Future roles of artificial intelligence in early pain management of newborns

Abstract

The advent of increasingly sophisticated medical technology, surgical interventions, and supportive healthcare measures is raising survival probabilities for babies born premature and/or with life-threatening health conditions. In the United States, this trend is associated with greater numbers of neonatal surgeries and higher admission rates into neonatal intensive care units (NICU) for newborns at all birth weights. Following surgery, current pain management in NICU relies primarily on narcotics (opioids) such as morphine and fentanyl (about 100 times more potent than morphine) that lead to a number of complications, including prolonged stays in NICU for opioid withdrawal. In this paper, we review current practices and challenges for pain assessment and treatment in NICU and outline ongoing efforts using Artificial Intelligence (AI) to support pain- and opioid-sparing approaches for newborns in the future. A major focus for these next-generation approaches to NICU-based pain management is proactive pain mitigation (avoidance) aimed at preventing harm to neonates from both postsurgical pain and opioid withdrawal. AI-based frameworks can use single or multiple combinations of continuous objective variables, that is, facial and body movements, crying frequencies, and physiological data (vital signs), to make high-confidence predictions about time-to-pain onset following postsurgical sedation. Such predictions would create a therapeutic window prior to pain onset for mitigation with non-narcotic pharmaceutical and nonpharmaceutical interventions. These emerging AI-based strategies have the potential to minimize or avoid damage to the neonate's body and psyche from postsurgical pain and opioid withdrawal.

Keywords: neonatal intensive care unit; neonatal pain assessment; neonatal pain prediction; newborn pain management; opioid‐based pain management.

FIGURE 1

Comparison of NOWS incidents per 1000 births in North America

FIGURE 2

Potential benefits of Early Pain Detection (EPD) in neonates. This schematic shows how pain prediction prior to pain onset could create a time window (30‐40 min) for controlling pain using fast‐acting, nonopioid pain medications, for example, intravenous acetaminophen or ibuprofen. The goal of EPD is to “flatten the curve” for the recurring cycle of intermittent postsurgical pain, narcotic treatment, and opioid withdrawal (as shown by larger peaks and valleys), leading to less toxic stress (smaller peaks and valleys) on babies in NICU

FIGURE 3

AI system for early pain detection of neonates. The future multimodal AI system can observe several modalities such as face, body, crying sound, physiological signals, and assess the current pain as well as predict the pain beforehand