Preemies Subjected to Many Painful Procedures

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Preemies Subjected to Many Painful Procedures

Mon November 10, 2003 04:18 PM ET

 

By Alison McCook

NEW YORK (Reuters Health) - Preemies and other ill newborns undergo several

painful procedures during their first days of life, and only one-third receive

any medication to alleviate their pain, researchers said Monday.

Premature babies can feel pain, and previous research has suggested that pain

early in life can increase the risk of stress and illness, and may have

long-lasting effects on how a child responds to pain.

Doctors should try to avoid painful procedures when possible, and " reduce pain

by treating the pain, either with non-pharmacological or pharmacological

treatment, " study authors Sinno H. P. Simons and Dr. Monique van Dijk of the

Erasmus MC-Sophia Children's Hospital in the Netherlands told Reuters Health.

Simons, van Dijk and their colleagues recorded all of the procedures experienced

by 151 infants during the first 14 days they spent in intensive care. Most of

the babies were born prematurely, underweight, or suffering from respiratory

problems.

The researchers distributed a list of procedures to nurses and doctors working

with hospitalized babies, and asked them to rate the pain associated with each

procedure. Pain was rated on a scale of 0 to 10, with 10 representing the worst

possible pain.

Intubation, in which caregivers insert a tube into an infant's windpipe,

received a pain score of 9, while the pain associated with diaper changes fell

at less than 2, the authors report in the Archives of Pediatric & Adolescent

Medicine.

The authors found that hospitalized infants underwent an average of 14

procedures every day. Of the 31 different procedures rated by doctors and

nurses, 26 received a pain score of more than 4 out of 10.

However, on a given day, less than 35 percent of infants received any pain

medication, and almost 4 out of 10 newborns received no pain medication during

their entire stay in intensive care.

Doctors may hesitate to provide newborns with pain medication out of fear of the

side effects, Simons and van Dijk said. For instance, opioids -- a type of pain

medication that includes morphine -- can cause a drop in blood pressure, they

noted.

In addition, it is very difficult to tell if an infant is distressed or in pain,

and therefore difficult to determine how well pain medications are working, the

authors added.

" Caregivers try to assess pain by looking at facial expression, body movements,

posture, crying, " they said. However, sometimes when an infant is very ill with

a condition known to be painful, she will appear calm, with a blank face and

little body movement. " This may be due to lack of energy and due to the illness

severity, " Simons and van Dijk said.

The researchers recommended that doctors try to reduce the number of painful

procedures without risking an infant's health, or substitute a less painful

procedure for a painful one.

For example, they noted that caregivers suctioned out infants' nose and

windpipes several times each day, procedures with average pain scores that were

rated more than 5. It may be possible to suction less and still keep infants

breathing normally, Simons and van Dijk said.

Additionally, they suggested that doctors consider non-pharmacological

strategies that can ease pain. For instance, reducing the loud noises and bright

lights of intensive care, and giving babies a sweetened solution or pacifier may

ease an infant's distress, they noted.

SOURCE: Archives of Pediatric & Adolescent Medicine, November 2003.

 

 

 

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