Assessing pain in preterm infants in the neonatal intensive care unit: moving to a 'brain-oriented' approach

Liisa Holsti, Ruth E Grunau, Eilon Shany
2011 Pain Management  
Preterm infants in the neonatal intensive care unit undergo repeated exposure to procedural and ongoing pain. Early and long-term changes in pain processing, stress-response systems and development may result from cumulative early pain exposure. So that appropriate treatment can be given, accurate assessment of pain is vital, but is also complex because these infants' responses may differ from those of full-term infants. A variety of uni-and multidimensional assessment tools are available;
more » ... er, many have incomplete psychometric testing and may not incorporate developmentally important cues. Near-infrared spectroscopy and/or EEG techniques that measure neonatal pain responses at a cortical level offer new opportunities to validate neonatal pain assessment tools. More than 12 million premature infants are born worldwide each year [101] . Preterm newborns shift abruptly from the protective intrauterine environment to the neonatal intensive care unit (NICU), where they undergo essential life-saving, invasive care-related procedures. For example, an infant born at less than 29 weeks gestational age may experience 300 or more painful procedures over a 3-month stay in the NICU [1]. Despite national and international guidelines that call for minimizing painful procedures in these neonates [2] , the high rate of exposure to these procedures continues [3] . To increase awareness of the importance of assessing and managing pain, some suggest that pain should be considered an adverse event [4] . Since the rapidly developing nervous system of immature preterm neonates differs from term infants, preterm infants are particularly vulnerable to the effects of pain and stress. In the neonatal period they are at risk of enhanced pain sensitivity (for a review see [5]). For these infants, poorly managed pain and stress may have important consequences. Continual adaptation to repeated pain appears to induce functional changes in stress and pain
doi:10.2217/pmt.10.19 pmid:21874145 pmcid:PMC3161414 fatcat:euoszz3qmfdbbiwpevkjcf3g6m