Suzanne S. Toce, MD, Medical Director Neonatal Intensive Care Unit, Gundersen Lutheran Medical Center
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“Pain is inevitable; Suffering is optional.”
It is clear that newborns experience pain. Pain results in physiologic, metabolic, and behavioral changes. Untreated, severe, or prolonged pain increases mortality and morbidity. Why do health care providers ever perform painful procedures without providing analgesia? When queried about circumcision, those physicians not providing analgesia cited concern over risks of analgesia, perceptions that analgesia isn’t warranted or is ineffective, unfamiliarity with the techniques, and time constraints.
What is the scope of the problem?
- Healthy term newborns have 3-5 painful procedures in the nursery
- In the NICU, each newborn has an average of 16 painful or stressful procedures per day, almost ¼ without pharmacologic or nonpharmacologic therapy
What does research teach us about neonatal pain?
- Pain in newborns is frequently unrecognized and undertreated
- Newborns, even premature newborns, are capable of feeling pain
- Newborns are no less sensitive to pain than older children; in fact they may be more sensitive and more susceptible to long term effects
- Newborns are capable of expressing pain and discomfort
- Newborns do not need to learn about pain; they can feel it with the first experience
- Newborns do remember pain, especially repeated noxious stimuli
- Neonatal pain has short and long term adverse effects
- Pain can be accurately assessed at the bedside with validated tools
- Pharmacologic and non pharmacologic measures to provide pain relief are available and safe
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The Author: Suzanne S. Toce, MD, is Medical Director of the Neonatal Intensive Care Unit in the Departments of Pediatrics and Medical Humanities at Gundersen Lutheran Medical Center in La Crosse Wisconsin. www.gundluth.org. Further information on ChiPPS, the Childrens Project on Palliative/Hospice Services, may be found at www.nhpco.org/i4a/pages/index.cfm?pageid=3409.
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