Neonatal Pain and Stress: Assessment and Management

Relief of human suffering is one of the most important goals of all healthcare providers. Advances in neonatology have significantly reduced neonatal morbidity and mortality, but pain, discomfort, and stress remain sad realities for babies in the neonatal intensive care unit (NICU). Assessing, managing, and trying to limit these clinical realities, particularly while caring for critically ill neonates, remain challenging and increasingly controversial. Fortunately, considerable clinical and laboratory research and clinical dialogue continue to push neonatal providers toward best clinical practices in this problematic arena. This chapter describes the history, developmental biology, and public policies that have informed and shaped current clinical practices; it also summarizes relevant clinical and basic research regarding clinical assessment tools and both pharmacologic and nonphar¬macologic management approaches. Finally, future directions in this field are suggested.