1. PHARMACOLOGIC MANAGEMENT OF NEONATAL PAIN Dr. ARAMESH NEONATOLOGIST AJUMS

2. GENERAL CONSIDERATION 1- Complementary Therapies ENVIRONMENTAL BEHAVIORAL 2- Prophylaxis vs. Pain Management 3- Gestational Maturity 4- Long-Term Complication INTELIGENCE MOTOR FUNCTION BEHAVIOR

3. Local AnestheticsMaximum Dose Lidocaine 0.5% 5mg / kg, SQ Topical EMLA 5%  33-37 wk PMA (> 1.8kg): 0.5 gr for 1-2 h.  > 37 wk PMA (> 2.5 kg): 1gr for 1-2 h.

4. COMMONLY USED ANALGESIC AGENTS IN NEONATES ANALGESICSINTUBATEDNON-INTUBATEDINFUSION IN INTUBATED NEONATES Morphine0.05-0.15 mg /kg (IV /SQ) 0.025 – 0.05 mg /kg (IV / SQ) Fantanyl1-3 ngr/ kg IV (Over 5 min) 0.25- 1 ngr / kg IV (over 5 min) Acetaminophen 10-15 mg /kg Po/Pg /PR Q 6h and/or PRN (Max. Dose : 40 mg /kg/d)

5. COMMONLY USED SEDATIVE AGENTS IN NEONATES SEDATIVESDRUGDOSE Short TermMidazolam0.05 – 0.1 mg/Kg IV / Intra-nasal Chloral Hydrate 20-30 mg/Kg, PO / PG Long TermPhenobarbital Loading : 5-15 mg/Kg PO/PG/IV Maintenance: 3-4 mg/Kg

6. ANALGESIA FOR MINIMALLY INVASIVE PROCEDEERES ProceduresIntubated / ventilatedNon-intubated Arterial Puncture24% Sucrose (0.5 – 1.5 ml) Veni-Puncture24% Sucrose(0.5 – 1.5 ml) Heel- Stick blood Draw24% Sucrose(0.5 – 1.5 ml) Intravenous placement24% Sucrose(0.5 – 1.5 ml) Lumbar puncture 24% Sucrose PO And morphine IV / SQ OR Fentanyl 24% Sucrose PO And EMLA + Lidocaine 0.5% ( If > 34 WK PMA) Dressing change 24% Sucrose PO And morphine IV / SQ OR Fentanyl // ET- Suctioning Morphine OR Fentanyl IV N/A Immunization injections N/A 24% sucrose OR Topical EMLA (In> 34 WK PMA)

7. ANALGESIA FOR INVASIVE PROCEDURES: PRETERM & TERM ProcederesIntuvated/ventilatedNon- intuvatid Intubation (Emergency) NONE Intubation (Elective)Fentanyl / Morphine M. Ventilation:  1 ST day  > 1 day Fentanyl / Morphine N/A Chest tube:  Insertion  In–Place  Removal Lidocaine + M / F Fentanyl / Morphine Lidocaine + M / F Fentanyl / Morphine Umbilical catheter placementFentanyl / Morphine PICCFentanyl / Morphine / EMLA Fentanyl / Morphine

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