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Updated: Jan 16, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Sedation, Analgesia, and Delirium in Neonates: A Comprehensive Review

Emily C Gritz1,2, Andrew M Barr3, DonnaMaria E Cortezzo1,2,4,5

  • 1Division of Neonatology, Connecticut Children's Medical Center, Hartford, Connecticut.

Neoreviews
|September 30, 2025
PubMed

Insights

Neonatal pain, agitation, and delirium (PAD) require prompt management. This review details pharmacologic strategies to effectively treat these symptoms in intensive care, minimizing long-term neurodevelopmental effects.

Area of Science:

  • Neonatal intensive care
  • Pediatric pharmacology
  • Neurodevelopmental outcomes

Background:

  • Neonates in intensive care often experience pain, agitation, and delirium (PAD) due to procedures and therapies.
  • Early recognition and treatment of PAD are crucial for reducing morbidity and mortality.
  • Nonpharmacologic interventions alone are frequently insufficient for managing PAD symptoms.

Purpose of the Study:

  • To review the pathophysiology, impact, assessment, and management of PAD in neonates.
  • To enhance clinicians' understanding of pharmacologic therapies for PAD.
  • To guide individualized and targeted pharmacologic treatment strategies for neonatal PAD.

Main Methods:

  • Comprehensive literature review on neonatal PAD.
  • Summary of pathophysiological mechanisms of PAD.
  • Analysis of pharmacologic and nonpharmacologic management options.

Main Results:

  • Effective management of neonatal PAD requires understanding its underlying pathophysiology.
  • Targeted pharmacologic therapies can be tailored to individual patient needs.
  • Protocols for medication initiation and titration are essential for safe and effective treatment.

Conclusions:

  • Individualized pharmacologic management is key to treating neonatal PAD.
  • Judicious use of medications, guided by protocols, can minimize long-term neurodevelopmental risks.
  • Further research into optimal pharmacologic strategies for neonatal PAD is warranted.

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