Abstract Compared with adults, neonates tend to have stronger and more persistent biological perception of pain. They may have the memory for pain and the negative effects caused by pain may exist for a long time. Therefore, standardized pain management can reduce or prevent the adverse effect of pain on body and mind and promote the rehabilitation process. In order to further deepen the understanding of pain management and standardize the analgesic measures for neonates, the Neonatologist Branch of Chinese Medical Association and Editorial Board of Chinese Journal of Contemporary Pediatrics have developed an expert consensus based on the clinical evidence in China and overseas and with reference to clinical experience from the following aspects:evaluation of neonatal pain and methods and techniques of pain management. It is recommended to adopt a step-by-step analgesic management for neonates. For mild pain stimulation, it is effective to relieve the pain by gentle touch and non-nutritive sucking combined with sucrose feeding. For moderate pain, selection of appropriate trocar needle and skilled puncture are important to reduce the pain, and in addition, the application of local anesthetics at the site of puncture also has a good effect. For severe pain, intravenous sedative drugs are often required, but no consistent evidence has been obtained so far.
Neonatology Branch of Chinese Medical Association,Editorial Board of Chinese Journal of Contemporary Pediatrics. Expert consensus on neonatal pain assessment and analgesia management (2020 edition)[J]. CJCP, 2020, 22(9): 923-930.
Neonatology Branch of Chinese Medical Association,Editorial Board of Chinese Journal of Contemporary Pediatrics. Expert consensus on neonatal pain assessment and analgesia management (2020 edition)[J]. CJCP, 2020, 22(9): 923-930.
Mcpherson C, Miller SP, El-Dib M, et al. The influence of pain, agitation, and their management on the immature brain[J]. Pediatr Res, 2020, 88(2):168-175.
[2]
Burnsed JC, Heinan K, Letzkus L, et al. Gabapentin for pain, movement disorders, and irritability in neonates and infants[J]. Dev Med Child Neurol, 2020, 62(3):386-389.
[3]
Guyatt GH, Oxman AD, Schünemann HJ, et al. GRADE guidelines:a new series of articles in the journal of clinical epidemiology[J]. J Clin Epidemiol, 2011, 64(4):380-382.
[4]
Schünemann HJ, Jaeschke R, Cook DJ, et al. An official ATS statement:grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations[J]. Am J Respir Crit Care Med, 2006, 174(5):605-614.
[5]
Committee on Fetus and Newborn, Section on Anesthesiology and Pain Medicine. Prevention and management of procedural pain in the neonate:an update[J]. Pediatrics, 2016, 137(2):e20154271.
[6]
Mangat AK, Oei JL, Chen K, et al. A review of non-pharmacological treatments for pain management in newborn infants[J]. Children (Basel), 2018, 5(10):130.
[7]
Stevens B, Johnston C, Petryshen P, et al. Premature infant pain profile:development and initial validation[J]. Clin J Pain, 1996, 12(1):13-22.
[8]
Hummel P, Puchalski M, Creech SD, et al. Clinical reliability and validity of the N-PASS:neonatal pain, agitation and sedation scale with prolonged pain[J]. J Perinatol, 2008, 28(1):55-60.
[9]
Lawrence J, Alcock D, McGrath P, et al. The development of a tool to assess neonatal pain[J]. Neonatal Netw, 1993, 12(6):59-66.
[10]
Krechel SW, Bildner J. CRIES:a new neonatal postoperative pain measurement score. Initial testing of validity and reliability[J]. Paediatr Anaesth, 1995, 5(1):53-61.
[11]
Grunau RE, Oberlander T, Holsti L, et al. Bedside application of the Neonatal Facial Coding System in pain assessment of premature neonates[J]. Pain, 1998, 76(3):277-286.
[12]
Huang XZ, Li L, Zhou J, et al. Evaluation of three pain assessment scales used for ventilated neonates[J]. J Clin Nurs, 2018, 27(19-20):3522-3529.
[13]
Pölkki T, Korhonen A, Axelin A, et al. Development and preliminary validation of the Neonatal Infant Acute Pain Assessment Scale (NIAPAS)[J]. Int J Nurs Stud, 2014, 51(12):1585-1594.
[14]
Debillon T, Zupan V, Ravault N, et al. Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants[J]. Arch Dis Child Fetal Neonatal Ed, 2001, 85(1):F36-F41.
[15]
Bellieni CV, Tei M, Coccina F, et al. Sensorial saturation for infants' pain[J]. J Matern Fetal Neonatal Med, 2012, 25(Suppl 1):79-81.
Roshanray A, Rayyani M, Dehghan M, et al. Comparative effect of mother's hug and massage on neonatal pain behaviors caused by blood sampling:a randomized clinical trial[J]. J Trop Pediatr, 2020. DOI:10.1093/tropej/fmaa001. Online ahead of print.
Pillai Riddell RR, Racine NM, Turcotte K, et al. Non-pharmacological management of infant and young child procedural pain[J]. Cochrane Database Syst Rev, 2011(10):CD006275.
[20]
Kurdahi Badr L, Demerjian T, Daaboul T, et al. Preterm infants exhibited less pain during a heel stick when they were played the same music their mothers listened to during pregnancy[J]. Acta Paediatr, 2017, 106(3):438-445.
[21]
Shah SR, Kadage S, Sinn J. Trial of music, sucrose, and combination therapy for pain relief during heel prick procedures in neonates[J]. J Pediatr, 2017, 190:153-158.e2.
[22]
Barandouzi ZA, Keshavarz M, Montazeri A, et al. Comparison of the analgesic effect of oral sucrose and/or music in preterm neonates:a double-blind randomized clinical trial[J]. Complement Ther Med, 2020, 48:102271.
[23]
Liu MF, Lin KC, Chou YH, et al. Using non-nutritive sucking and oral glucose solution with neonates to relieve pain:a randomised controlled trial[J]. J Clin Nurs, 2010, 19(11-12):1604-1611.
Pölkki T, Korhonen A. The effectiveness of music on pain among preterm infants in the neonatal intensive care unit:a systematic review[J]. JBI Libr Syst Rev, 2012, 10(58):4600-4609.
Thakkar P, Arora K, Goyal K, et al. To evaluate and compare the efficacy of combined sucrose and non-nutritive sucking for analgesia in newborns undergoing minor painful procedure:a randomized controlled trial[J]. J Perinatol, 2016, 36(1):67-70.
[28]
Johnston CC, Stremler R, Horton L, et al. Effect of repeated doses of sucrose during heel stick procedure in preterm neonates[J]. Biol Neonate, 1999, 75(3):160-166.
[29]
Ohlsson A, Shah PS. Paracetamol (acetaminophen) for prevention or treatment of pain in newborns[J]. Cochrane Database Syst Rev, 2020, 1(1):CD011219.
[30]
Shah PS, Herbozo C, Aliwalas LL, et al. Breastfeeding or breast milk for procedural pain in neonates[J]. Cochrane Database Syst Rev, 2012, 12:CD004950.
[31]
Johnston C, Campbell-Yeo M, Fernandes A, et al. Skin-to-skin care for procedural pain in neonates[J]. Cochrane Database Syst Rev, 2014(1):CD008435.
[32]
Fallah R, Habibian S, Noori-Shadkam M. Efficacy and safety of single low dose intravenous fentanyl in pain reduction of lumbar puncture in near term neonates by a randomized clinical trial[J]. Iran J Child Neurol, 2016, 10(2):60-66.
[33]
Ng E, Taddio A, Ohlsson A. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit[J]. Cochrane Database Syst Rev, 2012(6):CD002052.
[34]
Fatollahzade M, Parvizi S, Kashaki M, et al. The effect of gentle human touch during endotracheal suctioning on procedural pain response in preterm infant admitted to neonatal intensive care units:a randomized controlled crossover study[J]. J Matern Fetal Neonatal Med, 2020. DOI:10.1080/14767058.2020.1755649. Online ahead of print.
[35]
Zhu A, Benzon HA, Anderson TA. Evidence for the efficacy of systemic opioid-sparing analgesics in pediatric surgical populations:a systematic review[J]. Anesth Analg, 2017, 125(5):1569-1587.
[36]
Ohlsson A, Shah PS. Paracetamol (acetaminophen) for prevention or treatment of pain in newborns[J]. Cochrane Database Syst Rev, 2016, 10(10):CD011219.
[37]
Moss JR, Watcha MF, Bendel LP, et al. A multicenter, randomized, double-blind placebo-controlled, single dose trial of the safety and efficacy of intravenous ibuprofen for treatment of pain in pediatric patients undergoing tonsillectomy[J]. Paediatr Anaesth, 2014, 24(5):483-489.
[38]
Monnelly VJ, Anblagan D, Quigley A, et al. Prenatal methadone exposure is associated with altered neonatal brain development[J]. Neuroimage Clin, 2017, 18:9-14.
[39]
Qiu J, Zhao L, Yang Y, et al. Effects of fentanyl for pain control and neuroprotection in very preterm newborns on mechanical ventilation[J]. J Matern Fetal Neonatal Med, 2019, 32(22):3734-3740.
[40]
Hartley C, Moultrie F, Hoskin A, et al. Analgesic efficacy and safety of morphine in the Procedural Pain in Premature Infants (Poppi) study:randomised placebo-controlled trial[J]. Lancet, 2018, 392(10164):2595-2605.
[1]
ZHANG Yong-Fang, YU Xin-Qiao, LIAO Jian-Hua, YANG Feng, TAN Cong-Rong, WU Su-Ying, DENG Shi-Qing, FENG Jun-Yuan, HUANG Jia-Yan, YUAN Zuo-Fen, LIU Kai-Dian, HUANG Zhen-Ju, ZHANG Li-Fang, CHEN Zheng-Guo, XIA Hong, LUO Lin-Lin, HU Yan, WU Hua-Sheng, XIE Hong-Ling, FEI Bao-Min, PANG Qing-Wei, ZHANG Song-Hua, CHENG Bi-Xia, JIANG Lang, SHEN Chang-Tao, YI Qiong, ZHOU Xiao-Guang. A clinical epidemiological investigation of neonatal acute respiratory distress syndrome in southwest Hubei, China[J]. CJCP, 2020, 22(9): 942-947.
LI Qian-Qian, DONG Xiao-Yue, QIAO Yu, YIN Yu-Jie, GAO Yan, ZHOU Jin-Jun, YANG Li, ZHU Rong-Ping, WANG Fu-Dong, WAN Jun, XU Yan, PAN Zhao-Jun, WANG Wei-Yuan, YAN Jun-Mei, HAN Shu-Ping, LU Hong-Yan, HU Yu-Hua, LI Shuang-Shuang, WANG Jin-Xiu, WU Ming-Fu, WANG Jun, DENG Xiao-Yi, YU Zhang-Bin. An investigation of severe neonatal hyperbilirubinemia in 13 hospitals of Jiangsu Province, China[J]. CJCP, 2020, 22(7): 690-695.
