Adequate Pain Management and Sedation in the Neonate: a Fine Balance

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Publication Date



doi: 10.1007/s40746-018-0109-0


Purpose of review

With heightened awareness of long-term neurocognitive effects of pain and stress in the neonatal population, increased focus has been placed on pain assessment as well as potential effects of routinely administered analgesics/sedatives in our neonatal intensive care units (NICUs). Our goal was to review recently published literature on current pain assessment practices, novel approaches to management, pharmacogenomics in the neonate, and risks of commonly used medications.

Recent findings

There is an increasing trend in the administration of analgesics and sedatives in NICUs, despite reports of the negative effects these medications may have on neonatal brain development. As in the adult world, studies are finding that pharmacogenomics has the potential to play a significant role in adequate pain control and sedation in the individual neonatal patient. Due to increased reports of adverse effects of commonly used medications such as morphine and midazolam, new pharmacologic agents are being evaluated in the neonatal population as possibly safer alternatives.


There have been significant advances in our knowledge of pain and sedation in the neonate, ranging from a better understanding of long-term neurocognitive effects of pain in neonatal brain development to the role of pharmacogenomics in the NICU setting. These developments have opened the door for continued learning and investigation into the ideal management of neonatal pain and sedation.

Journal Title

Curr Treat Options Peds



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Neonatal intensive care unit I NICU I Neonatal pain I Neonatal sedation