Effects of hydrotherapy and hammock positioning on pain reduction in preterm neonates.

Preterm infants are subjected to numerous painful procedures during their hospitalisation. Parental involvement, especially mothers, in pain management has been emphasised as one of the most effective approaches for relieving this pain. Understanding mothers' experiences is critical to improving neonatal pain management. This study aimed to explore the lived experiences of mothers from participating in pain management for hospitalised preterm infants during invasive procedures. This research is a qualitative study with an interpretive phenomenological approach. Data were collected through unstructured interviews with 10 mothers of preterm infants, employing purposeful sampling using a sequential and emergence-driven strategy with a saturation/redundancy approach to select participants. Interviews were initiated with an open-ended question about the mothers' experiences of participating in infants' pain management during invasive procedures, followed by probing questions based on their experiences. Data analysis was conducted through an interpretive phenomenological analysis approach. The analysis revealed a constitutive pattern of 'progressive development of capability', comprising three themes: reconstructing the healing role of the mother, maternal growth and transformation, and becoming a healing agent. The subthemes are as follows: 'Sense of helplessness', 'mother on the margin', 'becoming an advocate', 'witnessing pain, discovering responsibility', 'observation and learning', 'laying the groundwork for participation', 'maternal selflessness', 'understanding the maternal healing power' and 'self-confidence'. The findings of this study revealed that mothers of preterm infants gradually develop the capability to manage their infants' pain with the support and education of healthcare professionals. Empowering mothers as active partners through staff education and attention to family-centred care approaches can improve neonatal pain management.

Sex-related differences in response to noxious stimulation at the beginning of life explored through a secondary analysis.

The effect of kangaroo care in relieving pain of vaccination procedures in newborns in a hospital in Saudi Arabia.

Resource-limited countries like Malawi often face shortages of essential medications, often leaving neonates with unmet pain management needs and contributing to poor neonatal outcomes. Involving parents to provide nonpharmacological pain management interventions (NPPMI) would be a safer and cost-effective strategy to promote maternal involvement and improve neonatal outcomes. This study was conducted to explore maternal involvement in nonpharmacological pain management during painful procedures in Chatinkha Neonatal Unit at Queen Elizabeth Central Hospital in Blantyre, Malawi. A descriptive qualitative design was used to collect data from in-depth interviews conducted with 20 parents of neonates who had undergone painful procedures in the neonatal unit. Data were analyzed using thematic analysis. Four themes emerged from the study: (1) parent knowledge on involvement and NPPMI, (2) healthcare worker practices in involving parents in pain management, (3) parent desire for involvement in pain management, and (4) barriers to parent involvement in neonatal pain management. This study showed that maternal involvement in neonatal pain management is poor and the use of NPPMI is substandard in Malawian neonatal units. A contributing factor is lack of parental knowledge, which results from lack of education and support from healthcare providers. To address this, clear protocols to guide maternal involvement in pain management are needed. Future studies should aim at designing and evaluating structured educational programs for both healthcare providers and parents on the use of NPPMI.

Background Preterm neonates requiring noninvasive respiratory support are exposed to prolonged noxious stimuli, predisposing them to stress and adverse neurodevelopmental outcomes. Pharmacological interventions are limited by safety concerns, while nonpharmacological strategies, such as immediate Kangaroo Mother Care (iKMC), provide a promising alternative. However, evidence on iKMC’s effect on acute prolonged pain in ventilated preterm neonates is limited. Objective To assess acute prolonged pain in preterm neonates admitted to the neonatal intensive care unit using the Premature Infant Pain Profile (PIPP) scale at 12 and 72 h of noninvasive respiratory support, and to evaluate the role of iKMC in pain mitigation. Methods A prospective cohort study was conducted in preterm neonates (<37 weeks) requiring more than 72 h of noninvasive respiratory support. iKMC was initiated within 2 h of life as per protocol. Pain was assessed by the original PIPP scale at 12 and 72 h after initiating respiratory support, and cumulative iKMC hours were recorded. The exact timing of iKMC initiation (birth to skin-to-skin placement) was prospectively documented. Results Of 276 neonates enrolled, 26 were excluded (16 required invasive ventilation; 10 became unstable, needing inotropes). Of the remaining cohort, 72% received continuous positive airway pressure, 18% heated humidified high flow nasal cannula, and 10% oxygen via nasal cannula. The mean PIPP score was 15.94 ± 1.719 at 12 h, significantly reducing to 5.70 ± 1.843 at 72 h with iKMC. The mean daily iKMC duration was 5.70 ± 1.843 h, and the mean initiation age was 1.75 ± 0.17 h (median 1.7 h). No neonate discontinued iKMC due to intolerance. Conclusion Preterm neonates on noninvasive respiratory support who received iKMC had significantly lower PIPP scores. iKMC appears to be a safe, feasible, and effective nonpharmacological intervention for reducing acute prolonged pain in this vulnerable population.

BackgroundNeonates and infants presenting for surgery experience not only pain but also heightened pain sensitivity due to immaturity of the nervous system, which may increase the risk of neurodevelopmental disorders. Improving awareness, assessment, and timely intervention of pediatric postoperative pain is critical.MethodsNeonates and infants aged 0–12 months who underwent abdominal and/or sacroperineal surgeries between September 2022 and July 2023 were randomly assigned to a treatment group (oral paracetamol suspension, 0.1 mL/kg [10 mg/kg] administered every 6 hours for four doses after recovery from general anesthesia) or a control group (oral sterile water, 0.1 mL/kg). The primary outcome was postoperative pain intensity. Secondary outcomes included changes in liver and kidney function indices—aspartate aminotransferase (AST), alanine aminotransferase (ALT), blood urea nitrogen (BUN), and creatinine (Cr)—measured preoperatively and 48 hours postoperatively.ResultsA total of 220 neonates and infants were included. Postoperative pain scores were significantly lower in the treatment than in the control group at each time point at all assessed time points (1, 6, 12, 18, 24, 36, and 48 hours after recovery from general anesthesia, p<0.001). No significant differences were observed between groups in changes in AST, ALT, BUN, or Cr levels from baseline to 48 hours postoperatively.ConclusionsRepeated oral administration of paracetamol after recovery from general anesthesia effectively reduces postoperative pain in neonates and infants without adversely affecting hepatic or renal function. This approach is safe and suitable for routine clinical use.Trial registration numberNCT05564819.

Using near infrared spectroscopy (NIRS) to assess pain in neonates undergoing circumcision- a pilot study

To assess the clinical validity and reliability of the Neonatal Pain, Agitation, and Sedation Scale (N-PASS) for acute pain in infants with illnesses treated in the neonatal intensive care unit (NICU). Data of 32 infants were collected. NICU nurses measured pain and distress scores using the Japanese version of the N-PASS (henceforth, N-PASS-J) at baseline and during skin puncture. To determine internal consistency, discriminant validity, and convergent validity, we calculated Cronbach's alpha, conducted a one-way repeated measures ANOVA, and examined correlation coefficients with established pain measurement tools. Data were collected for 122 scenes: 61 at baseline and 61 at the time of the skin puncture. The median (IQR) gestational age of participants was 32 (29-37) weeks, and corrected gestational age at measurement was 33 (30-37) weeks. Cronbach's alpha for the five N-PASS-J items was 0.93. Pain and distress scores were significantly higher at the time of blood collection than at rest (mean ± SD) (baseline: 0.3 ± 0.6; skin puncture: 5.2 ± 2.4, F (1, 120) = 232.5, p < 0.0001). The correlation coefficient between the distress scores and the Face Scale for Pain Assessment Preterm Infant score was 0.91. The N-PASS-J is a dependable and valid instrument for assessing acute pain in infants with illness treated in the NICU.

Neonatal pain facial expression recognition based on spatio-temporal interactive triple-stream transformer network

Repeated painful procedures are associated with a multitude of effects on neurodevelopment in preterm infants, and current methods of neonatal pain management are unable to prevent the distress and long-term changes induced by these procedures. Cannabidiol (CBD) may be particularly effective for neonatal pain management because it reduces pain unpleasantness ratings, mitigates biological stress responses, and has minimal side effects in adults. However, there is limited research on the effects of neonatal CBD exposure. The present study investigates the efficacy of CBD treatment in mitigating neonatal vocalization responses, as well as short- and long-term behavioral outcomes following neonatal pain exposure. We show that neonatal pain exposure decreases USV emission and increases adult anxiety-like behavior in male rats compared to neonatal touch exposure. Neonatal CBD treatment also decreases pups' USV lengths and male pups' USV counts compared to vehicle treatment but is unable to rescue the neonatal pain-related increased anxiety-like behavior in adulthood. Additionally, neonatal CBD increases baseline corticosterone levels in adult male subjects and decreases adult female body weight compared to vehicle. More research is needed to determine whether CBD may be a safe and effective neonatal pain management medication.

ABSTRACT Objective Preterm birth alters typical brain development due to complex exposures related to neonatal illness, pain management, and brain injury. Despite an increased understanding of neonatal brain injury on developmental outcomes, the association of cerebellar maturation with school‐age motor and cognitive function remains incompletely understood. The current study evaluated neonatal clinical factors associated with regionally specific cerebellar volumes and white matter pathways at 8 years of age in children born preterm (24–32 weeks of gestational age). Methods Neuroimaging, clinical, and behavioral data were collected from 130 children born very preterm (24–32 weeks' gestational age) at BC Women's Hospital. Cerebellar subregions were automatically segmented using CerebNet, and cerebellar white matter connectivity was assessed using tractography. The relationships between cerebellar subregion volumes and neonatal clinical factors were examined using constrained principal component analysis. Cognitive and motor neurodevelopmental outcomes related to cerebellar volume and connectivity were also investigated. Results Neonatal clinical factors including mechanical ventilation, number of invasive procedures, and opioid exposures were associated with reduced cerebellar volumes in specific subregions. Acute neonatal mortality risk (i.e., SNAPPE‐II) was negatively associated with cerebellar connectivity at 8 years. Reduced cerebellar volumes and structural connectivity were related to poorer cognitive and motor outcomes. Interpretation In very preterm children, neonatal illness severity and exposure to invasive procedures and opioids are associated with reduced cerebellar volumes, connectivity, and poorer neurodevelopmental outcomes at 8 years.

BackgroundBoth benign and malignant tumors in neonates frequently necessitate invasive diagnostic and therapeutic procedures, exposing infants to significant pain and stress during critical periods of brain development. Procedural stress can disrupt the hypothalamic-pituitary-adrenal axis, affect synaptic pruning, and alter myelination, potentially leading to long-term cognitive and neurodevelopmental impairments. While standard medical care remains the cornerstone of management, there is growing interest in multimodal interventions—including integrative therapies, physiotherapy, and non-pharmacological approaches such as massage, music therapy, kangaroo care, and sensory stimulation—to mitigate discomfort and support neurodevelopmental outcomes.ObjectiveThis study aimed to systematically evaluate how well multimodal therapies reduce stress and suffering while enhancing neurodevelopmental outcomes in infants with both benign and malignant tumors.MethodsThe PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) standards will be followed in the conduct of this systematic review. Studies that use multimodal therapies (eg, physiotherapy, massage, music therapy, kangaroo care, or other non-pharmacologic techniques) for newborns with proven malignant or benign tumors will be considered. A thorough literature search will be conducted using databases such as the PubMed, Embase, and CINAHL, Cochrane, and CancerLi. Cohort studies, case-control studies, quasi-experimental studies, and randomized controlled trials will all be considered. Measures of pain (such as validated neonatal pain scales), stress (such as cortisol levels and behavioral markers), and neurodevelopment (such as the Bayley Scales of Infant Development) will be the main objectives.ResultsThe anticipated timeline for completing this systematic review is June 2025 to December 2027. Two independent reviewers will conduct each stage of the review process in a blinded manner to minimize bias.ConclusionsThis systematic review aims to provide evidence-based insights into the role of multimodal interventions in enhancing standard care for neonates undergoing tumor-related procedures. Conclusions regarding clinical impact will be conditional on the quality and consistency of the evidence, as assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). The findings are expected to guide future research, inform cautious clinical recommendations, and support the development of integrative strategies to optimize neurodevelopmental outcomes in this vulnerable population.

BackgroundTimely and accurate assessment of pain and sedation in newborns is essential for effective management. Therefore, neonatal pain and sedation assessment remains a key global issue in neonatal intensive care unit (NICU) nursing practice. This study examined the inter-rater reliability of Neonatal Pain Agitation, and Sedation Scale (N-PASS) scores among NICU patients.MethodsThis prospective observational study assessed agreement among 19 NICU nurses and two independent researchers who completed 190 observations from 82 preterm infants. Each evaluator rated N-PASS independently and blindly. Agreement among three raters—a nurse and two researchers—were analyzed using the intraclass correlation (ICC) and the Fleiss kappa test.ResultsAgreement levels varied across N-PASS subscales. The ICC and kappa values indicated moderate-to-good reliability for the pain/agitation subscale, whereas the ICC values for the sedation subscale indicated excellent or moderate reliability. Nurses assigned higher mean pain/agitation scores than researchers.ConclusionsNICU nurses must improve their N-PASS assessment skills for both pain and sedation. NICU nurse managers should prioritize improving these competencies to improve pain experiences and ensure adequate sedation, given their significant impact on short- and long-term outcomes in preterm infants.

Background: It is documented that neonatal pain perception is well structured, but the and capacity of repeated painful procedures carried out at early neonatal life stages in changing consecutive pain responses is disputed. Obstetric factors that affect fetal stress, maturity, and admission of newborns to the neonatal intensive care unit (NICU) can be critical in the modulation of neonatal pain processing; yet, they are frequently not adequately represented in studies of neonatal pain. The objective is to assess how repeated painful stimuli affect behavioural pain response in neonates 34 weeks old or older, after conception, and combine/ ingest any prenatal and birth-related obstetric factors that could moderate neonatal pain adjustment. Material and Methods: It was a prospective cohort study conducted at a tertiary-care teaching hospital from October 2021 to September 2022. A total of 100 neonates (34 weeks post-conceptional age) were recruited and divided into cases (undergoing more than 10 painful procedures in the NICU) and controls (undergoing fewer than three painful procedures). The matching of the groups was based on post-conceptional age, postnatal age (within a range of 7 days), and sex. A uniform, painful stimulus was used: intramuscular injections of Hepatitis B vaccine at the time of discharge. Duration of cry (Primary outcome), latency to cry, and Modified Facial Coding Score (MFCS) were used to evaluate the behavioural pain reactions. Obstetric variables, including details of antenatal, intrapartum, and delivery-room care, were prospectively documented and studied as possible factors in modifying the response to pain. Results: The median length of cry was not significantly different between cases [26 seconds (IQR 20 48 seconds)] and controls [30.5 seconds (IQR 20 78 seconds)] (p &gt; 0.05). There was equal latency to cry. Immediately after the injection, the MFCS scores in NICU-exposed neonates were much higher, but the disparities resolved by 1 and 3 minutes. Antenatal complications, mode of delivery, and delivery-room interventions remained unaffected in the independent effects of obstetric risk factors on pain response when gestational maturity was factored in. Conclusion: Repeated exposure to painful procedures in infants with a neonatal age of at least 34 weeks after conception gained no significant changes in general behavioural pain response. Neonatal pain processing seems to be moderated by gestational maturity factor and obstetric antecedents rather than being influenced by cumulative procedural exposure per se. These results highlight the role of combined obstetric-neonatal interventions, focused on reducing stress in the first days and improving neurodevelopmental outcomes. Keywords: Neonatal pain; Repeated painful procedures; Gestational maturity; Late Preterm neonates; Neonatal intensive care unit; Behavioural pain response

The impact of repetitive neonatal procedural pain on cognitive behavioral development in male Mice: A microglial Perspective.

ABSTRACT Objective: To study cases of neonates diagnosed with ankyloglossia in a maternity hospital, submitted to frenotomies with the aid of a high-power laser. Material and Methods: 18 newborns in a maternity hospital between 2021 and 2022, with difficulties in breastfeeding due to ankyloglossia, participated in this cohort study. Neonates submitted to frenotomy with high-power laser were evaluated pre, trans, and postoperatively. Data were obtained from the patient's medical records and assessment form, questionnaire Bristol Tongue Assessment Tool (BTAT), Martinelli´s Protocol, Neonatal Infant Pain Scale (NIPS), and questions answered by mothers and by the performing professional. Results: There was a significant difference in the benefits of surgical removal of the lingual frenulum on tongue movements. Neonatal pain scores significantly decreased in the immediate postoperative period after frenotomy. The mother's perception of the improvement in the quality of breastfeeding in the postoperative period was positive (p&lt;0.001). Conclusion: Lingual frenotomy in neonates, performed with the aid of a high-power surgical laser, didn't bring discomfort, bleeding, or infections during the trans and postoperative period, and made breastfeeding possible, bringing benefits to the mother-baby dyad.

Examining the impact of white noise on pain, comfort, crying time, and physiological parameters during vitamin K intramuscular administration.

Thai parents' perspectives on understanding and involvement in non-pharmacological neonatal pain management.

ABSTRACTBackgroundInvolving mothers in their infant's pain management is an essential part of family‐centred care in a neonatal intensive care unit (NICU). Healthcare professionals commonly use sweet solutions, such as oral glucose, to relieve pain in infants during heel lances and other procedures. However, there is a lack of knowledge about how mothers perceive the use of oral glucose for pain management.AimTo describe mothers' views on the use of oral glucose for neonatal pain relief.Study DesignA qualitative descriptive study was conducted in a neonatal intensive care unit in Finland between May 2023 and May 2024. The participants were mothers (n = 25), recruited from a randomised controlled trial (RCT) involving newborns. Data were collected through semi‐structured interviews based on an interview guide, and analysed using content analysis.FindingsMothers' views on the use of glucose for neonatal pain relief consisted of four main categories: ‘Varying perceptions of acceptability’, ‘An easy‐to‐implement method’, ‘Contradictory opinions on effectiveness’ and ‘Another method would be better’.ConclusionsMothers found glucose to be an easy‐to‐use method for neonatal pain relief, but their opinions on its effectiveness varied. They recommended combining glucose with another method or adopting a mother‐led approach to improve pain management.Relevance to Clinical PracticeHealthcare professionals should recognise the individual nature of each mother's perception of glucose as a method of newborn pain management and consider this perspective when providing counselling and planning pain relief methods.