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In Reply: Dr Kumar expresses concern that our epidemiologic study may encourage the use of pharmacological analgesia for procedures that may not be associated with significant pain. He notes that in the NEOPAIN trial, morphine therapy did not improve clinical outcomes in ventilated preterm infants and that open-label morphine doses were associated with significant adverse effects.^1-2

The Comment in our study stated that analgesic treatments should be individualized and tailored to the invasiveness or presumed pain intensity of each procedure. The study did not recommend the use of pharmacological analgesia for all minor procedures; indeed, morphine is ineffective for procedural pain in preterm neonates.³ Furthermore, in our article we cautioned that administration of analgesic drugs for stressful, nonpainful procedures is inappropriate, since the adverse effects of these agents certainly outweigh the benefits in this context. For minor procedures, the use of nonpharmacological interventions (eg, oral sweet solutions, sucking, breastfeeding) are . . . [Full Text of this Article]

Ricardo Carbajal, MD, PhD
ricardo.carbajal@trs.aphp.fr
Centre National de Ressources de lutte contre la Douleur
Hôpital d’enfants Armand Trousseau
Paris, France

K. J. S. Anand, MBBS, DPhil
Department of Pediatrics
University of Arkansas for Medical Sciences
Little Rock

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