We read with interest the article, "Practical approach to neonatal
analgesia"(1). The authors have dealt with many aspects of neonatal
analgesia. Surprisingly, there is no section on the assessment of pain
in neonates.
Many validated pain measures are currently
available to assess pain in both term and preterm infants. Behavioral
and physiological alterations of neonatal pain are incorporated in
these pain measures. Some of the well-validated pain scores include
the Neonatal Facial Coding System, the Objective Pain Scale, CRIES
(crying, requirement for oxygen, increase in heart rate, blood
pressure, facial expression and sleeplessness), Premature Infant Pain
Profile (PIPP) and the Neonatal Infant Pain Scale(2).
The approach to neonatal analgesia could have been
better summarized. The authors have underplayed the role of fentanyl,
alfentanyl and sufentanyl in neonatal analgesia by quoting various
side effects. However, chest wall and glottic rigidity are most often
seen with bolus doses; and fentanyl and its congeners can be safely
used as small frequent doses (0.5 to 10 µg/kg) or as infusions
(1-5 µg/kg/h)(2). EMLA is not an effective analgesic for heel
lancing and the side effect of methemoglobinemia with repeated usage
in preterms has not yet been adequately studied(3).
Srinivas Murki,
Sourabh Dutta,
Neonatology Division,
Department of Pediatrics,
Postgraduate Institute of Medical
Education and Research,
Chandigarh 160 012, India.
