![]() Once the existence of neonatal pain was acknowledged and methods for clinical assessment had been validated 14, 15, the stage was set for advances in neonatal pain management.Īvoiding prolonged or repetitive pain/stress during NICU care This popular precept was challenged by accumulating data on hormonal-metabolic responses to surgical procedures performed under minimal anesthesia 9, 10, which were effectively reduced by giving potent anesthesia 11- 13, the identification of a “pain system” and initial data on its early development, rich observations on crying activity and other behaviors of newborns subjected to painful stimuli in the NICU – all of which contributed to a scientific rationale for neonatal pain perception and its clinical implications 3. Watson's Behaviorist Manifesto in 1913 5), and as the behaviorist movement waned, it was followed by 4) an era placing undue emphasis on the structural development of the brain and its responses 6- 8. A recent historical analysis suggests four related causes contributed to a widely prevalent denial of infant pain 4: 1) a Darwinian view that held newborns as less evolved human beings, 2) extreme caution and skepticism in interpreting scientific data that suggested infant pain, 3) an extreme reductionism whereby a mechanistic “behaviorism” became the dominant model human psychology in the earlier half 20th century (following J. Robust responses to painful stimuli were often dismissed as physiological or behavioral reflexes, and not related to the conscious experience of pain 3. One unfortunate consequence was that infant surgery was conducted routinely with minimal or no anesthesia until the late 1980s 1, 2. During the 20 th century, however, most procedures and clinical practices established in neonatal intensive care units (NICUs) uniformly denied or disregarded the occurrence of neonatal pain. Routine assessment and management of neonatal pain has evolved to become an important therapeutic goal in the 21 st century. Approaches for implementing an effective pain management program in the Neonatal ICU are summarized, together with practical protocols for procedural, postoperative, and mechanical ventilation-associated neonatal pain and stress. Acetaminophen, ibuprofen and other drugs are used for neonates, although their efficacy and safety remains unproven. Non-opioid drugs include various sedatives and anesthetic agents, mostly used as adjunctive therapy in ventilated neonates. Opioids form the mainstay for treatment of severe pain morphine and fentanyl are the most commonly used drugs, although other opioids are also available. Local and topical anesthetics can reduce the acute pain caused by skin-breaking or mucosa-injuring procedures. They are used for procedures causing acute, transient, or mild pain, or as adjunctive therapy for moderate or severe pain. ![]() Non-pharmacologic approaches include kangaroo care, facilitated tucking, non-nutritive sucking, sucrose and other sweeteners, massage and acupuncture therapy. Reducing invasive procedures, and using pharmacological, behavioral or environmental measures can be used to manage neonatal pain. ![]() ![]() ![]() Neonatal pain should be assessed routinely using context-specific, validated and objective pain methods, despite the limitations of currently available tools. Effective pain management is a desirable standard of care for preterm and term newborns and may potentially improve their clinical and neurodevelopmental outcomes. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |