Question&Answer in NB
Pain Management in the Neonate

Professor Mohammad H. Soltanzadeh , MD,ID

        Professor of Pediatrics,  Shaheed  Beheshti  University

         Of Medical Sciences  , Tehran , IRAN

Question 1

An obstetrician is about to do a circumcision without using analgesia .

When you question this practice , he replies that neonates cannot perceive pain.

Is this correct  ?


He is not correct.


When does pain perception develop in the human fetus  ?


Cutaneous sensory receptors 1st appear in the perioral area during the 8wks of gestation

They are present in all cutaneous & mucus surfaces by the 20wks of gestation


Are neonate less sensitive to pain than older children or adults ?


No ! Developmentally regulated processes & behavioral reflexes suggest that pain thresholds increase progressively during late gestation & in the postnatal period.

Preterm neonates have much greater sensitivity to pain than term neonates .

They manifest prolonged hyperalgesia after tissue injury.


What kind of painful experiences are neonates exposed to in the NICU ?


Neonates admitted to a modern-day NICU are often exposed to pain or noxious stimulation from a variety of sources.

These include postoperative pain resulting from surgery to repair a hernia or to ligate a PDA .

Acute pain caused by circumcision.

Repeated heel sticks.

Venipunctures .

Tracheal suctioning


Chest tubes

Prolonged or chronic pain from :NEC

Meningitis ,birth trauma, or ventilation

Even routine care such as : Diaper changes , daily weights , removal of adhesive tape ,burns from transcutaneous probes, rectal stimulation

Key points pain management in neonates

All neonates feel pain& one must effectively deal with the potential for pain during any procedure performed during the neonatal period.

Premature infants have a greater sensitivity to pain than term infants.

Although children may not directly recall painful experiences from the NICU stay , they may demonstrate altered behavioral states from painful experiences that were not well managed.

Morphine & fentanyl appear to be equally effective for pain relief in neonates & appear to have similar outcomes in follow –up studies .

Methadone & some of the newer narcotic agonists e.g. buprenorphine as well as a number of other agents , appear to be optimal treatments for narcotic withdrawal in neonates.

Paregoric & phenobarbital are no longer drugs of choice.

داروهای ضد درد وآرام بخش در نوزادان

لیدوکائین 5/  تا 1 درصد   زیرجلدی 5 میلی گرم پر کیلو

کرم EMLA2-5 درصد 33-37 هفته 5/ گرم برای 1-2 ساعت وبعد پاک شود

بیش از 37 هفته  1 گرم برای 1-2 ساعت وسپس پاک شود

ضد درد در اعمال تهاجمی

شریانی ووریدی : سوکروز 20 درصد5/1 -3 سی سی پر کیلو اورال

از پاشنه پا ورگ گیری  : 5/1 -3 سی سی پر کیلو اورال


 سوکروز 20 درصد 5/1 -3 سی سی پرکیلو اورال

سولفات مرفین 05/-15/ میلی گرم پرکیلو وریدی یا زیر جلد

فنتانیل2-3 میکروگرم پر کیلووریدی

EMLA یا لیدوکائین 5/ درصد

تعویض پانسمان:

 سوکروز 20 در صد 5/1-3 سی سی پر کیلو اورال

سولفات مرفین 05/-025/میلی گرم  پر گیلو وریدی

فنتانیل 25/ -1 میکروگرم پر کیلو وریدی

ساکشن لوله تراشه :

سولفات مرفین یا فنتانیل


سوکروز 20 درصد 5/1 – 3 سی سی پر کیلو اورال

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