Neonatal Pain: Suffering, Pain, and Risk of Brain Damage in the Fetus and Newborn

251 Pages·2017·2.435 MB·English

by  Giuseppe Buonocore, Carlo Valerio Bellieni (eds.)

Giuseppe Buonocore
Carlo Valerio Bellieni
Editors
Neonatal Pain
Suff ering, Pain, and
Risk of Brain Damage in
the Fetus and Newborn
Second Edition
123
Neonatal Pain
Giuseppe Buonocore
Carlo Valerio Bellieni
Editors
Neonatal Pain
Suffering, Pain, and Risk of Brain
Damage in the Fetus and Newborn
Second Edition
Editors
Giuseppe Buonocore Carlo Valerio Bellieni
Department of Molecular and Developmental Department of Pediatrics
Medicine University Hospital of Siena
University of Siena Siena
Siena Italy
Italy
Azienda Ospedaliera Universitaria Senese
Siena
Italy
ISBN 978-3-319-53230-1 ISBN 978-3-319-53232-5 (eBook)
DOI 10.1007/978-3-319-53232-5
Library of Congress Control Number: 2017941710
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Contents
Introduction: Pain and Suffering from the Womb Onwards? ......... ix
Note to the Second and Updated Edition .......................... xi
Part I Delivery and Pain
1 Gender Differences in Pain Since Birth ....................... 3
Anna Maria Aloisi, Irina Butkevich, and Stefano Pieretti
2 Stress and Pregnancy: CRH as Biochemical Marker ............ 11
Silvia Vannuccini, Caterina Bocchi, Filiberto Maria Severi,
and Felice Petraglia
3 Pain Control During Labour ................................ 29
Chiara Benedetto, Marina Zonca, Davide Sturla, Fulvio Borella,
and Evelina Gollo
Part II Fetal Pain
4 Fetal Stress: Ultrasound Study of Fetal Behavior ............... 37
Caterina Bocchi, Silvia Vannuccini, Filiberto Maria Severi,
Carlo Valerio Bellieni, and Felice Petraglia
5 Prenatal Affective Exchanges and Their Subsequent Effects
in Postnatal Life .......................................... 43
Catherine Dolto
6 Foetal Pain ............................................... 53
G. Noia, E. Cesari, M.S. Ligato, D. Visconti, M. Tintoni, I. Mappa,
C. Greco, G.P. Fortunato, and A. Caruso
7 Analgesia During Fetal Surgery ............................. 65
Gloria Pelizzo
8 New Insights into Prenatal Stress: Immediate-
and Long-Term Effects on the Fetus and Their Timing .......... 75
Kieran J. O’Donnell, Nadja Reissland, and Vivette Glover
v
vi Contents
Part III Neonatal Pain
9 Understanding Infant Pain Responding Within
a Relational Context ....................................... 89
Jordana Waxman, Jodi Martin, and Rebecca Pillai Riddell
10 Detecting Acute Pain is Enough: The Conundrum
of Pain Assessment ........................................ 105
C.V. Bellieni and G. Buonocore
11 Analgesic Procedures in Newborns ........................... 113
Laura Giuntini, Cristina Navarra, Rossella Angotti,
and Giovanna Amato
12 Nonpharmacological Treatment of Neonatal Pain ............... 125
R. Carbajal
13 Sensorial Saturation and the 3Ts Rule ........................ 141
C.V. Bellieni and G. Buonocore
14 Surgical Use of Analgesic Drugs ............................. 147
A.M. Guadagni and L. Manganozzi
15 Physical Risk Agents in Incubators ........................... 171
Renata Sisto
Part IV Pain: A Risk Factor for Brain Damage
16 Neonatal Stressors ......................................... 185
M. Delivoria-Papadopoulos and P. Kratimenos
17 New Insights into Neonatal Hypersensitivity ................... 195
C.J. Woodbury
18 From the Gate-Control Theory to Brain Programs
for Neonatal Pain ......................................... 205
Kanwaljeet J.S. Anand
19 Long-Term Consequences of Pain and Stress in Neonates ........ 213
Kim Kopenhaver Doheny
20 Drawbacks of Analgesics in Neonatal Age:
How to Ensure Safe and Effective Use in Newborns ............. 227
Karel Allegaert and John N. van den Anker
Part V Pain and Communication
21 Disclosure of Pathology to the Newborn’s Family ............... 241
P. Arosio
Contents vii
22 Pain and Grief in the Experience of Parents of Children
with a Congenital Malformation ............................. 247
Luigi Memo and Emanuele Basile
23 Invest in Prenatal Life: A High-Yield Stock .................... 251
M. Enrichi
Erratum ..................................................... E1
Introduction: Pain and Suffering
from the Womb Onwards?
What is pain? To paraphrase Augustine of Hippo: “If nobody asks me, I know; if I
try to explain it, I don’t know” (Confessions 11.14.17).
Pain is the only sensation that we cannot remember. We can remember the stimu-
lus that provoked pain or its organic consequences, but we cannot recall pain as we
recall flavours, noises, and images. It is difficult to describe pain, but we can describe
its features, which are of three types:
• The stimulus. We recognize a stimulus as potentially painful even if we cannot
see the sufferer’s reaction, because we appreciate its intensity and nature (e.g. a
lancet on the skin).
• Bodily consequences. Examples are lesions, hormone production (cortisol,
endorphins, epinephrine), and changes in physiological parameters (heart rate,
blood pressure, sweating).
• Behavioural changes.
All three of these features are evident in the case of newborns. Newborns are
“psychobiologically social beings” [1] and can feel anxiety and fear. This book will
show that they can feel pain even before birth.
But what is “pain”—a term often confused with “suffering”? Cassell wrote:
“A search in the medical and social-science literature did not help me in understand-
ing what suffering is: the word ‘suffering’ was often coupled with the word ‘pain’,
as in ‘pain and suffering’” [2]. Although pain and suffering are closely identified in
the medical literature, they are phenomenologically distinct. “Pain has a felt quality,
a felt intensity. Suffering, on the other hand, is not located in the body” [3], or “Pain
refers to extreme physical distress and comes in many varieties: throbbing, piercing,
burning. Suffering, by contrast, refers to a state of psychological burden or oppres-
sion, typically marked by fear, dread or anxiety” [4].
“Suffering can be defined as the state of severe distress associated with events
that threaten the intactness of the person” [2]. Schopenhauer usefully defined suf-
fering as “the gap between what we demand or expect from life and what actually
comes to us” [5]—an idea recently echoed by van Hoof: “Suffering is to be under-
stood as frustration of the tendency towards fulfilment of the various aspects of our
being” [6]. Do newborns have desires? Clinical observation of newborns is enough
to suggest a nature marked by deep desires: growing, feeding, seeking milk, and
ix
x Introduction: Pain and Suffering from the Womb Onwards?
crying to obtain it are signs of a desire for health [7, 8]. But desires are a person’s
main feature are newborns and fetuses persons? Boethius, in his Liber de persona et
duabus naturis, defined personhood as “an individual substance of rational nature”
(naturae rationalis individua substantia; Chap. 111, PL 64, 1343), and newborns/
fetuses are individuals and with a rational nature, though they do not yet exercise
it. Thus, it is reasonable to say that newborns and even fetuses are persons, with all
their unexpressed desires and, consequently, suffering.
This book can help us to define what pain and suffering are. Pain is a fundamen-
tally “physical” phenomenon, the clash arising from an attack on one’s physical
integrity, whereas suffering is something broader, with pain as one of its sources
and desire as its condition. We can define it as the clash arising from an attack on
the integrity of one’s self as a person.
In conclusion, we can say that newborns and fetuses can feel pain and suffer [9].
This book will show that their personhood becomes more and more evident with the
acquisition of progressive skills beginning in prenatal life. Recognizing human dig-
nity and human suffering from life in the womb onwards is a clinical duty in the
service of better treatment. This book has been written to overcome anything that
would come between an awareness of this fact and the shared effort to provide
effective treatment of pain and stress in the preverbal patient.
Siena, Italy G. Buonocore
Siena, Italy C.V. Bellieni
References
1 . Als H, Duffy FH, McAnulty GB (1996) Effectiveness of individualised neurode-
velopmental care in the newborn intensive care unit. Acta Paediatr Suppl 416:
21–30
2. Cassell EJ (1982) The nature of suffering and the goals of medicine. N Engl J
Med 306:639–645
3. Portmann J (1999) Abortion: three rival versions of suffering. Camb Q Healthc
Ethics 8:489–497
4. Callahan D (1996) The goals of medicine: setting new priorities. The Hastings
Center Report Special Suppl 6:S9–S13
5 . Schopenhauer A (1965) On the basis of morality. Trans. Payne EFJ. Indianapolis,
BobbsMerrill, p 19
6. Van Hoof S (1998) Suffering and the goals of medicine. Med Health Care Philos
1:125–131
7. Bellieni CV, Bagnoli F, Buonocore G (2003) Alone no more: pain in premature
children. Ethics Med 19:5–9
8. Bellieni CV, Bagnoli F, Perrone S, et al (2002) Effect of multisensory stimulation
on analgesia in term neonates: a randomized controlled trial. Pediatr Res
51:460–463
9. Bellieni C (2005) Pain definitions revised: newborns not only feel pain, they also
suffer. Ethics Med 21:5–9
Note to the Second and Updated Edition
Ten years after, we need to double the success of the first edition of Neonatal Pain.
Several progresses appeared in the field of neonatal pain treatment and assessment,
and they required a new and fresh update. This edition faces the problem of long-
term consequences of pain on the infantile brain, of pain treatment during prenatal
surgery, and much more.
We thank all the authors of the first edition for their patient work and all the new
authors for their stimulating approach to this discussion.
We sincerely look forwards to knowing the readers’ reactions towards this new
book.
Carlo Valerio Bellieni, Giuseppe Buonocore
xi