Neonatal discomfort, stress, or pain may be associated with routine patient care (eg, physical examination and diaper changes), moderately invasive care measures (eg, suctioning, phlebotomy, and peripheral intravenous line placement), or more invasive procedures (eg, chest tube placement and circumcision).
Pain in the neonate can be classified into three categories :
- Acute or physiological pain occurs from skin-breaking procedures or tissue injury caused by diagnostic or therapeutic interventions. Infants admitted to the neonatal intensive care unit (NICU) repeatedly experience acute pain from an average of 12 to 16 invasive procedures each day [2,3].
- Established pain occurs following surgery, or localized inflammatory conditions (eg, abcess or thrombophlebitis), or birth-related trauma.
- Prolonged pain results from severe diseases like necrotizing enterocolitis or meningitis.
Care providers are expected to prevent any infant from experiencing pain if at all possible [4-6]. Pain assessment is a necessary part of neonatal pain management, as an indication for initiating therapy as well as assessing its effectiveness. It is challenging to detect and measure the intensity of pain in neonates because of their inability to communicate with care providers.
The need for effective pain management and the assessment of pain in neonates will be reviewed here. Prevention and treatment of neonatal pain are discussed separately. (See "Prevention and treatment of neonatal pain".)