{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T12:03:08Z","timestamp":1785585788726,"version":"3.56.0"},"reference-count":156,"publisher":"American Academy of Pediatrics (AAP)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,1]]},"abstract":"<jats:p>Neonates requiring intensive care and prolonged hospitalizations often undergo procedures and therapies that predispose them to pain, agitation, and delirium. Early recognition and treatment of these symptoms can decrease morbidity and mortality. While nonpharmacologic interventions can be beneficial, they often are insufficient in managing symptoms of pain, agitation, and delirium. Familiarity with the pharmacologic concepts and therapies used to target different pathophysiological mechanisms of pain and agitation will increase the neonatal clinician\u2019s ability to effectively use and tailor these medications to each patient\u2019s needs. In this review, we summarize the pathophysiology, impact, assessment, and management options for each symptom so clinicians can individualize care and use targeted pharmacologic therapies to effectively and safely treat symptoms in various clinical scenarios. We also discuss the importance of protocol use to ensure judicious medication initiation and titration to minimize long-term neurodevelopmental effects of pain, agitation, delirium, and their associated pharmacotherapies.<\/jats:p>","DOI":"10.1542\/neo.26-10-061","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:03:42Z","timestamp":1759277022000},"page":"e679-e703","source":"Crossref","is-referenced-by-count":2,"title":["Sedation, Analgesia, and Delirium in Neonates: A Comprehensive Review"],"prefix":"10.1542","volume":"26","author":[{"given":"Emily C.","family":"Gritz","sequence":"first","affiliation":[{"name":"1Division of Neonatology, Connecticut Children\u2019s Medical Center, Hartford, Connecticut"},{"name":"2Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew M.","family":"Barr","sequence":"additional","affiliation":[{"name":"3Division of Neonatology, Cincinnati Children\u2019s Hospital Medical Center, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"DonnaMaria E.","family":"Cortezzo","sequence":"additional","affiliation":[{"name":"1Division of Neonatology, Connecticut Children\u2019s Medical Center, Hartford, Connecticut"},{"name":"2Department of Pediatrics, University of Connecticut School of Medicine, Farmington, Connecticut"},{"name":"4Division of Pain and Palliative Care, Connecticut Children\u2019s Medical Center, Hartford, Connecticut"},{"name":"5Fetal Care Center, Connecticut Children\u2019s Medical Center, Hartford, Connecticut"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"issue":"4","key":"2025102913014592300_r1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/j.clp.2019.08.006","article-title":"nonpharmacologic management of pain during common needle puncture procedures in infants: current research evidence and practical considerations: an update","volume":"46","author":"McNair","year":"2019","journal-title":"Clin Perinatol."},{"issue":"2","key":"2025102913014592300_r2","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1002\/pne2.12035","article-title":"Historical roots of pain management in infants: A bibliometric analysis using reference publication year spectroscopy","volume":"2","author":"Anand","year":"2020","journal-title":"Paediatr Neonatal Pain."},{"issue":"2","key":"2025102913014592300_r3","doi-asserted-by":"crossref","first-page":"e74","DOI":"10.1097\/PCC.0000000000002873","article-title":"2022 Society of Critical Care Medicine clinical practice guidelines on prevention and management of pain, agitation, neuromuscular blockade, and delirium in critically ill pediatric patients with consideration of the ICU environment and early mobility","volume":"23","author":"Smith","year":"2022","journal-title":"Pediatr Crit Care Med."},{"issue":"2","key":"2025102913014592300_r4","first-page":"454","article-title":"Fetus and Newborn Committee. 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