Neonatal pain assessment: Do we have the right tools?

Area of Science:

• Neonatal Intensive Care Unit (NICU) care
• Pediatric pain management
• Infant development and wellbeing

Background:

• Neonatal pain is critical for infant development but often under-identified and undertreated, leading to adverse outcomes.
• Neonatal stress can be misidentified as pain, resulting in inappropriate treatment.
• Assessing neonatal pain is complex due to non-verbal communication, age-related variations, limited provider education, and tool utility challenges.

Purpose of the Study:

• To review existing research on neonatal pain assessment scales used in NICUs.
• To evaluate the strengths and limitations of current neonatal pain assessment tools.

Main Methods:

• A systematic review of original research published between 2016 and 2021.
• Searches conducted in Web of Science, PubMed, and CINAHL using keywords "neonatal pain assessment".
• PRISMA guidelines followed, with 15 articles selected after eliminating duplicates, irrelevant, or low-quality studies.

Main Results:

• Thirteen neonatal pain scales were evaluated.
• Key measurement categories include behavioral and physiological parameters, distinguishing between acute, chronic, and continuous pain, and differentiating pain from stress.
• No single scale demonstrated excellence across all crucial areas, with each having unique strengths and weaknesses.

Conclusions:

• Existing neonatal pain assessment scales have limitations in comprehensively and reliably measuring pain in vulnerable infants.
• Enhanced provider education on recognizing pain signals in premature neonates is necessary.
• Development of more comprehensive neonatal pain assessment tools is recommended to improve clinical utility and infant care.