The importance of the control of pain and stress in the newborn developmental care

Today with profound progress in the field of neonatology many premature and sick neonates are hospitalized for a long time in neonatal intensive care units (NICUS) and they are exposed to inevitable repeated painful procedures. It is known that neonates even the most premature ones can feel pain and in the neonatal period experiencing of untreated pain and stress may have serious short term and long term consequences such as changes in hemodynamic stability, behavioral alterations and changes in the white matter and subcortical gray matter of the brain which could lead to adverse neurological outcomes. In light of this knowledge, there has been international consensus and recommendations about the importance of assessment and management of pain and stress in neonates and there has been considerable progress in pain control in them. Despite these advances in science which have led to the changes of attitudes to neonatal pain, there are still gaps between knowledge and practice and there are several reports of low application of pain assessment tools and pain control techniques in neonatal intensive care units. Effective pain management needs using of validated standard methods for the diagnosis of pain and its assessment. Neonatal pain should be assessed routinely by using the currently available tools. Reducing invasive procedures, and using pharmacological, behavioral or environmental technics can be used to manage neonatal pain. Non-pharmacologic measures are used for control and prophylaxis of acute, transient, or mild pain and they include kangaroo mother care, facilitated tucking, non-nutritive sucking, the use of sucrose and other sweeteners, massage and acupuncture therapy. In procedures with skin or mucosal injury using of local and topical anesthetics can reduce the acute pain. The mainstay for treatment of severe pain are opioids; the most commonly used drugs in this category are morphine and fentanyl, although there are some other opioids. There are also non-opioid drugs include various sedatives and anesthetic agents, which are used in ventilated neonates.