Neonates’ Pain Should Preferably Be Managed Without Drugs

The AAP therefore recommends that for mild to moderate pain, practitioners should look for non-pharmacologic interventions, such as those backed by additional research as detailed in the updated policy. The recommended approaches include skin-to-skin contact, facilitated tucking, sensorial stimulation, swaddling, non-nutritive sucking, and massage.

The next level of care would be oral sucrose and/or glucose, which should be tracked as medications. For those whose pain cannot be managed with these approaches, doctors should weigh the risks and benefits of pharmacologic interventions with opioids, benzodiazepines, and other drugs. For some procedures, such as circumcision, chest drain insertion and removal, and nonemergency intubations, the AAP recommends routine pain management. However, more research is needed as to the best way to manage pain during other procedures like mechanical ventilation.

Additional recommendations include creating a pain prevention and treatment plan that includes judicious use of approved procedures and routine pain assessment; using validated neonatal pain assessment tools before, during, and after painful procedures; and that healthcare providers and family members should receive continuing education on assessment and management of pain. The AAP policy statement, called “Prevention and Management of Procedural Pain in the Neonate,” was published in the February 2016 issue of Pediatrics.

“There's emerging evidence that parents particularly can be very effective in helping the nurse at the bedside to contain the baby, or provide the pacifier the sucrose is on, or perform skin-to-skin care or breastfeeding during the procedure, so really integration of the parent into the whole plan of care can be really effective,” said lead co-author Erin Keels, APRN, the National Association of Neonatal Nurses (Chicago, IL, USA) liaison to the AAP Committee on Fetus and Newborn (COFN).

“Communication barriers can make neonatal pain difficult to assess and manage. There are more than 40 neonatal assessments tools, some of which are included in a table in the policy. However, there is no gold standard,” added Ms. Keels. “The cues from baby to baby are just a little bit different, and we’re still trying to figure that out, how best to be able to evaluate each baby’s level of pain individually.”

Related Links:
American Academy of Pediatrics
National Association of Neonatal Nurses