Consensus Statement for the Prevention and Management of Pain in the Newborn

Abstract

Objective To develop evidence-based guidelines for preventing or treating neonatal pain and its adverse consequences. Compared with older children and adults, neonates are more sensitive to pain and vulnerable to its long-term effects. Despite the clinical importance of neonatal pain, current medical practices continue to expose infants to repetitive, acute, or prolonged pain.

Design Experts representing several different countries, professional disciplines, and practice settings used systematic reviews, data synthesis, and open discussion to develop a consensus on clinical practices that were supported by published evidence or were commonly used, the latter based on extrapolation of evidence from older age groups. A practical format was used to describe the analgesic management for specific invasive procedures and for ongoing pain in neonates.

Results Recognition of the sources of pain and routine assessments of neonatal pain should dictate the avoidance of recurrent painful stimuli and the use of specific environmental, behavioral, and pharmacological interventions. Individualized care plans and analgesic protocols for specific clinical situations, patients, and health care settings can be developed from these guidelines. By clearly outlining areas where evidence is not available, these guidelines may also stimulate further research. To use the recommended therapeutic approaches, clinicians must be familiar with their adverse effects and the potential for drug interactions.

Conclusion 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.

Arch Pediatr Adolesc Med. 2001;155:173-180

Participants (listed alphabetically) of the International Evidence-Based Group for Neonatal Pain are the following: Huda Huijer Abu-Saad, Maastricht, the Netherlands; K. J. S. Anand, Little Rock, Ark (chair); Albert Aynsley-Green, London, England; Eduardo Bancalari, Miami, Fla; Franca Benini, Padova, Italy; G. David Champion, Darlinghurst, Australia; Kenneth D. Craig, Vancouver, British Columbia; Tomasz S. Dangel, Warszawa, Poland; Elisabeth Fournier-Charrière, Kremlin-Bicetre, France; Linda S. Franck, London, England; Ruth Eckstein Grunau, Vancouver, British Columbia; Steen A. Hertel, Copenhagen, Denmark; Evelyne Jacqz-Aigrain, Paris, France; Gerhard Jorch, Magdeburg, Germany; Benjamin I. Kopelman, São Paulo, Brazil; Gideon Koren, Toronto, Ontario; Björn Larsson, Stockholm, Sweden; Neil Marlow, Nottingham, England; Neil McIntosh, Edinburgh, Scotland; Arne Ohlsson, Toronto, Ontario; Gunnar Olsson, Stockholm, Sweden; Fran Porter, St Louis, Mo; Renate Richter, Erlangen, Germany; Bonnie Stevens, Toronto, Ontario; and Anna Taddio, Toronto, Ontario.

These efforts were supported by an unrestricted educational grant from Astra Pharmaceuticals (now

AstraZeneca Inc, London, England) and were developed at 2 meetings of the International Evidence-Based Group for Neonatal Pain (Nice, France, April 21-23, 1998, and Baden, Austria, August 20-22, 1999).

The group gratefully acknowledges Jonas Nylander, Nadia Hammouda (AstraZeneca, Inc), Brian Parsons, Anna Welsh (Colwood Healthworld, London, England), Sarah Knott, and Daphne Steptoe (Wells Medical, Royal Tunbridge Wells, Kent, England) for helping in the development of these guidelines.

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