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Electrophysiological Measurements and Analysis of Nociception in Human Infants
Published on: December 20, 2011
Pain in very preterm infants-prevalence, causes, assessment, and treatment. A nationwide cohort study
Hillary Graham1, Neda Razaz1, Stellan Håkansson2
1Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
Insights
Many very preterm infants experience pain, with pain prevalence decreasing as gestational age increases. Pain assessment and pharmacological treatment are common, but pain management requires further optimization in neonatal care.
Area of Science:
- Neonatalogy
- Pediatric Pain Management
- Clinical Epidemiology
Background:
- Pain management in preterm infants, especially extremely preterm, is under-researched.
- Limited data exists on the epidemiology, causes, and treatment of pain in very preterm infants.
Purpose of the Study:
- To investigate the epidemiology of pain in very preterm infants.
- To explore causes, pain assessment methods, and treatment strategies for pain in this population.
Main Methods:
- Utilized registry data from a Swedish nationwide cohort of liveborn infants <32 weeks' gestational age (GA).
- Analyzed proportions of infants exposed to painful procedures, experiencing pain, assessed with scales, and receiving pharmacological treatment by postnatal day.
- Included 3686 infants discharged between January 2020 and June 2024.
Main Results:
- 11.6% had painful conditions; 84.1% experienced at least one potentially painful procedure.
- 74.6% experienced pain, accounting for 15.2% of neonatal care days.
- Pain prevalence decreased with increasing GA; reported pain matched procedures more closely in later preterm infants (28-31 weeks GA).
- Pain scales used in 75.0%; 81.7% received pharmacological treatment (mostly topical/oral).
- Intravenous treatment increased with GA among infants in pain.
Conclusions:
- Despite analgesia/anesthesia, very preterm infants frequently experience pain.
- Understanding pain epidemiology by GA and postnatal age is crucial for clinical management.
- Further research is needed to reduce pain and its adverse effects in this vulnerable group.
Abstract:
Studies on pain in preterm infants have usually been confined to observations of painful procedures, and information from extremely preterm infants is limited. Using registry data from a Swedish nationwide cohort, this study explored the epidemiology of pain in very preterm infants, its causes, assessments, and treatment strategies. We included liveborn infants <32 weeks' gestational age (GA) discharged between January 2020 and June 2024. Proportions of infants exposed to potentially painful procedures, experiencing pain, assessed with pain scales, and receiving pharmacological treatment were calculated by each postnatal day. Among 3686 infants (mean birthweight 1176 g, GA 28.2 weeks), 11.6% had a painful condition and 84.1% were exposed to at least 1 potentially painful procedure. In total, 74.6% experienced pain, corresponding to 28,137/185,008 (15.2%) days of neonatal care. For every 2-week increase in GA, significantly lower proportions of infants experienced pain. In infants <28 weeks of GA, proportions with reported pain were approximately half the rate of painful procedures, while in infants born at 28 to 31 weeks, reported pain closely matched exposure to painful procedures. Pain scales were used in 75.0% of the infants. Pharmacological pain treatment was administered to 81.7% of infants, primarily topically or orally. Among infants with pain, proportions treated intravenously were larger at higher GAs. Despite effective analgesia/anesthesia, many very preterm infants experience pain. Visualizing pain epidemiology, procedures, conditions, and treatment by postnatal and gestational age may guide clinical management and generate research hypotheses to reduce short- and long-term adverse effects.
