Evaluation of Pain Assessment in Our Neonatal Intensive Care Unit

Abstract

SUMMARY S tarting at birth, critically ill newborn babies undergo repetitive, painful stimuli as part of diagnostic and therapeutic procedures that are necessary for their survival (Slater , 2010). In the neonatal intensive care unit (NICU) during the first two weeks after birth, newborns are exposed to approximately 16 invasive procedures per day, of which only one-third are completed under analgesia (Carbajal, 2008). Some common painful procedures include: - Heel prick. - Arterial or venous line insertion. - Inserting naso-gastric tube. - Intubation. - Chest drain insertion. - Pulling off tape. Guiding Principle Neonates, term and preterm, do experience pain and have the right to receive effective and safe pain relief We all react to pain with behavioural, physiological and biochemical and hormonal changes. The cardiovascular and respiratory effects associated with the endocrine-metabolic response to acute nociceptive stimuli may increase neonatal morbidity and mortality (Johnston, 2011). The assessment of pain in newborns represents a great challenge. Two of the major limitations to achieving pain relief in clinical practice include - The lack of a reliable biomarker. - The absence of a gold standard scale that is capable of measuring the intensity of the pain. Although there are more than 30 scales for assessing pain in newborns, no specific scale has demonstrated superiority. Most of these instruments rely on physiological and behavioral and hormonal parameters which are indirect responses to the painful stimulus (Carbajal, 2008). • Physiological parameters, including - Heart rate. - Respiratory rate. - Oxygen saturation. - Intracranial and blood pressure Among others, have the advantage of being objective measures, but changes in these parameters are not specific to painful phenomenon (Raeside, 2011). • The main behavioral responses to pain in preverbal infants are crying and body and facial movements. The facial expression reflects the painful experience effectively and specifically indeed, facial movements correlate best with cortical activity during a painful stimulus in comparison with physiologic indicators (Grunau, 1987). • Salivary cortisol: Cortisol level test which is the main adrenal glucocorticoid and plays a central role in glucose metabolism and in the body's response to stress (Elias, 2008). Our study use clinical pain assessment scales and compare it by noninvasive measure the salivary cortisol level to evaluate the accuracy of our clinical skills in evaluating neonatal pain. A cross sectional study of 50 full term infant gestional age between 37:41 weeks of both sexes randomly selected from our NICU. Patients will be enrolled after consideration of inclusion and exclusion criteria as follows: