Related Experiment Video
Updated: Dec 31, 2025
A Preterm Rat Model for Pain Studies
Published on: February 9, 2024
The influence of pain, agitation, and their management on the immature brain
Christopher McPherson1,2, Steven P Miller3, Mohamed El-Dib4
1Department of Pharmacy, St. Louis Children's Hospital, St. Louis, MO, USA.
Insights
Preterm infants in the neonatal intensive care unit (NICU) experience significant pain and stress. Developing a stepwise algorithm is crucial for preventing, assessing, and treating pain and agitation in these vulnerable infants.
Area of Science:
- Neonatalogy
- Pediatric Pain Management
- Neuroscience
Background:
- Preterm infants in neonatal intensive care units (NICUs) undergo frequent painful procedures and experience agitation.
- The neurobiological effects of pain and stress in preterm infants are well-documented, impacting neuroimaging and neurobehavioral outcomes.
- Limited methods exist for assessing chronic pain or agitation in neonates, despite validated tools for acute pain.
Purpose of the Study:
- To outline a stepwise algorithm for the prevention, assessment, and treatment of pain and agitation in preterm infants.
- To guide the judicious use of nonpharmacologic and pharmacologic interventions, considering their benefits and risks.
- To address the challenges of chronic sedation during invasive mechanical ventilation in neonates.
Main Methods:
- Review and synthesis of existing literature on pain and agitation management in preterm infants.
- Development of a tiered approach prioritizing nonpharmacologic interventions.
- Guidance on the use of pharmacologic agents, including sucrose, opioids, morphine, and dexmedetomidine.
Main Results:
- Nonpharmacologic interventions are recommended as a first-line approach for mild to moderately painful procedures.
- Sucrose can be used as an adjunctive therapy for minor painful procedures.
- Rapidly acting opioids (fentanyl, remifentanil) are foundational for moderately painful procedures, while low-dose morphine or dexmedetomidine may be considered cautiously for chronic sedation.
Conclusions:
- A structured, stepwise algorithm is essential for optimizing pain and agitation management in preterm infants.
- Balancing the benefits and risks of analgesia and sedation is critical.
- Continued research and cautious implementation of emerging therapies like dexmedetomidine are needed for chronic sedation challenges.
Abstract:
Preterm infants are exposed to frequent painful procedures and agitating stimuli over the many weeks of their hospitalization in the neonatal intensive care unit (NICU). The adverse neurobiological impact of pain and stress in the preterm infant has been well documented, including neuroimaging and neurobehavioral outcomes. Although many tools have been validated to assess acute pain, few methods are available to assess chronic pain or agitation (a clinical manifestation of neonatal stress). Both nonpharmacologic and pharmacologic approaches are used to reduce the negative impact of pain and agitation in the preterm infant, with concerns emerging over the adverse effects of analgesia and sedatives. Considering benefits and risks of available treatments, units must develop a stepwise algorithm to prevent, assess, and treat pain. Nonpharmacologic interventions should be consistently utilized prior to mild to moderately painful procedures. Sucrose may be utilized judiciously as an adjunctive therapy for minor painful procedures. Rapidly acting opioids (fentanyl or remifentanil) form the backbone of analgesia for moderately painful procedures. Chronic sedation during invasive mechanical ventilation represents an ongoing challenge; appropriate containment and an optimal environment should be standard; when indicated, low-dose morphine infusion may be utilized cautiously and dexmedetomidine infusion may be considered as an emerging adjunct.
Related Concept Videos
01:25Analgesia and Pain Management
01:20Pain