The importance of ‘awareness’ for understanding fetal pain |
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Authors: | David J Mellor Tamara J Diesch Alistair J Gunn Laura Bennet |
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Institution: | aRiddet Centre and Institute of Food, Nutrition and Human Health, College of Sciences, Massey University, Palmerston North, New Zealand;bDepartment of Physiology, University of Auckland, Private Bag 92019, Auckland, New Zealand |
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Abstract: | Our understanding of when the fetus can experience pain has been largely shaped by neuroanatomy. However, completion of the cortical nociceptive connections just after mid-gestation is only one part of the story. In addition to critically reviewing evidence for whether the fetus is ever awake or aware, and thus able to truly experience pain, we examine the role of endogenous neuroinhibitors, such as adenosine and pregnanolone, produced within the feto-placental unit that contribute to fetal sleep states, and thus mediate suppression of fetal awareness. The uncritical view that the nature of presumed fetal pain perception can be assessed by reference to the prematurely born infant is challenged. Rigorously controlled studies of invasive procedures and analgesia in the fetus are required to clarify the impact of fetal nociception on postnatal pain sensitivity and neural development, and the potential benefits or harm of using analgesia in this unique setting. |
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Keywords: | Fetus Nociception |
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