The first few weeks after a preterm baby is born are critical.

Dr. Manon Ranger
Dr. Manon Ranger

Infants in the neonatal intensive care unit (NICU) need to have blood tests and stressful interventions to keep them healthy. However, many of these life-saving medical procedures can also be painful and induce stress in these young babies, which can have lasting effects on brain development.

Dr. Manon Ranger has recently returned to BC Children’s Hospital and UBC to study whether we can develop new ways to reduce the impact of this early life stress.

Her research will be carried out at the BC Women’s Hospital + Health Centre NICU and the Centre for Molecular Medicine and Therapeutics (CMMT) at BC Children’s Hospital Research Institute. She is an assistant Professor at the School of Nursing at the University of British Columbia (UBC).

We spoke to Dr. Ranger about her work and how the treatment of pain in young children has changed over the years.

What got you started on this path?

In the 1970s and 80s the medical community believed babies’ brains weren’t developed enough to feel pain, especially if they were born weeks or months early.

When I was finishing my nursing degree at the University of Montreal in the 1990s, this paradigm was beginning to shift. Researchers were realizing that young babies do feel pain and that early life pain could impact their development. I became fascinated with the ongoing debate about how we should be caring for our very youngest children.

I first dipped my toes into the academic world when I began a masters in nursing at the University of Montreal. While there, I studied whether nurses had the necessary tools to assess and manage pain in the hospital. I loved being able to combine my passion for nursing with research to better care for our patients.

This newfound interest convinced me to pursue a PhD examining how to assess pain in infants. While my previous work involved managing pain in children as a clinical nurse specialist for the acute pain service at the Montreal Children’s Hospital, assessing pain in preterm infants is much more challenging. Some of these tiny patients can’t even cry properly, let alone tell a clinician what’s wrong. Today, there are over 40 different methods for assessing pain in infants, and yet nurses and doctors in neonatal intensive care units still struggle to recognize and properly treat it.

It’s now become my life’s work to understand how best to nurture the healthy development of preterm babies and to alleviate their pain as much as possible.

How can we assess the effect of pain in preterm infants?

One way to determine the impacts is through longer term studies. Dr. Ruth Grunau, whose team I joined as a UBC postdoctoral fellow from 2012 to 2016, followed very preterm children who were admitted at the BC Women’s NICU for up to 8 years. The team kept track of the skin-breaking procedures babies received while in the NICU, such as blood draws, and conducted developmental and neuroimaging tests at various time points until the children were school age. We were able to show that the pain-related stress from these life-saving medical procedures could affect brain development and were linked, among others, to anxious behaviours later in life.

There is still a lot of work to do to fully understand the impact of care and how we can do better. As a new investigator at BC Children’s, I will work to find out how we can reduce the harms of these necessary procedures.

What will your research at UBC and BC Children’s entail?

I will be blending basic science models in the CMMT with clinical research in the hospital to improve our understanding of pain-related stress in preterm infants.

When children are born several weeks early their immune system is usually under-developed, so they often acquire infections and undergo treatments which may have long-term effects on their development. As a result, it can be difficult for parents to hold their babies at this time, separating them both physically and emotionally. It’s important that studies in the lab help us understand how these factors interact and contribute to a baby’s growth.

What are your hopes for the future?

I would like to connect pain, infection, treatments, and parental connection in a unified theory that can guide how nurses and doctors can best treat and nurture preterm infants in intensive care.

I believe it’s vitally important that advances in neonatal care include a balanced approach of stress reduction and pain management to give these infants the best possible start in life.

I look forward to working with the fantastic researchers and clinical teams at BC Children’s Hospital to help protect our most vulnerable patients.