Gestational Age Associated with Pain Among Very Preterm Infants
Researchers analyzed liveborn infant data from January 2020 to June 2024 to determine prevalence, cause, and treatment strategies for pain among preterm infants.
Lower gestational ages (GAs) translated to higher proportions of very preterm (VPT) infants experiencing pain, according to data published in Pain.1 However, with pain being prominent among most VPT infants, researchers found that treatment was more common among patients with higher GAs and later postnatal ages.
Indeed, prior to the researchers’ study, GA has shown its importance in defining preterm infants. Those that are born before 37 weeks’ gestation are considered preterm, while under 32 week’s gestation is considered VPT, and under 28 weeks is considered extremely preterm (EPT).
“Each year, approximately 15 million infants are born preterm worldwide,” wrote authors of the study.1 “Among these, the survival of [VPT] and particularly [EPT] infants has increased significantly in recent decades, largely because of advancements in neonatal intensive care. Despite this beneficial development, numerous challenges persist, including infant exposure to painful conditions, procedures, and interventions.”
Infants have a unique experience with pain because of the brain's inability to react to it at such a young age. | image credit: _KUBE_ / stock.adobe.com
With both advancements and challenges existing in treating neonatal pain, the authors identified how further research on VPT infant pain is necessary. This specific population is a target for further research on pain because of infants’ vulnerability to pain stemming from their brains not being fully developed. And with a noticeable increase in the treatment of pain worldwide, researchers believe previous knowledge may be outdated.
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In their attempt to further understand preterm infant pain, researchers visualized the proportion of VPT infants with pain and explored its prevalence, causes, assessment, and treatment options. The patient population comprised of all liveborn VPT infants admitted into the NICU and discharged from January 1, 2020, to June 30, 2024.
The final study population consisted of 3686 total VPT infants with a combination of over 185,000 days of neonatal care reported. A total of 2748 (74.6%) infants reported at least 1 day of pain during a hospital stay, which accounted for 28,137 (15.2%) days of care.1
“Any pain during the admission was reported in 198/224 (88.4%) infants of 22 to 23 weeks' GA, corresponding to 3748 of 12,945 days in neonatal care (29.0%), and in 875/1340 (65.3%) infants of 30 to 31 weeks' GA, corresponding to 5319 of 44,639 days in neonatal care (11.9%),” they continued.
Researchers discovered a pattern that as GA was lower, the prevalence of pain increased. Furthermore, they found that at fixed postnatal ages of 6, 13, 20, 27, and 34 days, each 2-week increase in GA translated to fewer infants experiencing pain.
“In this population-based study of VPT infants in Sweden, we observed distinct patterns of causes and prevalence of pain, utilization of pain assessment scales, and pharmacological pain treatment, all intricately linked to [GA]. Higher proportions of infants with pain and more frequent use of pain assessment scales were observed at lower GAs and at earlier postnatal ages,” they wrote.1
There are several reasons why researchers have been attempting to better understand neonatal pain among infants. From improving a fetus’ quality of life to ensuring proper brain development through the visualization of infants’ pain, providers must be knowledgeable of how pain impacts the preterm population because of newborn patients’ inability to self-report pain. In their attempt to further knowledge of preterm infant pain, previous researchers have looked into the importance of GA in visualizing pain.
“Rigorous scientific studies have found that the connections necessary to transmit signals from peripheral sensory nerves to the brain, as well as the brain structures necessary to process those signals, do not develop until at or after 24 weeks of gestation. Because it lacks these connections and structures, a fetus or embryo does not have the physiological capacity to perceive pain until at least this [GA],” according to the American College of Obstetricians and Gynecologists.2
Several treatment options exist for treating preterm infants and providers are well aware of the importance of treating and identifying pain among this neonatal population. Authors of the study suggested that future research focus on GA as a key indicator for various pain outcomes among VPT infants.
“Despite effective analgesia/anesthesia, many VPT infants experience pain. Visualizing pain epidemiology, procedures, conditions, and treatment by postnatal and [GA] may guide clinical management and generate research hypotheses to reduce short and long-term adverse effects,” they concluded.1
READ MORE: Pain Management Resource Center
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