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Drawbacks of Analgesics in Neonatal Age: How to Ensure Safe and Effective Use in Newborns

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Neonatal Pain

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Abstract

The myth that immaturity protects neonates from pain perception and its negative effects was shown to be untrue by Anand et al. when they demonstrated that untreated perioperative pain resulted in increased morbidity and mortality. Moreover, these negative effects were also observed in later pediatric life and beyond [1, 2]. In essence, adequate analgesia in neonates should not only be given because of empathy or ethics, but it is a valid, appropriate, and needed part of medical and nursing care. More recently, experimental data in animals have provided evidence that perinatal exposure to analgesics also results in reduced brain growth, decreased neuronal packing density, and less dendritic growth and branching [3, 4]. This is because analgesics affect axonal growth and neuro-apoptosis. There seems to be an age-related window of vulnerability for apoptosis or dendritic changes related to human neonatal life and infancy, respectively. These anatomic findings are associated with persistent motor and learning disabilities. Besides the neurodevelopment issues, other compound-specific side effects (e.g., bleeding tendency, hepatic impairment, atopy, renal impairment, blood pressure) should also be considered. Although some of the concepts discussed in this chapter can also be applied to other compounds (e.g., benzodiazepines, propofol, inhalational agents, dexmedetomidine, clonidine, ketamine) or techniques (locoregional or spinal techniques) considered for analgesia, this chapter will focus on the short- and long-term side effects of opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), and paracetamol (acetaminophen) in neonates. At the end, we will provide some guidance on how we think the topics on side effects discussed in this chapter should be integrated into clinical pain management in neonates.

The original version of this chapter was revised. An erratum to this chapter can be found at DOI 10.1007/978-3-319-53232-5_24

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Acknowledgments

The clinical research of K Allegaert is supported by the Fund for Scientific Research, Flanders (fundamental clinical investigatorship 1800214N), and the research activities are further facilitated by the agency for innovation by Science and Technology in Flanders (IWT) through the SAFEPEDRUG project (IWT/SBO 130033). J van den Anker is supported by NIH (K24DA027992, R01HD060543, U54HD071601) and the European Commission (TINN2 [260908], NEUROSIS [223060]).

Author information

Authors and Affiliations

  1. Intensive Care and Department of Surgery, Erasmus MC-Sophia Children’s Hospital, Rotterdam, The Netherlands

    Karel Allegaert & John N. van den Anker

  2. Department of Development and Regeneration, KU Leuven, Neonatal Intensive Care Unit, University Hospital, Herestraat 49, 3000, Leuven, Belgium

    Karel Allegaert

  3. Department of Paediatric Pharmacology, University Children’s Hospital, Basel, Switzerland

    John N. van den Anker

  4. Division of Pediatric Clinical Pharmacology, Children’s National Medical Center, Washington, DC, USA

    John N. van den Anker

  5. Departments of Pediatrics, Integrative Systems Biology, Pharmacology & Physiology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    John N. van den Anker

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  1. Karel Allegaert
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Correspondence to Karel Allegaert .

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Editors and Affiliations

  1. Siena, Italy

    Giuseppe Buonocore

  2. Department of Pediatrics, University of Siena Department of Pediatrics, Siena, Italy

    Carlo Valerio Bellieni

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Allegaert, K., van den Anker, J.N. (2017). Drawbacks of Analgesics in Neonatal Age: How to Ensure Safe and Effective Use in Newborns. In: Buonocore, G., Bellieni, C.V. (eds) Neonatal Pain. Springer, Cham. https://doi.org/10.1007/978-3-319-53232-5_20

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  • DOI: https://doi.org/10.1007/978-3-319-53232-5_20

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-53230-1

  • Online ISBN: 978-3-319-53232-5

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