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01:37
A Preterm Rat Model for Pain Studies
Published on: February 9, 2024
Do ventilated neonates require pain management?
R Whit Hall1, Elaine Boyle, Thomas Young
1Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA. Hallrichardw@uams.edu
Seminars in Perinatology
|October 2, 2007
Summary
Mechanical ventilation causes stress and pain in neonates, impacting neuroendocrine responses. Current sedation practices have risks and benefits, with significant knowledge gaps regarding long-term outcomes.
Area of Science:
- Neonatal care
- Pediatric pain management
- Neuroendocrinology
Background:
- Mechanical ventilation in neonates is a significant stressor.
- Assisted ventilation is linked to chronic pain and adverse long-term outcomes.
- Neuroendocrine parameters, pain scores, and physiological responses are altered.
Purpose of the Study:
- To review the current understanding of pain and sedation in ventilated neonates.
- To discuss the benefits and risks of routine sedation.
- To identify knowledge gaps in chronic pain assessment and long-term treatment effects.
Main Methods:
- Literature review of studies on mechanical ventilation, pain, and sedation in neonates.
- Analysis of neuroendocrine responses (cortisol, beta-endorphine, catecholamines).
- Evaluation of common analgesic and sedative agents (opiates, benzodiazepines).
Main Results:
- Sedation can improve ventilator synchrony, pulmonary function, and reduce neuroendocrine stress responses.
- Pain medications, particularly opiates, have significant side effects (hypotension, chest wall rigidity, tolerance, dependence, withdrawal).
- Preemptive treatment does not consistently improve outcomes like death or intraventricular hemorrhage (IVH).
Conclusions:
- Assessing chronic pain in ventilated neonates is challenging and poorly validated.
- Opiates like morphine and fentanyl are commonly used, each with specific considerations.
- Further research is needed on the long-term effects of sedation and pain management strategies.
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