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Published on: September 24, 2020

Analgosedation in Neonatal Intensive Care: Current Strategies, Challenges, and Future Perspectives

Leonardo Detto1, Eleonora Alfieri1, Anna Munerati1

  • 1Pediatric Clinic, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy.

Life (Basel, Switzerland)
|July 28, 2026
PubMed

Insights

Managing pain and stress in neonatal intensive care is complex. Effective analgosedation (pain and sedation management) requires balancing medications with non-pharmacological methods for optimal infant comfort and development.

Area of Science:

  • Neonatal Intensive Care Medicine
  • Pediatric Pharmacology
  • Pain Management

Background:

  • Neonatal intensive care units (NICUs) frequently encounter pain and stress in critically ill newborns due to invasive procedures and life support.
  • Effective analgosedation is crucial for reducing infant distress, stabilizing physiology, and potentially preventing adverse neurodevelopmental outcomes.
  • Neonatal analgosedation is challenging due to infant immaturity, variable drug responses, and the risk of treatment complications.

Purpose of the Study:

  • To review current evidence on analgosedation strategies in the NICU.
  • To discuss clinical indications, pharmacological and non-pharmacological agents, monitoring, adverse effects, and future directions.
  • To emphasize the need for individualized, multimodal approaches to neonatal pain management.

Main Methods:

  • This is a narrative review of existing literature on neonatal analgosedation.
  • Evidence was synthesized focusing on key aspects of pain and sedation management in NICU settings.
  • The review examined pharmacological agents, non-pharmacological interventions, and assessment tools.

Main Results:

  • Opioids, benzodiazepines, dexmedetomidine, and ketamine offer benefits but have limitations, necessitating tailored use and monitoring.
  • Non-pharmacological methods like sucrose, non-nutritive sucking, and skin-to-skin care should complement pharmacological treatments.
  • Validated assessment tools (e.g., COMFORTneo, N-PASS, PIPP-R) aid in standardized pain evaluation and treatment guidance.

Conclusions:

  • Optimizing neonatal comfort requires a multidisciplinary, protocol-driven, and family-centered approach.
  • Individualized selection and titration of analgosedation agents, alongside non-pharmacological strategies, are essential.
  • Future advancements may involve objective monitoring, AI, and precision medicine to refine neonatal pain and stress management.

Keywords:
analgosedationneonatal intensive careneonatal painnon-pharmacological interventionspain assessmentprocedural analgesia

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