A recent review in Clinics in Perinatology outlined a five-step framework for making pain assessment and treatment a more routine part of newborn care.
This could be especially helpful to infants with fetal and neonatal alloimmune thrombocytopenia (FNAIT), who may face repeated procedures soon after birth, from blood draws and IV access to imaging and platelet transfusions.
FNAITFetal and neonatal alloimmune thrombocytopenia A rare condition in which a mother’s immune system attacks fetal platelets, leading to dangerously low platelet levels before and/or after birth. is a complex condition that can emotionally overwhelm affected families. Caregivers may experience significant distress when their baby requires NICUNeonatal intensive care unit A specialized hospital unit for newborns who need close monitoring and treatments such as platelet transfusions. admission — a process that may involve multiple blood draws, IV access, imaging studies, platelet transfusions, and close monitoring in the immediate newborn period. Prior research cited in the review suggests that newborns in NICUs undergo an average of 7.5 to 17.5 painful procedures per day during the first 14 days of life.
Read more about FNAIT treatment and care
Babies cry and become irritable for many reasons, many of them unrelated to pain. But in an environment like this, parents may find themselves repeatedly asking one question: Is my baby in pain?
That uncertainty reflects a broader challenge in neonatal care. In one prospective study cited by the authors, only 10.4% of newborns across 243 NICUs in 18 European countries had daily pain assessments. “Pain assessment should be performed and recorded as a routine vital sign,” the authors wrote.
The review outlines a 5-step neonatal Pain and Analgesics In Newborns (PAIN) ladder that NICU teams may use to reduce avoidable discomfort and treat pain when procedures are necessary. The ladder begins with preventing expected pain, including minimizing repeated procedures when possible.
It then moves to non-drug comfort measures, such as kangaroo care and breastfeeding, followed by medications when pain is mild, moderate, severe or persistent. Clinicians may move up or down the ladder based on the baby’s pain level and any side effects.
For parents navigating FNAIT, the ladder may help explain how NICU teams approach newborn comfort during repeated procedures. Rather than relying on crying alone, clinicians can use structured assessments, non-drug comfort measures, and medications when pain is more severe or persistent.
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