Neonatal pain management: still in search for the Holy Grail

Area of Science:

• Neonatal care
• Developmental pharmacology
• Pain management

Background:

• Inadequate pain management and analgesic misuse in neonates negatively impact neurodevelopmental outcomes.
• Current neonatal pain management relies on prevention, assessment, treatment, and reassessment, but faces challenges with frequent painful procedures.
• Existing pain assessment tools are subjective, highlighting the need for improved strategies.

Purpose of the Study:

• To address the ongoing search for optimal pain management in neonates.
• To explore the need for effective non-pharmacological preventive strategies.
• To investigate the development and validation of new pharmacological treatments and the role of pharmacogenetics in precision medicine for neonates.

Main Methods:

• Review of current epidemiological observations and clinical practices in neonatal intensive care units (NICUs).
• Analysis of the shift in analgesic use, including a move from opioids to paracetamol and increased use of short-acting agents like remifentanil and propofol.
• Exploration of pharmacogenetics as a tool for precision medicine in neonatal pain management.

Main Results:

• Neonates frequently undergo painful procedures, necessitating preventive, non-pharmacological strategies.
• Clinical practice shifts in NICUs require new pharmacological treatments and validated assessment tools.
• Pharmacogenetics offers a pathway to precision medicine in neonatal analgesia.

Conclusions:

• Improved neonatal pain management necessitates the integration of pharmacogenetics with clinical covariates such as weight, age, and disease characteristics.
• Further research is needed to validate new pharmacological treatments and refine pain assessment methods.
• Precision medicine approaches, including pharmacogenetics, hold promise for optimizing neonatal pain management and neurodevelopmental outcomes.