Pain Management Crisis in Neonatal Care: Study Reveals Alarming Trends

Infants born very early, requiring intensive care, often experience significant pain due to medical procedures and conditions. However, a recent comprehensive survey reveals that the healthcare system frequently fails to adequately address their pain. The findings, published in the journal Pain, highlight critical gaps in neonatal care pain management practices.

Scope of the Study

Over 4.5 years, neonatal care staff meticulously documented pain occurrences, causes, assessments, and treatments in premature babies across Sweden. The study encompassed 3,686 infants born between 22 and 31 weeks gestation from 2020 to 2024, totaling nearly 185,000 days of care. Data were collected through the Swedish Neonatal Quality register.

High Prevalence of Pain in Extremely Premature Infants

Infants born between 22 and 23 weeks gestation exhibited the highest proportion of painful medical conditions and experienced frequent, daily painful procedures throughout their first month of life. This aligns with the understanding that early-born infants require more intensive care, involving procedures such as ventilator treatment, tube feeding, catheter insertion, and surgeries, all potentially causing pain.

There is a strong correlation between acute morbidity and being born very early. The earlier a baby is born, the more intensive care it needs. Intensive care involves procedures that can be painful, such as ventilator treatment, tube feeding, insertion of catheters into blood vessels and surgical procedures. It also requires various tests and investigations that may involve pain.

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

Recognizing Pain in Infants

Nearly 90 percent of the most extremely preterm infants underwent painful procedures during their care. Health professionals reported that around 45 percent of babies experienced pain. However, data analysis on administered drugs suggests underreporting or undertreatment of pain.

Mikael Norman explains, “Somewhat surprisingly, the smallest babies who were most exposed to pain had the lowest proportion of treatment with morphine. This may be a case of undertreatment.”

Challenges in Pain Management

One significant limitation is the inability to determine the duration or severity of pain experienced by each infant. Caregivers answered yes or no to whether the infant had experienced pain in the last 24 hours, which could range from minor procedural pain to continuous medical pain.

“Much is done to alleviate pain in babies. No child in neonatal care is left with severe pain untreated,” he adds. “However, it is a problem and a challenge that healthcare professionals are not always able to determine whether children are in pain.”

Developing Better Pain Measurement and Treatment

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

Impact of Pain on Development

Pain in premature babies is not only distressing but can also negatively affect their development due to the strong brain signals pain generates. “The vision for all neonatal care is to be pain-free. The results of this survey will be of great importance for improving neonatal care and for future research in the field,” concludes Mikael Norman.

Future Directions

Addressing pain in neonatal care is crucial for the well-being and developmental outcomes of these infants. The research emphasizes the need for better pain measurement methods, more effective pain treatments, and continuous improvements in care practices.

Your thoughts on this critical issue are valuable. We encourage you to share your insights and experiences in the comments section below. Subscribe to our newsletter for more updates on neonatal care and other healthcare topics. Share this article on your social media platforms to help spread awareness and support.