Neonatal Physiotherapy Interventions in Reducing Acute Procedural Pain and Improving Neuromotor Development in a Preterm Neonate

Background: Repeated painful procedures are very common in neonatal intensive care unit (NICU). A combination of multisensory stimulation (MSS) and soft tissue therapy (STT) potentiates each other's analgesic effects and helps in reducing procedural pain. Case Description: Thirty-six weeks and 2 days old preterm neonate was undergoing venipuncture at right forearm for diagnostic purpose when admitted in NICU because of prematurity. MSS and STT were provided once in a day for 30 minutes, total for 5 days for pain relief and improvement in neuromotor outcomes. Outcomes: Pain intensity was assessed with Preterm Infant Pain Profile-Revised (PIPP-R) and Neonatal Pain, Agitation and Sedation Scale (N-PASS). The neuromotor outcomes were also assessed with Infant Neurological International Battery (INFANIB) and Premie-Neuro Scale. All the measurements were taken at baseline and after 5 days of intervention. The pain scores, PIPP-R and N-PASS, were measured at 30 seconds, 60 seconds, 90 seconds, and 120 seconds before the intervention. The PIPP-R: 7, 7, 10, and 6, and N-PASS scores before the intervention were: 2, 9, 4, and 5, respectively. After 5 days of intervention, the pain scores were PIPP-R: 3, 9, 3, and 3, and N-PASS: 3, 3, 4, and 4, respectively. The neuromotor tests, INFANIB and Premie-Neuro, were measured at baseline and postintervention. The scores were INFANIB: 58 and 60, respectively, and Premie-Neuro: 90 and 92, respectively. Discussion/Conclusion: Neonatal physiotherapist may give importance to procedural pain management in NICU settings to promote good clinical practice along with other physiotherapy interventions. Along with pain scores, neuromotor scores were improved after the 5th day of intervention in the preterm neonate. MSS and STT might help in reducing procedural pain and improving neuromotor outcomes after 5 days of intervention among preterm neonates.