Position statement
Posted: Feb 1, 2007 | Reaffirmed: Jan 30, 2017
A joint statement with the American Academy of Pediatrics
KJ Barrington, DG Batton, GA Finley MD, C Wallman; Canadian Paediatric Society, Fetus and Newborn Committee
Abridged version: Paediatr Child Health 2007;12(2):137-8
The prevention of pain in neonates should be the goal of all caregivers because painful exposures have the potential for deleterious consequences. Those neonates at greatest risk for neurodevelopmental impairment due to preterm birth (eg, the smallest and sickest) are also most likely to be exposed to the greatest number of painful stimuli in the neonatal intensive care unit (NICU). Although there are major gaps in our knowledge regarding the most effective way to prevent and relieve pain in neonates, proven and safe therapies are currently underutilized for routine minor, yet painful, procedures. Every health care facility caring for neonates should implement an effective pain prevention program that includes strategies for the following: routinely assessing pain; minimizing the number of painful procedures performed; effectively using pharmacological and nonpharmacological therapies for the prevention of pain associated with routine minor procedures; and eliminating pain associated with surgery and other major procedures.
Key words: Management; Neonates; Pain; Prevention
Objectives
The present updated statement is intended for health care professionals caring for neonates (preterm to one month of age). The objectives are to:
For more information, please refer to the full statement, which can be found in Pediatrics 2006;118(5):2231-41 or online at http://pediatrics.aappublications.org/content/118/5/2231.full.
Background
The prevention of pain in neonates is an expectation of parents. However, there are major gaps in our knowledge regarding the most effective way to accomplish this. The prevention of pain is important not only because it is an ethical expectation, but also because of potential deleterious consequences of repeated painful exposures. These consequences include altered pain sensitivity (which may last into adolescence) and permanent neuroanatomical and behavioural abnormalities, as found in animal studies. It appears that altered pain sensitivity can be ameliorated if effective pain relief is provided. The present updated statement deals primarily with pain prevention.
Clinical implications
Neonates in the NICU often experience painful procedures during routine care, such as needle insertions, suctioning, gavage tube placement and tape removal, as well as stressful disruptions, including diaper changes, chest physical therapy, physical examinations, environmental stimuli and nursing evaluations. Despite increased awareness by caregivers that neonates in the NICU frequently experience pain, effective pain relief for these routine procedures is often underutilized.
Clinical implications
Intercostal drains
Analgesia for chest drain insertion should comprise all of the following:
Chest drain removal
Analgesia for chest drain removal should comprise the following:
Intubation
This topic will be discussed further in a statement by the American Academy of Pediatrics and the Canadian Paediatric Society.
Retinal examination and surgery for retinopathy of prematurity
Circumcision
Pain relief for circumcision should always be provided. The American Academy of Pediatrics has published a separate statement on this subject. For more information, please refer to the full text of this position statement (Pediatrics 2006;118:2231-2241 or http://pediatrics.aappublications.org/cgi/reprint/118/5/2231).
Members: Keith J Barrington MD (chair); Joanne Embree MD (board representative); Haresh Kirpalani MD; Koravangattu Sankaran MD; Hilary Whyte MD; Robin Whyte MD
Liaisons: Dan Farine MD, Society of Obstetricians and Gynaecologists of Canada; David Keegan MD, Maternity and Newborn Care Committee, College of Family Physicians of Canada; Catherine McCourt MD, Health Surveillance and Epidemiology, Public Health Agency of Canada; Alfonso Solimano MD, Neonatal-Perinatal Medicine Section, Canadian Paediatric Society; Ann Stark MD, Committee on Fetus and Newborn, American Academy of Pediatrics; Amanda Symington, Neonatal Nurses
Principal authors: Keith J Barrington MD, Fetus and Newborn Committee, Canadian Paediatric Society; Daniel G Batton MD, Committee on Fetus and Newborn, American Academy of Pediatrics; G Allen Finley MD, Section on Anesthesiology and Pain Management, American Academy of Pediatrics; Carol Wallman, National Association of Neonatal Nurses, liaison to the American Academy of Pediatrics
Disclaimer: The recommendations in this position statement do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate. Internet addresses are current at time of publication.
Last updated: Feb 7, 2024