Issues in Neonatal Pain

It is a great pleasure to introduce this week’s guess bloggers: Dr. Marsha Campbell-Yeo (@drmcampbellyeo) and Dr Denise Harrison (@dharrisonCHEO), will also be co-leading this week’s ENB twitter chat on Wednesday the 7th of October between 8-9pm UK time focusing on ‘Issue in Neonatal pain’. Participating in the twitter chat requires a Twitter account; if you do not already have one you can create an account at www.twitter.com. Once you have an account contributing is straightforward – follow the discussion by searching links to #ebnjc or @EBNursingBMJ, or better still, create and send us a tweet (tweets are text messages limited to 140 characters) to @EBNursingBMJ. Add #ebnjc (the EBN chat hash tag) at the end of your tweet, this allows everyone taking part to view your tweets. 

The Power of a Parent’s Touch on Newborn Procedural Pain

Today’s guest blog comes from Dr. Marsha Campbell-Yeo (@drmcampbellyeo), assistant professor in Nursing at Dalhousie University and a certified neonatal nurse practitioner and clinician scientist at the IWK Health Centre. She is a recognized world leader related to the impact of maternally-led interventions on the immediate health outcomes of at-risk newborns. Her work examines maternal driven interventions to improve outcomes of medically at risk newborns specifically related to pain, stress and neurodevelopment.

No parent wants to see his or her child experience pain. Sadly, for parents of sick or preterm babies requiring hospital care, it’s a common event. Did you know that preterm and sick babies often undergo on average 10 painful procedures every day with the majority receiving little or no pain relief? Only as recently as the late 1980’s, it was thought that newborns couldn’t feel pain at all and even surgery was done without anesthetic! We now know that untreated pain during early life has both immediate and long-term harmful outcomes. For example, in addition to the immediate pain and stress they experience, these babies may develop learning and motor delays, behavior problems, and lower academic achievement later in life. There is also emerging evidence that these poor outcomes may be made worse and also impact the relationship mothers have with their children due to the prolonged mother and baby separation often experienced during prolonged hospital stays in a Neonatal Intensive Care Unit (NICU).

Despite these negative outcomes, pain associated with regular procedures continues to be undermanaged for these infants during their hospital stay. As a neonatal nurse practitioner and a researcher who has cared for mothers and babies for over 25 years, I decided to explore ways to minimize these negative outcomes. Historically, mothers have always been crucial to infant survival and well being but I noticed that they were not always involved in critical care settings. I decided to research this more to explore how to involve mothers and families in the care of newborns to minimize pain and improve long term outcomes for preterm and sick newborns and their families. Skin-to-Skin Contact (SSC), commonly referred to as Kangaroo Care (KC), is the upright holding of a diaper clad infant on his or her mothers’ chest and has been associated with numerous immediate benefits in a non-pain context in both developed and developing countries..

As a clinician, I had seen firsthand the impact that human touch such as breastfeeding, facilitated tucking, massage and most notably SSC can have on infants and mothers. So I decided to see what research had already been done on the impact that mothers have in minimizing newborn pain through SSC. I co-led a review on “Skin-to-skin care for procedural pain in infants”. This Cochrane review found that SSC between moms and infants significantly decreased pain in preterm and full term infants for a single painful procedure. From this finding, I decided to expand and explore whether SSC could play a role in minimizing pain when used during all painful procedures of an infant’s stay in the neonatal intensive care unit (NICU).

Currently, I am running a clinical trial called Trial of Repeated Analgesia in Kangaroo Care (TRAKC) which involves looking at how preterm babies who receive repeated kangaroo care differ developmentally at discharge from the hospital compared to babies who only get sweet taste, or sucrose, during all painful procedures. We will also be following up these babies to 18 months (TRAKC 18) to see if SSC provided during painful events in early life will influence if the children differ in their response to pain, the relationship they have with their mothers, and their behavioral development at 18 months of age.

Knowing the positive impact that mothers and dads too can have on minimizing pain during painful procedures that newborns experience is something that I felt I had to get into the hands of parents. Following my colleague Dr. Chambers in her “It Doesn’t Have To Hurt” video on managing needle pain in children, I decided to create the second parent friendly video titled “Power of a Parent’s Touch”. This video is meant to empower parents to help minimize neonatal pain in the NICU. Launched on December 2, 2014, it has received over 83,000 views.

https://www.youtube.com/watch?v=3nqN9c3FWn8

It’s not just the one in ten babies that are born preterm worldwide that are adversely affected by untreated pain. Untreated pain is an issue for every baby, even those that are born healthy. Every baby in the world undergoes painful procedures in the first few hours and days after birth and many can receive up to 20 injections in their first years. Parents are one of our most underutilized resources to help relive this pain. We need to change that. Parents can make a different.

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