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Pain Management in the NICU Lecture Pack

Brush up on your pain assessment and management skills! Babies in the NICU tend to require numerous painful interventions and research is showing that if that pain is not managed effectively and appropriately, there can be long lasting consequences for brain development. Join us as our expert speakers provide a focused look at the latest research and recommendations for assessing and managing pain in neonates. Topics include assessment, pain perception in infancy, effects of pain and anesthesia on the developing brain, and the latest on both pharmacological and non-pharmacological methods of pain relief.

$75.00 USD
Total CE Hours: 5.00   Access Time: 4 Weeks  
Lectures in this bundle (5):
Duration: 60 mins
Bianca Devsam, MasterAdvNursPrac, GradCertNICU, RN, RM
Pain Assessment in Ventilated, Sedated, and Muscle-Relaxed Neonates
Australia Bianca Devsam, MasterAdvNursPrac, GradCertNICU, RN, RM

Bianca completed her undergraduate nursing and midwifery training at the University of Queensland. She has been neonatal nursing for the last six years, and in that time completed her Postgraduate Certificate in Nursing Practice (Neonatal Intensive Care) and her Masters of Advanced Nursing Practice (Minor Thesis) at the University of Melbourne.

In 2016, Bianca participated in a Nursing Research program entitled ‘Building Evidence with Support to Transform (BEST) Practice at the Royal Children’s Hospital (RCH) in Melbourne, Victoria Australia, which were the beginnings of her nursing research journey. She investigated nursing assessment of pain in neonates, and instigated a hospital-wide change in the pain assessment tool utilised in neonates. Since then she has evaluated the clinical utility and inter-rater reliability of the modified Pain Assessment Tool (mPAT) that is now used at the RCH. She is currently a Nursing Research Clinical Nurse Consultant at the RCH.

Objective 1: Explain the complexities of pain assessment in neonates.

Objective 2: Apply the modified Pain Assessment Tool (mPAT) when assessing pain in ventilated, sedated and muscle-relaxed neonates in the clinical setting.

Objective 3: Analyze the latest research regarding neonatal pain assessment and the mPAT.

Australia Bianca Devsam, MasterAdvNursPrac, GradCertNICU, RN, RM

Neonates admitted to the Neonatal Intensive Care Unit (NICU) undergo numerous painful procedures each day, with fewer than one-third receiving analgesia. This is alarming as neonates who are critically ill and in pain are susceptible to developing life-threatening complications, since they cannot maintain homeostasis in a state of stress. Additionally, the cumulative effects of these painful experiences, has significant negative consequences to the neurodevelopment of these vulnerable neonates.

Pain assessment is fundamental to effective pain management although there is currently no universally accepted scale for pain assessment in neonates, and more evidence is required to determine the reliability and validity of existing pain assessment tools. Additionally, health clinicians do not know if the physiological and behavioural indicators of pain they observe are specific to pain, or a manifestation of the neonates medical condition, disease process, agitation, distress, fear, stress or even sadness. This issue is compounded when the expressive capacity of critically ill neonates is compromised by the administration of heavy sedation and muscle-relaxants. This presentation explores some of the complexities of pain assessment in neonates followed by practical advice for the health clinician, including a look at the modified Pain Assessment Tool (mPAT) and how it can help improve neonatal pain assessment in the clinical setting.

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Duration: 60 mins
Neonatal Pain: The Evidence and the Knowledge to Action Gap

Dr Denise Harrison is a Professor and the Chair in Nursing Care of Children, Youth and Families at the University of Ottawa and Children's Hospital of Eastern Ontario (CHEO), Canada. Her program of research titled Be Sweet to Babies focuses on pain management for neonates, infants and young children. She has co-produced a series of videos with parents and clinicians in multiple languages, showing effective pain management during painful procedures for newborns and infants up to one year of age. The videos are being used as knowledge translation interventions, and their effectiveness of implementation is being evaluated in diverse settings. Dr Harrison is an advocate for sick and healthy babies and their families, and argues that no non-urgent painful procedure should be performed without use of evidence-based pain management strategies.

Objective 1: Describe analgesic effects of breastfeeding, skin-skin care and sweet solutions

Objective 2: Use the Be Sweet to Babies videos in their diverse clinical settings

Objective 3: Demonstrate support and advocacy for mothers, fathers, other family members to hold their babies skin-skin during non-urgent blood work when feasible and appropriate.


There is abundant high-quality evidence demonstrating analgesic effects of breastfeeding, skin-skin care and sweet solutions (sucrose and glucose) for newborn infants during short lasting acute painful procedures. There is also growing and concerning evidence about long lasting adverse effects of painful procedures. Yet, studies continue to show that painful procedures are routinely performed on newborns with no pain management. This presentation will include an overview of the three recommended newborn procedural pain management strategies and the knowledge to action (KTA) gap concerning utilization of evidence in practice. Barriers and facilitators to using the three strategies in diverse clinical settings will be discussed and knowledge translation strategies being used to address KTA gaps in pain management in newborns will be presented.

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Duration: 60 mins
Long-Term Effects of Neonatal Pain on the Developing Brain

I am currently a Postdoctoral Scholar co-supervised by Dr. Melanie Noel (Psychologist and Assistant Professor in Psychology, University of Calgary) and Dr. Nivez Rasic (Anesthesiologist and Clinical Lead of the Vi Riddell Children’s Pain & Rehabilitation Program, Alberta Children’s Hospital) in the Department of Anesthesiology, Perioperative and Pain Medicine at the University of Calgary, Alberta Canada. In 2015, I completed a PhD in Neuroscience at the University of British Columbia under the supervision of Dr. Ruth Grunau (Psychologist and Professor in Pediatrics, University of British Columbia, Vancouver, British Columbia) and Dr. Steven Miller (Head of Neurology at the Hospital for Sick Children, and Professor in Pediatrics, University of Toronto, Toronto, Ontario). I have been studying pediatric pain in both healthy and clinical populations for over a decade. I have experience and expertise in both acute and chronic pain, and the transitions in-between, from infancy through to early adulthood.

Objective 1: Describe why infants born very preterm are particularly vulnerable to repeated exposure neonatal pain.

Objective 2: Describe up-to-date knowledge of the literature demonstrating the negative long-term effects of neonatal pain on the brain and neurodevelopmental outcomes of children born very preterm.

Objective 3: Discuss evidence-based interventions for neonatal pain in infants born very preterm including their efficacy and limitations.


As part of their lifesaving care, infants born very preterm (8 to 16 weeks too early) undergo repeated invasive procedures for what can be weeks to months on end. There is accumulating evidence demonstrating the negative long-term effects of repeated neonatal pain on the developing brain and neurodevelopmental outcomes of children born very preterm. The presentation will outline why infants born ≤32 weeks gestational age, are particularly vulnerable to repeated exposure to invasive procedures. I will highlight the latest literature exploring the long-term effects of neonatal pain on the brain and neurodevelopmental outcomes of both children born very preterm and animal models of prematurity. Furthermore, I will discuss evidence-based pain prevention and intervention strategies applied during neonatal intensive care. It is imperative that we continue to find ways to reduce the negative long-term effects of pain within this vulnerable population of infants born very-preterm.

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Duration: 60 mins
Rebeccah Slater, BSc, MSc, PhD, Professor
The Development of Human Pain
United Kingdom Rebeccah Slater, BSc, MSc, PhD, Professor

2. Rebeccah Slater is a Senior Wellcome Trust Research Fellow and Professor of Paediatric Neuroscience at the University of Oxford. She is also a Professorial Fellow st St John’s College, Oxford. Rebeccah studied Physics (BSc) at Imperial College and Neuroscience (MSc) at UCL, and in 2007 was awarded her PhD at UCL under the supervision of Prof Maria Fitzgerald. Since 2013 Rebeccah has led the Paediatric Neuroimaging Research Group, which focuses on understanding the mechanisms that underlie the development of pain perception in the human infant. She uses a range of non-invasive brain imaging tools, including EEG and fMRI, to explore the development of pain perception. She has published many articles about infant pain and has been passionately involved in science communication and the public engagement of science. She has taken part in discussions on TV and radio, including BBC Radio 4 and the BBC World Service. Rebeccah holds an honorary research position in the Neonatal Care Services at the John Radcliffe Children’s Hospital and is a PI at the Wellcome Centre for Integrative Neuroimaging (WIN).

Objective 1: Discuss how brain imaging can be used to better understand the development of pain perception in the human infant.

Objective 2: Discuss how infant pain experience can be influenced by intrinsic and external influences.

Objective 3: Analyze novel clinical trials to demonstrate how analgesic efficacy and safety of drugs can be measured in human infants.

United Kingdom Rebeccah Slater, BSc, MSc, PhD, Professor

Pain in infancy has negative long-term consequences and its prevention is a clinical priority, but adequate pain treatment requires mechanistic understanding of the structural and functional development of human pain-related brain circuitry. Recent scientific and technological advances provide insights into how noxious information is transmitted to the infant brain, providing a platform to ask how intrinsic brain network connectivity and the environment affect pain-related brain activity, behaviour and ultimately pain perception in the developing infant nervous system.

As infants cannot describe their pain, we are reliant on alternative methods to measure their pain experience. My goal is to understand the mechanisms that drive and modulate pain perception in early human development. In this talk, I will discuss a series of mechanistic studies in human infants that aim to better understand the development of human pain. I will address fundamental questions regarding the functional development of pain-related brain activity and behavior, and will discuss whether inherent individual differences in how the infant brain behaves at rest drives differences in pain vulnerability. Finally, I will describe how these mechanistic insights can be used to test new analgesic treatment options and improve the treatment of infant pain.

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Duration: 60 mins
Jim Thigpen, PharmD, BCPS
Clinical Pain Management in the Neonate
USA Jim Thigpen, PharmD, BCPS

Jim Thigpen, PharmD, BCPS, is Associate Professor, Department of Pharmacy Practice, Bill Gatton College of Pharmacy at East Tennessee State University.  He received his B.S. and PharmD degrees from the Medical University of South Carolina.  He completed a specialty residency in pediatrics and has served as a pediatric clinical pharmacist for the last 25 years.  He has a passion for educating student pharmacists, residents, and clinical team members in all aspects of pediatric pharmacotherapy.  He was awarded the Faculty Teaching Award in 2011 and the Outstanding Teacher Award by the classes of 2010, 2011 and 2015. His practice and research interests are broad and include neonatal abstinence syndrome, neonatal sepsis, medications in breastfeeding, among others. He has had the honor of speaking at the Academy of Neonatal Nursing Conference in 2012, 2014 and 2016.

Objective 1: Discuss the conditions that the neonate face and that cause pain and discomfort and which medications are the most appropriate depending on the clinical condition and patient parameters.

Objective 2: Identify the most commonly used medications for pain in the neonate and what factors would lead the caregiver to alter therapy and/or dose.

Objective 3: Describe the specific classes of pain medications that are appropriate for use in the neonate and describe the toxicities and administration issues.

USA Jim Thigpen, PharmD, BCPS

Managing pain and discomfort in the neonatal patient is complex in many ways. Immature metabolic processes can lead to unpredictable effects that may lead to either negative effects and/or unsuccessful control of pain. As we have learned more about these metabolic pathways and how these medications are utilized, more evidence now exists that determine when one medication may be preferred over another depending on the clinical situation. Looking into the future of drug dosing, we may soon be able to determine a neonate's pharmacogenomic profile in order to provide true personalized medicine.

This presentation will help the learner understand the complexities of these challenges and provide them with the information and the tools to provide state-of-the-art medical care.

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CERPs - Continuing Education Recognition Points
GOLD Conferences has been designated as a Long Term Provider of CERPs by the IBLCE--Approval #CLT114-07. This program is approved for 5 R-CERPs.

CMEs - Continuing Medical Education Credits for Physicians & Nurses
The AAFP has reviewed this activity and deemed it acceptable for AAFP credit. Term of approval is from 05/31/2022 to 05/31/2023. Physicians should claim only the credit commensurate with the extent of their participation in the activity. This activity is approved for  5 AAFP Prescribed credits.

Nursing Contact Hours
This nursing continuing professional development activity was approved by American Nurses Association Massachusetts, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Nurse Contact Hours will be valid through to 06/01/2023.
This lecture is approved for 5 Nurse Contact Hours.

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If you have already participated in this program, you are not eligible to receive additional credits for viewing it again. Please send us an email to [email protected] if you have any questions.

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Pain Management in the NICU

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