mild pain and with opioid drugs (fentanyl and morphine) in moderate and severe pain. A pure or complementary sedative agent can provide physiological stability in settings in which there are less acutely painful stimuli. After standard pain evaluation it is necessary to individualize treatment, to monitor clinical situation and to adjust dosage. Actual knowledge allows an effective reduction of pain even in very premature infants. Because of lack of clarity about early development of pain and stress reactivity at the time it is necessary to estimate benefits against potential risks of therapy.