Procedural Pain Assessments for Neonates at Risk of Neonatal Opioid Withdrawal Syndrome

Objectives: To identify evidence for pain assessment during acute procedures in hospitalized neonates at risk of neonatal opioid withdrawal syndrome (NOWS). Methods: This scoping review was conducted using the JBI scoping review methodology. The search strategy focused on identifying in-patient neonates undergoing acute painful procedures. Databases searched are MEDLINE, CINAHL, Embase, PsycInfo, and Scopus. The relevant data were extracted by two reviewers and the results were summarized in a narrative description and presented in a tabular format including the components of participants, concept, and context (PCC). Results: A total of 22,731 unique studies were screened, with five studies ultimately included. Of these studies, two included neonates at risk of NOWS but did not report pain responses separately. The three remaining studies observed procedural pain in opioid-exposed neonates compared to neonates without opioid exposure during heel lance. Pain assessment methods included physiologic responses and validated composite pain scores. When using composite pain tools, one study showed higher pain response in opioid-exposed neonates, while the other two studies showed the same or lower pain response. For skin conductance the findings from two studies were discrepant, with one study reporting higher pain response in opioid-exposed neonates and the other showing no statistically significant difference. Discussion: There is a need for more studies designed to examine the influence of opioid exposure and withdrawal on pain responding and management in neonates. As there is currently limited evidence to guide clinical care, clinicians should continue to use validated composite pain assessment tools and pain management strategies.