Pain in the Neonate: Acknowledgement to Action

With technological advancement and a better understanding of physiology, today there is irrefutable evidence that neonates do experience pain and even more so than their older counterparts. This pain sensitivity is further accentuated in preterm neonates as their pain modulating mechanism is under-developed. The hospitalized neonate is subjected to several procedures daily which result in pain of differing intensities. In the more premature neonates, even gestationally inappropriate procedures are perceived as noxious stimuli. Acute, prolonged and repetitive pain has been associated with both short and long term morbidities which result in not only delayed recovery but also neurodevelopmental and cognitive deficits in later life. As the sick and premature newborns neither verbalize nor mount vigorous behavioural responses to pain, it is often under recognized by the unpracticed healthcare provider. Several neonatal pain scales are available. However these are mostly validated for acute and not acute, repetitive or chronic pain which is the common problem faced by the sick newborns. Multidimensional pain assessment would include both physiological and behavioral parameters necessitating the use of multiple tools to complement each other. Several therapeutic options are available which include general measures which are neonatal friendly as well as non pharmacological and pharmacological measures. These used as combination therapy have been found to be more beneficial. Training of the healthcare providers so that the pain management protocol is appropriately implemented in the NICU as well as a continuous pain management quality improvement programmes with collaborative participation of all echelons would enable a more pain free and comfortable recovery of the neonates in hospital