title: Chronic pain in the newborn: toward a definition.
abstract: OBJECTIVE
  Chronic pain is poorly addressed in neonatal pain research. We aimed at contributing to define the concept of chronic pain in the newborn.
  
  
  METHODS
  We designed a Web-based, 3-round Delphi survey. We invited an international panel of experts (health care providers and parents) in the fields of neonatology and neonatal pain to participate.
  
  
  RESULTS
  In the first round, participants (n=189) answered 3 open-ended questions: (1) define chronic pain in your own words, (2) what are the possible causes, and (3) which signs and symptoms are used to diagnose chronic pain? The answers were categorized and summarized into 437 statements, which were valued by the participants (n=189) on a 5-point Likert scale. In the second round, the remaining participants (n=72) were asked to reflect on 65 selected statements with a mode or median ≥4 or mean ≥3.75. These threshold values provided the opportunity to reach consensus in the following round. In the third round, the remaining participants (n=33) were provided with the group and individual responses. This process resulted in 23 statements with mode, mean, and median of ≥4, on which the participants reached consensus.
  
  
  CONCLUSIONS
  Although several etiologic factors were defined, no useful diagnostic criterion could be identified. The survey resulted in a description of chronic pain in the newborn. Identifying chronic pain is clinically relevant because it interferes with growth, prolongs hospitalization, leads to altered pain perception, and impairs cognitive and behavioral development.
authors.affiliation: *Department of Pediatrics, Division of Neonatology, Máxima Medical Center, Veldhoven ‡Department of Pediatrics, Division of Neonatology, Maastricht University Medical Center, Maastricht, The Netherlands †Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN.
authors.forename: Christ-jan
authors.initials: CJ
authors.lastname: van Ganzewinkel
authors.forename: Kanwaljeet J S
authors.initials: KJ
authors.lastname: Anand
authors.forename: Boris W
authors.initials: BW
authors.lastname: Kramer
authors.forename: Peter
authors.initials: P
authors.lastname: Andriessen
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis* / Q000209:etiology*; D032921:Consensus; D003469:Culture; D006282:Health Personnel; D006801:Humans; D007231:Infant, Newborn; D038622:Internationality; D020407:Internet; D009626:Terminology as Topic