Newborns experience 'too much pain' during procedures, pediatrics group says
Newborn baby Bea Joy is held by relative Michelle Satur after her mother Emily Ortega, 21, gave birth in an improvised clinic at Tacloban airport Monday Nov. 11, 2013 in Tacloban city, Leyte province in central Philippines. (AP Photo/Bullit Marquez)
Newborns are experiencing too much pain during routine medical procedures, the American Academy of Pediatrics is warning.
In an updated policy statement released Monday, the AAP said pain from these procedures can be significant, especially in premature infants.
“Research suggests that repeated exposure to pain early in life can create changes in brain development and the body's stress response systems that can last into childhood,” the academy said in a press release.
The policy statement, titled "Prevention and Management of Procedural Pain in the Neonate: An Update," will appear in the February 2016 issue of Pediatrics.
The new statement recommends neonatal health care facilities develop and implement a pain prevention program that includes minimizing the number of painful procedures performed.
The authors of the statement say proven and safe therapies to treat and manage pain in newborns are "currently underused for routine minor, yet painful procedures." These procedures can include a heel lance, when a newborn’s heel is pricked to collect a blood sample, the insertion of an IV,circumcision, chest drain insertion and removal, and non-emergency intubations
Therapies to treat pain include several non-pharmacological treatments, such as swaddling, skin-to-skin contact and breastfeeding, the statement says.
While administering sucrose and glucose to neonates is an effective way to reduce pain, the authors of the statement expressed concern that excessive use could possibly affect neurological development.
They note that while the practice of administering sucrose is common in most nurseries, doses vary widely.
They cite one study of 107 preterm infants that found worse neurodevelopmental scores at 32, 36 and 40 weeks' gestational age in infants who had received more than 10 doses of sucrose over a 24-hour period in the first week of life.
"The role and safety of long-term sucrose use for persistent, ongoing pain have not been systematically studied," the statement says.
The authors recommend that whenever sucrose or glucose is used to treat pain, it be prescribed and tracked as a medication.
They also recommend the following:
- Preventing and minimizing pain in neonates should be the goal of pediatricians and health-care providers who provide care for newborns. Written guidelines on pain management should be developed, based on evidence on both drug and non-drug therapies.
- Pain-assessment tools should be used before, during and after painful procedures to monitor the effectiveness of any interventions.
- Non-drug treatments should be consistently used.
- When using drug treatments, doctors and health-care providers who care for neonates must weigh the potential and actual benefits of pain-relief interventions against the burdens.
- Doctors, neonatal health-care providers, and family members should receive continuing education on how to assess and manage pain in newborns.
- More research should be conducted on pain-assessment tools.