Pain in vulnerable infants
Bonnie Stevens, RN, PhD Ruth Eckstein Grunau, PhD Guest Editors
Vulnerable neonates include those infants who areborn very prematurely, are ill, or are compromised because of disease, impairment, or adverse events in utero or during the neonatal period. These infants frequently spend their first days and weeks oflife hospitalized in the neonatal intensive care unit (NICU) where they are subjected to multiple invasive investigations and treatments that are frequently painful or at least stressful. In preterminfants, this pain and stress occurs during a critical period of rapid brain growth and development, leaving these infants as vulnerable candidates for both immediate and long-term sequelae. Althoughthere have been major scientific advances during the past decade in understanding pain and its management in infants, those who are at greatest risk for its consequences are the least well studied orunderstood. The developmental neurobiology of pain clearly demonstrates that the requisite afferent systems are functional at birth; however, the self-regulatory autonomic and neuroendocrine systemsmodulating sensory experience may be immature in the very preterm infant or may themselves be affected by illness. The development and impact of emotional experience in infants born very preterm who arecompromised or very ill is controversial and largely uncharted territory. Careful observation of biologic and behavioral indicators demonstrates with some clarity that the sensory, distressing, anddisruptive impact of pain is evident even in vulnerable infants; however, the challenges of recognizing pain and distinguishing pain from other conditions remain consid0095-5108/02/$ – see front matterD 2002, Elsevier Science (USA). All rights reserved. PII: S 0 0 9 5 - 5 1 0 8 ( 0 2 ) 0 0 0 2 3 - 4
Preface / Clin Perinatol 29 (2002) xv–xvii
erable in preverbal populations. Little...