Pain management

Question 1

Explain procedural pain and its management in the neonate

Answer 1

procedural pain is the pain felt by a neonate during medical procedures including heel pricks, IV insertion, NGT insertion, intubation etc. Exposure to repeated painful procedures have have negative impacts on neurodevelopment and pain perception long term.

Pain management involves pharmacological pain management throughadministration of EBM or sucrose, as well as practicing developmental care

Question 2

Outline some non pharmacological pain management strategies and their rationale/MOA

Answer 2

Sucrose - must be documented and if orally tolerated, reduces pain by releasing endogenous opioids

EBM/Breastfeeding - must be documented and if orally tolerated, reduces pain by releasing endogenous opioids

Swaddling - swaddling an infant allows them to feel contained and self soothe

NNS - allows infants to self soothe whilst developing their suck swallow breathe reflex - but does require parental consent

kangaroo care/skin to skin - consider stability of baby, type of procedure, and parents comfort level, but skin to skin is soothing and regulating

Clustered care - clustering care reduces the amount of times an infant needs to be disturbed for a painful procedure and protects sleep which is important in neurodevelopment, which repeated painful procedures can compromise.

Question 3

Describe the midwives role in pain assessment when caring for the newborn

Answer 3

The midwife must assess for pain or discomfort in the infant and address this pain in order to promote optimal development and avoid distress
- crying
- pushing away stimulus
- changes in facial expression
- vital sign instability