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Consensus Statement for the Prevention and Management of Pain in the Newborn
K. J. S. Anand, MBBS, DPhil;
and the International Evidence-Based Group for Neonatal Pain
Arch Pediatr Adolesc Med. 2001;155:173-180.
Objective To develop evidence-based guidelines for preventing or treating neonatal
pain and its adverse consequences. Compared with older children and adults,
neonates are more sensitive to pain and vulnerable to its long-term effects.
Despite the clinical importance of neonatal pain, current medical practices
continue to expose infants to repetitive, acute, or prolonged pain.
Design Experts representing several different countries, professional disciplines,
and practice settings used systematic reviews, data synthesis, and open discussion
to develop a consensus on clinical practices that were supported by published
evidence or were commonly used, the latter based on extrapolation of evidence
from older age groups. A practical format was used to describe the analgesic
management for specific invasive procedures and for ongoing pain in neonates.
Results Recognition of the sources of pain and routine assessments of neonatal
pain should dictate the avoidance of recurrent painful stimuli and the use
of specific environmental, behavioral, and pharmacological interventions.
Individualized care plans and analgesic protocols for specific clinical situations,
patients, and health care settings can be developed from these guidelines.
By clearly outlining areas where evidence is not available, these guidelines
may also stimulate further research. To use the recommended therapeutic approaches,
clinicians must be familiar with their adverse effects and the potential for
drug interactions.
Conclusion Management of pain must be considered an important component of the
health care provided to all neonates, regardless of their gestational age
or severity of illness.
Participants (listed alphabetically) of the International Evidence-Based
Group for Neonatal Pain are the following: Huda Huijer Abu-Saad, Maastricht,
the Netherlands; K. J. S. Anand, Little Rock, Ark (chair); Albert Aynsley-Green,
London, England; Eduardo Bancalari, Miami, Fla; Franca Benini, Padova, Italy;
G. David Champion, Darlinghurst, Australia; Kenneth D. Craig, Vancouver, British
Columbia; Tomasz S. Dangel, Warszawa, Poland; Elisabeth Fournier-Charrière,
Kremlin-Bicetre, France; Linda S. Franck, London, England; Ruth Eckstein Grunau,
Vancouver, British Columbia; Steen A. Hertel, Copenhagen, Denmark; Evelyne
Jacqz-Aigrain, Paris, France; Gerhard Jorch, Magdeburg, Germany; Benjamin
I. Kopelman, São Paulo, Brazil; Gideon Koren, Toronto, Ontario; Björn
Larsson, Stockholm, Sweden; Neil Marlow, Nottingham, England; Neil McIntosh,
Edinburgh, Scotland; Arne Ohlsson, Toronto, Ontario; Gunnar Olsson, Stockholm,
Sweden; Fran Porter, St Louis, Mo; Renate Richter, Erlangen, Germany; Bonnie
Stevens, Toronto, Ontario; and Anna Taddio, Toronto, Ontario.
Corresponding author and reprints: K. J. S. Anand, MD, Arkansas Children's
Hospital, S-431, 800 Marshall St, Little Rock, AR 72202 (e-mail: anandsunny{at}exchange.uams.edu).
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