title: [Consensus on the diagnostic and therapeutic approach to pain and stress in the newborn].
abstract: Pain and stress experienced by the newborn have not been addressed adequately. Infants in neonatal intensive care units often undergo painful and stressful invasive procedures, and inappropriate treatment increases morbidity and mortality. At the 5th Clinical Consensus of the Ibero-American Society of Neonatology, 32 neonatologists from the region were invited to establish recommendations for the diagnosis and treatment of neonatal pain and stress. Key themes were explored based on the best scientific evidence available in indexed databases. All attendees participated actively in a meeting in Santiago, Chile, with the objective of reaching a consensus on recommendations and conclusions. Pain and neonatal stress affect neurological development and long-term behavior and require timely diagnosis and appropriate management and treatment, including the use of drugs with an appropriate balance between effectiveness and toxicity. The Consensus emphasized the importance of assessing pain in the newborn from a multidimensional viewpoint, and provided recommendations on the indications and limitations for an individualized pharmacological therapy. The use of analgesics has precise indications but also important limitations; there is a lack of randomized studies in newborns, and adverse effects need to be considered. Nonpharmacological measures to mitigate pain were proposed. Stress management should begin in the delivery room, including maternal contact, stimulus reduction and the implementation of intervention reduction protocols. Recommendations for improving clinical practices related to neonatal pain and stress are presented.
authors.affiliation: Departamento de Neonatología, Hospital de Pediatría UMAE, Instituto Mexicano del Seguro Social, Jalisco, México, lulalemus@gmail.com.
authors.forename: María de Lourdes
authors.initials: Mde L
authors.lastname: Lemus-Varela
authors.affiliation: Sociedad Iberoamericana de Neonatología, Estados Unidos de América, California.
authors.forename: Augusto
authors.initials: A
authors.lastname: Sola
authors.affiliation: Regional Neonatal Center, María Fareri Children's Hospital/New York Medical College, Nueva York, Estados Unidos de América.
authors.forename: Sergio
authors.initials: S
authors.lastname: Golombek
authors.affiliation: Departamento de Neonatología, Universidad del Norte, Barranquilla, Colombia.
authors.forename: Hernando
authors.initials: H
authors.lastname: Baquero
authors.affiliation: Departamento de Neonatología, Facultad de Medicina-C.H.P.R., Montevideo, Uruguay.
authors.forename: Daniel
authors.initials: D
authors.lastname: Borbonet
authors.affiliation: Instituto Nacional Materno-Perinatal, Universidad Nacional Federico Villarreal, Lima, Perú
authors.forename: Carmen
authors.initials: C
authors.lastname: Dávila-Aliaga
authors.affiliation: Division of Neonatology, University of Miami, Miami, Florida, Estados Unidos de América.
authors.forename: Teresa
authors.initials: T
authors.lastname: Del Moral
authors.affiliation: Consejero de Relaciones Internacionales de SIBEN, México DF, México.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Lara-Flores
authors.affiliation: Departamento de Neonatología, Hospital Central Ignacio Morones Prieto, Universidad Autónoma de San Luis Potosí, San Luis de Potosí, México.
authors.forename: María Victoria
authors.initials: MV
authors.lastname: Lima-Rogel
authors.affiliation: Hospital Niño Jesús, Barranquilla, Colombia.
authors.forename: Freddy
authors.initials: F
authors.lastname: Neira-Safi
authors.affiliation: Servicio de Pediatría, Hospital Privado de la Comunidad, Mar del Plata, Argentina.
authors.forename: Diego
authors.initials: D
authors.lastname: Natta
authors.affiliation: Departamento de Neonatología, Hospital San Juan de Dios, San José, Costa Rica.
authors.forename: Ada
authors.initials: A
authors.lastname: Oviedo-Barrantes
authors.affiliation: Docencia e Investigación, Hospital de Pediatría J. P. Garrahan, Buenos Aires, Argentina.
authors.forename: Susana
authors.initials: S
authors.lastname: Rodríguez
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D019422:Dietary Sucrose / Q000627:therapeutic use; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal / Q000379:methods; D007843:Latin America; D009359:Neonatology / Q000379:methods*; D041361:Pacifiers; D010146:Pain / Q000175:diagnosis*; D059408:Pain Management / Q000379:methods*; D010812:Physical Stimulation; D012955:Societies, Medical; D013030:Spain; D013312:Stress, Physiological / Q000187:drug effects
chemical_list: D000700:Analgesics; D019422:Dietary Sucrose; D006993:Hypnotics and Sedatives