Guidelines Seek to Limit Pain in Newborns
NEW YORK (Reuters Health) - Newborns are highly sensitive to pain and may be more vulnerable to its long-term consequences than older children and adults, an international committee reports.
The group's guidelines on preventing and managing pain in newborns dispute the notion that young infants cannot feel pain and challenge a reluctance among doctors to provide pain relievers during routine procedures such as blood sampling, immunization and circumcision.
Research indicates, however, that hormonal, metabolic and cardiovascular responses to surgery are more pronounced in newborns than in older children, the authors note.
``Management of pain must be considered an important component of the health care provided to all neonates, regardless of their gestational age or severity of illness,'' conclude Dr. K.J.S. Anand from Arkansas Children's Hospital in Little Rock and colleagues from the International Evidence-Based Group for Neonatal Pain.
The recommendations, published in the February issue of the Archives of Pediatric and Adolescent Medicine, state that doctors should allow newborns to be swaddled, kept in close contact with the mother or suck on a pacifier with a sugar solution during routine procedures such as a blood test. These simple measures have been shown to reduce a newborn's reaction to pain.
Topical pain relievers such as lidocaine can be used during circumcision. Clamps, which are used to protect the penis while the foreskin is being removed, should be used during the procedure, and acetaminophen may be given for postoperative pain, the group suggests.
Lidocaine can be used when a catheter has to be inserted in a vein or artery, and stronger drugs such as morphine or fentanyl may be given to newborns who require a tube in their chest or down their throat.
``Pain in newborns is often unrecognized and undertreated. Neonates do feel pain, and analgesia should be prescribed when indicated during their medical care,'' the authors assert.
They argue that the guidelines could ``not only improve the clinical care provided to all neonates, but may also have a positive impact on their subsequent health and behaviors during childhood and adolescence.''
Indeed, studies have shown that newborns who experience extreme pain may be at increased risk for illness and death. These experiences may also affect the way a child responds to pain in the future. For example, one study showed that babies who underwent a painful circumcision were more likely to have a more pronounced reaction to immunizations later on.
The current recommendations are based on a review of published medical studies.
SOURCE: Archives of Pediatric and Adolescent Medicine 2001;155:173-
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