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PAIN IN NEONATE

A. Dwi Bahagia Febriani,Neonatology Division,

Dept of Chil !ealth,"e i#al Fa#$lty,!asan$ in %niversity

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Intro $#tion

Twenty years ago & withhol ing anesthesia$ring neonatal perio be#a$se&

Newborns i not feel pain paintrans'ission re($ire #o'plete nerve'yelini)ation an a 'at$re #erebral #orte*to interpret the pain signal,

or if they i , the pain was not signi+#antan ha no long lasting #onse($en#es.nar#oti#s to treat pain in the newborn has

potentially angero$s si e e-e#ts, s$#h asrespiratory epression an hypotension.

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Pain &

an $npleasant sensory ane'otional e*perien#easso#iate with a#t$al or

potential tiss$e a'age

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Ob e#tive

I entify #o''on so$r#es of pain in healthyan si#/ neonates.

Physiologi# of neonatal pain Develop'ental #onse($en#es of $ntreate

pain.

Pain assess'ent tools Phar'a#ologi# an non phar'a#ologi#

pain 'anage'ent strategies Prevention of neonatal pain

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NOCICEPTO0 1no2#i2#ep2tor3

1no4s5ibreve6 sep7t5s#hwa6r3 5 noci- 8-ceptor 6

a re#eptor for pain#a$se by in $ry tobo tiss$es

Dorland Medical Dictionary: www.mercksource.com

P!:;IO

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Nerve +bers

Wright GH. www.medscape.com . 20

Fibertype

F$n#tion Dia'et

er 1'$3

C>1'?s3

A @ Proprio#eption,so'ato'otor

To$#h, press$re GH "otor to '$s#le spin leJ Pain& #ol , to$#h

B Preganglioni# a$tono'i# K C Ther'al pain,

'e#hanore#eptor.L.

.

Postganglioni# . .G

http://www.medscape.com/http://www.medscape.com/

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no#i#eption

Gw/ sensory&perioral w/sensory&fa#e,pal',sole

w/ Central Mperipheral w/

w/ sensory&'$#o$s 'e'brane

Lw/ thala'i# tra#/#o'plete Gw/

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Peripheral No#i#eptors&A. ;$bstan#e P Pain&

. AJ nerve fibers

. C +bers

B. =l$ta'ate to$#h&. A fibers

A pain in the foot sen s

'essages to the spinal #or whi#h are relaye to sti'$latethe e*or '$s#les

whi#h p$ll the li'b towar thebo y an to inhibit the

e*tensor '$s#les whi#h ta/ethe li'b away. 0es$lt& a re e*a#tion to p$ll away fro' the#a$se of pain.

The re e* 'essage ispro e#te to the brain where it#an be 'eas$re to in i#ate

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;$rfa#e nerve a'age at birth #an/ill spinal nerve #ells. Nearbys$rviving nerve #ells then spro$t to'a/e new #onne#tions whi#h #an'a/e the #hil hypersensitive to

Tiss$e a'age en riti# spro$ting hyperinnervation that last to a $lthoo

0epeate heel sti#/s 'ay lea to an abnor'al gait in

#hil hoo

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ain #arrying AJ, C fibers

To$#h #arrying A fibers

ynia & pain #a$se by sti'$l$s not nor'ally asso#iate wit

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;o$r#es of neonatal pain

Birth event

s#alp la#erations, severe hea'ol ing, an #lavi#$lar fra#t$res

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;o$r#es of neonatal pain

Invasive Procedures in NICU

!eel sti#/s, venip$n#t$re, en otra#healt$be s$#tioning, peripheral arterial linepla#e'ent or #hest t$be pla#e'ent.

Major Surgery #ar ia# or bowel s$rgery, that are

a##o'panie by intense pain.

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The E-e#ts of Pain

;hort ter'1a#$te pain3

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A#$te Pain E-e#t

A#$te pain #a$ses #hanges in physiologi#para'eters&

.Q stress hor'one level 1Q #ortisol,#ate#hola'ine, growth hor'one angl$#agon3.Changes of behavioral state

.Crying, fa#ial e*pressionL.Changes in sleep state

.Changes in responses toevelop'entally s$pportive #are

.Ca$ses a$tono'i# responses& QBP,

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Neonatal fa#tors lea ing to shortter' a verse ne$rologi# se($elae

A#$tepainf $l

sti'$li

Qe*#itabilityin the ;C!an lin

g,n$rsingpro#e $

re

Crying

QQ!0,BP,QR!0,

BPQCerebral

blooow

QCerebral

bloovol$'e!ypergly#e'ia,

la#ti# a#i osis,#atabolis',apoptosis

Chroni#

painSstress

;ti'$late !Pa*is

Diaphrag'ati#

splinting

Early I>!

!

P>