Many premature babies require intensive medical care, which often involves experiencing pain. However, the healthcare system does not offer adequate pain relief. This finding comes from the largest survey ever conducted on pain in neonatal care, recently published in the journal Pain.
Over a span of 4.5 years, neonatal care staff in Sweden tracked pain occurrences, their causes, and the methods used for pain assessment and treatment in preterm infants. The study focused on 3,686 babies born between 22 and 31 weeks of gestation from 2020 to 2024, accumulating more than 185,000 days of care as noted in the Swedish Neonatal Quality register.
The research revealed that infants born extremely prematurely, specifically between 22 to 23 weeks, faced the highest rates of painful medical conditions and underwent painful intensive care procedures almost daily during their first month of life. However, this is expected.
“There is a strong link between serious health issues and being born very early. The earlier a baby is born, the more intensive care they require. This level of care involves many painful procedures such as ventilator support, tube feeding, catheter insertion, and surgeries. It also includes various tests that may cause pain,” explains Mikael Norman, professor of pediatrics at the Department of Clinical Science, Intervention and Technology at Karolinska Institutet, who led the study.
A staggering 90 percent of the extremely preterm infants underwent painful procedures. Yet, healthcare professionals reported that only 45 percent of these babies seemed to experience pain—possibly because pain was largely managed or alleviated. However, an examination of the medications given points to other reasons.
“Interestingly, the tiniest babies who were subjected to the most pain received morphine treatment the least. This may suggest they were undertreated,” remarks Mikael Norman.
One limitation of the study is its inability to measure the duration or intensity of pain on the days recorded.
“Caregivers responded only ‘yes’ or ‘no’ to whether the infant experienced pain in the last 24 hours. This could range from brief procedural pain, like a needle stick, to more persistent pain due to medical conditions.
“Significant efforts are made to relieve pain in infants. No child in neonatal care should endure severe untreated pain,” he adds.
Nonetheless, it remains a challenge for healthcare professionals to consistently identify when children are in pain.
“This necessitates the development of better assessment scales or physiological methods for measuring pain. Enhanced pain management approaches are also required, likely using combinations of medications that minimize the risk of side effects,” suggests Dr. Norman.
It is crucial to enhance pain management for premature infants, as we now understand that strong pain signals negatively impact their development.
“The goal of all neonatal care is to minimize pain. The findings of this survey will be vital for advancing neonatal care and guiding future research in this area,” concludes Mikael Norman.
The research received primary funding from Region Stockholm, the Childhood Foundation of the Swedish Freemasons in Stockholm, and the Swedish Research Council.
Background:
Unlike older children and adults, newborns cannot express pain verbally. To objectively gauge pain in newborns, healthcare providers utilize various pain scales that assess the baby’s breathing, facial expressions, movements, and overall comfort. However, very premature infants may display fewer signs of pain compared to full-term babies, often showing only slight frowning or less movement.
When it comes to morphine treatment, there is a delicate balance between providing pain relief and risk of lowering blood pressure, which can be a side effect. Very premature babies already tend to have low blood pressure; exceeding this safety threshold could result in serious circulatory issues. This may explain why very young infants received less morphine than might be deemed appropriate, considering their higher levels of pain.
Source: Mikael Norman.
