Magazine article Drug Topics

New Guidelines Advise Pain Management for Neonates

Magazine article Drug Topics

New Guidelines Advise Pain Management for Neonates

Article excerpt

Is there pain associated with a venipuncture, venous or arterial catheter insertion, tracheal intubation or lumbar puncture? Almost all health professionals would answer with a resounding Yes. Yet, when these procedures are performed on neonates in the neonatal intensive care unit (NICU), it has not been uncommon to see no pain treatment given or, if pain treatment is given, it's limited to the initial procedure itself.

"Indeed, even in the late '80s, it was not uncommon for a baby to go into the operating room for open-heart surgery and get nothing but the anesthetic during the procedure," said Marcia Buck, clinical pharmacy specialist for pediatrics at the University of Virginia Children's Medical Center, Charlottesville, Va.

This seems almost unthinkable. What adult would tolerate this? But, critically ill and preterm neonates do not demonstrate vigorous responses to pain. So, unless pain is carefully assessed, it can be overlooked. To be certain it isn't overlooked, K. J. S. Anand, M.D., of Arkansas Children's Hospital, Little Rock, and the International Evidence-Based Group for Neonatal Pain have developed a "Consensus Statement for the Prevention and Management of Pain in the Newborn," published in the Archives of Pediatric and Adolescent Medicine in February.

"Anand's mission is to improve pain management," said Marita Nazarian, director of pharmacy at Arkansas Children's Hospital. "He's really changed our practice here quite a bit. I think we're more aggressive in treating pain. We're certainly looking for it consistently," she explained.

During the first few days and weeks after birth, all newborns undergo routine invasive medical procedures. However, healthy babies experience far fewer procedures than neonates in the NICU. One study found that neonates in the intensive care unit undergo as many as three invasive procedures per hour. Another documented a baby born at 23 weeks gestation, with a birth weight of 560 gm, had 488 invasive procedures. That same study found that endotracheal suction, heel prick, and blood sampling make up more than 90% of the procedures in the NICU.

The consensus statement covers neonatal types of pain experienced, pain assessment, and management. It also offers specific suggestions to treat pain from certain procedures, by using environmental methods, behavioral methods such as sucrose and nonnutritive sucking, as well as drugs for preemptive analgesia and ongoing pain. …

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