Pain management for newborns
Technology-based interventions vs non-pharmacological
A new systematic review has examined the effectiveness of technology-based interventions for reducing procedural pain among hospitalised neonates in comparison with other non-pharmacological interventions.
Using technology in neonatal care and pain management is increasing. Technology-based interventions can include robots that reduce pain in premature babies by simulating the maternal skin-to-skin contact, with humanoid robots representing the latest technology for procedural pain management in children. Social assistive robots with human-like features, such as eyes and mouth, have been used to relieve pain in paediatric patients during IV cannulation and vaccination. The pain-relieving effect of robots is based on distraction (e.g., the robot can play a tablet-based game with the child). Other technology-based interventions include electronic devices or digitalisation, virtual reality, artificial intelligence (AI) and eHealth applications.?
Various national and international guidelines provide recommendations on how to prevent or minimise pain in neonates as well as how to treat unavoidable pain. Non-pharmacological pain relief interventions, such as breastfeeding, skin-to-skin contact, and using sweet solutions are recommended for managing pain in minor procedures. Some non-pharmacological methods, including skin-to-skin contact, facilitated tucking, swaddling, and non-nutritive sucking on a dummy, alleviate pain by providing soothing tactile stimulation during a painful procedure.
There can be limitations in the application and effectiveness of non-pharmacological interventions, however. Techniques such as skin-to-skin contact, facilitated tucking, and swaddling might not work well when the newborn needs to be in a specific position for a procedure. Medical conditions in newborns, including extremely low birth weight, or a parent's absence can hinder the use of skin-to-skin contact and breastfeeding.
Each of the methods mentioned above provides some pain relief for newborns but is not completely effective. Also, there is not enough evidence to establish which of these non-pharmacological interventions is the superior technique for pain management.
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The systematic review included studies on a variety of interventions, such as acupuncture, non-invasive electrical stimulation of acupuncture points, vibratory stimulation, and recorded maternal voice, among others to compare the effectiveness of technology-based interventions for reducing procedural pain among hospitalised neonates compared with non-pharmacological interventions.
Results of the systematic review showed the effectiveness of technology-based interventions in relieving neonatal pain, either as a standalone method or in combination with another non-pharmacological method, was mixed. Recommendations for research are included in the systematic review report, which note the importance of taking ethical considerations into account. The inclusion criteria for the systematic review excluded any studies with “no pain relief” as a comparative intervention: “There is ample evidence on the effectiveness of various pain relief methods, so it is worthwhile to consider whether research in which certain neonates do not receive pain relief is ethical.”?
The systematic review is available in the August issue of JBI Evidence Synthesis:?
Palomaa, Anna-Kaija; Huhtala, Saija; Tuomikoski, Anna-Maria; P?lkki, Tarja
JBI Evidence Synthesis?21(8):p 1549-1581, August 2023. | DOI: 10.11124/JBIES-22-00179