Abstract

During hospitalization in the neonatal unit (NU), the newborn (NB) is continually exposed to procedures that can be considered painful and uncomfortable. The perception, assessment and management of neonatal pain are important actions for protection and prevention that must be offered to newborns who need neonatal intensive care. In a study conducted with health professionals from a NU in northeastern Brazil, through interviews with health professionals who perform procedures, it was possible to detect that the team recognizes neonatal pain, knows that the NB is able to express responses to it but confirms that they do not use all the management necessary for pain relief. International literature reports the same challenges in other services. Professionals recognized kangaroo care as an important pain protection strategy that guarantees humanized care. It was evident the need to improve the training of the healthcare teams to use continuous learning as to reinforce their theoretical principles, always remembering that skin-to-skin contact is a priority indication in this protection.

Keywords: Kangaroo Care; Preterm; Pain; Pain Assessment Scales

References

1. Brazil. Ministry of Health. Health Care Secretariat. Department of Strategic Programmatic Actions. Humanized care for the Newborn: Kangaroo Method: Technical Manual. 3^rd edition. Brasília: Ministry of Health (2017). 
2. Grunau RE. “Neonatal Pain in Very Preterm Infants: Long-Term Effects on Brain, Neurodevelopment and Pain Reactivity”. Rambam Maimonides Medical Journal 4.4 (2013): e0025. 
3. Carneiro T., et al. “Pain assessment in premature neonates admitted to the neonatal intensive care unit after respiratory physiotherapy”. Journal of the Health Sciences Institute 34 (2016): 219-223. 
4. Witt N., et al. “A Guide to Pain Assessment and Management in the Neonate”. Current Emergency and Hospital Medicine Reports 4 (2016): 1-10. 
5. Williams ACDC and Craig KD. “Updating the definition of pain”. Pain (2016). 
6. Harris J., et al. “Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals”. Intensive Care Medicine 42 (2016): 972-986. 
7. Victoria NC and Murphy AZ. “Exposure to early life pain: Long term consequences and contributing mechanisms”. Current Opinion in Behavioral Sciences 7 (2016): 61-68. 
8. Field T and Hernandez-Reif M. “Touch and Pain Perception in Infants”. In: Narvaez D, Panksepp J, Schore A., et al. (editions) Evolution, Early Experience and Human Development. New York: Oxford University Press (2013): 263-276. 
9. Gimenez IL., et al. “Neonatal pain: characterization of the physiotherapist's perception in the neonatal intensive care unit”. A Revista Paulista de Pediatria 38 (2020): e2018178. 
10. Andreazza MG., et al. “Perception of pain in neonates by the nursing staff of the neonatal intensive care unit”. Revista Brasileira De Pesquisa Em Saúde 19 (2017): 133-139. 
11. American Academy of Pediatrics. “Committee on Fetus and Newborns. Section on Anesthesiology and Pain Medicine. Prevention and Management of Procedural Pain in the Neonate: An Update”. Pediatrics 137 (2016): e20154271. 
12. Walker SM., et al. “Long-term impact of neonatal intensive care and surgery on somatosensory perception in children born extremely preterm”. 141 (2009): 79-87. 
13. Abdulkader HM., et al. “Prematurity and neonatal noxious events exert lasting effects on infant pain behavior”. Early Human Development 84 (2008): 351-355. 
14. Lerman J., et al. “Foundations of pediatric anesthesia”. In: Lerman J, Coté CJ, Steward DJ (eds) Manual of pediatric anesthesia. Switzerland: Springer (2017): 657. 
15. Melo GM and Cardoso MVLML. “Non-pharmacological measures in preterm newborns submitted to arterial puncture”. Revista Brasileira De Enfermagem 70 (2017): 335-343. 
16. Freud S. “The Ego and the Id”. V XIX. IMAGO (1976). 
17. Maxwell LG., et al. “Assessment of Pain in the Newborn: An Update”. Clinics in Perinatology 46 (2019): 693-707. 
18. Brazil. Ministry of Health. Health Care Secretariat. Newborn health care: guide for health professionals. 
19. Marcondes C., et al. “Knowledge of the nursing team about pain in premature newborns”. Revista de Enfermagem UFPE On Line 11 (2017): 3354-3359. 
20. Bardin L. “Content Analysis”. 1^st edition. Lisbon: Editions 70 (2016). 
21. Christoffel MM., et al. “Knowledge of health professionals in the assessment and treatment of neonatal pain”. Revista Brasileira de Enfermagem 69 (2016): 552-558. 
22. McPherson C., et al. “Brain Injury and Development in Preterm Infants Exposed to Fentanyl”. Annals of Pharmacotherapy 49 (2015): 1291-1297. 
23. Koren G., et al. “Maternal Drugs and the development fetus”. In: Macdonald MG, Mullett MD, Seshia MMK (editions) Avery / Neonatology: pathophysiology and management of the newborn. Philadelphia: Wolters Kluwe (2016): 314. 
24. Soares MFE., et al. “Newborn's pain under the mother's perception”. Rev Dor 18 (2017): 338-341. 
25. Mathelin C. “O Sorriso da Gioconda: psychoanalytic clinic with premature babies”. Rio de Janeiro: Freud's Company (1999). 
26. Courrone M. “Le prematuré: Un Bébé a part entire”. In: Busnel MC (edition) The language of babies. São Paulo: Escuta (1997): 130-138. 
27. Negri R. “The newborn in the intensive care unit: a neuropsychoanalytic prevention model”. Harris Meltzer Trust (2018). 
28. Marques ACG., et al. “Assessment of pain perception in newborns by health professionals in the neonatal unit”. Cad Collective Health 27 (2019): 432-436.