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Published on: February 9, 2024
Neonatal pain assessment: Do we have the right tools?
Amelia Llerena1, Krystal Tran2, Danyal Choudhary3
1Morsani College of Medicine, University of South Florida, Tampa, FL, United States.
Insights
Accurate neonatal pain assessment is vital but challenging. Current pain scales have limitations, indicating a need for improved tools and provider education for better infant care.
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.
Background:
The assessment and management of neonatal pain is crucial for the development and wellbeing of vulnerable infants. Specifically, neonatal pain is associated with adverse health outcomes but is often under-identified and therefore under-treated. Neonatal stress may be misinterpreted as pain and may therefore be treated inappropriately. The assessment of neonatal pain is complicated by the non-verbal status of patients, age-dependent variation in pain responses, limited education on identifying pain in premature infants, and the clinical utility of existing tools.
Objective:
We review research surrounding neonatal pain assessment scales currently in use to assess neonatal pain in the neonatal intensive care unit.
Methods:
We performed a systematic review of original research using PRISMA guidelines for literature published between 2016 and 2021 using the key words "neonatal pain assessment" in the databases Web of Science, PubMed, and CINAHL. Fifteen articles remained after review, duplicate, irrelevant, or low-quality articles were eliminated.
Results:
We found research evaluating 13 neonatal pain scales. Important measurement categories include behavioral parameters, physiological parameters, continuous pain, acute pain, chronic pain, and the ability to distinguish between pain and stress. Provider education, inter-rater reliability and ease of use are important factors that contribute to an assessment tool's success. Each scale studied had strengths and limitations that aided or hindered its use for measuring neonatal pain in the neonatal intensive care unit, but no scale excelled in all areas identified as important for reliably identifying and measuring pain in this vulnerable population.
Conclusion:
A more comprehensive neonatal pain assessment tool and more provider education on differences in pain signals in premature neonates may be needed to increase the clinical utility of pain scales that address the different aspects of neonatal pain.
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