Seminars in perinatology
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This article critically reviews the measures developed for assessing pain in the human neonate. Information was gathered with a computerized literature search of published articles and abstracts, a manual review of relevant conference proceedings, recently published journals, unpublished reports and manuscripts, and personal files. This identified 16 measures that were critically examined for their psychometric properties (reliability and validity) and clinical use. ⋯ A sufficient number of infant pain measures have now been developed to assess acute pain. There is a paucity of measures to assess chronic pain in infants, and measures for infants who are low birth weight, critically ill, or ventilated. Future research should be aimed at strengthening the properties of existing measures, and at the development of measures for those infants with chronic pain or special needs.
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Seminars in perinatology · Oct 1998
ReviewPractical approach to analgesia and sedation in the neonatal intensive care unit.
The anatomic and physiological bases for nociception are present even in very preterm neonates. Neonates show the same behavioral, endocrine, and metabolic responses to noxious stimuli as older subjects. Preterm infants appear to be more sensitive to painful stimuli and have heightened responses to successive stimuli. ⋯ A pure sedative agent can provide physiological stability in settings in which there are less acutely painful stimuli or when there are adverse effects from, or tolerance to, opiates. Local anesthesia of skin and mucous membranes is helpful for invasive procedures. Antipyretic analgesics such as acetaminophen have a role in inflammatory pain.
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Local and regional anesthetic techniques have a significant but limited place in the practice of infant pain control. In certain clinical circumstances, regional anesthetic techniques presumably afford many of the same advantages for the pediatric patient as in the adult patient. However, there are few controlled clinical trials on the advantages and adverse effects compared with conventional analgesic strategies. This article discusses the clinical application, effectiveness, safety, and outcomes of the available local and regional anesthetic techniques for control of postoperative and procedure-related pain in neonates and infants.
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In this review of the anesthetic considerations for the neonate who requires anesthesia for emergency surgery, the authors discuss preoperative, intraoperative, and postoperative management from an anesthetic perspective. Monitoring the cardiorespiratory and metabolic status of neonates during anesthesia is usually difficult because the neonate is not physically accessible. ⋯ Regional anesthesia and opioids may be included to decrease the intraoperative anesthetic requirements and prevent pain in the postoperative period. The pharmacology of specific anesthetic and adjuvant agents are discussed.
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Seminars in perinatology · Jun 1998
ReviewFutility considerations in the neonatal intensive care unit.
The purpose of this article is to summarize and comment on the history of medical decision making in the neonatal intensive care nursery, emphasizing considerations of futility. Several epochs will be described, with shifting roles of health care providers, the infant's family, and proxies for society at large. Futility has been an issue in the intensive care of newborn infants throughout the last 35 years. ⋯ In the 1990s, third party payors became increasingly assertive in limiting resource expenditure. These legal and societal mandates are frequently at variance with one another. Thus the issue of medical futility, as it applies to neonates in the United States, must be considered unresolved.