Pain in the newborn
Pain in the newborn
Pain in the newborn
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Pain in the newborn
Pain in the newborn
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Pain
Pain in the newborn 4
Painful procedures in the NICU
Epidemiology of procedural pain in infants in intensive care
Pain in the newborn
Number of Painful Procedures Period of time Total Percentage the Were Needle Puncture (%) 60.8 per patients Total Stay 70.0 Barker and Rutter, 1995 2-10 per day First 7 d 90.0 Johnston at al, 1997 14 per day First 14 d 15.6 Simons et al, 2003 1-16 per day First 14 d 25.6 Carbajal et al 2008 0.8 per day 7d 94.6 Johnston at al, 2011
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Consensus Statement for the Prevention and Management of Pain in the Newborn
Pain in the newborn
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Charter of the Rights of the Child
Pain in the newborn 7
OPBG
Pain in the newborn
Pain in the newborn
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Pain in the newborn
A. B. C.
Pain in the newborn 9
A. Anatomical characteristics of the nociceptive pathways
6th week Dorsal horn neurons form synapses with the developing sensory neurons
11th week Sensory endings reach the skin of the limbs
20th week Sensory endings reach the whole skin
24th week Anatomical development of the pain pathways with the formation of the spinal-reticular substance projections of the thalamus and the midbrain → medulla oblongata- periaqueductal substance-ipothalamus → cortex
30th week The organization of the laminar structure of the dorsal horns (Redex’s laminae), started during the 13th week, is complete.
Pain in the newborn
EG Observatory phenomena
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A. Anatomical characteristics of the nociceptive pathways
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Pain in the newborn
B. Neurophysiological characteristics of the nociceptive pathways
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Pain in the newborn
C. Physiological, behavioural and stress nociceptive responses
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in the newborn
Pain
C. Physiological, behavioural and stress nociceptive responses
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in the newborn
Pain
C. Nociceptive responses
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C. Nociceptive responses to stress
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C. Nociceptive responses to longterm stress
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C. Nociceptive responses to longterm stress
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Pain in the newborn
Pain in the newborn
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Postoperative period
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Pain in the newborn
Department of Medical and Surgical Neonatology (DNMC): protocols and guidelines
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OPBG Protocol: the pain scales
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in the newborn
Pain
OPBG Protocol: the newborn pain scales
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Pain in the newborn
Pain in the newborn
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Pain in the newborn
DNMC Protocols
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in the
Pain
newborn
A. Pharmacological interventions
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A. Pharmacological interventions in the DNMC
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A. Pharmacological interventions in the DNMC
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B. NON-pharmacological interventions
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in the newborn
Pain
B. NON-pharmacological interventions
Recommended use of non-pharmacological measures for puncture procedures in neonates and infants
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Intervention NNS Breast feading Facilitated Tucking/ Swaddling Sweet-Tasting Solution Intramuscular injection x x x x Subcutaneous injection x x x x Heel lance x x x x Venipuncture x x x x
B. NON-pharmacological interventions
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in the newborn
Pain
C. Preventive analgesia
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Pain in the newborn
Pain in the newborn
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Future perspectives…
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Take Home Message
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in the newborn
Pain
