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Newborns in Intensive Care Often Exposed to Pain

May change pain processing in brain, affect development, researcher says

TUESDAY, July 1 (HealthDay News) -- Although tiny babies receiving intensive care must undergo numerous painful interventions, not enough is being done to reduce their discomfort, new research suggests.

Of the 42,413 painful procedures included in this study, only 2 percent of babies received pain medications, and just 18.2 percent received non-pharmacological pain therapy. That means about four out of five babies received no interventions to lessen their pain, according to the study, which was published in the July 2 issue of the Journal of the American Medical Association.

"We found that babies are exposed to a lot of painful and stressful procedures, mostly not treated with pain-relieving interventions," said study author Dr. Ricardo Carbajal, a professor of pediatrics and chief of the National Center of Resources to Fight Pain at Children's Hospital Armand Trousseau in Paris.

The authors explain that it's especially important to control pain in neonates -- babies from 1 to 4 weeks old -- because they're more sensitive to pain, and repeated or prolonged exposure may alter the way their brains process pain. It may also affect their long-term development and behavior, Carbajal added.

With funding from two nonprofit foundations -- Fondation CNP and Fondation de France -- Carbajal and his colleagues reviewed data from 430 neonates admitted to hospitals in the Paris area between September 2005 and January 2006.

The average gestational age of the babies was 33 weeks -- a full-term pregnancy is 40 weeks, so these infants were born almost two months early. The average intensive care unit stay was just over eight days, according to the study.

During that time, the 430 infants underwent more than 60,000 first-attempt procedures. Of these, 42,413 were painful, and 18,556 were stressful. The babies also underwent more than 11,000 supplemental attempt procedures, including 10,366 painful and 1,180 stressful procedures.

The average number of procedures was 141 per baby. The type of procedure varied from a heel stick to draw blood to having to insert a chest tube.

Carbajal said there are numerous factors why neonates aren't receiving enough pain relief. One is a concern about side effects from pharmacological interventions; another is unfamiliarity with pain relief management for newborns and a lack of standardized policies in this setting. He also said that pharmaceutical companies haven't developed analgesic products especially for neonates.

He recommended that procedures be done in combination whenever possible, and that minor procedures should be accompanied by non-pharmacological pain-reducing methods, such as providing oral sucrose or glucose and sucking. He said topical anesthetics can be used to reduce pain from needle punctures, though it's not sufficient for heel stick pain. For major procedures, he said, analgesia in combination in non-pharmacological therapy is needed.

Carbajal said this study's findings would likely be similar in other areas of the world where neonatal intensive care is available.

"For most neonates who undergo any sort of painful procedure, it would be worthwhile to have a combination of pharmacological and non-pharmacological interventions," said Dr. Santhanam Suresh, an anesthesiologist at Children's Memorial Hospital in Chicago.

Carbajal added that parents can act as advocates for optimal pain management for their babies by asking the health-care team to use approaches that "limit the intensity, frequency or duration of pain."

More information

To learn more about pain and pain relief for babies, read this information from the University of Michigan.

SOURCES: Ricardo Carbajal, M.D., Ph.D., professor, pediatrics, and chief, National Center of Resources to Fight Pain, Children's Hospital Armand Trousseau, Paris; Santhanam Suresh, M.D., attending staff anesthesiologist, Children's Memorial Hospital, director, research, co-director, pain management service, and associate professor, anesthesia and pediatrics, Feinberg School of Medicine, Northwestern University, Chicago; July 2, 2008, Journal of the American Medical Association

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