Pain and pain-related stress in high-risk neonates at NICU – A narrative review

Exposure to pain and stress in the NICU significantly impacts the neurodevelopment of high-risk neonates, increasing the risk of developmental delays. The lack of standardized pain management policies hinders effective care. This narrative review examined observational studies on neonatal pain and stress. A systematic search in PubMed, EMBASE, CINAHL, Scopus, Web of Science, ProQuest, and Google Scholar identified 15 relevant studies. Findings revealed that neonates undergo a median of 16 procedures per day, with preterm infants experiencing more painful procedures than term neonates. Common procedures include heel lance, suctioning, venepuncture, catheter insertion, and tape removal, with arterial line insertion and intubation being the most painful. Neonatal gestational age, birth weight, NICU stay, and medical condition influenced pain frequency and intensity. Both pharmacological and nonpharmacological approaches effectively reduced pain and stress. Standardized pain management strategies are crucial to minimizing pain-related stress and its long-term neurodevelopmental consequences.