Quantification of neonatal procedural pain severity: a platform for estimating total pain burden in individual infants. Issue 6 (June 2020)

• Record Type: Journal Article
• Authors: Laudiano-Dray, Maria Pureza; Pillai Riddell, Rebecca; Jones, Laura; Iyer, Rajeshwari; Whitehead, Kimberley; Fitzgerald, Maria; Fabrizi, Lorenzo; Meek, Judith
• Is Part Of: Pain. Volume 161:Issue 6(2020)
• Publication Date: 2020-06
• Subjects: Neonatal -- Preterm -- Infant -- Pain -- Nociception -- PIPP -- NFCS -- Procedure -- Pain burden -- Severity -- NICU -- Pain score -- Reactivity -- Placebo -- Standard care; Pain -- Periodicals; Douleur -- Périodiques; Anesthésie -- Périodiques; Pain; Electronic journals; Periodicals; Electronic journals; 616.0472
• DOI: 10.1097/j.pain.0000000000001814
• Languages: English
• ISSNs: 0304-3959

Abstract

Abstract : Abstract: There is increasing evidence that long-term outcomes for infants born prematurely are adversely affected by repeated exposure to noxious procedures. These interventions vary widely, for example, in the extent of damage caused and duration. Neonatal intensive care unit (NICU) procedures are therefore likely to each contribute differently to the overall pain burden of individual neonates, ultimately having a different impact on their development. For researchers to quantify the procedural pain burden experienced by infants on NICU, we aimed to estimate the pain severity of common NICU procedures using published pain scores. We extracted pain scores over the first minute (pain reactivity) from the literature, using 59 randomized controlled trials for 15 different procedures. Hierarchical cluster analysis of average pain scores resulted in 5 discrete severity groups; mild (n = 1), mild to moderate (n = 3), moderate (n = 7), severe (n = 3), and very severe (n = 1). The estimate of the severity of individual procedures provided new insight into infant pain reactivity which is not always directly related to the invasiveness and duration of a procedure; thus, both heel lance and skin tape removal are moderately painful procedures. This estimate of procedural pain severity, based on pain reactivity scores, provides a novel platform for retrospective quantification of an individual neonate's pain burden due to NICU procedures. The addition of measures that reflect the recovery from each procedure, such as brain activity and behavioural regulation, would further improve estimates of the pain burden of neonatal intensive care. Abstract : Supplemental Digital Content is Available in the Text.A novel estimator, based on published pain reactivity scores, shows that common neonatal intensive care unit procedures fall into one of 5 severity groups from mild to severe.