NEONATAL PROCEDURAL PAIN AND ITS MANAGEMENT: A NARRATIVE REVIEW

N. Sharma¹, A.J. Samuel¹

Background: Neonates are experiencing pain but they are unable to express it. Repeated painful stimuli cause physiological, behavioral and social, and neurodevelopment problems in neonates admitted in neonatal intensive care units (NICU). Common procedures in NICU lead to procedural and postoperative pain in fragile neonates, though neonatal physiotherapy interventions including Soft tissue therapy and multi-sensory stimulation, might be beneficial in managing neonatal procedural pain, and further can also show improvement in their neurodevelopmental outcomes.

Purpose: The purpose of this narrative review is to highlight the importance of procedural pain, scales used to highlight the strategies adopted to relieve procedural pain, and promote neurodevelopment among neonates.

Methods: A review of existing literature was performed through three online research databases, PubMed, SCOPUS, and Web of science of published literature. We searched using the keywords,  “Neonates”, “Procedural Pain”, “Infants”, “Neonates”, “NICU”, “Pain”, “Soft tissue therapy” and “Neonates” combined using Boolean terms “AND”, “NOT” or “NOT” from inception to June 2020. The search strategy was focused on procedural pain and its causes, and subsequently on its treatment strategies and evaluation procedures.

Results: In recent years, there is increased awareness regarding pain management among neonates. Neonates aged between 32 weeks and 39 weeks of gestation are included in the study. Neonates admitted in Neonatal intensive care units (NICU) are frequently experiencing painful procedures. The various tissue-damaging medical procedures such as venous and arterial puncture, heel lancing, and removal of adhesive tapes lead to pain and stress in neonates. The effects of procedural pain among neonates could have an impact on behavioral and, cognitive sequel including attention deficit disorder, altered pain processing, impaired visual – perceptual ability, and poor executive functions. Some common assessment tools used for measuring procedural and postoperative pain among neonates and infants are Premature infant pain profile (PIPP), Neonatal infant pain scale (NIPS), CRIES scale, Neonatal pain agitation and sedation scale (N-PASS), and COMFORT scale. This review found that there are several traditional methods for managing neonatal procedural pain namely Massage therapy, foot massage, aromatherapy, acupuncture, Yakson touch, Multi-sensory stimulation, Facilitated tucking, Swaddling, Music therapy, Non-nutritive sucking, and Kangaroo mother care are most widely studied. Currently, there is no definitive physiotherapy treatment protocol available for managing neonatal procedural pain. Soft tissue therapy combined with multi-sensory stimulation might be considered beneficial if administered for a minimum of 5 days for neonates experiencing procedural pain.

Conclusion(s): Neonates admitted in NICU experiencing procedural pain, which further can also affect their neurodevelopment outcomes. Combined effects of soft tissue therapy and multi-sensory stimulation might be beneficial in relieving procedural pain and promotes neurodevelopment among neonates. But high quality randomized controlled studies are needed to confirm this.

Implications: Standardized Physiotherapy protocol including soft tissue therapy and multisensory stimulation to be developed for neonates with procedural pain, for the effective and easy implication of these strategies in treating neonates with procedural pain.

Funding, acknowledgements: None

Keywords: Neonates, Pain, Neonatal Intensive Care Units

Topic: Paediatrics

Did this work require ethics approval? No

Institution: Maharishi Markandeshwar Institute of physiotherapy and Rehabilitation

Committee: Maharishi Markandeshwar Institute of Medical Sciences and Research

Reason: Ethical approval is not required as it is a narrative review