Herramientas para evaluar la nocicepción neonatal intraoperatoria: Revisión sistemática de la literatura

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Fecha de publicación:: 2025

Institución:: Universidad de Caldas

Repositorio:: Repositorio Institucional U. Caldas

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dc.title.none.fl_str_mv	Herramientas para evaluar la nocicepción neonatal intraoperatoria: Revisión sistemática de la literatura
title	Herramientas para evaluar la nocicepción neonatal intraoperatoria: Revisión sistemática de la literatura
spellingShingle	Herramientas para evaluar la nocicepción neonatal intraoperatoria: Revisión sistemática de la literatura 610 - Medicina y salud 3. Ciencias Médicas y de la Salud Neonatos Nocicepción Dimensión del dolor Anestesia Revisión Sistemática Monitoreo Fisiológico Medicina
title_short	Herramientas para evaluar la nocicepción neonatal intraoperatoria: Revisión sistemática de la literatura
title_full	Herramientas para evaluar la nocicepción neonatal intraoperatoria: Revisión sistemática de la literatura
title_fullStr	Herramientas para evaluar la nocicepción neonatal intraoperatoria: Revisión sistemática de la literatura
title_full_unstemmed	Herramientas para evaluar la nocicepción neonatal intraoperatoria: Revisión sistemática de la literatura
title_sort	Herramientas para evaluar la nocicepción neonatal intraoperatoria: Revisión sistemática de la literatura
dc.contributor.none.fl_str_mv	Ocampo Acevedo, Federico Universidad de Caldas Trujillo Mejía, Alexander Arango Gomez, Fernando Mejía Aguilar, Lina Paola Rodríguez, Daniel
dc.subject.none.fl_str_mv	610 - Medicina y salud 3. Ciencias Médicas y de la Salud Neonatos Nocicepción Dimensión del dolor Anestesia Revisión Sistemática Monitoreo Fisiológico Medicina
topic	610 - Medicina y salud 3. Ciencias Médicas y de la Salud Neonatos Nocicepción Dimensión del dolor Anestesia Revisión Sistemática Monitoreo Fisiológico Medicina
description	figuras, tablas
publishDate	2025
dc.date.none.fl_str_mv	2025-02-10T16:11:33Z 2025-02-10T16:11:33Z 2025-02-08
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dc.identifier.none.fl_str_mv	https://repositorio.ucaldas.edu.co/handle/ucaldas/21983 Universidad de Caldas Repositorio Institucional Universidad de Caldas repositorio.ucaldas.edu.co
url	https://repositorio.ucaldas.edu.co/handle/ucaldas/21983
identifier_str_mv	Universidad de Caldas Repositorio Institucional Universidad de Caldas repositorio.ucaldas.edu.co
dc.language.none.fl_str_mv	spa
language	spa
dc.relation.none.fl_str_mv	Departamento Administrativo Nacional de Estadistica. Nacimientos 2021 [Internet]. 2021. Available from: https://www.dane.gov.co/index.php/estadisticas-por-tema/salud/nacimientosy-defunciones/nacimientos/nacimientos-2021 Butler EK, Tran TM, Nagarajan N, Canner J, Fuller AT, Kushner A, et al. Epidemiology of pediatric surgical needs in low-income countries. PLoS One. 2017;12(3):1–9 Hall RW, Anand KJS. Pain Management in Newborns. Clin Perinatol [Internet]. 2014 Dec;41(4):895–924. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0095510814000864 Anand KJS, Brown MJ, Causon RC, Christofides ND, Bloom SR, AynsleyGreen A. Can the human neonate mount an endocrine and metabolic response to surgery? J Pediatr Surg [Internet]. 1985 Feb;20(1):41–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022346885803900 Anand KJS, Sippell WG, Aynsley-Green A. RANDOMISED TRIAL OF FENTANYL ANAESTHESIA IN PRETERM BABIES UNDERGOING SURGERY: EFFECTS ON THE STRESS RESPONSE. Lancet [Internet]. 1987 Jan;329(8524):62–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673687919076 Hall RW, Anand KJS. Short- and Long-term Impact of Neonatal Pain and Stress. Neoreviews [Internet]. 2005 Feb 1;6(2):e69–75. Available from: https://publications.aap.org/neoreviews/article/6/2/e69/88577/Short-andLong-term-Impact-of-Neonatal-Pain-and Walker SM. Long-term effects of neonatal pain. Semin Fetal Neonatal Med [Internet]. 2019 Aug;24(4):101005. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1744165X19300356 Marchant A. “Neonates do not feel pain”: a critical review of the evidence. Biosci Horizons [Internet]. 2014 Sep 25;7:hzu006-hzu006. Available from: https://academic.oup.com/biohorizons/articlelookup/doi/10.1093/biohorizons/hzu006 Schiller RM, Allegaert K, Hunfeld M, van den Bosch GE, van den Anker J, Tibboel D. Analgesics and Sedatives in Critically Ill Newborns and Infants: The Impact on Long-Term Neurodevelopment. J Clin Pharmacol [Internet]. 2018 Oct;58:S140–50. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jcph.1139 Loeser JD, Treede RD. The Kyoto protocol of IASP Basic Pain Terminology. Pain. 2008;137(3):473–7 Maxwell LG, Fraga M V., Malavolta CP. Assessment of Pain in the Newborn. Clin Perinatol [Internet]. 2019 Dec;46(4):693–707. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0095510819300934 Renn CL, Dorsey SG. The Physiology and Processing of Pain. AACN Clin Issues Adv Pract Acute Crit Care [Internet]. 2005 Jul;16(3):277–90. Available from: http://journals.lww.com/00044067-200507000-00002 Zegarra JW. Bases fisiopatológicas del dolor. Acta Médica Peru. 2007;24(2):35–8. Davis PJ, Cladis FP. Smith’s Anesthesia for Infants and Children. 10th ed. Philadelphia: ELSEVIER; 2022. 233-253 p. Oberlander TF, Grunau RE, Fitzgerald C, Whitfield MF. Does Parenchymal Brain Injury Affect Biobehavioral Pain Responses in Very Low Birth Weight Infants at 32 Weeks’ Postconceptional Age? Pediatrics [Internet]. 2002 Sep 1;110(3):570–6. Available from: https://publications.aap.org/pediatrics/article/110/3/570/64147/DoesParenchymal-Brain-Injury-Affect-Biobehavioral Fabrizi L, Slater R, Worley A, Meek J, Boyd S, Olhede S, et al. A Shift in Sensory Processing that Enables the Developing Human Brain to Discriminate Touch from Pain. Curr Biol [Internet]. 2011 Sep;21(18):1552–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0960982211008852 Raffaeli G, Cristofori G, Befani B, De Carli A, Cavallaro G, Fumagalli M, et al. EDIN Scale Implemented by Gestational Age for Pain Assessment in Preterms: A Prospective Study. Biomed Res Int [Internet]. 2017;2017:1–8. Available from: https://www.hindawi.com/journals/bmri/2017/9253710/ Anand KJS. Consensus Statement for the Prevention and Management of Pain in the Newborn. Arch Pediatr Adolesc Med [Internet]. 2001 Feb 21 1;155(2):173. Available from: http://archpedi.jamanetwork.com/article.aspx?doi=10.1001/archpedi.155.2.1 73 Slater R, Cantarella A, Franck L, Meek J, Fitzgerald M. How well do clinical pain assessment tools reflect pain in infants? PLoS Med. 2008;5(6):0928–33 Raeside L. Physiological measures of assessing infant pain: a literature review. Br J Nurs [Internet]. 2011 Nov 23;20(21):1370–6. Available from: http://www.magonlinelibrary.com/doi/10.12968/bjon.2011.20.21.1370 Craig KD, Whitfield MF, Grunau RVE, Linton J, Hadjistavropoulos HD. Pain in the preterm neonate: behavioural and physiological indices. Pain [Internet]. 1993 Mar;52(3):287–99. Available from: https://journals.lww.com/00006396-199303000-00003 Lim BG. Nociception monitoring tools using autonomic tone changes for intraoperative analgesic guidance in pediatric patients. Anesth Pain Med [Internet]. 2019 Oct 31;14(4):380–92. Available from: https://www.anesthpain-med.org/journal/view.php?id=10.17085/apm.2019.14.4.380 Huiku M, Uutela K, van Gils M, Korhonen I, Kymäläinen M, Meriläinen P, et al. Assessment of surgical stress during general anaesthesia. Br J Anaesth [Internet]. 2007 Apr;98(4):447–55. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0007091217354958 Song IK, Ji SH, Kim EH, Lee JH, Kim JT, Kim HS. Comparison of the effect of different infusion rates of sufentanil on surgical stress index during cranial pinning in children under general anaesthesia: A randomized controlled study. BMC Anesthesiol. BMC Anesthesiology; 2017;17(1):1–7 Chen X, Thee C, Gruenewald M, Wnent J, Illies C, Hoecker J, et al. Comparison of Surgical Stress Index-guided Analgesia with Standard Clinical Practice during Routine General Anesthesia. Anesthesiology [Internet]. 2010 May 1;112(5):1175–83. Available from: https://pubs.asahq.org/anesthesiology/article/112/5/1175/9884/Comparisonof-Surgical-Stress-Index-guided Pomeranz B, Macaulay RJ, Caudill MA, Kutz I, Adam D, Gordon D, et al. Assessment of autonomic function in humans by heart rate spectral analysis. Am J Physiol Circ Physiol [Internet]. 1985 Jan 1;248(1):H151–3. Available from: https://www.physiology.org/doi/10.1152/ajpheart.1985.248.1.H151 Jeanne M, Logier R, De Jonckheere J, Tavernier B. Validation of a graphic measurement of heart rate variability to assess analgesia/nociception balance during general anesthesia. In: 2009 Annual International Conference of the IEEE Engineering in Medicine and Biology Society [Internet]. IEEE; 2009. p. 1840–3. Available from: http://ieeexplore.ieee.org/document/5332598/ Constant I, Sabourdin N. Monitoring depth of anesthesia: from consciousness to nociception. A window on subcortical brain activity. Morton N, editor. Pediatr Anesth [Internet]. 2015 Jan;25(1):73–82. Available from: https://onlinelibrary.wiley.com/doi/10.1111/pan.12586 Gjerstad AC, Wagner K, Henrichsen T, Storm H. Skin Conductance Versus the Modified COMFORT Sedation Score as a Measure of Discomfort in Artificially Ventilated Children. Pediatrics [Internet]. 2008 Oct 1;122(4):e848– 53. Available from: https://publications.aap.org/pediatrics/article/122/4/e848/71408/SkinConductance-Versus-the-Modified-COMFORT Sabourdin N, Arnaout M, Louvet N, Guye M-L, Piana F, Constant I. Pain monitoring in anesthetized children: first assessment of skin conductance and analgesia-nociception index at different infusion rates of remifentanil. Davidson A, editor. Pediatr Anesth [Internet]. 2013 Feb;23(2):149–55. Available from: https://onlinelibrary.wiley.com/doi/10.1111/pan.12071 Ranger M, Johnston CC, Limperopoulos C, Rennick JE, du Plessis AJ. Cerebral Near-Infrared Spectroscopy as a Measure of Nociceptive Evoked Activity in Critically III Infants. Pain Res Manag [Internet]. 2011;16(5):331–6. Available from: http://www.hindawi.com/journals/prm/2011/891548/ Xie W, Wang X, Huang R, Chen Y, Guo X. Assessment of four pain scales for evaluating procedural pain in premature infants undergoing heel blood collection. Pediatr Res [Internet]. Springer US; 2021;89(7):1724–31. Available from: http://dx.doi.org/10.1038/s41390-020-1034-z Bishop B. An Extensive Literature Review on Neonatal Pain Assessment & Management [Internet]. University of Arkansas; 2020. Available from: https://scholarworks.uark.edu/nursuht/128 Beltran OA. Revisiones sistemáticas de la literatura. Rev Colomb Gastroenterol. 2005;20(1):60–9. Vasiliadis HS, Martí-Carvajal A, Salanti G. El papel de las revisiones sistemáticas en anestesiología basada en la evidencia. Rev Colomb Anestesiol [Internet]. 2011 May;39(2):163–71. Available from: http://linkinghub.elsevier.com/retrieve/pii/S0120334711920024 Brown EN, Pavone KJ, Naranjo M. Multimodal General Anesthesia. Anesth Analg [Internet]. 2018 Nov;127(5):1246–58. Available from: http://journals.lww.com/00000539-201811000-00023 Marino P. Analgesia and Sedation in the ICU. In: Marino’s The ICU Book. Fourth. Wolters Kluwer; 2014. p. 428–30. Olsson E, Ahl H, Bengtsson K, Vejayaram DN, Norman E, Bruschettini M, et al. The use and reporting of neonatal pain scales: a systematic review of randomized trials. Pain [Internet]. 2021 Feb;162(2):353–60. Available from: https://journals.lww.com/10.1097/j.pain.0000000000002046 Maitra S, Baidya DK, Khanna P, Ray BR, Panda SS, Bajpai M. Acute perioperative pain in neonates: An evidence-based review of neurophysiology and management. Acta Anaesthesiol Taiwanica [Internet]. 2014 Mar;52(1):30–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1875459714000241 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ [Internet]. 2021 Mar 29;n71. Available from: https://www.bmj.com/lookup/doi/10.1136/bmj.n71 Wells G, Shea B, O’Connell D, Peterson J, Welch V. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in metaanalyses [Internet]. The Ottawa Hospital Research Institute. 2011 [cited 2024 Sep 5]. Available from: https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp Buyuktiryaki M, Uras N, Okur N, Oncel MY, Simsek GK, Isik SO, et al. Evaluation of prolonged pain in preterm infants with pneumothorax using heart rate variability analysis and edin (Échelle douleur inconfort nouveauné, neonatal pain and discomfort scale) scores. Korean J Pediatr. 2018;61(10):322–6 Faye PM, De Jonckheere J, Logier R, Kuissi E, Jeanne M, Rakza T, et al. Newborn infant pain assessment using heart rate variability analysis. Clin J Pain. 2010;26(9):777–82 Neumann C, Babasiz T, Straßberger-Nerschbach N, Schindler E, Reuter C, Weinhold L, et al. Comparison of the Newborn Infant Parasympathetic Evaluation (NIPETM) index to changes in heart rate to detect intraoperative nociceptive stimuli in healthy and critically ill children below 2 years: An observational study. Paediatr Anaesth. 2022;32(7):815–24. Yoshida K, Obara S, Inoue S. Analgesia nociception index and high frequency variability index: promising indicators of relative parasympathetic tone. J Anesth [Internet]. 2023 Feb 22;37(1):130–7. Available from: https://link.springer.com/10.1007/s00540-022-03126-8 Zhang K, Wang S, Wu L, Song Y, Cai M, Zhang M, et al. Newborn infant parasympathetic evaluation (NIPE) as a predictor of hemodynamic response in children younger than 2 years under general anesthesia: an observational pilot study. BMC Anesthesiol [Internet]. 2019 Dec 11;19(1):98. Available from: https://bmcanesthesiol.biomedcentral.com/articles/10.1186/s12871- 019-0774-y Sakthivel M, Su V, Nataraja RM, Pacilli M. Newborn and Infant Parasympathetic Evaluation (NIPETM) Monitor for Assessing Pain During Surgery and Interventional Procedures: A Systematic Review. J Pediatr Surg [Internet]. 2024 Apr;59(4):672–7. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022346823007406
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dc.publisher.none.fl_str_mv	Universidad de Caldas Facultad de Ciencias para la Salud Colombia, Caldas, Manizales Especialización en Anestesiología
publisher.none.fl_str_mv	Universidad de Caldas Facultad de Ciencias para la Salud Colombia, Caldas, Manizales Especialización en Anestesiología
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spelling	Herramientas para evaluar la nocicepción neonatal intraoperatoria: Revisión sistemática de la literatura610 - Medicina y salud3. Ciencias Médicas y de la SaludNeonatosNocicepciónDimensión del dolorAnestesiaRevisión SistemáticaMonitoreo FisiológicoMedicinafiguras, tablasAntecedentes: El manejo del dolor y la nocicepción en neonatos ha sido un tema de debate durante décadas. A pesar de que se ha demostrado que los recién nacidos poseen el sustrato biológico necesario para percibir el dolor y que este tiene consecuencias importantes en su desarrollo, su evaluación sigue siendo un desafío, especialmente en contextos quirúrgicos donde la anestesia general limita el uso de escalas conductuales tradicionales. Debido a esto se han desarrollado diferentes herramientas para identificar la nocicepción en los neonatos, utilizando variables fisiológicas relacionadas con el dolor y la nocicepción. El objetivo de esta revisión es evaluar la calidad de la evidencia y el impacto del uso de herramientas para la monitorización nociceptiva en neonatos llevados a cirugía. Métodos: Se realizó una revisión sistemática de la literatura siguiendo las guías PRISMA, incluyendo estudios con neonatos (< 30 días) que midieran nocicepción intraoperatoria o en pacientes bajo sedación y ventilación mecánica. Se excluyeron estudios basados exclusivamente en escalas conductuales, que incluyeran pacientes mayores de 30 días, reportes de caso o artículos de revisión. Se aplicó la herramienta Newcastle-Ottawa Quality Assessment Form para evaluar el riesgo de sesgo y la calidad metodológica de los estudios seleccionados. Resultados: Se evaluaron 5 bases de datos, identificando 136 estudios, de los cuales solo 2 cumplieron los criterios de inclusión, abarcando un total de 51 neonatos. Uno evaluando el NIPE index y el otro el HFVI. En la calificación general de sesgo se encontró un bajo riesgo en todos los estudios. Uno de los estudios evaluó el Newborn Infant Parasympathetic Evaluation (NIPE) index en neonatos pretérmino sometidos a toracostomía, encontrando una correlación significativa entre el NIPE y la escala de dolor EDIN (r = -0,59; p = 0,003), lo que sugiere su utilidad para detectar dolor prolongado en esta población. El segundo estudio analizó el High-Frequency Variability Index (HFVI) en neonatos posquirúrgicos, identificando una correlación negativa fuerte entre el HFVI y el EDIN score (r = -0,7; p < 0,01), con una sensibilidad del 90% y especificidad del 75% para predecir dolor clínicamente significativo (EDIN >5). Conclusión: Existen poca cantidad de estudios que evalúen la medición de nocicepción en neonatos y los pocos disponibles no son ensayos clínicos que permitan un análisis más profundo del efecto de estas herramientas de monitorización nociceptiva. Se requieren investigaciones adicionales que evalúen su impacto en desenlaces clínicos, consumo de opioides y costos en salud. Esta revisión puede servir como base para el desarrollo de futuros ensayos clínicos que permitan dilucidar la utilidad y el impacto de estas herramientas.Background Effective nociception monitoring in neonates undergoing surgery remains a clinical challenge due to the effects of general anesthesia in behavioral scales. Various monitoring tools have been developed to assess nociception during anesthesia, yet their reliability and clinical utility remain unclear. This systematic review aims to evaluate the current evidence on nociception monitoring tools in neonates and their potential impact on postoperative outcomes. Methods A systematic review was conducted in accordance with PRISMA guidelines to evaluate nociception monitoring tools used during neonatal surgery. Databases including PubMed, Scopus and ScienceDirect were searched for studies published until January 2023. Inclusion criteria focused on studies assessing nociception in neonates under general anesthesia or sedation excluding that only apply behavioral scales. Quality assessment followed Newcastle-Ottawa Scale, and data reporting followed the PRISMA guidelines. Results Two studies with 51 participants were included. One study evaluated the NIPE index in preterm neonates undergoing thoracostomy, showing a moderate correlation with the EDIN scale (r = −0.59, p = 0.003). The second study analyzed the HFVI in neonates after major surgery, identifying a strong correlation with the EDIN score (r = −0.7, p < 0.01), with a sensitivity of 90% and specificity of 75% for detecting significant pain (EDIN >5). Conclusions Nociception monitoring tools hold potential for improving neonatal anesthesia management, though current evidence underscores the need for further validation and standardization. The findings highlight significant gaps in tool reliability and clinical integration, suggesting priorities for future research.Introducción / marco teórico / nocicepción y dolor en los neonatos / definición de nocicepción / definición de dolor / fisiología de la nocicepción y el dolor / la nocicepción y el dolor durante el periodo fetal y neonatal / métodos de evaluación de la nocicepción y el dolor en los neonatos / revisión sistemática de la literatura / definición / elaboración de una revisión sistemática de la literatura / planteamiento del problema y justificación / pregunta de investigación / objetivo general / objetivos específicos / metodología / criterios de inclusión / criterios de exclusión modelo de flujograma del proceso de selección de artículos para la revisión sistemática / modelo para tabla de extracción de datos. fuente: elaboración propia / resultados / resultados de la búsqueda sistemática / flujograma del proceso de selección de artículos para la revisión sistemática / calidad de los estudios incluidos / calidad de los estudios incluidos usando la newcastle-ottawa quality assesment scale for cohort studies / metodos de monitorización nociceptiva descritos / newborn infant parasympathetic evaluation (nipe) / high frequency variability index (hfvi) / discusión / conclusiones / conflictos de intereses / bibliografíaEspecializaciónEspecialista en AnestesiologíaUniversidad de CaldasFacultad de Ciencias para la SaludColombia, Caldas, ManizalesEspecialización en AnestesiologíaOcampo Acevedo, FedericoUniversidad de CaldasTrujillo Mejía, AlexanderArango Gomez, FernandoMejía Aguilar, Lina PaolaRodríguez, DanielIbañez Dosman, Juan Pablo2025-02-10T16:11:33Z2025-02-10T16:11:33Z2025-02-08Trabajo de grado - Especializaciónhttp://purl.org/coar/resource_type/c_46ecTextinfo:eu-repo/semantics/reporthttp://purl.org/coar/resource_type/c_93fc26 páginasapplication/pdfapplication/pdfapplication/pdfapplication/pdfhttps://repositorio.ucaldas.edu.co/handle/ucaldas/21983Universidad de CaldasRepositorio Institucional Universidad de Caldasrepositorio.ucaldas.edu.cospaDepartamento Administrativo Nacional de Estadistica. Nacimientos 2021 [Internet]. 2021. Available from: https://www.dane.gov.co/index.php/estadisticas-por-tema/salud/nacimientosy-defunciones/nacimientos/nacimientos-2021Butler EK, Tran TM, Nagarajan N, Canner J, Fuller AT, Kushner A, et al. Epidemiology of pediatric surgical needs in low-income countries. PLoS One. 2017;12(3):1–9Hall RW, Anand KJS. Pain Management in Newborns. Clin Perinatol [Internet]. 2014 Dec;41(4):895–924. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0095510814000864Anand KJS, Brown MJ, Causon RC, Christofides ND, Bloom SR, AynsleyGreen A. Can the human neonate mount an endocrine and metabolic response to surgery? J Pediatr Surg [Internet]. 1985 Feb;20(1):41–8. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0022346885803900Anand KJS, Sippell WG, Aynsley-Green A. RANDOMISED TRIAL OF FENTANYL ANAESTHESIA IN PRETERM BABIES UNDERGOING SURGERY: EFFECTS ON THE STRESS RESPONSE. Lancet [Internet]. 1987 Jan;329(8524):62–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0140673687919076Hall RW, Anand KJS. Short- and Long-term Impact of Neonatal Pain and Stress. Neoreviews [Internet]. 2005 Feb 1;6(2):e69–75. Available from: https://publications.aap.org/neoreviews/article/6/2/e69/88577/Short-andLong-term-Impact-of-Neonatal-Pain-andWalker SM. Long-term effects of neonatal pain. Semin Fetal Neonatal Med [Internet]. 2019 Aug;24(4):101005. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1744165X19300356Marchant A. “Neonates do not feel pain”: a critical review of the evidence. Biosci Horizons [Internet]. 2014 Sep 25;7:hzu006-hzu006. Available from: https://academic.oup.com/biohorizons/articlelookup/doi/10.1093/biohorizons/hzu006Schiller RM, Allegaert K, Hunfeld M, van den Bosch GE, van den Anker J, Tibboel D. Analgesics and Sedatives in Critically Ill Newborns and Infants: The Impact on Long-Term Neurodevelopment. J Clin Pharmacol [Internet]. 2018 Oct;58:S140–50. Available from: https://onlinelibrary.wiley.com/doi/10.1002/jcph.1139Loeser JD, Treede RD. The Kyoto protocol of IASP Basic Pain Terminology. Pain. 2008;137(3):473–7Maxwell LG, Fraga M V., Malavolta CP. Assessment of Pain in the Newborn. Clin Perinatol [Internet]. 2019 Dec;46(4):693–707. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0095510819300934Renn CL, Dorsey SG. The Physiology and Processing of Pain. AACN Clin Issues Adv Pract Acute Crit Care [Internet]. 2005 Jul;16(3):277–90. Available from: http://journals.lww.com/00044067-200507000-00002Zegarra JW. Bases fisiopatológicas del dolor. Acta Médica Peru. 2007;24(2):35–8.Davis PJ, Cladis FP. Smith’s Anesthesia for Infants and Children. 10th ed. Philadelphia: ELSEVIER; 2022. 233-253 p.Oberlander TF, Grunau RE, Fitzgerald C, Whitfield MF. Does Parenchymal Brain Injury Affect Biobehavioral Pain Responses in Very Low Birth Weight Infants at 32 Weeks’ Postconceptional Age? Pediatrics [Internet]. 2002 Sep 1;110(3):570–6. 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Herramientas para evaluar la nocicepción neonatal intraoperatoria: Revisión sistemática de la literatura

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