Journal of Pain & Relief
Open Access

Abstract

Critically ill immature preterm infants experience multiple noxious stimuli while receiving care in the Neonatal Intensive Care Unit (NICU). These noxious stimuli include, but are not limited to: venipuncture; insertion of intravenous and arterial catheters; suctioning of the nose, mouth and oropharynx; endotracheal intubation for mechanical ventilation; insertion of chest drains; and repositioning and other types of patient manipulation. The delivery of optimal doses of analgesics for these noxious stimuli is a major challenge due to the lack of knowledge about drug disposition and its effects in this population. Beyond the lack of knowledge for dose selection and response prediction, it is also relevant to consider the clinical importance of new consequences of analgesic use such as opioid-induced tolerance, hyperalgesia drug related toxicities and neonatal drug discontinuation syndrome, which challenge the current paradigm for pain management in the newborn infant population. In addition, the impact of pain in the neurodevelopment aligned to fast development of the immature brain increase the complexity in the evaluation of nociception/pain. The drug therapy used in pain management relies on an adequate pain assessment of the preterm neonate. The development of computational algorithms to measure nociception/pain in real-time constitutes the next step for pain management in the NICU. An efficient evaluation system may decrease the uncertainty on drug dosage, increase patient safety and improve pain management addressing the impact of pain in the immature brain and explain the neurologic pathway of pain in preterm infants.

Biography

Email: nadja.bressan@sickkids.ca