Newborn care survey shows inadequate pain relief for premature babies

Newborn care survey shows inadequate pain relief for premature babies

A large proportion of babies born very prematurely require intensive feeding, which can be painful. However, the healthcare system does not fully provide pain relief. This shows the largest survey to date of pain in newborn care, which has now been published in the journalpain.

Every day for 4.5 years, neonatal care staff recorded the occurrence of pain, the causes of pain, and the assessment and treatment of pain in preterm infants in Sweden. The study includes 3,686 babies born between 22 and 31 weeks of gestation from 2020 to 2024. The total observation time was just over 185,000 days. Data were collected from the Swedish Newborn Quality Register.

When assessing the registry data, researchers found that babies born extremely prematurely in weeks 22 to 23 had the highest rates of painful illnesses and almost daily painful intensive care procedures in the first month after birth. However, this is not surprising.

There is a strong correlation between acute morbidity and very preterm birth. The earlier a baby is born, the more intensive care it needs. Intensive care involves painful procedures such as: B. Ventilation treatment, tube feeding, insertion of catheters into blood vessels and surgical procedures. It also requires various tests and examinations that may include pain. “

Mikael Norman, Professor of Pediatrics at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet and lead researcher of the study

90 percent of extremely premature infants underwent painful procedures. Despite this, health professionals reported that only 45 percent of babies experienced pain - which may be because pain was largely prevented or treated. However, a review of the medications administered suggests that other explanations exist.

"Somewhat surprisingly, the smallest babies, who were exposed to the most pain, had the lowest rates of treatment with morphine. This may be a case of undertreatment," says Mikael Norman.

One limitation is that the study could not determine the duration or severity of pain for each specified day.

"The caregivers only answered yes or no to the question whether the child had experienced pain in the last 24 hours. This can range from short-term and so-called procedural pain from a needle prick during a test to continuous pain due to various medical conditions.

"A lot is being done to relieve pain in babies. No child in neonatal care goes untreated," he continues.

However, it is a problem and challenge that health professionals are not always able to determine whether children are in pain.

"This includes developing better rating scales or physiological techniques to measure pain. Better pain treatments are also needed, perhaps with combinations of drugs with lower risk of side effects," says Dr. Norman.

It is very important to improve pain management in premature babies as we now know that their development is negatively affected by the strong signals in the brain that cause pain.

"The vision for all newborn care is to be pain-free. The results of this survey will be of great importance for improving newborn care and for future research in this field," concludes Mikael Norman.

The research was mainly funded by Stockholm Region, the Swedish Freemasons' Childhood Foundation in Stockholm and the Swedish Research Council.

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