AAP offers guidance on neonatal pain management
The youngest, most fragile patients often face many painful procedures in their first weeks of life, yet there has been little research and evidence-based protocols established outlining the most effective assessments and treatments for neonates.
Erin Keels, APRN, MS, NNP-BC, of Nationwide Children’s Hospital in Columbus, Ohio and lead author of new guidance from the American Academy of Pediatrics (AAP), says while there is new data available on pain management in neonates for pediatricians, there is still much work to be done.
Around the same time the previous AAP policy statement on neonatal pain from 2006 was due to be reviewed, a meta-analysis of studies on non-pharmacologic interventions and pharmacologic therapies for neonates was conducted, says Keels. That meta-analysis revealed large gaps in assessment and treatment protocols, as well as evidence about what interventions work.
“Relative to the 2006 statement, we have better outcomes data related to the usefulness of nonpharmacologic interventions such as skin-to-skin care/contact, breastfeeding, sensorial sensation, and strategic positioning/tucking,” Keels says. “At the same time, we continue to be challenged for long-term neurodevelopmental outcomes with repeated/excessive use of sucrose or glucose and other medication-based therapies.”
Previous guidelines developed by the AAP and the Canadian Pediatric Society addressed the need to assess neonatal pain and provided recommendations on preventing and minimizing pain as well as promptly and adequately treating unavoidable pain.
Despite these previous efforts, Keels says neonatal pain continues to be “inconsistently assessed and inadequately managed.”
Keels cites a French study from 2008 that revealed only 21% of infants were provided interventions and medications aimed at alleviating pain before procedures, and only 34% continued to receive some kind of pain relief following their procedures.
Preventing and treating pain in neonate is not only the ethical thing to do, but it is also important to prevent long-term negative effects of treatment, Keels says.
“Exposure to repeated painful stimuli early in life is known to have short- and long-term adverse sequelae,” Keels notes. “These sequelae include physiologic instability, altered brain development, and abnormal neurodevelopment, somatosensory, and stress response systems, which can persist into childhood. Nociceptive pathways are active and functional as early as 25 weeks’ gestation and may elicit a generalized or exaggerated response to noxious stimuli in immature newborn infants.”