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Studies Urge Soothing Pain in Babies

Preemies often don't get drugs they need to ease it

FRIDAY, Nov. 14, 2003 (HealthDayNews) -- Two new studies suggest the level of pain and stress in treating babies in certain situations could and should be lowered.

The first, a study of premature and underweight babies by doctors in the Netherlands, found that, despite undergoing a variety of painful procedures, few of them receive appropriate pain-reducing drugs.

The research, appearing in the November issue of the Archives of Pediatrics and Adolescent Medicine, suggests that even though previous studies have shown underweight infants experience pain, many daily procedures are still performed without painkillers. It also says preemies who undergo many painful procedures may suffer from short- and long-term stress and other detrimental effects.

"We found an average of 14 painful procedures per day and -- in the first day especially -- you have so many things to do, critical things, you may be unaware of the pain," says Dr. Dick Tibboel, a pediatric surgeon at Erasmus Medical Center in The Netherlands. "So what this study shows is the minds of the people working in the NICU [neonatal intensive care unit] may have to be reset on this. They are so concerned about the care of the baby, and so forth -- the baby may not cry -- they have to look more at ways, procedural ways, to reduce pain."

Working at Sophia Children's Hospital in Rotterdam, researchers gathered data on 151 neonates during their first 14 days of their NICU admission, including failed procedures (for example, multiple catheter insert attempts).

The information was then linked to estimates of the intensity of pain for each procedure, obtained from the opinions of experienced clinicians. The researchers also evaluated the use of analgesic therapy, and compared it to current guidelines.

Most of the procedures, 26 of 31, were estimated to be painful with pain scores of greater than 4 on a 10-point scale. Analgesic therapy (provided before the painful procedures) was provided to fewer than 35 percent of neonates per study day, while 39.7 percent of the babies did not receive any analgesic therapy in the neonatal intensive care unit.

Tibboel says he wants to know the long-term effects of the pain on the tiny babies. "Studies have shown that mice subjected to pain have shown changes in their spinal cords in the very early days of development," he says. "But we don't know if this is applicable to humans yet."

In a separate study appearing in the same issue, researchers found infants held by a parent and given a bottle or pacifier during multiple immunization shots cried, on average, about one-third the time (19 seconds) of infants who were placed on an examination table (57.5 seconds).

Researchers studied 116 infants, at an average age of 2 months, being immunized in a randomized control group study and recorded the procedure for crying and heart rate before, during and just after the procedures.

Routine immunization injections, the study found, are the most common and painful childhood procedures. With the introduction of new vaccines, children may now receive up to 20 injections by their second birthday.

But others failed to see much point in such a study, saying most immunization programs see it as beneficial to put infants at the most ease as possible.

"This is surprising, because it's the usual practice here in our country," says Dr. Jean-Paul Buts, a professor of pediatrics and president of the Belgian Society of Pediatrics in Brussels. "We place the children on the parent's knee and do what we can to make them at ease."

More information

Read more about pain and infants from the American Pain Society and the Virtual Children's Hospital at the University of Iowa.

SOURCES: Dick Tibboel, M.D., Ph.D., pediatric surgeon, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands; Jean-Paul Buts, M.D., Ph.D., professor, pediatric gastroenterology and nutrition, Catholic University at Louvain, and president, Belgian Society of Pediatrics, Brussels; November 2003 Archives of Pediatrics and Adolescent Medicine
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