Addressing Postoperative Pain for Infants in the NICU

Infant pain can be challenging to identify and treat accurately, especially in the postoperative patient. Failure to recognize pain in infants has been associated with poor neurologic outcomes and increased risk of death. A literature review was conducted using PubMed and CINAHL from 2019 to 2024. Articles included those published in the English language, published within the last 5 years, that discussed infant postoperative pain, pain assessment, and treatment. Sources utilized outside the 5-year time frame are primary sources from the most current systematic literature reviews. Inadequately managed pain in infants can have long-term consequences, including the development of chronic pain. These concerns make adequate treatment of all pain essential, though recognition of pain can be complex in preverbal and neurologically immature patients. Several evidence-based pain assessment scales are available but must be used appropriately in the right population and setting. Five pain scales appropriate for postoperative pain in the infant population are COMFORT; Cries, Requires oxygen, Increased vital signs, Expression, Sleeplessness (CRIES); Face, Legs, Activity, Cry, and Consolability (FLACC); Neonatal Pain, Agitation, and Sedation Scale (N-PASS); and Premature Infant Pain Profile-Revised (PIPP-R). Nursing staff and providers must be educated in proper pain assessment and advocate for adequate analgesia for their postoperative patients. While some infants will require opioids for adequate pain relief, nonopioid pain medications can be used in the postoperative period. An algorithm for postoperative analgesia in neonates and infants could be beneficial in appropriately treating pain with targeted interventions, escalating care, and reducing cumulative opioid exposure.