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Prevention and management of procedural pain in the neonate: an update, American Academy of Pediatrics, 2016
  1. Yinru Lim1,
  2. Sunit Godambe2
  1. 1 Department of Paediatrics, North Middlesex University Hospital NHS Trust, London, UK
  2. 2 Division of Neonatology, Imperial College Healthcare NHS Trust, St Mary’s Hospital, London, UK
  1. Correspondence to Dr Yinru Lim, Department of Paediatrics, North Middlesex University Hospital NHS Trust, London, N18 1QX, UK; yinrulim85{at}gmail.com

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Background

Neonates, especially preterm infants, are often subjected to frequent painful procedures during their stay in the neonatal intensive care unit.1 Repeated painful stimuli in early life are known to result in both short-term and long-term sequelae. These include physiological instability, abnormal somatosensory and stress responses, and effects on long-term neurodevelopment, behavioural and social-emotional outcomes.2 3 The management of pain in a neonate is also challenging because neonates are unable to report pain, and it can be particularly difficult to assess pain in the extreme preterm, ill or neurologically compromised neonate. Therefore, it is important that all healthcare professionals who are involved in the care of these infants are aware of how to assess pain and stress, and manage pain appropriately.

Information about current guideline

In February 2016, the American Academy of Pediatrics (AAP) published an updated guideline entitled ‘Prevention and management of procedural pain in the neonate’.4 The guideline development group included representatives from the AAP Committee of Fetus and Newborn, 2015–2016, and Section on Anesthesiology and Pain Medicine Executive Committee, 2014–2015.

Previous guideline

The previous guideline on the management and prevention of procedural pain in the neonate was published by the AAP in 2007. This revision updates previous recommendations with new evidence to aid healthcare professionals to ‘implement a pain assessment and management plan for the prevention of pain associated with routine minor procedures, and with surgery and other major procedures in neonates.’

Key issues

  • Pain assessment

    • Effective and reliable pain assessment tools are essential for the management of neonatal pain. Numerous neonatal pain scales exist but only five have been subjected to rigorous psychometric testing …

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