[Nonpharmacologic management of pain in neonates]

It has taken a staggering amount of time for the medical community to realize that new-borns are able to feel pain. The treatment of neonatal pain during procedures has become mandatory, not only for humanitarian reasons which could alone justify the soothing of pain in these infants but also because repeated and prolonged pain may have long-term consequences in neonates. Nonpharmacological interventions which comprise environmental and behavioral interventions have a wide applicability for neonatal pain management alone or in combination with pharmacological treatments. These interventions are not necessarily substitutes or alternatives for pharmacological interventions but are complimentary. Nonpharmacological interventions can reduce neonatal pain indirectly by reducing the total amount of noxious stimuli to which infants are exposed and directly, by blocking nociceptive transduction or transmission or activation of descending inhibitory pathways or by activating attention and arousal systems that modulate pain. This article describes prevention, environmental interventions, and behavioral strategies. Within the behavioral strategies, sweet solutions, especially sucrose and glucose, with or without non-nutritive sucking, skin to skin contact, and breastfeeding during procedures have been studied and their analgesic efficacy has been shown. A practical approach is described hereafter. Give 1-2 ml of oral sucrose or glucose 30% at 2 min before a minor painful procedures in term neonates or neonates weighing more than 2500 g. The analgesic efficacy of sucrose and glucose seems similar. For preterm neonates weighing less than 2500 g, give 0.5 ml of oral sucrose or glucose 30%, and for those weighing less than 1500 g, 0.3 ml of oral sucrose or glucose 30%. Since a synergistic effect has been shown for the association of sweet solutions and pacifiers, give a pacifier together with sweet solutions. For term neonates that are breastfed, consider breastfeeding during procedures. These nonpharmacological interventions are suitable for minor procedures. They should not constitute the sole analgesic when performing more invasive procedures.