Rebeccah Slater, BSc, MSC, MA(Oxon), PhD and Eric Gibson, MD
Neonatal pain is frequently undertreated and under recognized. The use of analgesic options is limited because of a scarce evidence base and limited safety profile. Dr. Slater discusses findings from the Poppi trial and future directions for research in the area of neonatal pain control.
Neonatal pain has immediate and long-term effects but is often undertreated and under recognized. Premature infants in neonatal intensive care units undergo frequent painful procedures without adequate pain relief. Analgesic options are limited because few clinical trials have been done in infants, and efficacy and safety data are frequently inconclusive. The Poppi trial (procedural pain in premature infants) is a single-center, masked, randomized, placebo-controlled trial that sought to test the routine use of oral morphine in non-ventilated premature infants before heel lancing and retinopathy of prematurity screening to safely provide analgesia and reduce physiological instability. The trial concluded that the use of morphine has the potential to cause harm without any suggestion of analgesic benefit in this select population. Further research is needed to identify safer and more efficacious means of providing analgesia. Key areas for investigation include the use of alternative analgesics and nonpharmacologic means of pain control.