Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Review

Clinical Importance of Pain and Stress in Preterm Neonates

Anand K.J.S.

Author affiliations

Emory University School of Medicine, Egleston Children’s Health Care System, Atlanta, Ga., USA

Related Articles for ""

Biol Neonate 1998;73:1–9

Do you have an account?

Login Information





Contact Information












By signing up for MyKarger you will automatically participate in our year-End raffle.
If you Then Do Not wish To participate, please uncheck the following box.

Yes, I wish To participate In the year-End raffle And Get the chance To win some Of our most interesting books, And other attractive prizes.


I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information












By signing up for MyKarger you will automatically participate in our year-End raffle.
If you Then Do Not wish To participate, please uncheck the following box.

Yes, I wish To participate In the year-End raffle And Get the chance To win some Of our most interesting books, And other attractive prizes.


I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Review

Published online: December 19, 1997
Issue release date: January 1998

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 0

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: https://www.karger.com/NEO

Abstract

Clinical and laboratory investigations of neonatal pain suggest that preterm neonates have an increased sensitivity to pain and that acute painful stimuli lead to the development of prolonged periods of hyperalgesia. Non-noxious stimuli during these periods of hyperalgesia may expose preterm neonates to established or chronic pain. Acute physiologic changes caused by painful or stressful stimuli can be implicated as important factors in the causation or subsequent extension of early intraventricular hemorrhage (IVH) or the ischemic changes leading to periventricular leukomalacia (PVL). Therapeutic interventions that provide comfort/analgesia in preterm neonates were correlated with a decreased incidence of severe IVH. Long-term follow-up studies of preterm neonates may substantiate the preliminary data associating repetitive painful experiences with some of the neurobehavioral and developmental sequelae resulting from neonatal intensive care.


References

  1. Anand KJS, Aynsley-Green A: Metabolic and endocrine effects of surgical ligation of patent ductus arteriosus in the human preterm neonate: Are there implications for further improvement of postoperative outcome? Mod Probl Paediatr 1985;23:143–157.
  2. Anand KJS, Sippell WG, Aynsley-Green A: Randomized trial of fentanyl anaesthesia in preterm babies undergoing surgery: Effects on the stress response. Lancet 1987;i:243–248.
  3. Anand KJS, Sippell WG, Schofield NM, Aynsley-Green A: Does halothane anaesthesia decrease the metabolic and endocrine stress responses of newborn infants undergoing operation? Br Med J 1988;296:668–672.
  4. Rogers MC: Do the right thing – pain relief in infants and children. N Engl J Med 1992;326:55–56.
  5. Anand KJS, Hickey PR: Pain and its effects in the human neonate and fetus. N Engl J Med 1987;317:1321–1329.
  6. Anand KJS, Carr DB: The neuroanatomy, neurophysiology and neurochemistry of pain, stress, and analgesia in newborns, infants, and children. Pediatr Clin North Am 1989;36:795–822.
  7. Craig KD, Whitfield MF, Grunau RV, Linton J, Hadjistavropoulos HD: Pain in the preterm neonate: Behavioural and physiological indices. Pain 1993;52:287–299.
  8. Fitzgerald M: Neurobiology of fetal and neonatal pain; in Wall PD, Melzack R (eds): The Textbook of Pain. Edinburgh, Churchill Livingstone, 1994, pp 153–163.
  9. Johnston CC, Stevens B, Craig KD, Grunau RVE: Developmental changes in pain expression in premature, full-term, two- and four-month-old infants. Pain 1993;52:201–208.
  10. Fitzgerald M, Shaw A, MacIntosh N: The postnatal development of the cutaneous flexor reflex: A comparative study in premature infants and newborn rat pups. Dev Med Child Neurol 1988;30:520–526.
  11. Anand KJS, Craig KD: Editorial: New perspectives in the definition of pain. Pain 1996;67:3–6.
  12. Barker DP, Rutter N: Exposure to invasive procedures in neonatal intensive care unit admissions. Arch Dis Child 1995;72:F47–F48.
  13. Barker DP, Rutter N: Stress, severity of illness, and outcome in ventilated preterm infants. Arch Dis Child 1996;75:187–190.
  14. Bauchner H, May A, Coates E: Use of analgesic agents for invasive medical procedures in pediatric and neonatal intensive care units. J Pediatr 1992;121:647–649.
  15. Anand KJS, McGrath PJ: An overview of current issues and their historical background; in Anand KJS, McGrath PJ (eds): Pain in Neonates. Amsterdam, Elsevier, 1993, pp 1–18.
  16. Walco GA, Cassidy RC, Schechter NL: Pain, hurt, and harm: The ethics of pain control in infants and children. N Engl J Med 1994;331:541–543.
  17. Lima JD, Lloyd-Thomas AR, Howard RF, Sumner E, Quinn TM: Infant and neonatal pain: Anaestetists’ perceptions and prescribing patterns. Br Med J 1996;313:787.
  18. Anand KJS, Selanikio JD, SOPAIN Study Group: Routine analgesic practices in 109 neonatal intensive care units (NICUs) (abstract). Pediatr Res 1996;39:192A.
  19. Falcon M, Guendellman D, Stolberg A, Frenk H, Urca G: Development of thermal nociception in rats. Pain 1996;67:203–208.
  20. Fitzgerald M: Spontaneous and evoked activity of foetal primary afferents ‘in vivo’. Nature 1987;326:603–605.
  21. Fitzgerald M, Millard C, McIntosh N: Cutaneous hypersensitivity following peripheral tissue damage in newborn infants and its reversal with topical anaesthesia. Pain 1989;39:31–36.
  22. Marti E, Gibson SJ, Polak JM, Facer P, Sringall DR, van Aswegen G, Aitchison M, Koltzenburg M: Ontogeny of peptide- and amine-containing neurones in motor, sensory and autonomic regions of rat and human spinal cord, dorsal root ganglia and rat skin. J Comp Neurol 1987;266:332–359.
  23. Anand KJS: Neonatal stress responses to anaesthesia and surgery. Clin Perinatol 1990;17:207–214.
  24. Anand KJS, Brown MJ, Causon RC, Christofides ND, Bloom SR, Aynsley-Green A: Can the human neonate mount an endocrine and metabolic response to surgery? J Pediatr Surg 1985;20:41–48.
  25. Yaster M: The dose response of fentanyl in neonatal anesthesia. Anesthesiology 1987;66:433–435.
    External Resources
  26. Greenley WJ, de Bruijn NP: Changes in sufentanil pharmacokinetics within the neonatal period. Anesth Analg 1988;67:86–90.
    External Resources
  27. Chay PCW, Duffy BJ, Walker JS: Pharmacokinetic-pharmacodynam- ic relationships of morphine in neonates. Clin Pharmacol Ther 1992;51:334–342.
  28. Basbaum AI: Memories of pain. Science Med 1996;Nov/Dec:22–31.
  29. Fitzgerald M, Reynolds ML, Benowith LI: GAP-43 expression in the developing rat lumbar spinal cord. Neuroscience 1991;41:187–199.
  30. Fitzgerald M, Millard C, MacIntosh N: Hyperalgesia in premature infants. Lancet 1988;8580:292.
  31. Anand KJS: Relationships between stress responses and clinical outcome in newborns, infants, and children. Crit Care Med 1993;21:S358–S359.
    External Resources
  32. Anand KJS, McGrath PJ: Future directions; in Anand KJS, McGrath PJ (eds): Pain in Neonates. Amsterdam, Elsevier, 1993, pp 321–333.
  33. McIntosh N: Pain in the newborn, a possible new starting point. Eur J Pediatr 1997;56:173–178.
    External Resources
  34. Pokela ML: Pain relief can reduce hypoxemia in distressed neonates during routine treatment procedures. Pediatrics 1994;93:379–383.
  35. Abdel-Rahman AM, Rosenberg AA: Prevention of intraventricular hemorrhage in the premature infant. Clin Perinatol 1994;21:505–521.
    External Resources
  36. Perlman J, Thach B: Respiratory origin of fluctuations in arterial blood pressure in premature infants with respiratory distress syndrome. Pediatrics 1988;81:399–403.
    External Resources
  37. Zernikow B, Michel E, Kohlmann G, Steck J, Schmitt RM, Jorch G: Cerebral autoregulation of preterm neonates – a non-linear control system. Arch Dis Child 1994;70:F166–F173.
  38. Haxhija EQ, Rosegger H, Prechtl HF: Vagal response to feeding tube insertion in preterm infants: Has the key been found? Early Hum Dev 1995;41:15–25.
  39. Ramaekers VT, Casaer P, Daniels H: Cerebral hyperperfusion following episodes of bradycardia in the preterm infant. Early Hum Dev 1993;34:199–208.
  40. Low JA, Froese AB, Smith JT, Galbraith RS, Sauerbrei EE, Karchmar EJ: Hypotension and hypoxemia in the preterm newborn during the four days following delivery identify infants at risk of echosonographically demonstrable cerebral lesions. Clin Invest Med 1992;15:60–65.
  41. Pinto-Martin JA, Riolo S, Cnaan A, Holzman C, Susser MW, Paneth N: Cranial ultrasound prediction of disabling and nondisabling cerebral palsy at age two in a low birth weight population. Pediatrics 1995;95:249–254.
  42. Fiselier T, Monnens L, Moerman E, Munster P, Jansen M, Peer P: Influence of the stress of venepuncture on basal levels of plasma renin activity in infants and children. Int J Pediatr Nephrol 1983;4:181–185.
    External Resources
  43. Greisen GS, Frederiksen PS, Hertel M, Christensen NJ: Catecholamine response to chest physiotherapy and endotracheal suctioning in preterm infants. Acta Paediatr Scand 1985;74:525–529.
    External Resources
  44. Lagercrantz H, Nilsson E, Redham I, Hjemdahl P: Plasma catecholamines following nursing procedures in a neonatal ward. Early Hum Dev 1986;14:61–65.
    External Resources
  45. Greenough A, Lagercrantz H, Pool J, Dahlin I: Plasma catecholamine levels in preterm infants. Acta Paediatr Scand 1987;76:54–59.
    External Resources
  46. Greenough A, Nicolaides KH, Lagercrantz H: Human fetal sympathoadrenal responsiveness. Early Hum Dev 1990;23:9–13.
  47. Vohr B, Ment LR: Intraventricular hemorrhage in the preterm infant. Early Hum Dev 1996;44:1–16.
  48. Anderson GD, Bada HS, Shaver DC, Harvey CJ, Korones SB, Wong SP, Arheart KL, Magill HL: The effect of cesarean section on intraventricular hemorrhage in the preterm infant. Am J Obstet Gynecol 1992;166:1091–1099.
  49. Blair E, Stanley FJ: Intrapartum asphyxia: A rare cause of cerebral palsy. J Pediatr 1988;112:515–519.
    External Resources
  50. Wells JT, Ment LR: Prevention of intraventricular hemorrhage in preterm infants. Early Hum Dev 1995;42:209–233.
  51. Anand KJS, Aynsley-Green A: Measuring the severity of surgical stress in newborn infants. J Pediatr Surg 1988;23:297–305.
  52. Goldstein RF, Brazy JE: Narcotic sedation stabilizes arterial blood pressure fluctuations in sick premature infants. J Perinatol 1991;11:365–371.
  53. Quinn MW, Wild J, Dean HG, Hartley R, Rushforth JA, Puntis JW, Levene MI: Randomised double-blind controlled trial of effect of morphine on catecholamine concentrations in ventilated preterm babies. Lancet 1993;342:324–327.
  54. Orsini AJ, Leef KH, Costarino A, Dettorre MD, Stefano JL: Routine use of fentanyl infusions for pain and stress reduction in infants with respiratory distress syndrome. J Pediatr 1996;129:140–145.
  55. Cepeda EE, Lee MI, Mehdizadeh B: Decreased incidence of intraventricular hemorrhage in infants of opiate dependent mothers. Acta Paediatr Scand 1987;76:16–18.
    External Resources
  56. Perlman JM, Goodman S, Kreusser KL, Volpe JJ: Reduction in intraventricular hemorrhage by elimination of fluctuating cerebral blood flow velocity in preterm infants with respiratory distress syndrome. N Engl J Med 1985;312:1353–1357.
  57. Als H, Lawhon G, Gibes R, Duffy FH, McAnulty G, Blickman JG: Individualized developmental care for the very low-birth weight preterm infant: Medical and neurofunctional effects. JAMA 1994;272:853–858.
  58. Becker PT, Grunwald PC, Moorman J, Stuhr S: Outcomes of developmentally supportive nursing care for very low birth weight infants. Nursing Res 1991;40:150–155.
  59. Ment L, Oh W, Ehrenkranz RA, Philip AGS, Vohr B, Allan W, Duncan CC, Scott DT, Taylor KJW, Katz KH, Schneider KC, Makuch RW: Low-dose indomethacin an prevention of intraventricular hemorrhage: A multicenter randomized trial. Pediatrics 1994;93:543–550.
  60. Ment LR, Vohr B, Oh W, et al: Neurodevelopmental outcome at 36 months’ corrected age of preterm infants in the multicenter indomethacin intraventicular hemorrhage prevention trial. Pediatrics 1996;98:714–718.
    External Resources
  61. Sims C, Johnson CM, Bergesio R, Delfos SJ, Avraamides EA: Rectal indomethacin for analgesia after appendicectomy in children. Anaesth Intensive Care 1994;22:272–275.
  62. Johnston CC, Stevens BJ: Experience in a Neonatal Intensive Care Unit affects pain response. Pediatrics 1996;98:925–930.
  63. Richards MPM, Bernal JF, Brackbill Y: Early behavioral differences: Gender or circumcision? Dev Psychobiol 1976;9:89–95.
  64. Dixon S, Snyder J, Holve R, Bromberger P: Behavioral effects of circumcision with and without anesthesia. J Dev Behav Pediatr 1984;5:246–250.
  65. Emde RN, Harmon RJ, Metcalf D, Koenig KL, Wagonfield S: Stress and neonatal sleep. Psychosom Med 1971;33:491–497.
  66. Gunnar MR, Porter FL, Wolf CM, Rigatuso J, Larson MC: Neonatal stress reactivity: Predictions to later emotional temperament. Child Dev 1995;66:1–13.
  67. Taddio A, Goldbach M, Ipp M, Stevens B, Koren G: Effect of neonatal circumcision on pain responses during vaccination in boys. Lancet 1995;345:291–292.
  68. Taddio A, Katz J, Ilersich AL, Koren G: Effect of neonatal circumcision on pain response during subsequent routine vaccination. Lancet 1997;349:599–603.
  69. Ramsay DS, Lewis M: The effects of birth condition on infant’s cortisol response to stress. Pediatrics 1995;95:546–549.
  70. Levine S, Haltmeyer GC, Karas GG, Denenberg VH: Physiological and behavioral effects of infantile stimulation. Physiol Behav 1967;2:55–64.
  71. Levine S: Infantile experience and resistance to physiological stress. Science 1957;126:405–406.
  72. Levine S: Plasma-free corticosteroid response to electric shock in rats stimulated in infancy. Science 1962;135:795–796.
  73. Ader R, Grota LJ: Effects of early experience on adrenocortical reactivity. Physiol Behav 1969;4:303–305.
    External Resources
  74. Plotsky PM, Meaney MJ: Early postnatal experience alters hypothalamic corticotropin-releasing factor (CRF) mRNA, median eminence CRF content and stress-induced release in adult rats. Mol Brain Res 1993;18:195–200.
  75. Meaney MJ, Sharma S, Sarrieau S, Plotsky PM: Postnatal development and environmental regulation of hippocampal glucocorticoid and mineralcorticoid receptors in the rat. Dev Brain Res 1988;43:158–162.
  76. Pieretti S, d’Amore A, Loizzo A: Long-term changes induced by developmental handling on pain threshold: Effects of morphine and naloxone. Behav Neurosci 1991;105:215–218.
  77. Neveu PJ, Deleplanque B, Puglisi-Allegra S, Amato FRD, Cabib S: Influence of early life events on immune reactivity in adult male mice. Dev Psychobiol 1994;27:205–213.
  78. Anand KJS, Coskun V, Thrivikraman KV, Nemeroff CB, Plotsky PM: Long-term behavioral effects of repetitive pain in neonatal rat pups. Physiol Behav, submitted.
  79. Francis D, Diorio J, LaPlante P, Weaver S, Seckl JR, Meaney MJ: The role of early environmental events in regulating neuroendocrine development. Ann New York Acad Sci 1996;794:136–152.
  80. McEwen BS: The Plasticity of the hippocampus is the reason for its vulnerability. Trends in Neurosciences 1994;6:239–246.
  81. Fillion TJ, Blass EM: Infantile experience with suckling odors determines sexual behavior in male rats. Science 1986;231:729–731.
  82. Jacobson B, Eklund G, Hamberger L, Linnarsson D, Sevdall G, Vlaverius M: Perinatal origin of adult self-destructive behavior. Acta Psychiatr Scand 1987;76:364–371.
  83. Hack M, Friedman H, Fanaroff AA: Outcomes of extremely low birth weight infants. Pediatrics 1996;98:5:931–937.
  84. Hutton JL, Pharoah POD, Cooke RWI, Stevenson RC: Differential effects of preterm birth and small gestational age on cognitive and motor development. Arch Dis Childh 1997;76:F75–F81.
  85. Grunau RVE, Whitfield MF, Petrie JH, Fryer EL: Early pain experience, child and family factors as precursors of somatization: A prospective study of extremely premature and fullterm children. Pain 1994;56:353–359.
  86. Herzog JM: The Neonatal Intensive Care Syndrome: A pain complex involving neuroplasticity and psychic trauma; in Call JD, Galenson E, Tyson RL (eds): Frontiers of Infant Psychiatry. New York, Basic Books, 1983, pp 291–300.
  87. Grunau RVE, Whitfield MF, Petrie JH: Pain sensitivity and temperament in extremely-low-birthweight premature toddlers and preterm and full-term controls. Pain 1994;58:341–346.
  88. Korner AF, Stevenson DK, Forrest T, Constantinou JC, Dimiceli S, Brown BS: Preterm medical complications differentially affect neurobehavioral functions: Results from a new neonatal medical index. Infant Behav Dev 1994;17:37–43.
    External Resources
  89. Deren S: Children of substance abusers: A review of the literature. J Subst Abuse Treat 1986;3:77–94.

Article / Publication Details

First-Page Preview
Abstract of Review

Published online: December 19, 1997
Issue release date: January 1998

Number of Print Pages: 9
Number of Figures: 0
Number of Tables: 0

ISSN: 1661-7800 (Print)
eISSN: 1661-7819 (Online)

For additional information: https://www.karger.com/NEO


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.