Babies’ pain is subject of study
Posted on Wednesday, July 2, 2008
Newborns treated in intensivecare units undergo many painful and stressful procedures during their first days of life, many of which are done without medication or other pain relief, according to a study published today in the Journal of the American Medical Association.
Medical advances have made it possible for doctors to save the lives of increasingly younger and more fragile babies, but they must do more and more procedures to do so. Hospital intensive-care units should do all they can to reduce pain, stress and discomfort for newborns, according to the study.
“Most clinicians are very compassionate, and are extremely aware of the fact that they need to reduce the pain and suffering, but despite their best efforts babies do get exposed to a lot of pain,” said Dr. K. J. S. Anand, who works in intensive care at Arkansas Children’s Hospital and has been studying pain in newborns for 25 years.
Some babies may experience long-term effects from repeated pain exposure, such as reduced pain perception or other developmental problems, said Anand, also a professor of pediatrics, anesthesiology, pharmacology and neurobiology at the University of Arkansas for Medical Sciences.
Anand was one of 19 authors of the study that examined procedures done on 430 newborns during their first 14 days in treatment in ICUs in and around Paris between September 2005 and January 2006. The study was led by Dr. Ricardo Carbajal, of the Hopital d’enfants Armand Trousseau in Paris.
Each newborn in the study underwent an average of 16 procedures a day, of which an average of 10 were considered “painful,” such as being pricked on the heel with a needle for a blood sample, having a breathing tube inserted, or a chest tube drained of fluid. Some babies had as many as 51 painful procedures in a day.
Anand said the study reflects what is happening in North America. He hopes to do similar research in Arkansas.
Newborns — especially premature babies — are more sensitive to pain than older babies, children and adults because their young bodies aren’t yet prepared for it, Anand said. They have a higher density of pain receptors in their skin and unlike more developed people, they can’t protect themselves.
“If babies were able to talk or were able to resist being subjected to pain then we wouldn’t be doing so many procedures on them [without pain relief ],” Anand said.
Of 42, 413 painful procedures documented in the study, babies were given pain relief in 50. 9 percent of cases. Of those, 2. 1 percent were given medicine and 18. 2 percent were given some other form of therapy to reduce pain prior to the specific procedure.
The rest were given either a combination of therapies, or were already receiving pain relief for another purpose.
The study also looked at procedures classified as “stressful,” such as getting X-rays, a head ultrasound or even a bath. In 22. 8 percent of those cases, babies had some form of relief.
Of 60, 969 first-time procedures in the study, 69. 9 percent were painful and 30. 4 percent were stressful.
Research has shown that “repeated and prolonged pain” to babies can affect the way they process pain as they get older, their behavior and their development, according to the study. Newborns who experience a lot of pain may have learning problems in school, and are at an increased risk for attention-deficit disorder, Anand said.
Many develop a very high tolerance for pain, while others may be at risk of developing chronic pain conditions as they grow older, he said.
“The prevention of pain in critically ill neonates is not only an ethical obligation, but it also averts immediate and long-term adverse consequence,” according to the study.
The study found that babies were less likely to have painful procedures without some form of pain relief during the daytime, and if they had a parent by their bedside, Anand said.
Several things other than medication can be done to help reduce pain for infants. For example, nurses might use a local anesthetic cream, or rub a sugar water solution on a baby’s mouth a couple of minutes before a procedure to help calm him, Anand said.
Skin-to-skin contact with their mother or father also calms a baby and helps reduce pain and stress.
“Parents really have a great opportunity to participate in the care of their child by asking, ‘ What is being done to make my baby comfortable ? Is my baby in pain ?’” Anand said. “By doing skin-to-skin care or simply being at the bedside and stroking their leg — they really, simply by their presence and their loving therapeutic touch, can reduce the stressfulness of their baby’s experience.” In 2006, the American Academy of Pediatrics emphasized the need for health-care providers to implement ways to reduce pain for newborns, such as eliminating unnecessary procedures and minimizing failed attempts.
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