1. The American Academy of Pediatrics (AAP) policy statement reviews the literature on the efficacy and importance of neonatal pain reduction techniques and recommends that neonatal healthcare providers employ strategies to assess, prevent, and manage pain in neonates.
Statement Rundown: Through this policy statement, the AAP addresses the importance of appropriate evaluation, prevention, and management of pain in neonates, which is currently inconsistent. Pain prevention and treatment is important in neonates from both an ethical and biological standpoint. Exposure to repeated painful stimuli early in life is associated with short- and long-term deleterious effects, including abnormal development and poor stress response. The assessment of pain in neonates is challenging, however a number of tools exist to monitor responses to painful stimuli in infants. The AAP recommends these be used routinely. Both non-pharmacological and pharmacological treatment strategies have been found to be effective in reducing pain in neonates. Strategies such as non-nutritive sucking, breastfeeding, skin-to-skin contact, and facilitated tucking should be used consistently for short, mild to moderately painful procedures. The use of glucose or sucrose has been shown to reduce pain in moderately painful procedures, especially in combination with other techniques. It should be treated as a pharmacological intervention, with its use and effectiveness closely tracked. Further pharmacological methods, such as opioids and other sedatives/analgesics, should be used judiciously. Weighing the benefit of pain reduction with the risk of adverse effects, such as respiratory depression, hypotension and possibly neurotoxicity, is important. Many medications routinely used in older children and adults, such as ketamine, methadone, propofol, and dexmedetomidine lack adequate research and experience in the neonatal population. The AAP also recommends further research into neonatal pain assessment and intervention, as well as routine continuing education to physicians, healthcare providers, and family members regarding neonatal pain.
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