Newborn babies who spend time in the intensive care unit (ICU) undergo an average of 141 painful or stressful procedures during their stay, including suctioning of the nose and throat, heel sticks, and needle jabs, according to a new study. What’s more, they get some sort of pain relief or comfort only 20% of the time.
The study, which was published July 2 in the Journal of the American Medical Association, was conducted in France, but the results apply to the United States as well.
“These neonatal ICUs in France are delivering state-of-the-art care and are as aggressive about treating pain as we are in the U.S. and Canada,” says study coauthor K.J.S. Anand, MBBS, DPhil, a professor of Pediatrics, Anesthesiology, Pharmacology, Neurobiology, and Developmental Sciences at the University of Arkansas for Medical Sciences.
The results are “dramatically surprising,” he says. They “really call attention to the fact that there’s a huge burden of pain and suffering experienced by newborn babies in the ICUs.”
An average of 141 painful and stressful proceduresIn the study, Ricardo Carbajal, MD, PhD, of the Hopital d’enfants Armand Trousseau in Paris, and colleagues had 13 ICUs in the Paris area record the number of painful and stressful procedures experienced by a total of 430 babies in their first two weeks in the hospital.
Overall, they found the babies had an average of 141 procedures during the stay, of which 70% were painful and 30% were known to be stressful, such as having their mouth suctioned or being weighed.
There was an average of 12 painful procedures per baby per day.
Some type of pain relief was used in about 20% of the painful procedures; they included giving the baby a sugar solution to drink, a pacifier to suck on, or both. Pain-relief medication was used only 2% of the time.
It’s not that doctors and nurses are uncaring or are callously performing unnecessary procedures, says Dr. Anand. “I don’t have a shred of doubt that any of these procedures were not necessary,” he says. “They are necessary for the survival of these babies.”
One reason for the high number of procedures is that technological advances have allowed smaller and smaller babies to survive, and more infants are spending the first few weeks of their lives in an ICU. Such babies undergo a lot of tests, including heel sticks to provide spots of blood to test for jaundice, blood sugar levels, and electrolytes.
Why so many painful procedures?Some doctors and nurses may fear that routine pain relief, even if it’s a sugar solution, may harm the baby, says Anna Taddio, PhD, an associate professor at the University of Toronto and a clinical specialist at the Hospital for Sick Children. (She was not involved in the JAMA study but published her own study about infant pain in the July 1 issue of Canadian Medical Association Journal.)
Many studies have shown that babies experience less pain if they drink a sugar solution, but none have looked at whether it’s safe to give a sugar solution a dozen times a day. Some health professionals worry that it may cause elevated blood sugar levels in the baby, she says.
You want to treat pain “with something that works quickly and safely, that’s easy to give, doesn’t cost a lot of money, and doesn’t cause serious side effects,” she says. “There are not too many drugs that fit that bill.”
However, some pain relief techniques are definitely being underused, according to Dr. Anand, who says there were a total of 42,413 painful procedures counted during the study, but “skin-to-skin contact was barely used—4 to 10 times—total,” says Dr. Anand. “This is amazing.”
Something as simple as skin-to-skin contact, such as laying an infant between the mother’s breasts, is known to ease an infant’s pain.
“Skin-to-skin contact with the mother or father stimulates the body's own mechanism that dampens the incoming painful stimuli,” he says.
Pain is thought to have lasting aftereffectsDr. Anand thinks that health-care providers should be more concerned about the long-lasting effects of pain, rather than pain relief.
“I think there is an extravagant degree of concern about the dangers of pain relief,” he says. “Pain is not given the necessary degree of attention it deserves.”
Studies have found that newborns are more sensitive to pain than older infants and children, and painful procedures early in life can have long-lasting effects.
“We do know that repeated pain exposure causes babies to have altered pain processing,” says Dr. Anand. Some infants may grow into children who have a lower- or higher-than-normal response to pain, and some may be at risk for chronic pain conditions, he says.
There are things that parents can do to make sure their infant receives pain relief in the hospital. Babies were more likely to get pain relief if the parents were present and the procedure was performed during the daytime, according to the study.
Dr. Anand recommends that parents be proactive about asking about pain relief for their infant.
“It’s literally their right to ask for pain relief,” he says. “I think what parents can really do is to be at the bedside and ask the staff, 'What are you doing to make my baby comfortable? What are you doing to avoid the pain and stress that my baby may be perceiving?'”
By Theresa Tamkins