Pediatricians urge better pain relief for preemies
It happens every day to the most vulnerable infants in hospital intensive care units: Fragile babies, born way too soon, are poked, prodded and jabbed as part of medical care meant to help them survive.
Heel sticks for blood tests, inserting IV tubes, adjusting breathing machines — even the gentlest jostling to remove a bandage from translucent skin can cause kitten-like whimpers and tiny arms and legs to suddenly jerk. Sometimes, there’s no sound at all — just a dip on the heart rate monitor.
It used to be thought that these infants were too young to feel pain. But even now, experts say pain relief for newborns and especially preemies is often inadequate, despite evidence that low-tech comforting methods and medication can both be effective.
The American Academy of Pediatrics has new advice — and an admonishment.
Pain in newborns “continues to be inconsistently assessed and inadequately managed,” according to the academy, whose headquarters is in Elk Grove Village. Remedies “are currently underused for routine minor yet painful procedures.”
Preventing and reducing pain, particularly in preemies, is important because of the potential consequences for infant development, the academy says in a recent policy statement.
Research suggests that repeated bouts of pain leave infants prone to potential long-term ill effects including changes in nerve structures and brain development, as well as hypersensitivity to touch and stress. And it’s the smallest and sickest babies who experience the greatest number of painful procedures.
Pain assessment can be a significant challenge in preemies, said newborn specialist Erin Keels, the pediatrics academy policy’s lead author.
Preemies’ pain cues aren’t always obvious. They often have multiple health problems that need attention, and in busy intensive care units, pain relief for everyday minor procedures can sometimes get overlooked, says Keels, who’s a nurse at Nationwide Children’s Hospital in Columbus, Ohio.
The new guidance was prompted in part by recent research showing benefits from alternatives to medication. These include sugar-dipped pacifiers, tight swaddling and skin-to-skin contact with moms and dads.
Newer ways to measure infant pain also are being tested, including measuring brain waves and electrical impulses in the skin.
At Advocate Children’s Hospital in Oak Lawn, tiny twins Evelyn and Olivia Niedermeyer are helping find answers.
The babies, born in January, arrived more than a month early, weighing less than 3 pounds. They’re now part of a study comparing infants’ reactions to two tiny devices used to detect retinopathy — an eye disease that can cause blindness in very premature babies.
The metal devices prop eyelids open so doctors can look beyond the eyeballs’ surface into the retina. The hospital is trying to find out which of the two devices causes less discomfort, says Debra Skopec, a newborn intensive care nurse and the study’s leader.
Skopec wraps the babies’ legs into a little ball and holds them tightly during the exams and swaddles them after “confinement” meant to be comforting. Immediately after the tests, she watches for any changes in vital signs shown on wall-mounted monitors.
The twins squeal during the exam, and it all makes their mom, Angelica Juarez, feel helpless.
“I want to cry,” she says during a hospital visit, fighting tears. “And I don’t want my babies to hurt.”
Juarez says she agreed to take part to help future babies experience less pain.
“It’s scary,” she says, “but it’s necessary.”