Newborns in intensive care units may undergo hundreds of painful or stressful procedures — usually without painkillers, a study published today says.

On each day in intensive care, babies underwent an average of 16 procedures, such as needle sticks or bandage removals, according to the study in the Journal of the American Medical Association. Because of the difficulty of drawing blood from such tiny veins, one procedure could actually involve 10 to 15 needle sticks.

One baby in the study had 95 "heel sticks" in two weeks, the study shows.

"This is barbaric," says co-author K.J.S. Anand, a professor at the University of Arkansas for Medical Sciences.

Anand says doctors have a number of ways to relieve infant pain: by providing acetaminophen or other drugs, anesthetic creams or even a small dose of sugar, which blocks pain signals in the brain. "Kangaroo care," in which parents hold an undressed baby on their bare chests with as much skin contact as possible, also blocks pain signals and provides comfort.

Yet hospital staff provided analgesia in only 20 percent of procedures, according to the French-led study of 430 newborns, conducted in hospitals around Paris. The study's main author, Ricardo Carbajal, says the situation is almost certainly the same in the United States.

The American Academy of Pediatrics issued a policy statement in 2006 that recommended specific methods for reducing infant discomfort, including urging hospitals to perform as few painful procedures as possible.

Experts say they have only recently begun to understand infant pain.

Two decades ago, doctors believed newborns didn't experience pain, Anand says. Doctors even performed surgery on infants without pain relief, he says.

Yet babies need pain relief today more than ever, Carbajal says, as more premature infants survive and spend their first few weeks in intensive care. Babies in the study were born an average of seven weeks early.

Many such babies would have died 20 years ago, Carbajal says. Now that doctors have gotten so good at saving lives, it's time for hospitals to enforce policies that reduce pain and stressful procedures, he says.

Neuroscientist Rebeccah Slater of University College London says she hopes the study will change hospital practices.

Unrelieved pain may alter the way children later sense and react to pain, Anand says. Babies who are stuck repeatedly with needles may cry and suffer more during later vaccinations, for example. Their heels also may become hypersensitive, making it harder for them to walk.

This won't hurt ...

Babies are more likely to receive pain relief if their parents are present during procedures, a new study shows. Hospitals can take other measures to ease pain. They could:

• Give a small spoonful of sugar two minutes before the shot.

• Give children's acetaminophen 10 to 15 minutes before.

• Rub the skin with numbing cream.

• Allow the baby to suck on something for comfort.

• Let a parent hold the baby, undressed, on the parent's chest, with as much skin-to-skin contact as possible.


Source: Journal of the American Medical Association and K.J.S. Anand of the University of Arkansas for Medical Sciences.