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Correspondence to Author: Lawrence Rhein, 

UMass Memorial Medical Center, 119 Belmont St, Worcester, MA 01605, United States

Abstract:

During a neonate’s stay in the neonatal intensive care unit (NICU), they will undergo many painful, but necessary, procedures to deliver treatment and to monitor physiological status. Many of these methods will involve skin breaks by a needle. While pharmacological analgesics are available for larger procedures like surgeries and intubation, the volume of painful procedures neonates must endure makes the use of pharmacological analgesics impractical for every painful procedure. Due to their immature nervous system, preterm neonates have limited ability to modulate pain. Recent studies have demonstrated that repeated pain endured during the neonatal period is associated with long-term neurological deficits. Over the past decades, studies have begun to quantify the effectiveness of non-pharmacological comfort tools (nonnutritive sucking, swaddling, oral sucrose, ShotBlocker, etc.) in reducing neonatal pain during needles sticks. However, while these tools may be present for providers in the NICU, there are various clinical components that may limit a neonate’s ability to receive these important non-pharmacological tools during a needle stick. This review analyzes the conditions where a neonate would not be able to receive a non-pharmacological comfort tool and should serve as a resource for NICUs attempting to implement guidelines for non-pharmacological comfort tool use. Future research should investigate non-pharmacological tool compatibility with various neonatal conditions for the equitable use of pain management strategies in NICU settings. Impact : • Increase in commonly used diagnostic tools and treatment types in neonatology over last century have led to increased volume of routine painful procedures involving skin breaks for neonates. • High incidence of neonatal pain is associated with poor long-term neurological deficits, necessitating the use of non-pharmacological comfort tools during needle stick procedures. • While growing evidence shows non-pharmacological comfort tool efficacy in reducing pain, no review has been done on the various clinical conditions that hinder a neonate’s ability to receive non-pharmacological comfort tools during painful procedures.

Keywords:

Neonatal pain, NICU painful procedures, needle sticks, non-pharmacological analgesics, pain management, newborns, comfort measures.

Citation:

Lawrence Rhein. Clinical Limitations of Non-pharmacological Comfort Tools for Needle Sticks in Neonatal Intensive Care Units (NICU). Journal of Clinical Pediatrics 2024.