title: Guidelines for procedural pain in the newborn.
abstract: Despite accumulating evidence that procedural pain experienced by newborn infants may have acute and even long-term detrimental effects on their subsequent behaviour and neurological outcome, pain control and prevention remain controversial issues. Our aim was to develop guidelines based on evidence and clinical practice for preventing and controlling neonatal procedural pain in the light of the evidence-based recommendations contained in the SIGN classification. A panel of expert neonatologists used systematic review, data synthesis and open discussion to reach a consensus on the level of evidence supported by the literature or customs in clinical practice and to describe a global analgesic management, considering pharmacological, non-pharmacological, behavioural and environmental measures for each invasive procedure. There is strong evidence to support some analgesic measures, e.g. sucrose or breast milk for minor invasive procedures, and combinations of drugs for tracheal intubation. Many other pain control measures used during chest tube placement and removal, screening and treatment for ROP, or for postoperative pain, are still based not on evidence, but on good practice or expert opinions.
  
  
  CONCLUSIONS
  These guidelines should help improving the health care professional's awareness of the need to adequately manage procedural pain in neonates, based on the strongest evidence currently available.
authors.affiliation: Neonatal Intensive Care Unit, Department of Paediatrics, University of Padova, Via Giustiniani 3, Padua, Italy. lago@pediatria.unipd.it
authors.forename: Paola
authors.initials: P
authors.lastname: Lago
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Garetti
authors.forename: Daniele
authors.initials: D
authors.lastname: Merazzi
authors.forename: Luisa
authors.initials: L
authors.lastname: Pieragostini
authors.forename: Gina
authors.initials: G
authors.lastname: Ancora
authors.forename: Anna
authors.initials: A
authors.lastname: Pirelli
authors.forename: Carlo Valerio
authors.initials: CV
authors.lastname: Bellieni
mesh_terms: D000698:Analgesia / Q000379:methods*; D000779:Anesthetics, Local / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000379:methods / Q000592:standards; D009359:Neonatology / Q000592:standards*; D010146:Pain / Q000517:prevention & control*; D059408:Pain Management
chemical_list: D000779:Anesthetics, Local