Giuseppe Buonocore & Carlo V. Bellieni 
Neonatal Pain 
Suffering, Pain, and Risk of Brain Damage in the Fetus and Newborn

For many years we have been talking about a very special patient, the embryo; and the numerous and encouraging successes brought about by embryofetal medicine in the application of both noninvasive therapies and invasive ultrasound-guided tre- ment are well known. On the other hand, it is more and more often the case today that the small patients in neonatal care are premature babies who have come to the world at a particul- ly low gestational age. This allows us to observe the continuity between the ph- es of growth inside the maternal uterus and after birth, which arrives at the correct moment for some lucky fetuses, for others very early, and for some altogether too soon. The neonatologists have the arduous task of sustaining these little patients in their strivings to survive, registering their energy and their vital dynamism, stu- ing the progressive development of the anatomical structures and the improvement of their physiology, verifying day by day the presence – sometimes fragile, so- times extremely resistant, but always human – of a child. A long line research has shown how, from the first moment onwards in that process of perfectly coordinated development that characterizes the life of the embryo, a human being gradually emerges who is increasingly able to interact with his or her environment.

Table of Content

Introduction: Pain and Suffering from the Womb Onwards?.- Introduction: Pain and Suffering from the Womb Onwards?.- Delivery and Pain.- Gonadal Hormones and Pain Modulation.- Stress and Pregnancy: CRF as Biochemical Marker.- Pain Control During Labour.- Fetal Pain.- Ultrasound and Fetal Stress: Study of the Fetal Blink-Startle Reflex Evoked by Acoustic Stimuli.- Prenatal Affective Exchanges and Their Subsequent Effects in Postnatal Life.- Pain in the Fetus.- New Insights into Prenatal Stress: Immediate and Long-Term Effects on the Fetus and Their Timing.- Neonatal Pain.- Pain Assessment and Spectral Analysis of Neonatal Crying.- Analgesic Procedures in Newborns.- Nonpharmacological Treatment of Neonatal Pain.- Sensory Saturation: An Analgesic Method.- Pharmacologic Analgesia in the Newborn.- Physical Stress Risk Agents in Incubators.- Pain: a Risk Factor for Brain Damage.- Neonatal Stressors.- New Insights into Neonatal Hypersensitivity.- From the Gate-Control Theory to Brain Programs for Neonatal Pain.- Pain and Communication.- Disclosure of Pathology to the Newborn’s Family.- Communication of Diagnosis: Pain and Grief in the Experience of Parents of Children with a Congenital Malformation.- Invest in Prenatal Life: a High-Yield Stock.

About the author

Giuseppe Buonocore is full professor of Pediatrics and Director of the Unit of Neonatology of the University Hospital of Siena.
He is involved in the coordination of numerous pan-European clinical trials, as for example of the European scientific network EURAIBI (acronym for EURope Against Infant Brain Injury). His research interests are in the mechanisms of cell damage in the neonatal brain, with special reference to hypoxia, the role of oxidant radicals in neonatal diseases and in babies with birth asphyxia. Additional research interest fields are ethics in perinatology and fetal and neonatal pain prevention. His research team is funded by several agencies including the Italian Ministry of University and Scientific Research -cofinance scheme for research projects of high national interest as well as European Community : NEOBRAIN project.
Author of more than 100 scientific publications in international journals with IF (‘Pediatric Research’, ‘Biology of Neonate’, ‘Free Radical Biology and Medicine’, ‘Acta Pediatrica’, ‘Archives Diseases in Children’, ‘ Journal of Pediatrics’ and others).
He is Past-President of the European Society for Pediatric Research, and currently a member of the Editorial Board of ‘Biology of Neonate’.
Dr. Bellieni, author of a chapter in the Encyclopedia of Pain, works in the University Hospital of Siena as well, and is a member of several national and international societiesm suche as the European Society of Pediatric Research, the Italian Society of Pediatrics and the Italian Society of Neonatology.