Pain in Infants: Pain Management Practices and the Association with Outcome

Infants born critically ill, including preterm born neonates or newborns with congenital heart disease, often spend the first weeks of life in intensive care. Many babies require life-saving critical care that often exposes these tiny neonates to hundreds of invasive procedures such as heel lances, endotracheal intubations, and surgical interventions. Increasing evidence suggests that exposure to noxious procedures early in life is associated with delayed brain development and adverse cognitive and motor outcomes. While neonatal invasive procedures are often managed with analgesic, anesthetic and/or sedative medications, practices often vary widely across hospitals. In turn, while these pharmacological interventions have a clear acute benefit, further research is needed to better understand the short- and long-term effects on infant and child outcome to better guide clinical decision making. Non-pharmacological bundles (i.e., sucrose, kangaroo care) show great promise in offering alternatives to pharmacological interventions to aid in neonatal pain management; yet, these practices can be challenging to quantify. Presently the utility of non-pharmacological bundles and the association with infant and caregiver outcomes is an active area of investigation.

A key area for discussion and future research in these vulnerable neonates is the trajectory of their behavioral, motor, cognitive, and language outcomes. While neonatal care is central to predicting outcome, environmental influences may also be important mediators of outcomes in these babies. The information gained from this research topic will address current research and evidence for current practices in the management of neonatal pain, as well as to promote further hypothesis-driven research in outcome assessment.
 
In this Research Topic on neonatal pain management and outcome assessments, we are inviting submissions of original research articles, reviews, short communications, and research reports focused on clinical research as well as translational studies focused on infants born critically ill in the following areas: 
 
• Neurological/physiological effects of analgesics, anesthetics and/or sedatives in neonates
• Characterizing procedural burden (i.e., neonatal surgery) and the association with outcomes
• New developments in pharmacological and non-pharmacological pain management
• Novel methods for outcome assessments (i.e., brain imaging, physiological recordings)
• Challenges in neonatal pain and associated outcome assessments