Pain in Neonates

Little attention has in the past been given to physiological or pathological responses of the infant to stimuli that produce pain in older individuals. All that has changed. Drs. Anand and McGrath have joined in writing and editing this collection of chapters on many aspects of nociception and the responses within the central nervous system, behavioral responses, endocrine, cardiovascular and immune functions. The question of the benefits of some pain to communicate the presence of a potentially dangerous event is the subject of a thoughtful discussion in Chapter 4. Nociception may trigger appropriate physiological responses. However, severe responses may in themselves be deleterious as documented by the improved outlook when they are blocked during surgery. The principles and pharmacotherapy with systemic analgesic drugs (especially opioids) is given extensive and informative consideration in Chapters 5 and 6. Regional and topical anesthesia in newborn infants is thoroughly covered in Chapter 7.
A welcome addition to the discussions in first chapters of the book, is the report of experienced neonatal nurses on individualized supportive care to reduce pain and stress in neonatal intensive care units. They provide a critical review of studies of behaviors of preterm and sick infants, which they augment with a description of current practices. The remaining topics that serve to broaden the perspective of those caring for infants are indicated by the chapter titles: "Moral and ethical issues in clinical practice", "Research design and research ethics", "Social and legal issues", and finally, "Future directions" by the editors. Both editors have conducted extensive clinical research, much of which is reviewed in this remarkable textbook. This book, literally, opens the field of understanding pain in infancy, and offers a prescription for more ways to optimize care of newborn infants; it will surely stimulate further study of their neurologic responses.