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November 19, 2008

Prevention of Pain in Neonates

JAMA. 2008;300(19):2248-2249. doi:10.1001/jama.2008.610

To the Editor: The prevention of pain in neonates should be the goal of all caregivers, but the evidence for improved clinical outcomes with adequate pain control in newborns has been limited. The results of the NEOPAIN trial, the largest randomized controlled trial to date to evaluate benefits of pain control in critically ill neonates, indicated that morphine infusion in ventilated preterm infants controlled pain but had no beneficial effects on pulmonary outcomes and neurological morbidities.1,2 The use of open-label morphine doses was associated with significant adverse effects.1,2 Potential long-term benefits of pain control on neurodevelopmental outcomes for these infants have not yet been assessed. Summary proceedings from the Neonatal Pain Control Group again identified significant gaps in knowledge and raised concerns about possible adverse effects of analgesic exposure on long-term global developmental outcomes.3