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Pain Management in Newborns

From Prevention to Treatment

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Abstract

All neonates in the Neonatal Intensive Care Unit (NICU) or during the first days of life undergo painful and stressful procedures. Epidemiologic studies have shown that pain induced by these procedures is not effectively prevented or is inadequately treated. Pain experienced during the neonatal period may lead to negative outcomes, especially in preterm neonates. Prevention is the first step of pain management, and practical guidelines should be used in the NICU. Assessment must be done with adequate tools that take into account the infant’s pathology and gestational age. Distinguishing between acute and prolonged pain is important for both assessment and treatment. The most common drugs that have been studied for the treatment of pain and stress are opioids, hypnosedatives, and NMDA receptor antagonists. Morphine and fentanyl are most frequently used for acute or prolonged pain in the NICU. They have potent analgesic effects and few immediate or long-term adverse effects. Midazolam is a commonly used hypnosedative, but its adverse effects limit its use. Drugs such as propofol and ketamine have been used for acute painful procedures; however, further research is needed to assess their long-term effects. Use of non-pharmacologic pain management techniques has increased in recent years. These methods are easy, inexpensive, and effective in helping newborns recover from painful procedures. Sweet solutions and non-nutritive sucking, breastfeeding, skin-to-skin mother care, swaddling, and facilitated tucking are the most commonly employed and evaluated non-pharmacologic methods. Hospitals should promote and improve parent involvement in pain management. In-service education and well organized hospital teams are crucial for successful implementation of pain protocols in newborns.

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References

  1. Merskey H, Albe-Fessard D, Bonica J. Pain terms: a list with definitions and notes on usage. Recommended by the IASP Subcommittee on Taxonomy. Pain 1979 Jun; 6(3): 249–52

    Google Scholar 

  2. Anand KJ, Hickey PR. Pain and its effects in the human neonate and fetus. N Engl J Med 1987 Nov 19; 317(21): 1321–9

    Article  PubMed  CAS  Google Scholar 

  3. McIntosh N. Pain in the newborn, a possible new starting point. Eur J Pediatr 1997 Mar; 156(3): 173–7

    Article  PubMed  CAS  Google Scholar 

  4. Batton DG, Barrington KJ, Wallman C. Prevention and management of pain in the neonate: an update. Pediatrics 2006 Nov; 118(5): 2231–41

    Article  PubMed  Google Scholar 

  5. Simons SH, van Dijk M, Anand KS, et al. Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med 2003 Nov; 157(11): 1058–64

    Article  PubMed  Google Scholar 

  6. Carbajal R, Rousset A, Danan C, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA 2008 Jul 2; 300(1): 60–70

    Article  PubMed  CAS  Google Scholar 

  7. Menon G, Anand KJ, McIntosh N. Practical approach to analgesia and sedation in the neonatal intensive care unit. Semin Perinatol 1998 Oct; 22(5): 417–24

    Article  PubMed  CAS  Google Scholar 

  8. Giannakoulopoulos X, Sepulveda W, Kourtis P, et al. Fetal plasma cortisol and beta-endorphin response to intrauterine needling. Lancet 1994 Jul 9; 344(8915): 77–81

    Article  PubMed  CAS  Google Scholar 

  9. Anand KJ, Sippell WG, Aynsley-Green A. Pain, anaesthesia, and babies [letter]. Lancet 1987 Nov 21; 2(8569): 1210

    Article  PubMed  CAS  Google Scholar 

  10. Carbajal R, Gall O, Annequin D. Pain management in neonates. Expert Rev Neurother 2004 May; 4(3): 491–505

    Article  PubMed  Google Scholar 

  11. Fitzgerald M, Millard C, McIntosh N. Cutaneous hypersensitivity following peripheral tissue damage in newborn infants and its reversal with topical anaesthesia. Pain 1989 Oct; 39(1): 31–6

    Article  PubMed  CAS  Google Scholar 

  12. Fitzgerald M. Development of the peripheral and spinal pain system. In: Anand KJ, Stevens B, McGrath P, editors. Pain in neonates. Amsterdam: Elsevier Science, 2000

    Google Scholar 

  13. Walker SM, Franck LS, Fitzgerald M, et al. Long-term impact of neonatal intensive care and surgery on somatosensory perception in children born extremely preterm. Pain 2009 Jan; 141(1–2): 79–87

    Article  PubMed  Google Scholar 

  14. Carbajal R, Nguyen-Bourgain C, Armengaud JB. How can we improve pain relief in neonates? Expert Rev Neurother 2008 Nov; 8(11): 1617–20

    Article  PubMed  Google Scholar 

  15. Stevens BJ, Franck LS. Assessment and management of pain in neonates. Paediatr Drugs 2001; 3(7): 539–58

    Article  PubMed  CAS  Google Scholar 

  16. Johnston CC, Stevens BJ. Experience in a neonatal intensive care unit affects pain response. Pediatrics 1996 Nov; 98(5): 925–30

    PubMed  CAS  Google Scholar 

  17. Taddio A, Shah V, Gilbert-MacLeod C, et al. Conditioning and hyperalgesia in newborns exposed to repeated heel lances. JAMA 2002 Aug 21; 288(7): 857–61

    Article  PubMed  Google Scholar 

  18. Taddio A, Katz J, Ilersich AL, et al. Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997 Mar 1; 349(9052): 599–603

    Article  PubMed  CAS  Google Scholar 

  19. Ranger M, Johnston CC, Anand KJ. Current controversies regarding pain assessment in neonates. Semin Perinatol 2007 Oct; 31(5): 283–8

    Article  PubMed  Google Scholar 

  20. Anand KJ, Hall RW. Controversies in neonatal pain: an introduction. Semin Perinatol 2007 Oct; 31(5): 273–4

    Article  PubMed  CAS  Google Scholar 

  21. Debillon T, Zupan V, Ravault N, et al. Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001 Jul; 85(1): F36–41

    Article  PubMed  CAS  Google Scholar 

  22. Hummel P, Puchalski M, Creech SD, et al. Clinical reliability and validity of the N-PASS: neonatal pain, agitation and sedation scale with prolonged pain. J Perinatol 2008 Jan; 28(1): 55–60

    Article  PubMed  CAS  Google Scholar 

  23. Anand KJ. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001 Feb; 155(2): 173–80

    PubMed  CAS  Google Scholar 

  24. Stevens B, Johnston C, Petryshen P et al. Premature Infant Pain Profile: development and initial validation. Clin J Pain 1996; 12: 13–22

    Article  PubMed  CAS  Google Scholar 

  25. Grunau R, Craig KD. Pain expression in neonates: facial action and cry. Pain 1987; 28: 395–410

    Article  PubMed  CAS  Google Scholar 

  26. Lawrence J, Alcock D, McGrath P, et al. The development of a tool to assess neonatal pain. Neonat Network J Neonat Nurs 1993; 12: 59–66

    CAS  Google Scholar 

  27. Krechel S, Bildner J. CRIES: a new neonatal postoperative pain measurement score: initial testing of validity and reliability. Paediatr Anaesth 1995; 5: 53–61

    Article  PubMed  CAS  Google Scholar 

  28. Bergqvist LL, Katz-Salamon M, Hertegard S, et al. Mode of delivery modulates physiological and behavioral responses to neonatal pain. J Perinatol 2009; 29(1): 44–50

    Article  PubMed  CAS  Google Scholar 

  29. Slater R, Fitzgerald M, Meek J. Can cortical responses following noxious stimulation inform us about pain processing in neonates? Semin Perinatol 2007 Oct; 31(5): 298–302

    Article  PubMed  Google Scholar 

  30. Merskey H, Bogduk N. Classification of chronic pain: description of chronic pain syndromes and definition of pain terms. Seattle (WA): IASP Press, 1994

    Google Scholar 

  31. Anand KJ. Pain assessment in preterm neonates. Pediatrics 2007 Mar; 119(3): 605–7

    Article  PubMed  CAS  Google Scholar 

  32. Anand KJ. Systemic analgesic therapy. In: Anand KJ, Stevens B, McGrath P, editors. Pain in neonates. Amsterdam: Elsevier, 2000: 159–88

    Google Scholar 

  33. Walker SM. Pain in children: recent advances and ongoing challenges. Br J Anaesth 2008 Jul; 101(1): 101–10

    Article  PubMed  CAS  Google Scholar 

  34. Ancora G, Mastrocola M, Bagnara C, et al. Influence of gestational age on the EDIN score: an observational study. Arch Dis Child Fetal Neonatal Ed 2009 Jan; 94(1): F35–8

    Article  PubMed  CAS  Google Scholar 

  35. Royal Australasian College of Physician, Paediatrics and Child Health Division. Guideline statement: management of procedure-related pain in neonates [online]. Available from URL: http://www.racp.edu.au/hpu/paed/pain/index.htm [Accessed 2010 Aug 10]

  36. Allegaert K, Tibboel D. Shouldn’t we reconsider procedural techniques to prevent neonatal pain? Eur J Pain 2007 Nov; 11(8): 910–2

    Article  PubMed  CAS  Google Scholar 

  37. Shah V, Ohlsson A. Venepuncture versus heel lance for blood sampling in term neonates. Cochrane Database Syst Rev 2007; (4): CD001452

    Google Scholar 

  38. McKechnie L, Levene M. Procedural pain guidelines for the newborn in the United Kingdom. J Perinatol 2008 Feb; 28(2): 107–11

    Article  PubMed  CAS  Google Scholar 

  39. Taddio A, Yiu A, Smith RW, et al. Variability in clinical practice guidelines for sweetening agents in newborn infants undergoing painful procedures. Clin J Pain 2009 Feb; 25(2): 153–5

    Article  PubMed  Google Scholar 

  40. Debillon T, Bureau V, Savagner C, et al. Pain management in French neonatal intensive care units. Acta Paediatr 2002; 91(7): 822–6

    Article  PubMed  CAS  Google Scholar 

  41. Lefrak L, Burch K, Caravantes R, et al. Sucrose analgesia: identifying potentially better practices. Pediatrics 2006 Nov; 118Suppl. 2: S197–202

    Article  PubMed  Google Scholar 

  42. Latimer MA, Johnston CC, Ritchie JA, et al. Factors affecting delivery of evidence-based procedural pain care in hospitalized neonates. J Obstet Gynecol Neonatal Nurs 2009 Mar–Apr; 38(2): 182–94

    Article  PubMed  Google Scholar 

  43. Vardi A, Salem Y, Padeh S, et al. Is propofol safe for procedural sedation in children? A prospective evaluation of propofol versus ketamine in pediatric critical care. Crit Care Med 2002 Jun; 30(6): 1231–6

    Article  PubMed  CAS  Google Scholar 

  44. Stehna N, Suresh S. Central and peripheral regional analgesia and anaesthesia. In: Anand KJ, Stevens B, McGrath P, editors. Pain in neonates and infants. Amsterdam: Elsevier Science, 2007

    Google Scholar 

  45. Anand KJ. Pharmacological approaches to the management of pain in the neonatal intensive care unit. J Perinatol 2007 May; 27Suppl. 1: S4–11

    Article  PubMed  CAS  Google Scholar 

  46. Anand KJ, Barton BA, McIntosh N, et al. Analgesia and sedation in preterm neonates who require ventilatory support: results from the NOPAIN trial. Neonatal Outcome and Prolonged Analgesia In Neonates. Arch Pediatr Adolesc Med 1999 Apr; 153(4): 331–8

    PubMed  CAS  Google Scholar 

  47. Simons SH, van Dijk M, van Lingen RA, et al. Routine morphine infusion in preterm newborns who received ventilatory support: a randomized controlled trial. JAMA 2003 Nov 12; 290(18): 2419–27

    Article  PubMed  CAS  Google Scholar 

  48. Carbajal R, Lenclen R, Jugie M, et al. Morphine does not provide adequate analgesia for acute procedural pain among preterm neonates. Pediatrics 2005 Jun; 115(6): 1494–500

    Article  PubMed  Google Scholar 

  49. Anand KJ, Hall RW, Desai N, et al. Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet 2004 May 22; 363(9422): 1673–82

    Article  PubMed  CAS  Google Scholar 

  50. Menon G, Boyle EM, Bergqvist LL, et al. Morphine analgesia and gastrointestinal morbidity in preterm infants: secondary results from the NEOPAIN trial. Arch Dis Child Fetal Neonatal Ed 2008 Sep; 93(5): F362–7

    Article  PubMed  CAS  Google Scholar 

  51. Rao R, Sampers JS, Kronsberg SS, et al. Neurobehavior of preterm infants at 36 weeks postconception as a function of morphine analgesia. Am J Perinatol 2007 Oct; 24(9): 511–7

    Article  PubMed  Google Scholar 

  52. Roze JC, Denizot S, Carbajal R, et al. Prolonged sedation and/or analgesia and 5-year neurodevelopment outcome in very preterm infants: results from the EPIPAGE cohort. Arch Pediatr Adolesc Med 2008 Aug; 162(8): 728–33

    Article  PubMed  Google Scholar 

  53. Franck LS, Vilardi J, Durand D, et al. Opioid withdrawal in neonates after continuous infusions of morphine or fentanyl during extracorporeal membrane oxygenation. Am J Crit Care 1998 Sep; 7(5): 364–9

    PubMed  CAS  Google Scholar 

  54. Tibboel D, Anand KJ, van den Anker JN. The pharmacological treatment of neonatal pain. Semin Fetal Neonatal Med 2005 Apr; 10(2): 195–205

    Article  PubMed  CAS  Google Scholar 

  55. Bellu R, de Waal KA, Zanini R. Opioids for neonates receiving mechanical ventilation. Cochrane Database Syst Rev 2008; (1): CD004212

    Google Scholar 

  56. Attardi DM, Paul DA, Tuttle DJ, et al. Premedication for intubation in neonates [abstract]. Arch Dis Child Fetal Neonatal Ed 2000 Sep; 83(2): F161

    Article  PubMed  CAS  Google Scholar 

  57. Thomas RL, Parker GC, Van Overmeire B, et al. A meta-analysis of ibuprofen versus indomethacin for closure of patent ductus arteriosus. Eur J Pediatr 2005 Mar; 164(3): 135–40

    Article  PubMed  CAS  Google Scholar 

  58. Van Overmeire B, Smets K, Lecoutere D, et al. A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus. N Engl J Med 2000 Sep 7; 343(10): 674–81

    Article  PubMed  Google Scholar 

  59. Olkkola K, Hamunen K. Pharmacokinetics and pharmacodynamics of analgesic drugs. In: Anand KJ, Stevens B, McGrath P, editors. Pain in neonates. Amsterdam: Elsevier Science, 2000: 135–58

    Google Scholar 

  60. Shah V, Taddio A, Ohlsson A. Randomised controlled trial of paracetamol for heel prick pain in neonates. Arch Dis Child Fetal Neonatal Ed 1998 Nov; 79(3):F209–11

    Article  PubMed  CAS  Google Scholar 

  61. Beasley R, Clayton T, Crane J, et al. Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6–7 years: analysis from phase three of the ISAAC programme. Lancet 2008 Sep 20; 372(9643): 1039–48

    Article  PubMed  CAS  Google Scholar 

  62. Bhutta AT. Ketamine: a controversial drug for neonates. Semin Perinatol 2007 Oct; 31(5): 303–8

    Article  PubMed  Google Scholar 

  63. Rovnaghi CR, Garg S, Hall RW, et al. Ketamine analgesia for inflammatory pain in neonatal rats: a factorial randomized trial examining long-term effects. Behav Brain Funct 2008 Aug 7; 4: 35

    Article  CAS  Google Scholar 

  64. Sanders RD, Weimann J, Maze M. Biologic effects of nitrous oxide: a mechanistic and toxicologic review. Anesthesiology 2008 Oct; 109(4): 707–22

    Article  PubMed  CAS  Google Scholar 

  65. Carbajal R, Biran V, Lenclen R, et al. EMLA cream and nitrous oxide to alleviate pain induced by palivizumab (Synagis) intramuscular injections in infants and young children. Pediatrics 2008 Jun; 121(6): e1591–8

    Article  PubMed  Google Scholar 

  66. Milesi C, Pidoux O, Sabatier E, et al. Nitrous oxide analgesia for intubating preterm neonates: a pilot study. Acta Paediatr 2006 Sep; 95(9): 1104–8

    Article  PubMed  Google Scholar 

  67. Hall RW, Boyle E, Young T. Do ventilated neonates require pain management? Semin Perinatol 2007 Oct; 31(5): 289–97

    Article  PubMed  Google Scholar 

  68. Ng E, Taddio A, Ohlsson A. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Cochrane Database Syst Rev 2003; (1): CD002052

    Google Scholar 

  69. Ghanta S, Abdel-Latif ME, Lui K, et al. Propofol compared with the morphine, atropine, and suxamethonium regimen as induction agents for neonatal endotracheal intubation: a randomized, controlled trial. Pediatrics 2007 Jun; 119(6): e1248–55

    Article  PubMed  Google Scholar 

  70. Papoff P, Mancuso M, Caresta E, et al. Effectiveness and safety of propofol in newborn infants. Pediatrics 2008 Feb; 121(2): 448; author reply, 449

    Article  PubMed  Google Scholar 

  71. Parke TJ, Stevens JE, Rice AS, et al. Metabolic acidosis and fatal myocardial failure after propofol infusion in children: five case reports. BMJ 1992 Sep 12; 305(6854): 613–6

    Article  PubMed  CAS  Google Scholar 

  72. Lehr VT, Taddio A. Topical anesthesia in neonates: clinical practices and practical considerations. Semin Perinatol 2007 Oct; 31(5): 323–9

    Article  PubMed  Google Scholar 

  73. Carbajal R, Maclart E. Application of EMLA cream without an adhesive film. Arch Pediatr 1997; 4(4): 384–5

    Article  Google Scholar 

  74. O’Brien L, Taddio A, Lyszkiewicz DA, et al. A critical review of the topical local anesthetic amethocaine (Ametop) for pediatric pain. Paediatr Drugs 2005; 7(1): 41–54

    Article  PubMed  Google Scholar 

  75. Jain A, Rutter N. Does topical amethocaine gel reduce the pain of venepuncture in newborn infants? A randomised double blind controlled trial. Arch Dis Child Fetal Neonatal Ed 2000 Nov; 83(3): F207–10

    Article  PubMed  CAS  Google Scholar 

  76. Lemyre B, Hogan DL, Gaboury I, et al. How effective is tetracaine 4% gel, before a venipuncture, in reducing procedural pain in infants: a randomized double-blind placebo controlled trial. BMC Pediatr 2007; 7: 7

    Article  PubMed  Google Scholar 

  77. Shah VS, Taddio A, Hancock R, et al. Topical amethocaine gel 4% for intramuscular injection in term neonates: a double-blind, placebo-controlled, randomized trial. Clin Ther 2008 Jan; 30(1): 166–74

    Article  PubMed  CAS  Google Scholar 

  78. Cignacco E, Hamers JP, Stoffel L, et al. The efficacy of non-pharmacological interventions in the management of procedural pain in preterm and term neonates: a systematic literature review. Eur J Pain 2007 Feb; 11(2): 139–52

    Article  PubMed  Google Scholar 

  79. Als H, Lawhon G, Duffy FH, et al. Individualized developmental care for the very low-birth-weight preterm infant: medical and neurofunctional effects. JAMA 1994 Sep 21; 272(11): 853–8

    Article  PubMed  CAS  Google Scholar 

  80. Field T, Goldson E. Pacifying effects of nonnutritive sucking on term and preterm neonates during heelstick procedures. Pediatrics 1984 Dec; 74(6): 1012–5

    PubMed  CAS  Google Scholar 

  81. Blass EM, Watt LB. Suckling- and sucrose-induced analgesia in human newborns. Pain 1999 Dec; 83(3): 611–23

    Article  PubMed  CAS  Google Scholar 

  82. Blass EM, Hoffmeyer LB. Sucrose as an analgesic for newborn infants. Pediatrics 1991 Feb; 87(2): 215–8

    PubMed  CAS  Google Scholar 

  83. Okan F, Coban A, Ince Z, et al. Analgesia in preterm newborns: the comparative effects of sucrose and glucose. Eur J Pediatr 2007 Oct; 166(10): 1017–24

    Article  PubMed  CAS  Google Scholar 

  84. Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev 2010; (1): CD001069

    Google Scholar 

  85. Stevens B, Taddio A, Ohlsson A, et al. The efficacy of sucrose for relieving procedural pain in neonates: a systematic review and meta-analysis. Acta Paediatr 1997 Aug; 86(8): 837–42

    Article  PubMed  CAS  Google Scholar 

  86. Ramenghi LA, Evans DJ, Levene MI. “Sucrose analgesia”: absorptive mechanism or taste perception? Arch Dis Child Fetal Neonatal Ed 1999 Mar; 80(2): F146–7

    Article  PubMed  CAS  Google Scholar 

  87. Taddio A, Shah V, Hancock R, et al. Effectiveness of sucrose analgesia in newborns undergoing painful medical procedures. CMAJ 2008 Jul 1; 179(1): 37–43

    Article  PubMed  Google Scholar 

  88. Carbajal R, Chauvet X, Couderc S, et al. Randomised trial of analgesic effects of sucrose, glucose, and pacifiers in term neonates. BMJ 1999 Nov 27; 319(7222): 1393–7

    Article  PubMed  CAS  Google Scholar 

  89. Gibbins S, Stevens B, Hodnett E, et al. Efficacy and safety of sucrose for procedural pain relief in preterm and term neonates. Nurs Res 2002 Nov–Dec; 51(6): 375–82

    Article  PubMed  Google Scholar 

  90. Johnston CC, Filion F, Snider L, et al. Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks’ postconceptional age. Pediatrics 2002 Sep; 110(3): 523–8

    Article  PubMed  Google Scholar 

  91. Johnston CC, Filion F, Snider L, et al. How much sucrose is too much sucrose [letter]? Pediatrics 2007 Jan; 119(1): 226

    Article  PubMed  Google Scholar 

  92. Whitelaw A, Sleath K. Myth of the marsupial mother: home care of very low birth weight babies in Bogota, Colombia. Lancet 1985 May 25; 1(8439): 1206–8

    Article  PubMed  CAS  Google Scholar 

  93. Mooncey S, Giannakoulopoulos X, Glover V, et al. The effect of mother-infant skin-to-skin contact on plasma cortisol and beta-endorphin concentrations in preterm newborn. Infant Behavior and Development 1997; 20(4): 553–7

    Article  Google Scholar 

  94. Gray L, Watt L, Blass EM. Skin-to-skin contact is analgesic in healthy newborns. Pediatrics 2000 Jan; 105(1): e14

    Article  PubMed  CAS  Google Scholar 

  95. Johnston CC, Stevens B, Pinelli J, et al. Kangaroo care is effective in diminishing pain response in preterm neonates. Arch Pediatr Adolesc Med 2003 Nov; 157(11): 1084–8

    Article  PubMed  Google Scholar 

  96. Johnston CC, Filion F, Campbell-Yeo M, et al. Kangaroo mother care diminishes pain from heel lance in very preterm neonates: a crossover trial. BMC Pediatr 2008 Apr 24; 8: 13

    Article  Google Scholar 

  97. Castral TC, Warnock F, Leite AM, et al. The effects of skin-to-skin contact during acute pain in preterm newborns. Eur J Pain 2008 May; 12(4): 464–71

    Article  PubMed  Google Scholar 

  98. Freire NB, Garcia JB, Lamy ZC. Evaluation of analgesic effect of skin-to-skin contact compared to oral glucose in preterm neonates. Pain 2008 Sep 30; 139(1): 28–33

    Article  PubMed  CAS  Google Scholar 

  99. Bauer K, Pyper A, Sperling P, et al. Effects of gestational and postnatal age on body temperature, oxygen consumption, and activity during early skin-to-skin contact between preterm infants of 25–30-week gestation and their mothers. Pediatr Res 1998 Aug; 44(2): 247–51

    Article  PubMed  CAS  Google Scholar 

  100. Shah PS, Aliwalas LI, Shah V. Breastfeeding or breast milk for procedural pain in neonates. Cochrane Database Syst Rev 2006; (3): CD004950

    Google Scholar 

  101. Carbajal R, Veerapen S, Couderc S, et al. Analgesic effect of breast feeding in term neonates: randomised controlled trial. BMJ 2003 Jan 4; 326(7379): 13

    Article  PubMed  Google Scholar 

  102. Codipietro L, Ceccarelli M, Ponzone A. Breastfeeding or oral sucrose solution in term neonates receiving heel lance: a randomized, controlled trial. Pediatrics 2008 Sep; 122(3): e716–21

    Article  PubMed  Google Scholar 

  103. Nishitani S, Miyamura T, Tagawa M, et al. The calming effect of a maternal breast milk odor on the human newborn infant. Neurosci Res 2009 Jan; 63(1): 66–71

    Article  PubMed  CAS  Google Scholar 

  104. Leslie A, Marlow N. Non-pharmacological pain relief. Semin Fetal Neonatal Med 2006 Aug; 11(4): 246–50

    Article  PubMed  Google Scholar 

  105. Golianu B, Krane E, Seybold J, et al. Non-pharmacological techniques for pain management in neonates. Semin Perinatol 2007 Oct; 31(5): 318–22

    Article  PubMed  Google Scholar 

  106. Franck LS, Cox S, Allen A, et al. Parental concern and distress about infant pain. Arch Dis Child Fetal Neonatal Ed 2004 Jan; 89(1): F71–5

    Article  PubMed  CAS  Google Scholar 

  107. Franck LS, Allen A, Cox S, et al. Parents’ views about infant pain in neonatal intensive care. Clin J Pain 2005 Mar–Apr; 21(2): 133–9

    Article  PubMed  Google Scholar 

  108. Taddio A, Shah V, Atenafu E, et al. Influence of repeated painful procedures and sucrose analgesia on the development of hyperalgesia in newborn. Pain 2009; 144: 43–8

    Article  PubMed  CAS  Google Scholar 

  109. Slater R, Cornelissen L, Fabrizi L, et al. Oral sucrose as an analgesic drug for procedural pain in newborn infants: a randomised controlled trial. The Lancet, early online publication, 1 September 2010 [online]. Available from URL: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61303-7/abstract [Accessed 2010 Sep 24]

  110. Lasky R. Is sucrose an effective analgesic for newborn babies? The Lancet, early online publication, 1 September 2010 [online]. Available from URL: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61358-X/fulltext [Accessed 2010 Sep 24]

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No sources of funding were used to prepare this review. The authors have no conflicts of interest that are directly relevant to the content of this review. The authors thank Rachel Gooze for editing the manuscript with respect to language.

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Walter-Nicolet, E., Annequin, D., Biran, V. et al. Pain Management in Newborns. Pediatr-Drugs 12, 353–365 (2010). https://doi.org/10.2165/11318900-000000000-00000

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