Systematic Reviews
Copyright ©The Author(s) 2021.
World J Clin Cases. Jul 26, 2021; 9(21): 5921-5931
Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5921
Table 1 Search strategy for PubMed
#1“Pain” [Mesh]390.237
#2“Acute Pain” [Mesh]2.063
#3“Pain Management” [Mesh]33.044
#4#1 OR #2 OR #3402.906
#5“Infant, Newborn” [Mesh]600.745
#6"Intensive Care Units, Neonatal" [Mesh]14.373
#7“Nursing Care” [Mesh]134.280
#8#4 AND #5 AND #6 AND #748
#9#8 Filters: Full text; published in the last 10 yr 19
Table 2 Studies characteristics included in the review
Level of Evidence
Research Design
Pain Assessment
Pain Management
Painful Procedures
Gonzalez et al[3]IaSystematic reviewScales: NIPS, PIPP, CRIES, NFCS, COMFORTNPI: Environmental, behavioral and nutritional intervention: sucrose, dummy (non-nutritive suction), kangaroo method or skin to skin.PI: Paracetamol, morphine, ketamine, metamizole, thiopental, chloral hydrate…Venipuncture, lumbar/heel puncture, peripheral/central venous catheter insertion, umbilical catheterization, injections, aspiration, orogastric catheterizationTo know the neonatal pain impact and its treatment in painful procedures. Purpose: To sensitize health professionals about pain management in NBs
Avila-Alvarez et al[21]IIIMulticenter, observational, longitudinal and prospective studyNANPI: Sweet oral solution: Sucrose (most common) and glucose. PI: Fentanyl (most used), midazolam, morphine, paracetamolInvasive and non-invasive mechanical ventilationTo determine the clinical practice in relation to sedation and analgesia in Spanish ICUs and to identify factors associated with the use of drugs
Guzmán et al[10]IIIProspective-descriptive pilot studyObservational: Signs of pain (crying), contraction of facial muscles, heart rate and respiratory rateSentire method: Psychotherapeutic pain management through music and touchClinical procedures, separation from mother, ambient noise > 45 dBAnalyze the effectiveness of the Sentire method
San Martín et al[11]IIIDescriptive correlational cross-sectional studySusan Givens-Bell ScaleNAVenous and arterial puncture, orogastric catheterization, aspiration of secretionsAssess the pain intensity in NB against nursing procedures
Aguilar et al[22]IaSystematic reviewMost employed: PIPP and NIPSNPI: Oral administration of sweet solutions, breastfeeding and kangaroo careHeel puncture, injections and vaccines, venous lines cannulationTo analyze studies that assess the effectiveness of NPIs during painful procedures
Avila-Alvarez et al[5]IIIObservational longitudinal prospective studyMost used scales: NIPS, CRIES and Susan-Givens. Others: PIPP, NPASS, COMFORTPI: Sedative or analgesic medicationInvasive mechanical ventilationTo determine the clinical practice in relation to the assessment of neonatal pain in Spain and the factors associated with the use of scales
Veronez et al[12]IIIQualitative descriptive studyObservation: Crying, facial expression, irritability and agitation. Physiological alterations: Heart rate, blood pressure, respiratory parameters, etcNPI(mild pain): Oral glucose administration, non-nutritive suction, group procedures, environmental measuresPI (severe pain): Non-opioid and opioid analgesicsVenous puncture, capillary glycemia, adhesive removal, tracheal aspiration, dressings…Describe the perception of neonatal pain by ICU nursing professionals
Do Prado et al[13]IaSystematic reviewPhysiological and behavioral alterations. Scales: NIPS, NFCS, PIPP, CRIES, N-PASNPI: Oral glucose and non-nutritive suction (most used), environmental and postural care, breastfeeding… PI: NSAIDs, opioids, sedatives, local anestheticsVenipuncture, blood collection, gastric catheterization, intubation…To analyze the Brazilian scientific production on the evaluation and therapeutic approach of pain in newborns admitted to NICU
Thomé et al[14]IIICross-sectional studyNIPS scaleNAOrotracheal tube and airway aspiration, venipuncture, intubation and insertion of PICCAssess pain in NBs admitted to the NICU during invasive procedures
Do Nascimento et al[15]IIIDescriptive exploratory study with a qualitative approachPhysiological and behavioral responses. Scales: NFCS, NIPS and PIPPNPI: Non-nutritive suction, positioning and containment. PI: Opioids, topical analgesics and sedativesDiagnostic, surgical and therapeutic procedures: Venipuncture, capillary blood glucose, improper management, orotracheal aspiration…Identify how the nursing staff assesses and manages NB pain in the NICU
Costa et al[16]IIIDescriptive cross-sectional studyScales: NIPS, CRIES. Physiological and behavioral alterationsNPI: Oral glucose, non-nutritive sucking and laying. PI: Paracetamol, fentanyl and morphineVenous punctures, tracheal aspirations, surgeriesVerify the nurses knowledge and practices about NBs pain management admitted to the NICU
Bonolo et al[17]IIIDescriptive exploratory studyPhysiological and behavioral indicators: Heart rate, facial expression, cryingScales: CRIES, PIPP, NIPS, NFCS, N-PASSNPI: Positioning, non-nutritive suction, environmental measures. PI: Opioids, NSAIDs, local anestheticsVenipuncture, overhandling, heel stick, blood draw, aspirationTo characterize the nursing staff and identify how it assesses and manages pain for preterm newborns
Alves et al[18]IIIConvergent care studyEscala: PASVital signs daily assessmentNPI: Reducing environmental stimulus, grouping procedures and promoting sleep, kangaroo mother care, containment during procedures, administration of oral glucose, non-nutritive suckingEnvironmental stimulus and invasive procedures: Venous/arterial puncture, oro/nasogastric catheterization, endotracheal aspiration, lumbar punctureDevelop a nursing care plan based on non-pharmacological methods for neonatal pain treatment in ICUs.
Assunçao et al[19]IaExploratory qualitative bibliographic reviewPhysiological indicators (heart rate, respiratory rate, oxygen saturation) and behavioral (crying, facial expression and motor activity). Scales: NFCS, NIPS, PIPPNPI: Non-nutritive suction, oral glucose/sucrose, positioning, skin-to-skin contact, environmental measures… PI: Opioids (morphine, fentanyl) non-opioids (acetaminophen, dipyrone) and sedatives (propofol, midazolam, diazepam)Mechanical ventilation, postoperative period, insertion of central catheter and thoracic drainsAnalyze the evaluation and intervention methods of neonatal pain and reflect on the nurse competence in the control and management of pain
Stevens et al[24]IaLiterature review of randomized control trialsScales: PIPP, DAN, NIPS, NFCS, NAPI, N-PASS, BPSN. Physiological and behavioral indicatorsNPI: Sucrose administration (most effective in combination with other interventions, such as non-nutritive sucking)Heel puncture, venous/arterial puncture, injections, bladder and nasogastric catheterization, circumcision, retinopathy of prematurity eye examTo determine the efficacy, dose and method of sucrose administration for pain relief during procedures in the NB
Desai et al[25]IIIScales: N-PASS and NIPSNALaboratory tests, venous/arterial puncture, intubation, aspirations…To improve newborns acute and chronic pain measurements in a NICU by implementing the N-PASS scale
Santos et al[20]IIIQualitative descriptive studyPhysiological and behavioral indicators (heart rate, breath rate, crying, facial expression..)NPI: Containment, environmental measures (light and noise), touch, skin-to-skin contact, non-nutritive suction and glucoseVenous punctures, orogastric and bladder catheterization, capillary blood glucose, dressings, airway aspiration, orotracheal intubationAnalyze the parameters used by the nursing team to assess pain and intervention in the premature newborn
Dionysakopoulo et al[23]IIICross-sectional studyMost used scales: NIPS, PIPP Others: CRIES, NFCS, OPS, PAT, N-PASSNAVenipuncture, airway aspiration, tube placement and removal…Evaluation and validation of scales (NIPS-PIPP) in hospitalized newborns in two Greek ICUs