Impact of Pain and Stress on Developing Brain and Correlation with Outcome

Critically ill neonates are exposed to numerous painful procedures as part of lifesaving intensive care. These exposures occur during a period of brain maturation and growth. Pain pathways are still maturing and developing at the time of painful exposures. Repetitive early life exposure to painful procedures has been associated with alterations in brain maturation and growth and poorer neurodevelopmental outcomes; the impact of early life pain appears to persist until at least school age. However, commonly used analgesic medications to treat pain in neonates have also been associated with altered brain maturation and poorer neurodevelopmental outcomes. In this chapter, we review the neurobiology of pain in the developing brain, neonatal pain assessment methods, and associations of neonatal pain and analgesia exposure with brain maturation and neurodevelopmental outcomes.