Diabetes and perinatal loss, a continuing problem

Need for non-invasive pain reduction strategies in neonates. Sir,The pain perception in neonates has been clearly described. 1,2 During the intensive care of neonates, they are exposed to many procedures, including intubation, IV access, central line placement, chest tube insertion, lumber puncture, catheterization, suprapubic aspiration etc.These procedures are associated with pain and stress.However, no clear guidelines are available for alleviating the distress by premedication during such procedures.Researchers are looking for methods to minimize the pain and distress in neonates during these procedures.Examples include the use of thiopental as premedication before intubation, 3 local anesthetics before heel prick 4 and lumber puncture. 5he goal is to choose a method of analgesia that is non-invasive and less painful.An intramuscular injection before an elective procedure is not acceptable.Similarly, patch therapy with local anesthetics or premedication will be a problem in acute situations, such as immediate intravenous access or emergency intubation.There exists an urgent need for randomized control trials on this issue.The questions are: what type of drug (analgesic, sedative or anesthetics) should be used in what procedures, what should be the mode of administration (IM, IV, ET or non-invasive), and what should be the dose adjusted for gestational age.We look forward to have some answers in near future.