The importance of pain control in the neurodevelopment of premature neonates

Background and Aim : Despite therapeutic and technological advances in the neonatal intensive care units (NICUs), which have led to dramatic reduction in mortality, Infants are still under stimulation including acoustic, visual, and tactile stimuli that can lead to complications of maldevelopment. Newborn Individualized Developmental Care and Assessment Program (NIDCAP) (based on Synactive Theory of Development) can reduce these stimuli. However, performing invasive procedures and repeated pain experiences in infants is inevitable. Pain by stimulating the autonomic nervous system leads to disturbances in neurodevelopment and sensory integration and affects learning power. According to the American Pain Association, pain is the fifth vital sign and caregivers should care about it. Therefore, this study was conducted to evaluate the effects of pain on neural development and its control methods in preterm infants based on the results of studies.Methods : In this review study, information was collected between 2010 and 2019 through a review of related literature and articles and a targeted search for information sources in English and Persian articles and databases. The keywords were pain management, NIDCAP, neurodevelopment, premature neonates. Of the 53 articles found, 15 were eligible.Results : In premature infants, neural pathways and centers are immature and more vulnerable. Therefore, inadequate pain management has more damaging and lasting effects on the physiology and neuropsychological status of the infant, thereby weakening the immune system and delaying wound healing. Increased monoamine production of the sympathetic system and its stimulation by pain has a negative effect on the cardiovascular system, the gastrointestinal tract and the urinary tract, which sometimes leads to organ ischemia. It also causes behavioral problems such as stress, fear, anxiety, irritability, damage to emotional relationships, and developmental delays that sometimes persist into adulthood. The experience of stress and pain in the infant should be very low to maintain the physiological state. Therefore, how to control pain in infants has become one of the biggest care challenges. There are various ways to control and reduce pain. Non-pharmacological methods such as skin massage, swaddling, listening to music or lullaby, non-nutritional sucking (NNS), eating dextrose, breastfeeding, skin contact and kangaroo mother care (KMC), different baby siting conditions such as the fetal condition and etc., reduce the perception of pain and reduce its complications.Conclusion : Proper treatment and management of pain is important and has long-term neuropsychological benefits. Therefore, understanding the nature of pain and its evaluation and management can minimize the side effects and provide a suitable basis for the development of the nervous system and the successful development of the brain.

کلیدواژه ها:

Neurodevelopment ، premature infants ، pain management ، NIDCAP