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Guidelines for procedural pain in the newborn
Paola Lago1, Elisabetta Garetti, Daniele Merazzi
1Neonatal Intensive Care Unit, Department of Paediatrics, University of Padova, Via Giustiniani 3, Padua, Italy. lago@pediatria.unipd.it
Insights
Managing procedural pain in newborns is crucial, as it can lead to long-term issues. Guidelines recommend sucrose or breast milk for minor procedures and drug combinations for tracheal intubation, but evidence for other interventions is limited.
Area of Science:
- Neonatal care
- Pain management
- Evidence-based medicine
Background:
- Procedural pain in newborns can have detrimental acute and long-term effects on behavior and neurological outcomes.
- Pain control and prevention in neonates remain controversial issues.
- Lack of standardized guidelines for managing procedural pain in newborns.
Purpose of the Study:
- To develop evidence-based guidelines for preventing and controlling procedural pain in neonates.
- To provide a global analgesic management strategy considering various measures.
- To enhance healthcare professionals' awareness of adequate procedural pain management in neonates.
Main Methods:
- Systematic review of literature.
- Data synthesis and expert consensus among neonatologists.
- Incorporation of SIGN (Scottish Intercollegiate Guidelines Network) classification.
- Consideration of pharmacological, non-pharmacological, behavioral, and environmental measures.
Main Results:
- Strong evidence supports sucrose or breast milk for minor invasive procedures.
- Combinations of drugs are recommended for tracheal intubation.
- Many pain control measures for procedures like chest tube placement/removal, ROP screening/treatment, and postoperative pain lack strong evidence, relying on good practice or expert opinion.
Conclusions:
- Developed guidelines aim to improve healthcare professional awareness regarding neonatal procedural pain management.
- Management should be based on the strongest available evidence.
- Further research may be needed to establish evidence-based practices for all neonatal procedures.
Unlabelled:
Despite accumulating evidence that procedural pain experienced by newborn infants may have acute and even long-term detrimental effects on their subsequent behaviour and neurological outcome, pain control and prevention remain controversial issues. Our aim was to develop guidelines based on evidence and clinical practice for preventing and controlling neonatal procedural pain in the light of the evidence-based recommendations contained in the SIGN classification. A panel of expert neonatologists used systematic review, data synthesis and open discussion to reach a consensus on the level of evidence supported by the literature or customs in clinical practice and to describe a global analgesic management, considering pharmacological, non-pharmacological, behavioural and environmental measures for each invasive procedure. There is strong evidence to support some analgesic measures, e.g. sucrose or breast milk for minor invasive procedures, and combinations of drugs for tracheal intubation. Many other pain control measures used during chest tube placement and removal, screening and treatment for ROP, or for postoperative pain, are still based not on evidence, but on good practice or expert opinions.
Conclusion:
These guidelines should help improving the health care professional's awareness of the need to adequately manage procedural pain in neonates, based on the strongest evidence currently available.
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