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  • Sensory nerve terminals exist on all body surfaces by 22–29 wk of gestation.

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  • Pain assessment should be performed using validated tools in all patients upon admission and then at regularly defined intervals.
  • Physiologic responses to pain include increased circulating levels of catecholamines, increased HR, and increased BP.

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  • Repeated or long-term painful stimuli result in long-term changes such as a lowered pain threshold.

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  • Response to painful stimuli contribute to physiologic disturbances such as hypoxia, hypercarbia, acidosis, and hyperglycemia; this may lead to alterations in oxygen delivery and cerebral blood flow.

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  • Infants have long-term disturbances in pain perception that persist well into childhood.

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  • An absence of behavioral or physiologic cues that might indicate pain does not indicate an absence of pain.

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Behavioral Measures

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  • Swaddling: Keeping the extremities flexed and close to the trunk

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  • Pacifiers: Used for non-nutritive sucking

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  • “Kangaroo care”

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  • Developmentally appropriate care

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  • Minimize noise and light stimuli

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Sucrose

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  • Sensory nerve terminals exist on all body surfaces by 22–29 wk of gestation.

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  • Pain assessment should be performed using validated tools in all patients upon admission and then at regularly defined intervals.
  • Physiologic responses to pain include increased circulating levels of catecholamines, increased HR, and increased BP.

++

  • Repeated or long-term painful stimuli result in long-term changes such as a lowered pain threshold.

++

  • Response to painful stimuli contribute to physiologic disturbances such as hypoxia, hypercarbia, acidosis, and hyperglycemia; this may lead to alterations in oxygen delivery and cerebral blood flow.

++

  • Infants have long-term disturbances in pain perception that persist well into childhood.

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  • An absence of behavioral or physiologic cues that might indicate pain does not indicate an absence of pain.

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NOTE: See chapter 2 for additional information on side effects, dosing, and precautions.

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Nonopioid Analgesic

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  • Acetaminophen
    • 1.5–1.9 kg: 20 mg PO Q12h
    • 2.0–2.9 kg: 30 mg PO Q8h
    • 3.0–3.9 kg: 40 mg PO Q8h
    • 4.0–5.2 kg: 60 mg PO Q6h
    • 5.3–7.9 kg: 80 mg PO Q4h (do not exceed 5 doses per day)

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Opioid Analgesics

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  • Morphine
    • Intermittent IV dosing: 0.05–0.1 mg/kg/dose Q3–4h
    • Intermittent PO dosing: 0.2–0.5 mg/kg/dose Q4–6h
    • IV continuous infusion: Initial: 0.01–0.02 mg/kg/h
    • All dosing should be titrated to effect
  • Fentanyl
    • Intermittent IV dosing: 1–2 mcg/kg/dose Q2h
    • IV continuous infusion: 1–5 mcg/kg/h
    • All dosing should be titrated to effect

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See chapter 2.

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  • For minimally invasive procedures, combinations of a pacifier, swaddling, or sucrose can be used.
    • Arterial or venous puncture, or heelstick
    • Peripheral IV placement
    • Umbilical arterial or venous catheter placement
    • Endotracheal suctioning

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  • The above measures plus topical anesthetic (see chapter 2 for listing and precautions of ...

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