Pediatric Drugs

, Volume 12, Issue 6, pp 353–365 | Cite as

Pain Management in Newborns

From Prevention to Treatment
  • Elizabeth Walter-Nicolet
  • Daniel AnnequinEmail author
  • Valerie Biran
  • Delphine Mitanchez
  • Barbara Tourniaire
Review Article


All neonates in the Neonatal Intensive Care Unit (NICU) or during the first days of life undergo painful and stressful procedures. Epidemiologic studies have shown that pain induced by these procedures is not effectively prevented or is inadequately treated. Pain experienced during the neonatal period may lead to negative outcomes, especially in preterm neonates. Prevention is the first step of pain management, and practical guidelines should be used in the NICU. Assessment must be done with adequate tools that take into account the infant’s pathology and gestational age. Distinguishing between acute and prolonged pain is important for both assessment and treatment. The most common drugs that have been studied for the treatment of pain and stress are opioids, hypnosedatives, and NMDA receptor antagonists. Morphine and fentanyl are most frequently used for acute or prolonged pain in the NICU. They have potent analgesic effects and few immediate or long-term adverse effects. Midazolam is a commonly used hypnosedative, but its adverse effects limit its use. Drugs such as propofol and ketamine have been used for acute painful procedures; however, further research is needed to assess their long-term effects. Use of non-pharmacologic pain management techniques has increased in recent years. These methods are easy, inexpensive, and effective in helping newborns recover from painful procedures. Sweet solutions and non-nutritive sucking, breastfeeding, skin-to-skin mother care, swaddling, and facilitated tucking are the most commonly employed and evaluated non-pharmacologic methods. Hospitals should promote and improve parent involvement in pain management. In-service education and well organized hospital teams are crucial for successful implementation of pain protocols in newborns.


Morphine Neonatal Intensive Care Unit Alfentanil Preterm Neonate Palivizumab 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to prepare this review. The authors have no conflicts of interest that are directly relevant to the content of this review. The authors thank Rachel Gooze for editing the manuscript with respect to language.


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Copyright information

© Adis Data Information BV 2010

Authors and Affiliations

  • Elizabeth Walter-Nicolet
    • 1
  • Daniel Annequin
    • 1
    Email author
  • Valerie Biran
    • 2
  • Delphine Mitanchez
    • 2
  • Barbara Tourniaire
    • 1
  1. 1.Unité Fonctionnelle de lutte contre la douleur, Hôpital d’enfants Armand TrousseauAssistance Publique Hôpitaux de ParisParisFrance
  2. 2.Service de Néonatologie, Hôpital d’enfants Armand TrousseauAssistance Publique Hôpitaux de ParisParisFrance

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