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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
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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>