The Misunderstanding that Led to Surgeries on Babies Being Performed without Anesthesia
By: Sehaj Kang
Have you ever been in pain? The searing-hot, blinding white-type of pain that makes you want to yell, scream and cry to stop whatever is causing it? If you have experienced such a thing, you most likely would have been able to communicate your distress and excruciating discomfort to others in order to try and prevent it. However, this very notion - the whole concept of communicating your semblance of pain - is what a newborn infant lacks.
As such, this lack of oral response poses a dead end for health professionals, leaving them to rely on an infant's body language to reach conclusions on their ability to feel pain. Consequently, a slew of experiments were conducted in the 1940s surrounding this very concept. The results showcased that infants did not properly develop their neurological capabilities for pain since they did not respond to pin pricks tests.
A neonatal heel prick test is conducted on newborns to collect a sample of blood, whereby a pinprick puncture in the heel of the foot is made.
As a result, this concept underpinned the notion that babies could not feel pain, which then led doctors and surgeons to perform many invasive operations and surgeries on babies without the use of anesthesia. Instead, a simple muscle relaxant was used to keep the infant from thrashing around. As one can imagine, this notion in itself - of conducting an operation without anesthesia - sounds very gruesome and unethical. However, that’s exactly what happened for many years. While the procedures such preemies underwent only became longer, more invasive and complicated, the process without anesthesia was accompanied with great suffering and emotional distress.
You might wonder how someone could stomach the thought of operating on a child without anesthesia? Well, it is said that many surgeons “developed an attitude of emotional detachment and dispassion”, yet it is still quite mind boggling how far this would have gotten someone...
It was later on, in the 1980s that this concept of babies not being able to feel pain began to differ after experimenting with some animal models. The results essentially surrounded the idea that the structural and functional connections with the nervous system required to perceive pain are present from birth. However, the mystery still somewhat remained in that we were not sure if these connections were as tuned as in adults, or if they experience pain the same way. Additionally, clinical investigators also started exploring ways to measure pain in infants since we were able to identify significant responses from babies after heel stick blood tests in the form of changes in heart rate and breathing, crying and grunting, and the release of a hormone known as cortisol. This, paired with other extensive research, eventually led to the conclusion that an infant's pain should also be accurately assessed in the form of a neonatal scoring system like the Premature Infant Profile. The Premature Infant Profile is a pain scoring system for preterm neonates which measures behaviour indicators like facial expressions and other physiological indicators to identify the intensity of a baby’s pain.
As such, these revolutionary findings, along with other extensive experiments conducted in neurology, finally helped health professionals and scientists conclude that babies do, in fact, feel pain. With that being said, in 1987, the American Academy of Pediatricians also “formally declared it unethical to operate on newborns without anesthesia”.
Looking back, it seems like quite the horror story to read about such a dire miscalculation and misunderstanding to have concluded something so extreme about such tender and precious gems, however, like anything, mankind has evolved for the better to reckon our shortcomings.
References:
McRobbie, L. R. (2017, July 29). When babies felt no pain - The Boston Globe. Retrieved from http://www.bostonglobe.com/ideas/2017/07/28/when-babies-felt-pain/Lhk2OKonfR4m3TaNjJWV7M/story.html.
Laura Jones Research Associate in Neuro. (2019, May 21). The mystery of how babies experience pain. Retrieved from https://theconversation.com/the-mystery-of-how-babies-experience-pain-88714
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