Neonatal Pain Management Research Articles

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

Pose-invariant and occlusion-robust neonatal facial pain assessment

Neonatal Facial Pain Assessment (NFPA) is essential to improve neonatal pain management. Pose variation and occlusion, which can significantly alter the facial appearance, are two major and still unstudied barriers to NFPA. We bridge this gap in terms of method and dataset. Techniques to tackle both challenges in other tasks either expect pose/occlusion-invariant deep learning methods or first generate a normal version of the input image before feature extraction, combining these we argue that it is more effective to jointly perform adversarial learning and end-to-end classification for their mutual benefit. To this end, we propose a Pose-invariant Occlusion-robust Pain Assessment (POPA) framework, with two novelties. We incorporate adversarial learning-based disturbance mitigation for end-to-end pain-level classification and propose a novel composite loss function for facial representation learning; compared to the vanilla discriminator that implicitly determines occlusion and pose conditions, we propose a multi-scale discriminator that determines explicitly, while incorporating local discriminators to enhance the discrimination of key regions. For a comprehensive evaluation, we built the first neonatal pain dataset with disturbance annotation involving 1091 neonates and also applied the proposed POPA to the facial expression recognition task. Extensive qualitative and quantitative experiments prove the superiority of the POPA.

Organisational challenges of pain management in neonatal intensive care unit: a qualitative study

ObjectivesDespite credible evidence, optimal neonates’ pain management in the neonatal intensive care unit (NICU) is a challenging issue. In this regard, the organisational context is an essential factor. The existing...

Parents' experiences with interprofessional collaboration in neonatal pain management: A descriptive qualitative study.

To describe parents' experiences with interprofessional collaboration (IPC) in neonatal pain management. Neonatal care should be based on IPC, and non-pharmacological pain-relieving methods are recommended to be used primarily that enables parental participation. However, there is a lack of knowledge about pain management on IPC from the parent's viewpoint. A descriptive qualitative study. The research involved a purposive sample of parents (n = 16) whose infant had been treated at a neonatal intensive care unit in Finland. Interviews were conducted with participants from all over Finland who were recruited through the national association for premature infants. Parents discussed their experiences during semi-structured interviews which were guided by the subareas of IPC, partnership, cooperation and coordination. The data were analysed using deductive-inductive content analysis. The reporting of results followed COREQ guidelines. Based on the parent's experiences the partnership involved themes of understanding the neonatal pain management context, being able to influence the pain management, and feeling valued. Cooperation included themes of identifying different roles and equality. Coordination was described through the sharing of knowledge, skills and expertise, as well as feeling supported by professionals. Parental involvement on IPC should be developed through interventions that involve training around pain assessment and non-pharmacological pain-relief methods. Professionals involved in neonatal care should act in a goal-oriented and unified manner to promote a culture of care that allows for active parental participation. The research has been carried out in accordance with good scientific practice. Only the research team has been involved in the design, conduct, analysis and drafting of the manuscript.

Effective pain management strategies for common pediatric conditions

Pain management in neonates, infants, and children is a complex and challenging aspect of healthcare, with a high prevalence of undertreatment. Efforts have been made to improve pain assessment and implement effective interventions. Pharmacological approaches include non-opioid analgesics, opioids, and adjuvant analgesics, while non-pharmacological interventions involve physical techniques and cognitive behavioral strategies. Pediatric pain management requires considering developmental stages, individual variability, and emotional factors. Accurate pain assessment, weight-based dosing, and involving parents are crucial. Minimizing procedural pain and addressing psychosocial aspects contribute to better outcomes. Comprehensive pain management is necessary to prevent long-term consequences and enhance recovery. However, there is a persistent gap between evidence-based guidelines and clinical practice, indicating the need for further education and training. Implementation of pain management protocols and multidisciplinary approaches involving healthcare providers, psychologists, physical therapists, and educators are essential. By adopting these strategies, healthcare providers can improve the quality of life for pediatric patients, reduce the burden on the healthcare system, and mitigate the long-term impact of untreated pain.

A Bibliometric Analysis of Neonatal Pain Management Research From 2010 to 2022.

Research related to neonatal pain management has received increasing attention in recent years. Effective pain management contributes to the maintenance of the healthy physical and mental growth of the newborn. To better understand this research topic, we analyzed the current state of development in this field over the past thirteen years by bibliometric analysis and provide directions for future research. Original articles were collected from the Web of Science Core Collection (WoSCC) between January 1, 2010, to December 31, 2022, the title and abstract clearly stating 'neonatal pain management' or its alternative search keywords. CiteSpace, VOSviewer, and the WoS analysis tool were used to analyze and present the data. A total of 967 articles met the inclusion criteria. Significant growth of the number of publications increased roughly fourfold from 2010 to 2022. Overall, the United States and Canada were the highest contributors to neonatal pain management research. Weak cooperation was observed in international research (developing and developed countries) and cross-institutional cooperation. Neonatal pain-related research was the most common focus. Pain education and interventions for parents and medical personnel have also received increasing attention recently. The current study revealed that research in terms of publications on neonatal pain management has rapidly increased for more than the past ten years. Developed countries, especially the United States and Canada, were more concerned with this topic than developing countries. More international research and cross-institutional cooperation are required to promote the development of neonatal pain medicine in the future.

Developing an educational program to enhance nursing and midwifery competence in neonatal pain management

Developing an educational program to enhance nursing and midwifery competence in neonatal pain management

Nurses' experience of integrating evidence-based changes into their practice: A qualitative study.

To explore the experiences of neonatal and NICU nurses on participating in evidence-based changes in their neonatal pain management practice. It is a qualitative conventional content analysis. A purposive sample with nurses working in neonatal and NICUs was used. The data were collected through 11 semi-structured in-depth individual interviews, five focused group discussions, and observations and analyzed using the conventional content analysis method based on the Elo and Kyngäs model. The COREQ checklist was used for writing the report. Analysis of gathered data led to the emergence of four themes, including 'being in a supportive and encouraging atmosphere', 'a journey from resistance to adherence', 'achieving multi-dimensional improvements', and 'facing obstructive challenges'.

Music therapy and neonatal pain management: An interview with Dr Alexandra Ullsten.

Alexandra Ullsten, PhD, works as a music and art therapist, and postdoctoral researcher at the Central Hospital in Karlstad, Region Värmland, Sweden. She is affiliated researcher to the School of Health Sciences, Örebro University, Sweden. In 2010, Dr Ullsten pioneered the implementation of neonatal music therapy in Swedish healthcare. The Central Hospital Karlstad neonatal intensive care unit (NICU) became the first hospital and NICU in the Nordic countries to offer a family-centred music therapy programme for hospitalised infants and their parents. Alexandra’s research area concerns family-centred music therapy during painful procedures in neonatal care focusing on parent-delivered pain management such as parental infant-directed singing. She is one of the “grandparents” of Rhythm, Breath, Lullaby NICU Music Therapy (RBL) and a member of the international research network, Pain in Early Life (PEARL). She is the principal investigator of the interdisciplinary multi-centre research project, “Parents as pain management in Swedish neonatal care – SWEpap”. Dr Ullsten graciously agreed to partake in an interview and provide an insight into her research and the role music can play as affective support for infants and their parents during painful procedures in the NICU.

Neonatal pain perception, management and review of practises among medical workers in Nigeria newborn units.

Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage. The perception of pain is variable and knowledge may not match practise. To ascertain the knowledge, attitude and practice of neonatal pain management (NPM) among HCW in newborn units across Nigeria. The validated questionnaire administered to consenting doctors and nurses working in various newborn units in Nigeria was utilised. There were 256 respondents from tertiary institutions 228 (89.1%) located in 31 states of Nigeria. There were 91% doctors and 8.6% nurses'. The perception of newborn pain was high (≥95%) among doctors and nurses . Up to 67.1% of the doctors and 57.1% of nurses were aware of NPM. One third (37.3%) of doctor respondents knew of NPM from friends and colleagues while half of the nurses knew from course textbooks.Pain definition was in most by sensation (94%), 50% by emotion. Most nurses were aware of the subjective report of potential tissue damage and knew the facial expressions of pain compared to doctors. Crying was equally recognised as an expression of pain. Perception of non-pharmacologic methods of NPM was highest for massaging and KMC; the knowledge of Sucrose analgesia was low. Procedural pain perception was poor and analgesia was for few procedures. Perception of pain was high but did not match knowledge and practice of NPM. Formal education on NPM was lacking in the training of HCW.

Non-opioid analgesics for procedural pain in neonates.

Non-opioid analgesics for procedural pain in neonates.

Assessment and management of neonatal pain: a best practice implementation project.

Neonates are exposed to varying degrees of pain during their hospitalization, which are going to have a profound impact on their lives. Interventions to alleviate neonatal pain are inadequate and inconsistent. The project aims to promote evidence-based practice (EBP) for the assessment and management of neonatal patients with acute pain and to evaluate the impact of these practices on neonatal pain in hospital. The current project was conducted in the neonatal department of a tertiary hospital in China. Five audit criteria were developed for baseline and follow-up audits. The project used the JBI PACES software and JBI's Getting Research into Practice audit and feedback tool to take evidence-based healthcare into practice. A total of 100 neonates with acute pain procedures were evaluated at baseline and follow-up audit. The results showed a poor compliance of the five audit indicators in the baseline audit and a significantly improved compliance of the five audit indicators in the follow-up audit. Compared to the baseline audit, audit criterion 1 increased from 0% to 86.1%, audit criterion 2 increased from 36.1% to 82.5%, audit criterion 3 increased from 12% to 61%, audit criterion 4 increased from 0% to 66%, and audit criterion 5 increased from 6% at baseline to 71% in the follow-up audit. The project found that EBP can help nursing staff effectively manage neonatal patients who are experiencing acute painful operations. Further studies are necessary to ensure the sustainability of the criteria in the project.

Dexmedetomidine: An Alternative to Pain Treatment in Neonatology.

Infants might be exposed to pain during their admissions in the neonatal intensive care unit [NICU], both from their underlying conditions and several invasive procedures required during their stay. Considering the particularities of this population, recognition and adequate management of pain continues to be a challenge for neonatologists and investigators. Diverse therapies are available for treatment, including non-pharmacological pain management measures and pharmacological agents (sucrose, opioids, midazolam, acetaminophen, topical agents…) and research continues. In recent years one of the most promising drugs for analgesia has been dexmedetomidine, an alpha-2 adrenergic receptor agonist. It has shown a promising efficacy and safety profile as it produces anxiolysis, sedation and analgesia without respiratory depression. Moreover, studies have shown a neuroprotective role in animal models which could be beneficial to neonatal population, especially in preterm newborns. Side effects of this therapy are mainly cardiovascular, but in most studies published, those were not severe and did not require specific therapeutic measures for their resolution. The main objective of this article is to summarize the existing literature on neonatal pain management strategies available and review the efficacy of dexmedetomidine as a new therapy with increasing use in the NICU.

Low neonatal pain management practices and associated factors among nurses and midwives working in governmental hospitals of central Ethiopia, 2021

BackgroundNeonatal pain management is a significant problem in the clinical settings of developing countries. Several studies have revealed that neonatal pain management practices among health professionals were overlooked. As a result, the data regarding the factors affecting nurses' and midwives' neonatal pain management practices is essential in designing interventions to address this gap. Therefore, this study aimed to assess neonatal pain management practices and associated factors among nurses and midwives working in government hospitals in central Ethiopia from September 1, 2019 to September 30, 2021. MethodsAn institution-based quantitative cross-sectional study design was employed among randomly selected 268 nurses and midwives after obtaining ethical approval from Ambo University. The data were collected using a pretested, structured, self-administered questionnaire. The collected data were checked, coded, and entered into Epi-data version 3.1 and exported to SPSS version 25 for analyses. Bivariate and multivariate logistic regression analyses were carried out. The odd ratio along with the 95% CI were computed to ascertain the association. ResultsThe study revealed that 37.3% [95% CI: 31.4–43.3] of the study participants had good practices for neonatal pain management. Respondents with less than five years of work experience [AOR = 2.4 (1.16, 4.99)], Nurses or Midwives with no neonatal pain training [AOR = 2.89 (1.58, 5.29), poor neonatal pain knowledge [AOR = 1.09 (1.09, 3.61)], and an unfavorable attitude toward neonatal pain [AOR = 3.19 (1.74, 5.85)] were factors significantly associated with poor neonatal pain management practice. ConclusionsThe overall practice of neonatal pain management is low. Factors like work experience, training, knowledge, and attitude were significantly associated with poor practices in neonatal pain management. All stakeholders should consider the necessary interventions. Moreover, educational and convenient training programs on neonatal pain management are needed to better assess and manage neonatal pain.

Evidence-based guideline for neonatal pain management in China (2023)

Pain disrupts neonatal vital signs and internal environment homeostasis and affects the recovery process, and recurrent pain stimulation is one of the important risk factors for neurodevelopmental disorders and some chronic diseases. In order to standardize pain management practice in neonatal wards in China and effectively prevent and reduce the adverse effects of pain on the physical and mental development of neonates, National Clinical Research Center for Child Health and Diseases (Children's Hospital of Chongqing Medical University) convened a multidisciplinary panel to formulate the evidence-based guideline for neonatal pain management in China (2023 edition) following the principles and methods for the guideline development issued by the World Health Organization. Based on the best evidence and expert consensus, this guideline gives 26 recommendations for nine clinical issues, i.e., the classification and definition of neonatal pain, common sources of pain, pain assessment principles, pain assessment methods, analgesic principle, non-pharmaceutical analgesic methods, pharmaceutical analgesic methods, parental participation in pain management, and recording methods for pain management, so as to provide medical staff with guidance and a decision-making basis for neonatal pain assessment and analgesia management.

Neonatal pain assessment: Do we have the right tools?

The assessment and management of neonatal pain is crucial for the development and wellbeing of vulnerable infants. Specifically, neonatal pain is associated with adverse health outcomes but is often under-identified and therefore under-treated. Neonatal stress may be misinterpreted as pain and may therefore be treated inappropriately. The assessment of neonatal pain is complicated by the non-verbal status of patients, age-dependent variation in pain responses, limited education on identifying pain in premature infants, and the clinical utility of existing tools. We review research surrounding neonatal pain assessment scales currently in use to assess neonatal pain in the neonatal intensive care unit. We performed a systematic review of original research using PRISMA guidelines for literature published between 2016 and 2021 using the key words "neonatal pain assessment" in the databases Web of Science, PubMed, and CINAHL. Fifteen articles remained after review, duplicate, irrelevant, or low-quality articles were eliminated. We found research evaluating 13 neonatal pain scales. Important measurement categories include behavioral parameters, physiological parameters, continuous pain, acute pain, chronic pain, and the ability to distinguish between pain and stress. Provider education, inter-rater reliability and ease of use are important factors that contribute to an assessment tool's success. Each scale studied had strengths and limitations that aided or hindered its use for measuring neonatal pain in the neonatal intensive care unit, but no scale excelled in all areas identified as important for reliably identifying and measuring pain in this vulnerable population. A more comprehensive neonatal pain assessment tool and more provider education on differences in pain signals in premature neonates may be needed to increase the clinical utility of pain scales that address the different aspects of neonatal pain.

Recommendations for Minimum Residency Training Requirements in Pediatric Hospital Medicine.

Recommendations for Minimum Residency Training Requirements in Pediatric Hospital Medicine.

Ethonursing Study of Pain Management in Neonates in Indonesia

PurposeEven though Indonesia is comprised of at least 1,300 ethnic groups, no specific traditional method for reducing pain, especially in neonates, has been elaborated. AimThis study aimed to investigate the traditional methods used by the Sundanese people in Indonesia to manage pain in neonates. MethodsThis ethnonursing study was conducted in the Pangandaran District, West Java Province, Indonesia. Thirty informants including health cadres, midwives, and community leaders in the health sector, such as trained traditional birth attendants and female elders, participated in this study. Data were collected through interviews and focus group discussions, as well as from field notes. Data were analyzed using the four phases of qualitative analysis based on Leininger's theory. ResultsSix themes were identified in this study: (1) Preference for the use of traditional methods to treat pain in neonates and infants, (2) Desire to obtain information on the safe use of traditional medicine, (3) Desire to use practical pain management methods, (4) Easy to get modern medicine, (5) Use of medicinal plants, (6) Physical methods. ConclusionsThis study demonstrates the need for better harmonization between the use of traditional and modern medicines, in both research and practice, to determine the most appropriate mix that combines the strengths of each method based on accurate scientific evidence.

Effectiveness of Non-Pharmacological Methods, Such as Breastfeeding, to Mitigate Pain in NICU Infants.

Neonates do experience pain and its management is necessary in order to prevent long-term, as well as, short-term effects. The most common source of pain in the neonatal intensive care unit (NICU) is caused by medically invasive procedures. NICU patients have to endure trauma, medical adhesive related skin injuries, heel lance, venipuncture and intramuscular injection as well as nasogastric catheterization besides surgery. A cornerstone in pain assessment is the use of scales such as COMFORT, PIPP-R, NIPS and N-PASS. This narrative review provides an up to date account of neonate pain management used in NICUs worldwide focusing on non-pharmacological methods. Non-steroidal anti-inflammatory drugs have well established adverse side effects and opioids are addictive thus pharmacological methods should be avoided if possible at least for mild pain management. Non-pharmacological interventions, particularly breastfeeding and non-nutritive sucking as primary strategies for pain management in neonates are useful strategies to consider. The best non-pharmacological methods are breastfeeding followed by non-nutritive sucking coupled with sucrose sucking. Regrettably most parents used only physical methods and should be trained and involved for best results. Further research in NICU is essential as the developmental knowledge changes and neonate physiology is further uncovered together with its connection to pain.

The effect of Helfer skin tap technique on hepatitis B vaccine intramuscular injection pain in neonates: A randomized controlled trial

ContextThe aim of neonatal pain management is to reduce pain and help the baby cope with pain. ObjectiveThis study aimed to determine the effect of Helfer skin tap technique (HSTT) on hepatitis B vaccine intramuscular (IM) injection pain in neonetes. DesignRandomized controlled study SettingThis study was conducted with neonatal infants born vaginally in the delivery room of a state hospital in Turkey. ParticipantsThis study was conducted total 60 neonates including 30 in the HSTT group and 30 in the Routine Technique (RT) group. InterventionsParticipants were randomized into the HSTT group and the Routine Technique (RT) group. Main outcome measuresData were collected using a questionnaire form and the Neonatal Infant Pain Scale (NIPS). ResultsWhile the means of the total pain scores in the HSTT group were found to be 1.73 ± 2.04 during injection and 1.73 ± 0.98 after injection, in the RT group, the mean scores were 5.56 ± 0.92 during injection and 4.90 ± 1.25 after injection. The difference between the groups arising in the comparison of means of the total pain scores obtained during and after injection in HSTT and RT groups was determined to be statistically significant (p <0.05). ConclusionIn conclusion, HSTT was proven to be effective in reducing hepatitis B vaccine intramuscular (IM) injection pain in neonates. This study demonstrates that HSTT is associated with reduced pain in newborns during hepatitis B vaccine IM injections.