Prolonged pain in premature neonates hospitalised in the NICU: A principle based concept analysis

BACKGROUND: Premature neonates in neonatal intensive care units face frequent exposure to noxious stimuli, leading to acute, prolonged, or chronic pain. Despite its impact, prolonged pain remains poorly defined and managed due to inconsistent terminology in the literature and lack of understanding in the scientific and clinical communities. OBJECTIVE: This concept analysis seeks to establish a clear theoretical definition of prolonged pain in premature neonates hospitalised in neonatal intensive care units. METHODS: This concept analysis follows the principle-based (epistemology, pragmatic, linguistic and logic) concept analysis methodology described by Smith and Mörelius (2021) using a phased approach with quality evaluation. A systematic search was conducted in ten multidisciplinary health related databases, the grey literature, as well as manual searches of references. Articles were systematically screened two independent reviewers. A hybrid approach was used for the analysis, more specifically, deductive analysis was used for the epistemological principle using Anand's (2017) theoretical pain framework and inductive analysis was used for the pragmatic, linguistic and logic principles. RESULTS: This analysis encompassed 81 articles published between 1997 and 2026, revealing theoretical convergence elements pertaining to the principles of epistemology, pragmatism, linguistics and logic. A comprehensive definition emerged from the conceptual components (preconditions, characteristics and outcomes) informed by the four principles. IMPLICATION FOR PRACTICE: This definition will improve the identification, evaluation, and treatment of prolonged pain in hospitalised premature infants, while standardising pain taxonomy in premature infants and enhancing both the scientific and clinical understanding of their pain experiences.