Short- and Long-term Impact of Neonatal Pain and Stress

Abstract

Listen

Translate article

After completing this article, readers should be able to: 1. Define the short- and long-term effects of acute pain on neonates. 2. Estimate the short- and long-term effects of repetitive pain and stress on neonates. 3. Understand how pain affects preterm and term neonates differently. 4. Synthesize the animal and human data that describe the effects of pain. Pain is an inseparable part of everyday life. It is universal, protective, and crucial for survival. Pain can have profound deleterious and disruptive effects on the quality of life. —Menon, Anand, McIntosh, 1998 Approximately 300,000 neonates are admitted to neonatal intensive care units (NICUs) annually in the United States. During their hospital stay, most infants undergo hundreds of diagnostic and therapeutic procedures that are necessary for their improved survival. Repetitive acute pain caused by invasive procedures, established pain resulting from neonatal diseases or surgery, and chronic/prolonged painful stimulation experienced by the NICU population often causes severe stress, probably leading to adverse neurologic outcomes. Follow-up studies of children and adolescents who were preterm infants have reported major developmental deficits, with lifetime needs for special assistance and increased health care costs for early intervention and special education. Early repetitive pain and maternal separation, both routine occurrences in the NICU, lead to permanent changes in peripheral, spinal cord, and supraspinal pain processing; neuroendocrine function; and neurologic development. These changes later manifest as abnormal pain states or pain thresholds, increased anxiety/stress disorders, attention-deficit disorder, or atypical behaviors such as hypervigilance and exaggerated startle responses. Although overall survival has improved dramatically, many NICU graduates have cerebral palsy, cognitive defects, attentional disorders, and other forms of long-term disability. Neonates are exposed to numerous painful procedures as well as chronic NICU care such as assisted ventilation. Large surveys from the United States and Canada have shown that neonates usually are treated for postoperative …