Neonatal Pain Assessment Research Articles

Evaluating neonatal pain via fusing vision transformer and concept-cognitive computing

In clinical nursing, neonatal pain assessment is a challenging task for preventing and controlling the impact of pain on neonatal development. To reduce the adverse effects of repetitive painful treatments during hospitalization on newborns, we propose a novel method (namely pain concept-cognitive computing model, PainC3M) for evaluating facial pain in newborns. In the fusion system, we first improve the attention mechanism of vision transformer by revising the node encoding way, considering the spatial structure, edge and centrality of nodes, and then use its corresponding encoder as a feature extractor to comprehensively extract image features. Second, we introduce a concept-cognitive computing model as a classifier to evaluate the level of pain. Finally, we evaluate our PainC3M on various open pain data sets and a real clinical pain data stream, and the experimental results demonstrate that our PainC3M is very effective for dynamic classification and superior to other comparative models. It also provides a good approach for pain assessment of individuals with aphasia (or dementia).

The Effect of Maternal Oxytocin Induction during Birth on Early Neonatal Pain and Stress: A Quasi-Experimental Study.

Oxytocin induction is a commonly used intervention during childbirth worldwide. This study aimed to compare the pain and stress levels of newborns born to mothers who administered synthetic oxytocin at birth with those who did not. This quasi-experimental study included 164 participants and their newborns who were delivered vaginally in a public hospital. The data were collected using an Information Form, a Neonatal Follow-Up Form, and the Assessment of Neonatal Pain and Stress Scale (ALPS-Neo). In the study, there were no differences between the two groups in terms of the participants' and newborns' demographic characteristics (p > .05). During and after drying, before, during, and after the first injection, and before, during, and after blood glucose measurement, the mean ALPS-Neo scores were higher in the oxytocin induction group, with the difference being statistically significant (p < .001). Although the data presented here are observational, the findings indicate that infants born to participants who underwent oxytocin induction exhibit more intense pain and stress responses. The pain-stress scores of newborns born to participants who underwent oxytocin induction were higher than those of newborns whose mothers did not receive oxytocin induction.

Developing and Validating a Multimodal Dataset for Neonatal Pain Assessment to Improve AI Algorithms With Clinical Data.

Using Artificial Intelligence (AI) for neonatal pain assessment has great potential, but its effectiveness depends on accurate data labeling. Therefore, precise and reliable neonatal pain datasets are essential for managing neonatal pain. To develop and validate a comprehensive multimodal dataset with accurately labeled clinical data, enhancing AI algorithms for neonatal pain assessment. An assessment team randomly selected healthy neonates for assessment using the Neonatal Pain, Agitation, and Sedation Scale. During painful procedures, 2 cameras recorded neonates' pain reactions on site. After 2weeks, assessors labeled the processed pain data on the EasyDL platform in a single-anonymized setting. The pain scores from the 4 single-modal data types were compared to the total pain scores derived from multimodal data. The On-Site Neonatal Pain Assessment completed using paper quality scales is referred to as OS-NPA, while the modality-data neonatal pain labeling performed using labeling software is MD-NPL. The intraclass correlation coefficient among the 4 single-modal groups ranged from 0.938 to 0.969. The overall pain intraclass correlation coefficient score was 0.99, with a Kappa statistic for pain grade agreement of 0.899. The goodness-of-fit for the linear regression models comparing the OS-NPA and MD-NPL for each assessor was greater than 0.96. MD-NPL represents a productive alternative to OS-NPA for neonatal pain assessment, and the validity of the data labels within the Multimodality Dataset for Neonatal Acute Pain has been validating. These findings offer reliable validation for algorithms designed to assess neonatal pain.

Comparative analysis of artificial intelligence and expert assessments in detecting neonatal procedural pain

Assessing pain in newborns in the NICU is crucial due to their frequent exposure to painful stimuli, yet it's challenging due to the subjective nature of current methods. This study aimed to evaluate the effectiveness of an AI system designed for automatic facial recognition by comparing its performance with the expert opinion of health care provider. This is a secondary analysis from an eye-tracking study, assessing neonatal pain evaluations by healthcare professionals. The performance of AI software, FaceReader 9, was compared to experts' evaluations using a visual-analog scale, focusing on identifying specific facial action units associated with different pain levels. The study found significant differences in AI-generated metrics—arousal and valence—across three stimulus types: non-noxious thermal, short-noxious, and prolonged-noxious, with p-values below 0.001. A strong correlation (r = 0.84, p ≤ .001) was observed between AI metrics and expert ratings. Eleven facial action units were identified as relevant to describe neonatal pain. The findings highlight the AI system's potential in accurately detecting and analyzing newborn facial expressions in response to varying pain intensities, demonstrating a significant correlation with healthcare professionals' assessments. This suggests that AI technology could enhance objective pain assessment in neonates.

Knowledge, Perception, and Attitudes of Nursing Staff about Assessment and Management of Neonatal Pain

Knowledge, Perception, and Attitudes of Nursing Staff about Assessment and Management of Neonatal Pain

Protocol for neonatal pain assessment and management: Application of the ALPS Neo scale in routine care

Background and objectives. Neonatal pain research has advanced, disproving earlier beliefs that neonates cannot feel pain due to immature nervous systems. Incomplete myelination slows but does not prevent pain conduction. Pain responses start around 7.5 weeks post-conception, with pain receptors throughout the body by 20 weeks. Pain pathways are established by 22 weeks, but full modulation develops by 32 weeks, making preterm infants more sensitive. Nociceptors detect pain through A-delta (sharp pain) and C-fibers (dull pain). Tissue damage releases chemicals that lower the pain threshold. Pain is classified as nociceptive, somatic, or visceral and can be acute or chronic. Early pain exposure affects later responses. Validated pain scales for neonates include COVERS, PIPP, NIPS, NFCS, and ALPS Neo. Current practice emphasizes preventing and treating pain to minimize stress. Materials and methods. This study at Life Memorial Hospital will analyze patients over 1 month and over 6 months, with ethical approval obtained beforehand. Inclusion criteria: neonates with a gestational age over 35 weeks, birth weight over 2000 grams, needing routine care. Exclusion criteria: neonates needing respiratory support/sedation or with abnormal neurological exams. We will use the ALPS Neo pain assessment scale for its reliability and ease of integration into daily care, aiming to reduce pain or stress duration. Patients will be scored on facial expression, breathing, extremity tone, hand/foot activity, and activity level. Scores of 3-5 will prompt non-pharmacological interventions. Scores above 5 will require frequent reassessments and possible pharmacological intervention. The medical team will be trained on the ALPS Neo scale and non-pharmacological pain reduction methods. Pain from procedures like vaccinations will be assessed during the first two days of life. Initially, control patients will be evaluated without interventions. Over the next 6 months, patients will receive non-pharmacological interventions, including non-nutritive sucking, sucrose, Kangaroo Mother Care, swaddling, and maternal milk or formula. Our group aims to establish an evidence-based protocol for pain assessment and management and to use it in prospective research in which the objectives would be to use a pain scale for more accurate pain data from procedures, identify and reduce the most painful procedures, evaluate and improve the effectiveness of pain management strategies. Conclusions. This observational study at Life Memorial Hospital will use the ALPS Neo pain assessment scale to improve neonatal pain management within the Kangaroo Mother Care program. By comparing a 1-month control group with a 6-month group, we aim to identify and reduce procedural pain. The ALPS Neo scale will enable precise pain assessment and targeted non-pharmacological interventions, potentially guiding future pain management strategies. The choice of ALPS Neo, which is familiar to our team, will ease training and implementation. Success may lead to exploring scales with objective measures, though ALPS Neo will initially drive our improvements in pain management.

Development of the neonatal pain response variable set: a mixed methods consensus process

While over 40 neonatal pain assessment scales have been published, owing to a lack of consensus and standardized metrics, there are more than 100 assessment indicators with varying descriptors and quality differences. This study aims to reach a consensus on optimal and comprehensive variables for neonatal pain assessment, leading to the development of a multidimensional neonatal pain response variable set. This study consisted of three phases: (1) A literature review was conducted to identify influencing factors and assessment indicators of neonatal pain response. (2) Panel meetings involving neonatal healthcare professionals evaluated and screened factors and indicators to develop an initial draft of the variable set. (3) Through two rounds of Delphi study achieved consensus, and determined the neonatal pain response variable set. Through a literature review and a panel meeting, the identified factors and indicators were categorized into contextual, physiological, and behavioral variables, forming an initial draft of the variable set. Sixteen professionals participated in two rounds of the Delphi study, with response rates exceeding 70%, and authority coefficients surpassing 0.7 in both rounds. The final iteration of the variable set includes 9 contextual variables, 2 physiological variables, and 5 behavioral variables. Conclusion: Neonatal pain response variable set developed in this study is scientific, comprehensive, and multidimensional, aligning with the characteristics of neonatal pain response and clinically applicable. The inclusion of contextual variables enhances the ability to confront the complexity of clinical environments and individual differences. It can provide a practical and theoretical basis for clinical research on neonatal pain assessment.What is Known:• Neonatal pain assessment relies on scales used by healthcare professionals currently. But there is no “gold standard” for neonatal pain assessment.• While over 40 neonatal pain assessment scales have been published, owing to a lack of consensus and standardized metrics, there are more than 100 assessment indicators with varying descriptors and quality differences. Most of scales overlook the clinical environment complexity individual differences in pain responses, diminishing the accuracy and applicability.What is New:• In addition to the commonly used physiological and behavioral variables in the scales, we have incorporated contextual variables to better address the complexity of clinical environments and individual differences in pain responses.• Through an evidence-based approach, developed a neonatal pain response variable set comprising 9 contextual variables, 2 physiological variables, and 5 behavioral variables.

Nurses' Assessment of Pain in Saudi Neonatal Intensive Care Units

BackgroundResearch reveals that neonatal pain management in Neonatal Intensive Care Units (NICUs) is suboptimal. There is limited research that assessed NICU nurses’ pain assessment practices in Saudi Arabia. AimTo assess the nurses’ pain assessment practices in the NICU in Saudi Arabia. DesignThis study used a descriptive cross-sectional design. SettingsResearch was conducted using an online survey. Participants/SubjectsThis study was carried out on 65 NICU nurses. The participants were recruited from one governmental and one private hospital in Saudi Arabia. MethodsData on pain assessment practices were collected, including the frequency of pain assessment, pain assessment scales used for preterm and term neonates, and pain assessment documentation. Data were analyzed using frequencies and percentages. ResultsThe majority of the participants (94%) routinely assessed pain and documented pain assessment (97%). One-third of the participants assessed pain regularly every hour (32%). The most used pain assessment scales for term neonates were the neonatal infant pain scale (40%) and the cry, required oxygen, increased vital signs, expression, and sleeplessness scale (23%). The most used pain assessment scales for preterm neonates were the neonatal infant pain scale (31%), the cry, required oxygen, increased vital signs, expression, sleeplessness scale (19%), and the premature infant pain profile (17%). ConclusionsNICU nurses in Saudi Arabia consistently assessed for and documented pain; however, the tools chosen were sometimes suboptimal. A substantial number of NICU nurses used invalid tools to assess pain in term and preterm neonates. An interventional program is needed to enhance the use of evidence-based practice recommendations regarding neonatal pain assessment by nurses in the Neonatal Intensive Care Units in Saudi Arabia.

Tracheal extubation under Narcotrend EEG monitoring at different depths of anesthesia after tonsillectomy in children: a prospective randomized controlled study.

This study aims to investigate whether tracheal extubation at different depths of anesthesia using Narcotrend EEG (NT value) can influence the recovery quality from anesthesia and cognitive function of children who underwent tonsillotomy. The study enrolled 152 children who underwent tonsillotomy and were anesthetized with endotracheal intubation in our hospital from September 2019 to March 2022. These patients were divided into Group A (conscious group, NT range of 95-100), Group B (light sedation group, NT range of 80-94), and Group C (conventional sedation group, NT range of 65-79). A neonatal pain assessment tool, namely, face, legs, activity, cry, and consolability (FLACC), was used to compare the pain scores of the three groups as the primary end point. The Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) scales were used to evaluate the cognitive function of children in the three groups before and after surgery as the secondary end points. Differences were observed in the awakening time and FLACC scores after awakening among the three groups (P < 0.05). Among them, Group A exhibited a significantly shorter awakening time and higher FLACC score after awakening than those in Groups B and C (both P < 0.05). The total incidence of adverse reactions in Group B was significantly lower than that in Groups A and C (P < 0.05). No significant difference was observed in MMSE and MoCA scores before the operation and at 7 days after the operation among the three groups (P > 0.05), but a significant difference was found in MMSE and MoCA scores at 1 day and 3 days after the operation among the three groups (P < 0.05). In addition, MMSE and MoCA scores of the three groups decreased significantly at 1 day and 3 days after the operation than those at 1 day before the operation (P < 0.05). When the NT value of tonsillectomy is between 80 and 94, tracheal catheter removal can effectively improve the recovery quality and postoperative cognitive dysfunction of children.

Neonatal Intensive Care Nurses' Knowledge of Neonatal Pain Assessment in Private and Public Hospitals in Jeddah, Saudi Arabia: A Cross-Sectional Study.

Neonatal Intensive Care Unit (NICU) nurses with adequate neonatal pain assessment knowledge are crucial in effective neonatal pain management. There is limited research that assessed the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment. To assess the knowledge of NICU nurses in Saudi Arabia regarding neonatal pain assessment. A cross-sectional design using an online survey was conducted to capture information regarding neonatal pain assessment knowledge from 125 NICU nurses in Saudi Arabia. Knowledge of pain assessment was assessed using a modified version of the knowledge, attitudes, and practice scale. Knowledge scores were classified as high, average, and low. Participants' knowledge regarding neonatal pain assessment was inadequate (Mean = 63/100). The majority of the participants had a low to average level of knowledge (n= 97, 78%). A significant proportion of NICU nurses had inadequate knowledge regarding neonatal pain assessment, which can be improved. Educational interventions are needed to boost these nurses' knowledge regarding neonatal pain assessment.

Biomarkers for assessing pain and pain relief in the neonatal intensive care unit.

Newborns admitted to the neonatal intensive care unit (NICU) regularly undergo painful procedures and may face various painful conditions such as postoperative pain. Optimal management of pain in these vulnerable preterm and term born neonates is crucial to ensure their comfort and prevent negative consequences of neonatal pain. This entails accurate and timely identification of pain, non-pharmacological pain treatment and if needed administration of analgesic therapy, evaluation of treatment effectiveness, and monitoring of adverse effects. Despite the widely recognized importance of pain management, pain assessment in neonates has thus far proven to be a challenge. As self-report, the gold standard for pain assessment, is not possible in neonates, other methods are needed. Several observational pain scales have been developed, but these often rely on snapshot and largely subjective observations and may fail to capture pain in certain conditions. Incorporation of biomarkers alongside observational pain scores holds promise in enhancing pain assessment and, by extension, optimizing pain treatment and neonatal outcomes. This review explores the possibilities of integrating biomarkers in pain assessment in the NICU.

Neonatal pain management practices in Somali region of Ethiopia: insights from neonatal intensive care unit providers.

Neonates admitted to neonatal intensive care units experience an average of 8-17 moderate to severe painful procedures per day. Because neonates lack the cognitive capacity to express their pain's location or severity, they are very dependent on healthcare providers to recognize, assess, and manage their pain. The health and development of newborns are negatively impacted by persistent or untreated pain experienced early in life. Therefore, studying neonatal pain management practices and associated factors in healthcare is critical to tackling workforce problems, enhancing neonatal care, and lowering the long-term health impacts of neonates. From January 1 to 30, 2023, a facility-based cross-sectional study design was used at six public hospitals in the Somali region of Ethiopia. A total of 336 healthcare providers enrolled using a simple random sample technique. A self-administered, structured questionnaire was utilized to collect the data. The analyses used bivariate and multivariate logistic regression. To find the association between the outcome and predictor factors, the odd ratio and the 95% CI were computed. The study revealed that 35.4% [95% CI 30.4%-40.5%] of respondents reported that they had good neonatal pain management practices. Ever having undergone training in neonatal pain assessment and management [AOR = 2.26 (95% CI 1.259, 4.07)], availability of pain assessment tools [AOR = 3.05 (95% CI 1.249, 7.469)], and having a favorable attitude toward neonatal pain management practice [AOR = 3.71 (95% CI 1.525, 9.035)] were found to be factors with a significant association with neonatal pain management practice. Based on the study's findings, there is a low level of neonatal pain management practice among healthcare providers in the Somali region. The study emphasizes the significance of having access to pain assessment tools and the requirement for healthcare professionals to get training on neonatal pain assessment and management.

Description of Perceptions of Neonatology Nurses in the Implementation of Assessment and Management of Pain in Neonates

Neonates with complications admitted to the Neonatal Intensive Care Unit (NICU) must receive various invasive actions that cause negative impacts, one of which is pain. The limited growth and development of neonates causes pain to be objective depending on the nurse's perception. As a result, pain is not managed properly and has a high risk of causing negative impacts for neonates. Objective: This study aims to identify the perception of neonatology nurses in the implementation of pain assessment and management in neonates. Method: This study used descriptive quantitative research with a cross-sectional time approach to neonatology nurses who were collected in pediatric nurse organizations in the West Java region using a convenience sampling technique. The instrument used was The Nurses' Attitudes and Perceptions of Pain Assessment in Neonatal Intensive Care Questionnaire (NAPPAQ). Results: The results of the study with a total of 72 respondents, 50% of respondents strongly agreed on the importance of pain assessment, and 48.6% strongly agreed on the importance of using pain assessment tools. The assessment tools that are often used in assessing pain are NIPS (72.2%), and non-pharmacological pain management that is often given is physical methods. Conclusions: Although most nurses agree on the importance of pain assessment, in practice there are still nurses who assess pain without using clear assessment tools.

Video-Based Neonatal Pain Assessment in Uncontrolled Conditions.

Neonatal pain can have long-term adverse effects on newborns' cognitive and neurological development. Video-based Neonatal Pain Assessment (NPA) method has gained increasing attention due to its performance and practicality. However, existing methods focus on assessment under controlled environments while ignoring real-life disturbances present in uncontrolled conditions. We propose a video-based NPA method, which is robust to four real-life disturbances and adaptively highlights keyframes. Our method involves a region-channel-attention module for extracting facial features under the disturbances of facial occlusion and pose variation; a body language analysis module robust to disturbances from body occlusion and movement interference, which utilizes skeleton sequences to represent the neonate's body; and a keyframes-aware convolution to get rid of information located at non-contributing moments. For evaluation, we built an NPA video dataset of 1091 neonates with disturbance annotations. The results show that our method consistently outperforms state-of-the-art methods on the full dataset and nine subsets, where it achieves an accuracy of 91.04% on the full dataset with an accuracy increment of 6.27%. Contributions: We present the problem of video-based NPA under uncontrolled conditions, propose a method robust to four disturbances, and construct a video NPA dataset, thus facilitating the practical applications of NPA.

NEONATAL PAIN MANAGEMENT PRACTICES AMONG NURSES WORKING IN NEWBORN UNITS IN NYANZA AND WESTERN KENYA

Background: Newborn babies in the Neonatal Intensive Care Units (NICU) and Newborn Units (NBUs) undergo several procedures that cause a significant amount of pain. Nurses play an essential role in the implementation of pain assessment and management measures in neonates. However, while it remains widely known that nurses play an important role in neonatal pain management, nurses’ practices on the management of pain in neonates admitted in Newborn care units have not been widely published within the nursing science.&#x0D; Objectives: To evaluate neonatal pain management practices among nurses working in newborn units in Nyanza and Western Kenya.&#x0D; Methods: A descriptive cross-sectional study using qualitative and quantitative approaches was used targeting 89 nurses. The collection of data was done through semi-structured, self-administered questionnaires with both closed and open –ended questions. Qualitative data was collected through in-depth interviews. Data obtained was analyzed using the statistical package for social science (SPSS) version 22.0 software. The study assumed a confidence level of 95% and a (p) value equal to or less than 0.05 was considered significant. Qualitative data was analyzed through logic checks to understand the emerging themes. Descriptive statistical analysis was done using frequencies, percentage and means.&#x0D; Results: The study established that a small percentage of the nurses practiced pain management in neonates through use of non-pharmacologic (34.8%) and pharmacologic (28.1%) strategies. The commonly used non-pharmacologic strategies include changing of nappies (71.9%) and repositioning (68.5). Pain assessment was however seldom done.&#x0D; Conclusion: Following the results, the study concluded that nurses practice pain management in neonates by implementing non-pharmacological and pharmacological strategies. The commonly used pain management strategy in neonates is utilization of non-pharmacological strategies such as change of nappies repositioning and kangaroo mother care. However, gaps exist in knowledge and competency on neonatal pain management aspects and practice. The study therefore recommended enhancement of awareness on aspects of neonatal pain among nurses to facilitate improved pain management practices in neonates. Further strengthening of nurses’ knowledge and skills on pain management in neonates through attending scheduled short courses, workshops and on job training is recommended.&#x0D;

Tube Laparostomy as Initial and Sole Intervention for Neonates with Idiopathic Pneumoperitonium.

Objective: To determine the efficacy of tube laparostomy an initial and sole surgical intervetion in neonates diagnosed with idiopathic pneumoperitonium. Study Design: Retrospective study. Setting: Department of Pediatric Surgery, Ghulam Muhammad Mahar Medical College Sukkur and Department of Pediatric Surgery, Chandka Medical College Larkana. Period: 1st April 2020 till 30th March 2023. Material &amp; Methods: Tube laparostomy was done in Operation Theater under local anesthesia in all neonates with pneumoperitonium. After the procedure all patients were kept in neonatal intensive care unit for close observation. Patients draining gut contents in the drain underwent exploratory laparotomy while who clinically improved with only serous discharge in the drains and recovered smoothly were labeled as cases of idiopathic or benign pneumopertonium. Data was collected that included, age, gender, weight, efficacy of the procedure, need to do exploratory laparotomy, post-operative pain scores assessed with the help of neonatal infant pain assessment, total hospital stay length and mortality. Results: A total of 178 cases of neonatal pneumoperitonium were diagnosed during the study period. Out of these 178 cases only 23 (12.92%) were labelled as idiopathic pneumoperitonium on the basis of absence of gut contents in the drainage. Out of these 23 cases, 22 (95.65%) were successfully treated with laparostomy and one case was proceeded with exploratory laparotomy. Post procedure NIPS score remained low and favorable with mean and standard deviation of 1.83±1.4. Total length of hospital stay ranged from 4 days to 15 days. Mean and standard deviation of hospital stay was 6.22±2.8 days. Conclusion: It is concluded in our study that tube laparostomy in cases of idiopathic pneumoperitonium is very efficacious treatment option. This procedure is is easy to do, can be safely done in critically ill patients, can be done under local anesthesia, results in lesser post-operative pain scores and reduces the hospital stay length and cost of treatment.

Human vs machine towards neonatal pain assessment: A comprehensive analysis of the facial features extracted by health professionals, parents, and convolutional neural networks

Neonates are not able to verbally communicate pain, hindering the correct identification of this phenomenon. Several clinical scales have been proposed to assess pain, mainly using the facial features of the neonate, but a better comprehension of these features is yet required, since several related works have shown the subjectivity of these scales. Meanwhile, computational methods have been implemented to automate neonatal pain assessment and, although performing accurately, these methods still lack the interpretability of the corresponding decision-making processes. To address this issue, we propose in this work a facial feature extraction framework to gather information and investigate the human and machine neonatal pain assessments, comparing the visual attention of the facial features perceived by health-professionals and parents of neonates with the most relevant ones extracted by eXplainable Artificial Intelligence (XAI) methods, considering the VGG-Face and N-CNN deep learning architectures. Our experimental results show that the information extracted by the computational methods are clinically relevant to neonatal pain assessment, but yet do not agree with the facial visual attention of health-professionals and parents, suggesting that humans and machines can learn from each other to improve their decision-making processes. We believe that these findings might advance our understanding of how humans and machines code and decode neonatal facial responses to pain, enabling further improvements in clinical scales widely used in practical situations and in face-based automatic pain assessment tools as well.

Developing a model of neonatal nurse-controlled analgesia: A Delphi study.

To develop a nurse-led model of analgesia to manage post-operative pain in the surgical neonate. A four-round e-Delphi study was conducted from March to December 2022. An e-Delphi method was used seeking a consensus of 70% or greater. Fifty-one experts were invited to join the panel. Members consisted of multi-disciplinary healthcare professionals who work in areas associated with neonatal care. In round 1, 49 statements relative to neonatal pain assessment and management were distributed to the panel. Panel members were asked to rate their level of agreeance on a Likert scale from 1 to 5 (1 = strongly disagree to 5 = strongly agree). Ratings equal to or greater than 4 represented agreement, 3 indicated uncertainty and 2 or less disagreement with the proposed statement. An opportunity for free-text responses after each statement was provided. This iterative process continued for three rounds. In the fourth and final round, the completed model of neonatal nurse-controlled analgesia was presented along with a further opportunity to provide feedback on the final version. Four rounds of statements and voting were required to reach consensus on a model of neonatal nurse-controlled analgesia. The model consists of criteria for use, over-arching guidelines and three separate pathways based on an individual baby's pain assessment scores, need for pain relieving interventions and time-lapsed post-surgical procedure. A comprehensive model of neonatal nurse-controlled analgesia, applicable to the Australasian context, was developed in collaboration with a group of neonatal experts. This study provides a multi-modal family-integrated model to manage neonatal post-operative pain. By providing nurses with increased autonomy to assess and manage acute pain, this model has the potential to not only provide a more responsive and individualized approach to alleviate discomfort, but highlights the integral role of parent partnerships in the neonatal intensive care. This study was reported in line with the Conducting and REporting of DElphi studies (CREDE) guidance on Delphi studies. No patient or public contribution was utilized for this study.

Procedural pain assessment in neonates at risk of neonatal opioid withdrawal syndrome: a scoping review protocol.

The objective of this review is to identify evidence on pain assessment during acute procedures in hospitalized neonates at risk of neonatal opioid withdrawal syndrome (NOWS). While all neonates are routinely exposed to various painful procedures, neonates at risk of NOWS have longer hospital stays and are exposed to multiple painful procedures. NOWS occurs when a neonate is born to a birth parent who identifies as having sustained opioid use (such as morphine or methadone) during pregnancy. Accurate pain assessment and management during painful procedures is critical for minimizing the well-documented adverse effects of unmanaged pain in neonates. While pain indicators and composite pain scores are valid and reliable for healthy neonates, there is no review of evidence regarding procedural pain assessment in neonates at risk of NOWS. Eligible studies will include those reporting on hospitalized pre-term and full-term neonates at risk of NOWS having pain assessments (ie, behavioral indicators, physiological indicators, validated composite pain scores) during and/or after exposure to an acute painful procedure. This review will follow the JBI scoping review methodology. Databases to be searched will include MEDLINE (Ovid), CINAHL (EBSCO), Embase, PsyclNFO (EBSCO), and Scopus. The relevant data will be extracted by 2 reviewers using a modified JBI extraction tool. The results will be summarized in narrative and tabular format, including the components of participants, concept, and context (PCC). Open Science Framework https://osf.io/fka8s .

Enhanced Recovery After Surgery (ERAS®) Consensus Recommendations for Neonatal Perioperative Pain Assessment, Education, and Management

Enhanced Recovery After Surgery (ERAS®) Consensus Recommendations for Neonatal Perioperative Pain Assessment, Education, and Management