This week’s blog has been written by Dr Siti Yuyun Rahayu Fitri, Associate professor in Pediatric Nursing, Faculty of Nursing at the Universitas Padjadjaran, Indonesia

The survival rate of neonates, especially those treated in Neonatal Intensive Care Units (NICUs), has improved significantly. This aligns with WHO data indicating that neonatal deaths have decreased by 44% since 2000 ¹. This decline in mortality rates is largely attributed to advancements in healthcare services and technology. However, the quality of life for these survivors remains a challenge, as they often face various issues due to prolonged treatment and environments that are not conducive to optimal neonatal development. Neonates treated in hospitals frequently undergo invasive procedures that result in pain. Studies show that neonates in NICUs experience an average of 7.5 to 17.3 painful procedures per day ². Unfortunately, pain management by healthcare professionals remains limited, with only 21% to 34% of cases receiving adequate treatment ³.

Several barriers hinder effective pain management, including inadequate staff knowledge about pain management and a lack of necessary equipment. It is imperative to take a serious and comprehensive approach to address pain management in neonates. Untreated pain in neonates can lead to various short-term complications, such as decreased oxygen saturation and increased heart rate, as well as long-term consequences, including poorer cognitive, motor, and behavioral neurodevelopment in infants and children born very preterm ⁴.

Various analgesic techniques and their variations have been studied across diverse contexts to reduce pain in neonates. Recently, cultural approaches have gained increasing prominence in neonatal healthcare and are becoming more widely accepted within communities ⁵. Culture has been recognized as a central element in nursing (referred to as cultural nursing), contributing to safer and more humane healthcare services ^6,7. A nurse’s understanding of cultural and traditional practices is therefore crucial. However, to ensure the safety of traditional health interventions, formal studies are necessary to gather data and evaluate current traditional practices within the community. Patients at the clinical level urgently need reliable information about complementary and alternative medicine from health professionals.

Cultural factors have significantly influenced the development of diverse pain management methods in various communities ⁸. Studies have shown that culture shapes the perception and response to pain, including in children. However, most research on cultural practices in pediatric pain management has overlooked neonates.

A review highlights the potential benefits of cultural practices in managing procedural pain in neonates, though these studies often face limitations related to trial design, standardization of procedures, and outcome measures. The advantages of cultural practices in neonatal pain management extend beyond measurable effects to include the processes and beliefs underpinning these practices. A balanced research approach is necessary to explore both the objective pain relief benefits of culturally based methods and the subjective meaning of these approaches in neonatal pain management.

Traditional analgesic methods have been studied in several countries and have shown relative effectiveness in reducing neonatal pain ⁹. Incorporating traditional knowledge and practices is essential when developing intervention strategies for neonatal health ¹⁰  because of the strong connection between cultural beliefs and newborn care ¹¹. According to the World Health Organization ¹², traditional medicine (TM)—including traditional analgesia—encompasses the knowledge, skills, and practices rooted in the theories, beliefs, and experiences of different cultures. TM is used not only for maintaining health but also for preventing, diagnosing, improving, or treating physical and mental illnesses.

As a pediatric nurse, I believe it is essential to consider and develop cultural or traditional approaches in managing pain in neonates. Nurses can play a crucial role in researching, validating, and ensuring that the pain management practices commonly used in the community are genuinely safe. Conversely, it is equally important to identify and address cultural practices for neonatal pain management that may be harmful or inconsistent with established health science principles.

By incorporating cultural approaches into pain management, we aim to achieve a harmonious integration of conventional and cultural treatments. This approach is not intended to conflict with modern medical practices but rather to create a synergy that leverages the strengths of both methods, ultimately finding the best combination of the two.

Achieving this harmony will require more in-depth research to build robust evidence supporting the integration of traditional and modern medicine. This balanced approach has the potential to enhance the quality and effectiveness of neonatal pain management while respecting cultural values and practices.

References

1. World Health Organization. Newborn mortality [Internet]. 2024 [cited 2024 Mar 14]. Available from: https://www.who.int/news-room/fact-sheets/detail/newborn-mortality
2. Cruz MD, Fernandes AM, Oliveira CR. Epidemiology of painful procedures performed in neonates: A systematic review of observational studies. Eur J Pain (United Kingdom). 2016;20(4).
3. Courtois E, Droutman S, Magny JF, Merchaoui Z, Durrmeyer X, Roussel C, et al. Epidemiology and neonatal pain management of heelsticks in intensive care units: EPIPPAIN 2, a prospective observational study. Int J Nurs Stud. 2016;59:79–88.
4. Vinall J, Grunau RE. Impact of repeated procedural pain-related stress in infants born very preterm. Pediatr Res [Internet]. 2014;75(5):584–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/24500615
5. Bangari A, Thapliyal SK, Ruchi R, Aggarwal B, Sharma U. Traditional beliefs and practices in newborn care among mothers in a tertiary care centre in Dehradun, Uttarakhand, India. Int J Community Med Public Heal. 2019;6(6):2600.
6. Leininger MMM. Transcultural nursing as a global care humanizer, diversifier, and unifier. Hoitot (Journal Nurs Sci. 1997;9(5):219–25.
7. Molloy L, Walker K, Lakeman R, Skinner I. Ethnonursing and the ethnographic approach in nursing. Nurse Res. 2015;23(2):17–21.
8. Narayan MC. Culture’s effects on pain assessment and management. Am J Nurs. 2010;110(4):38–47.
9. Fitri SYR, Wardhani V, Rakhmawati W, Pahria T, Hendrawati S. Culturally Based Practice in Neonatal Procedural Pain Management: A Mini Review. Front Pediatr. 2020;8(September):1–6.
10. Upadhyay RP, Singh B, Rai SK, Anand K. Role of cultural beliefs in influencing selected newborn care practices in rural Haryana. J Trop Pediatr. 2012;58(5):406–8.
11. Reshma, R. Sujatha. Cultural Practices and Beliefs on Newborn Care Among Mothers in a Selected Hospital of Mangalore Taluk. Nitte Univ J Heal Sci [Internet]. 2014;4(2):2249–7110. Available from: http://nitte.edu.in/journal/June2014/21-26.pdf
12. WHO. WHO Global Report On Traditional and Complementary Medicine 2019 [Internet]. World Health Organization. 2019. 1–228 p. Available from: https://apps.who.int/iris/bitstream/handle/10665/312342/9789241515436-eng.pdf?ua=1