Editorial: Measuring and managing pain in the fetus and neonate - a new era and new challenges

In just over three decades, our understanding of the effects of pain in the fetus and newborn has grown immensely. We have progressed from believing that, because of their anatomical and physiological immaturity, neonates were incapable of experiencing pain and responding to painful stimuli [1], to a point where the importance of pain management in neonates is now universally acknowledged. However, while we seek to minimise painful interventions as much as possible, for the majority of babies receiving life-saving intensive care, potentially painful procedures are an unavoidable daily occurrence highlighting the importance of this aspect of care [2]. We have had, for some time in our repertoire, a number of tools for the assessment and management of acute pain [3], though fewer to assess persistent pain [4]. Still the subjective nature of pain makes it challenging, no tool appears perfect, and many important questions remain unanswered. Recent years have seen greater awareness of the importance of preventing and treating pain in babies, yet even in areas where concerted efforts have been made to try to optimise and standardise management, such as the use of pre-medication for endotracheal intubation, translation of evidence into practice has been limited [5]. In addition, advances in science and technology, whilst welcomed, mean that we have to constantly reconsider and anticipate the potential effects of these changes in management on the comfort of our tiny patients. Clinical practice with respect to identification, assessment and treatment of pain remains extremely varied between and within neonatal units worldwide [6,7]. The search therefore continues for optimum ways of recognising and managing pain in vulnerable and sick preterm and term born neonates.