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Pain in newborns and prematures: current practice and knowledge
1Children's Hospital, University of Duesseldorf.
Insights
Newborns may experience pain, as evidenced by anatomical, physiological, and behavioral data. Despite proven anesthesia safety, some practices still withhold pain relief from neonates during surgery.
Area of Science:
- Neonatal care
- Pediatric anesthesiology
- Pain perception in infants
Background:
- The capacity of newborns to feel pain is not definitively established, leading to varied clinical approaches.
- Evidence suggests newborns, both full-term and preterm, may experience nociceptive activity.
- Current practices sometimes contradict demonstrated anesthesia efficacy and safety in neonates.
Purpose of the Study:
- To review evidence supporting pain perception in newborns.
- To address the discrepancy between demonstrated anesthesia safety and current withholding practices in neonates.
- To emphasize the ethical imperative of protecting neonates from pain and distress.
Main Methods:
- Review of anatomical, physiological, and behavioral evidence related to neonatal pain.
- Analysis of existing literature on anesthesia efficacy and safety in newborns.
- Examination of current clinical recommendations and practices regarding neonatal pain management.
Main Results:
- Multiple lines of evidence suggest newborns can experience distressing nociceptive activity.
- Anesthesia and analgesia have repeatedly been shown to be safe and effective in neonates.
- Outdated theories contribute to the undertreatment of pain in newborns during surgical procedures.
Conclusions:
- Physicians have a mandate to provide optimal therapy and protect neonates from pain, distress, and unease.
- Despite ongoing debate on the cognitive aspects of neonatal pain, clinical practice should prioritize pain prevention.
- Evidence supports the administration of adequate pain relief to newborns undergoing surgical procedures.
Abstract:
No unambiguous answer can be given as to whether newborns are able to feel pain similar to that experienced by older children and adults. However, there are several lines of evidence--anatomical, physiological and behavioral--which substantiate the possible presence of distressing nociceptive activity in the full-term and preterm neonate. Although the efficacy and safety of anesthesia in newborns and prematures has repeatedly been demonstrated, there are still numerous recommendations and current practices, based on antiquated theories, that withhold adequate medications from neonates during surgery. Even if the emotional and cognitive aspects of nociception in the newborn remain a subject of speculation giving rise to philosophical discussions as to the correct terminology, it is the mandate of newborns' physicians to provide the best possible therapy to their patients and to protect them from distress, unease and presumptive pain.