Kuhn P, Strub C, Astruc D
Médecine et Réanimation Néonatale, Service de Pédiatrie 2, Pôle Médico-Chirurgical Pédiatrique, CHU, Hôpital de Hautepierre, 28, avenue Molière, 67098 Strasbourg cedex, France.
Arch Pediatr. 2010 Sep;17 Suppl 3:S59-66. doi: 10.1016/S0929-693X(10)70903-9.
Several pain scales are available for newborns, but the assessment of pain in these preverbal beings, who are in continuing neurological development, remains challenging for healthcare teams. Although neonates at the end of life are particularly vulnerable to pain and discomfort, no assessment tool has been validated in this specific population. The difficulties for assessing pain in this context are copies of those potentially encountered in other situations. Questions arise about the limits of the available scales, about possible alterations of responses to a noxious stimulus in particular contexts (extreme immaturity, brain lesions), about possibly painful situations in palliative care, about the nature of scales to choose. Data show a perception of pain at a cortical level by extremely immature infants and the ability for neonates with significant neurological injury to express pain behaviours. For some potentially painful situations (dyspnoea, gasps, hunger) neonatal data are virtually nonexistent. Fundamental scientific data and clinical data from adults and children can give some answers. One will choose scales for which the staff is trained, easily usable (preference for behavioural scales), validated for all gestational ages, reliable in the event of neurological impairment or sedation. An assessment of prolonged pain (EDIN scale or COMFORT Behaviour scale) combined with measures of acute pain (DAN or NFCS scales) is recommended. These scales should be better validated for populations of newborns and situations that are specific to palliative care. A better assessment of the parental perception and of their distress about the discomfort or pain of their child is warranted.
有几种疼痛量表可用于评估新生儿的疼痛情况，但对于这些正处于持续神经发育阶段且不会言语的婴儿进行疼痛评估，对医疗团队来说仍然具有挑战性。尽管临终新生儿特别容易遭受疼痛和不适，但尚无评估工具在这一特定人群中得到验证。在此背景下评估疼痛的困难与其他情况中可能遇到的困难类似。出现了一些问题，比如现有量表的局限性、在特定情况下（极度不成熟、脑损伤）对有害刺激的反应可能发生的改变、姑息治疗中可能存在的疼痛情况、应选择何种性质的量表等。数据表明，极不成熟的婴儿在皮层水平能感知疼痛，患有严重神经损伤的新生儿有表达疼痛行为的能力。对于一些潜在的疼痛情况（呼吸困难、喘息、饥饿），几乎没有新生儿相关数据。来自成人和儿童的基础科学数据及临床数据能提供一些答案。应选择工作人员接受过培训、易于使用（优先选择行为量表）、适用于所有孕周、在神经功能受损或镇静情况下仍可靠的量表。建议结合急性疼痛测量量表（DAN或NFCS量表）对长期疼痛进行评估（使用EDIN量表或COMFORT行为量表）。这些量表应在新生儿群体和姑息治疗特定情况下得到更好的验证。有必要更好地评估父母对其孩子不适或疼痛的感知及痛苦程度。
