Painkillers often withheld from ill newborns

Pain-killing medicine is often withheld during painful and stressful procedures performed on critically ill newborn infants in intensive care units, according to a report released Tuesday.

“Multiple lines of evidence” suggest that repeated and prolonged exposure to pain alters newborn infants’ long-term development, and behavior, Dr. Ricardo Carbajal and colleagues note in the Journal of the American Medical Association. “It is essential, therefore, to prevent or treat pain” in newborns, they write.

Carbajal, at Hopital d’Enfants Armand Trousseau in Paris and colleagues studied 430 newborns treated at 14 intensive care units at hospitals in the Paris region.

During the patients’ first 14 days of admission to an ICU, staff members documented all procedures they considered to cause pain, stress or discomfort, along with the corresponding pain medicine administered.

The median number of procedures per infant per day was 16, including 10 that were painful. Some infants experienced up to 62 procedures per day. However, infants received specific medicine to deaden the pain for only about 20 percent of painful procedures, the team found.

Of particular concern to the investigators was the high rate of attempts required to complete many procedures. “Some painful procedures needed as many as 10 to 15 attempts for completion,” they report.

Only 21 percent of painful procedures were carried out with specific medicine for pain, which was predominantly nonpharmacological, such as sweet solutions and sucking. Rarely was the infant placed skin-to-skin with mom during a painful procedure.

“The number of painful procedures is so high that the first step to improve procedural pain management must significantly reduce these numbers,” the investigators write.

SOURCE: Journal of the American Medical Association, July 2, 2008.