Tiny and Vulnerable

"I've seen babies as small as 24 weeks' gestational age show a very clear facial grimace [in response to pain]."
"I hope this article will bring it to the forefront that it is an issue [scientists causing pain to babies during research practices], because I think some people just don't think about it."
Celeste Johnston, nursing professor, McGill University

Fotolia   Almost two-thirds of the 45 “neonate” pain studies published worldwide in the 30 months ending last June gave babies in the control group — the patients used as a comparison to the experimental treatment — either nothing or a placebo, the study reports.

 

Does it say something about the genders' capacity for empathy that it has taken two women to co-author a paper reflecting their study on newborn babies being used for research and in the process being routinely being hurt rather than preparing the babies with some level of anaesthetic beforehand as they would someone old enough to cry "Ow" when they're hurt, gaining the attention required to remind those administering a needle or a lance that they are responsible for a human being's pain?

Celeste Johnston, a professor emeritus at McGill, and her colleague, Carlo Bellieni of Siena's University Hospital, undertook a review of non-pharmacological procedures with the potential to alleviate the pain a baby might feel, such as placing sucrose in the mouth of the child, breastfeeding, having tactile [skin-to-skin] contact with a parent, or the use of a pacifier to remediate pain during research procedures.

They were aghast at the data that concluded that two-third of the "neonate" pain studies in a 30-month period published globally made mention of control group babies; patients utilized as a comparison to the experimental treatment; given either nothing to ameliorate physical distress or a placebo. In some of the studied instances researchers undertaking specific procedures such as eye exams or suctioning of the airways, there is no pain relief proven to be effective.

However, in research trials where evidence clearly demonstrates that pain can be alleviated, focusing on heel pricks or needles to draw blood, 66 percent failed to make any effort to treat control-group babies. It was not all that long ago that the scientific community seemed to think that newborns could not feel pain; a misconstruction which studies in the 1980s put to rest. Even 30 years earlier when Jewish baby boys were circumcised, it was common for the baby to be given a wine-drenched soother.

The two women researchers committed to fostering the understanding that efforts should routinely be made to mediate pain for babies, point out that when preemies are involved, they remain in an intensive care unit, subject to frequent painful procedures. Ruth Grunau, a neuroscientist at University of British Columbia, goes so far as to suggest that the very premature likely suffer developmental problems resulting from the pain suffered in hospital.

A single painful event such as a heel stick can cause blood-saturation levels to drop, a situation responded to of necessity by placing a baby on oxygen. For patients whose heels are the size of an adult fingertip, Dr. Grunau likens a heel stick to a significant source of pain: "It's like sticking a knife in your foot".  

Most trials on pain therapy for babies used comparison groups where the patients received a placebo or nothing at all after being lanced or having been needled with a syringe. Evidence has been brought forward that the pain experienced can contribute to long-term developmental problems. In any event, as far as the two researchers are concerned such practices are clearly unethical, a contradiction of the fundamental principle in medicine that cautions "first do no harm".

While researchers argue they have a requirement to compare pain treatment being studied to a placebo to obtain a clear and unequivocal view of whether the treatment works, the two women whose findings were published in the journal Acta Paediatrica, urge research-ethics boards to withhold approval of such trials, and for medical journals to bypass publishing their results.