A considerable number of premature infants require intensive medical care, which often involves painful procedures.
Sadly, the current healthcare system does not effectively address the pain management needs of these vulnerable patients.
This issue was underscored in a detailed survey published in the journal Pain, which examined pain assessment and management within neonatal care environments.
Pain Assessment and Management in Neonatal Care
During a thorough investigation spanning 4.5 years, neonatal healthcare professionals across Sweden meticulously recorded instances of pain, its sources, and the methods employed for both assessment and treatment in premature infants.
The research included data from 3,686 infants born between 22 and 31 weeks of gestation, covering a timeframe from 2020 to 2024, and accounted for over 185,000 days of neonatal care.
The Swedish Neonatal Quality Register facilitated this comprehensive data collection.
Findings from the analysis indicated that extremely premature infants—particularly those born at just 22 to 23 weeks—endured the greatest incidence of painful experiences, often facing uncomfortable interventions nearly every day during their first month of life.
This outcome aligns with existing knowledge about the severe health challenges associated with very early births.
Professor Mikael Norman, the leading researcher from the Department of Clinical Science, Intervention, and Technology at Karolinska Institutet, commented on the correlation between decreasing gestational age and the frequency of intensive medical procedures, many of which are painful.
These procedures encompass a range of interventions, including ventilatory support, tube feeding, catheter insertions, and various surgical operations, all of which can lead to discomfort.
Additionally, many diagnostic tests can be distressing for these young patients.
Challenges in Pain Management
Despite the clear evidence that 90 percent of the most fragile preterm infants underwent painful procedures, healthcare workers identified pain in only 45 percent of these cases.
This gap raises important questions about the accuracy of pain assessments, although it may suggest that there are effective pain management protocols in place.
Interestingly, the most at-risk infants—those experiencing considerable pain—received the least amount of morphine.
This raises concerns about potential undertreatment, as Professor Norman points out.
While the study reveals critical insights, it is essential to recognize its limitations, particularly regarding the inability to measure the duration or intensity of pain for each infant on a daily basis.
Caregivers could only indicate whether an infant experienced pain in the previous 24 hours, which might vary significantly: for some, it could be temporary discomfort from a needle, while for others, it could involve persistent pain linked to medical conditions.
This constraint limits the ability to distinguish between brief episodes of pain and ongoing discomfort that may require medical intervention.
Additionally, the study does not account for external factors such as environmental stressors or variations in caregiving approaches that might influence pain perception.
Understanding these nuances is crucial, much like how lifestyle support for back pain is essential in managing chronic discomfort in adults.
Efforts to alleviate pain in neonates have been ongoing, highlighting a shared belief among experts that no infant should suffer from unmanaged severe pain.
However, accurately measuring pain levels in these young patients remains a challenge for healthcare practitioners.
This may necessitate advancements in pain assessment methodologies and the exploration of new pharmacological treatments that minimize side effects.
Implications for Future Research
Improving pain management for premature infants is vital.
Research emphasizes that unaddressed pain can negatively affect their development due to an exaggerated neurological response to painful stimuli.
The ultimate goal within neonatal care is to provide a pain-free experience for these infants.
Insights derived from this survey are expected to guide the evolution of neonatal practices and shape future research in this critical field.
The funding for this important study came mainly from Region Stockholm, the Childhood Foundation of the Swedish Freemasons, and the Swedish Research Council.
Moreover, it’s significant to note that newborns lack the ability to articulate their pain, unlike older children and adults.
Consequently, healthcare providers must rely on various pain assessment tools that evaluate indicators such as breathing patterns, facial expressions, and physical movements, alongside the overall comfort level of the infant.
However, observations indicate that very premature infants often show fewer signs of discomfort compared to full-term infants.
When it comes to morphine administration, healthcare providers walk a fine line between delivering adequate pain relief and avoiding hypotension, a known side effect.
Given that many very premature infants already experience low blood pressure, this risk may lead to more cautious dosing of morphine, potentially resulting in insufficient pain management for those infants who are suffering significantly.
Source: ScienceDaily