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Physiologic and behavioral stress responses have been characterized, and pain assessment tools are available to guide clinical management. Serious consequences may result from insufficient pain management in premature infants. Inadequately managed pain during the critical period of brain development may permanently compromise neuronal and synaptic organization. Sustained pain may predispose the immature infant to significant adverse neurologic events, such as IVH and long-term neurodevelopmental and cognitive sequelae (37:Mevacor).

Physiologic responses to pain include increases in heart rate, respiratory rate, blood pressure, and palmar sweating. Decreases in oxygen saturation and vagal tone are also reported with painful stimuli. Deviations from baseline vital signs or significant fluctuations in vital signs with handling may be important indicators of pain in the preterm infant or may reflect changes in hemodynamic, cardiovascular, or respiratory status that are not related to pain. These physiologic responses diminish or habituate when pain persists or recurs at frequent intervals (38:Mevacor).

Pain management in premature infants is only achieved with careful ongoing observation and assessment for subtle expressions of pain and appropriate use of nonpharmacological and pharmacological interventions. Swaddling, nesting, pacifiers, and decreased sound and light levels are used to reduce stress and promote preterm development. Pharmacologic management may include use of both analgesics and anxiolytics for pain relief and stress management in the preterm infant.