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AAP updates guidelines on neonatal pain management, suggests alternatives for mild pain
An AAP policy statement has updated its recommendations to further limit or prevent unnecessary pain that neonates may be exposed to during routine procedures.
“Neonates are frequently subjected to painful procedures, with the most immature infants receiving the highest number of painful events,” Erin L. Keels, APRN, MS, NNP-BC, of the nurse practitioner team in the department of neonatology at Nationwide Children’s Hospital, and colleagues wrote. “Despite recommendations from the AAP and other experts, neonatal pain continues to be inconsistently assessed and inadequately managed. This statement updates previous recommendations with new evidence on the prevention, assessment and treatment of neonatal procedural pain.”
The policy statement — authored by the AAP’s Committee on Fetus and Newborn and the Section on Anesthesiology and Pain Medicine — is intended to update previous guidelines from the AAP and the Canadian Pediatric Society. The recommendations emphasize the importance of implementing a pain-prevention program for certain procedures. Keels and colleagues also wrote that health care facilities should implement pain assessment and management plans, which encourage the use of pharmacological and nonpharmacological treatments.
Recommended alternative therapies for treating pain among neonates included:
- skin-to-skin contact;
- facilitated tucking;
- sensorial stimulation;
- swaddling;
- non-nutritive sucking;
- positioning; and
- massaging.
Other recommendations in the report included:
- development and application of assessment tools for use before, during and after pain-inducing procedures;
- administration of oral sucrose or glucose solutions to alleviate mild pain;
- breast-feeding to alleviate mild to moderate pain;
- providing family members with tools and education to manage pain;
- using available evidence to weigh risks associated with painful procedures; and
- further research into the field of neonatal pain management.
“There are significant research gaps regarding the assessment, management, and outcomes of neonatal pain; and there is a continuing need for studies evaluating the effects of neonatal pain and pain-prevention strategies on long-term neurodevelopmental, behavioral, and cognitive outcomes,” Keels and colleagues wrote. “Despite incomplete data, the pediatrician and other health care professionals who care for neonates face the need to weigh … these concerns in assessing pain and the need for pain prevention and management on a continuing basis throughout the infant’s hospitalization.”
The report also detailed the history of the use of pharmacological treatments among neonates, and recommended their use when necessary. The authors said it is critical to alleviate pain among newborns because painful experiences at this time can have long-lasting effects. – by David Costill
Disclosure: The researchers report no relevant financial disclosures.
