NICU pain on the news tonight

[Imafloat, BSN, RN]

CBS evening news with Katie Couric is going to explore the problem of how under treating pain in newborns can lead to problems later in life. I am wondering if it has something to do with this new article. I thought of Steve and Elizabells when I read this article, I know pain control is not a priority to the powers that be on their unit.

http://children.webmd.com/news/20080...underestimated

Infant Pain May Be Underestimated: Researchers Say Current Methods to Determine Infant Pain May Be Inadequate

By Kelli Miller Stacy, WebMD Health News; Reviewed by Louise Chang, MD

June 23, 2008 -- Current tools used to tell if young babies are in pain may underestimate how much they are hurting, according to a study published in the June issue of PLoS Medicine.

Properly gauging infant pain can be difficult. Health care providers rely on a clinical assessment of factors such as facial expressions and changes in heart rate to tell if a baby's in pain, and to estimate how much pain treatment is required for uncomfortable medical procedures.

However, London-based researchers have found that such behavioral and physiological measures may not accurately reflect an infant's pain experience, and infants can be in pain without making it immediately known.

"An infant with a low pain score based on behavioral assessment tools alone may not be pain free," the researchers write in the journal article.

Inadequate pain management not only means an infant feels immediate discomfort, it may also lead to long-term effects. Some believe that repeated pain in premature infants may be linked to attention deficit disorder, learning disorders, and behavioral problems in later childhood.

Rebeccah Slater of the University College of London and colleagues wanted to see how well current clinical pain assessment tools reflected pain in infants. Their study involved 12 infants with stable vital signs. The team compared brain activity responses to behavioral and physiological changes (such as facial expression and heart rate changes) on 33 occasions when the infants needed a heel stick for a medical reason. No heel sticks were done solely for the purpose of the study. Brain activity was measured using a noninvasive technique called near-infrared spectroscopy, which is widely used in neonatal research.

Researchers examined the relationship between brain activity and infant pain scores, which were calculated using the well-established premature infant pain profile (PIPP). PIPP assigns a value to infant behaviors, such as facial expressions, based on age.

In 10 heel stick occasions, infants had changes in pain-related brain activity without displaying a change in facial expression. Overall, the study showed that brain activity changes were more strongly linked to infant behavior changes (facial expressions) than physical changes, such as heart rate fluctuations.

The findings suggest that infants may process pain at the brain level without producing detectable behavioral changes. The lack of a grimace or similar facial expression may be due to immature muscle responses, or it truly could be an absence of emotion, the researchers say.

"Either way, the infants may not actually be pain free," the researchers conclude in the journal article. "As a result, pain assessment based on behavioral tools alone should be interpreted with caution as they could under estimate the total pain response."

[WildcatFanRN, BSN, RN]

I've never understood why doctors and others feel that babies don't feel pain. I saw to circumcisions, one with numbing, one without. It was hard to tell which baby felt more pain, at least for ,me. The doctors explained their reasons during the procedures, one felt that anyone deserves pain medication. The other felt that the risks of the medication to the baby was to much. Its nice that they are actually bringing it up.

[eyknough]

I witnessed two circumcisions so far as a nursing student. One baby had the nerve block, the other did not.

The baby who had the nerve block cried for about 3 seconds during the shot, then squealed for about 30 seconds after the gomco clamp was applied.

The baby who did not receive anesthesia squealed horribly from the time the doctor applied the hemostats to his foreskin (so they can rip the foreskin from the head with another pair) until he was unstrapped and comforted.

To me there is no question: anesthetize that poor baby's wing wang!

[NICU_babyRN, BSN, RN]

I am lucky to have worked with the CREATOR of the NPASS tool! Pain management is a priority!!!!