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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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- Swaddling: Keeping the extremities flexed and close to the trunk
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- Pacifiers: Used for non-nutritive sucking
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- Developmentally appropriate care
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- Minimize noise and light stimuli
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- Sensory nerve terminals exist on all body surfaces by 22–29 wk of gestation.
++
- 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.
++
- An absence of behavioral or physiologic cues that might indicate pain does not indicate an absence of pain.
++
NOTE: See chapter 2 for additional information on side effects, dosing, and precautions.
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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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- 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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- 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 ...