Bridging the Gap: Maria Pureza Laudiano-Dray (Neuroprotection for Preterm Infants)

Our Bridging the Gap series makes a return! For each post, we interview women in neuroscience about health inequalities and the research aiming to close these gaps. In this article, we focus on neuroprotection in premature babies, and the communication tool that Maria Pureza Laudiano-Dray and her team are implementing to protect preterm infants’ developing brains during the earliest and most vulnerable stages of life. 

The 17^th of November marked World Prematurity Day, an awareness day highlighting the experiences of babies born too soon and the urgent need to support them, their families, and the clinicians who care for them. Around 1 in 13 babies in the UK are born before they reach term (before 37 weeks), often requiring specialised care such as breathing and feeding support in the neonatal intensive care unit (NICU). The earlier a baby is born, the less developed their organs and systems are, making them more vulnerable to short- and long-term complications (Bliss, 2024). Echoing the World Health Organisation’s Healthy beginnings, hopeful futures 2025 campaign, we are reminded of the importance of giving every child, including small and sick newborns, a fair chance at life (WHO, 2025). 

We interviewed Maria Pureza Laudiano-Dray, a Research Nurse at UCL, who is working on the development and distribution of a pain communication tool in the NICU. Pre-term infants undergo an average of 15 procedures per day with common procedures including heel lance for blood sampling and arterial puncture, required to manage cardiovascular instability (Siva et al., 2025). These life-saving, but painful, procedures are often unavoidable for infants born prematurely, and increasing evidence suggests that repeated exposure may have adverse long-term outcomes (Walker, 2019). During this critical developmental period, these risks can be mitigated by implementing neuroprotective strategies. By designing this tool, Pureza hopes to provide families and clinicians with practical ways to support and protect babies’ developing brains.

In this interview, Pureza reflected on her motivation to create the pain communication tool, her conversations with parents and neonatal staff that shaped its design, and her vision for improving premature infant care once this tool is disseminated throughout the NHS.

Moving from clinical to research

Could you tell us a little bit about yourself, your background, and how it has contributed to your current work?

I started as a neonatal nurse in clinical for 15-16 years, and I decided I wanted to become a research nurse and join the UCL research group because their focus is on pain and that’s my interest. How we can look at ways to manage that, and understanding more about pain was what made me make that move and has opened up a lot of opportunities for me. I’ve been with that group for the last 10 years and have continued to grow since.

What drove your decision to make this transition?

I was at the stage where I wanted to do more. At the time, I didn’t know what it was, but maybe it was a thirst for knowledge – to really understand more about pain! One of the things I found when I was working in a clinical setting was that I didn’t really know what happened to the babies after they left. As a clinical nurse, all we see is the day-to-day, and we’re very happy for them to be discharged home, but that’s where our journey with them ends. So, having that overview of their development post-discharge is really important to me and that’s why I felt like maybe it was time to go into research and see what was out there related to understanding babies’ development.

Was there something about working with babies, especially premature babies, in the neonatal units that drew you to this research?

It’s definitely about wanting to improve babies’ pain management in the NICU. You’re constantly doing essential, but painful procedures and, at that time, there was this debate: do babies feel pain? Since then, we have accepted that, yes, they do respond to pain, and this can affect their long-term brain development. So, pain management and, specifically, neuroprotection is really very important to me.

Premature infants, especially, are in a vulnerable state. How is neonatal research integrated into their routine care?

UCLH is a research hospital and has a lot of research being conducted at once. You have the research ethics committee that reviews all proposed research, and their number one aim is to ensure that this is safe for patients. In conducting your research, you’re also always looking at the safety of the patient.

One of the things I do when we conduct EEG studies is tell parents that we will always be led by the baby, and will pace according to the baby’s needs. We will not obstruct any care and that, as researchers, we are secondary. The procedures that babies go through are clinically required, and we use these procedures to record data that contributes to our research in understanding the neonatal brain. It’s voluntary, it should not cause any harm. Clinical care - standard care - should always come first. And that’s also how you maintain that trust from the parents who have consented to take part.

A communication tool for neonatal pain management

What made you want to develop a communication tool for pain management?

What we’ve learned whilst I was working is that babies’ pain assessment and our understanding of what’s really happening is quite limited. It’s all very vague and not one tool captures everything, so we’re constantly guessing what the pain levels might be for different procedures. At the same time, we’re also looking at studies investigating how we can manage the pain. A lot of the research at UCL has been looking at how babies are responding, and how the situation and context, such as stress, can lead us to potentially underestimate pain as well. All of that knowledge was really helpful in giving us a really broad overview about the impact of pain on babies.

One of the things we wanted to find out was how painful our procedures are if we’re just relying on our subjective views. It could vary across different people. We looked at pain scores. And the only way to do this was to do a systematic review and, because there’s so many pain assessment tools out there with various scales, we had to find a way of normalising the scores into a single scale (Laudiano-Dray et al., 2020).

Through our research, we identified that staff are less aware of neonatal neurodevelopment. As I mentioned, based on my experience, we don’t really see what the long-term outcomes are. So, with this framework, we wanted to answer the question: How can we bring that message, together with the estimated pain of procedures strategies, to reduce pain as well as raise awareness about long-term outcomes?

Do you encourage parents to help with pain management, or would it primarily rest on neonatal staff to communicate the pain severity of the procedure and how it can be managed?

This is where, when we designed this infographic (pictured below), we had both the staff and parents in mind, making it really easy to talk about pain. One of the barriers is about addressing how painful a procedure is, and that can cause anxiety among staff when they’re asked, “is it painful?”. We wanted to develop this into an easy tool so that staff and parents can, in one view, visualise the pain score of different procedures relative to others by using a traffic light system. This helps with communication and helps to manage expectations between staff and parents. It allows staff to say, transparently, that yes, it could be painful. However, we have strategies such as skin-to-skin, swaddling or medication so we can reduce the pain according to the procedure carried out.

Infographic for parents and neonatal staff: Pain communication tool depicting different procedures that preterm infants often undergo. Procedures are organised by pain severity in a traffic light system and are accompanied by appropriate strategies that can be used to support babies before, during and after the procedure. Find out more about the British Association of Perinatal Medicine’s framework for Management of Neonatal Pain here.

Hopefully, with this tool, we can ease anxiety that staff may have communicating this to parents. For parents, we made the icons really easy so that they can see that these are strategies that they already use right now - they probably didn’t realise this is something which can be used for pain management as well. Things like supporting the baby, skin-to-skin contact, and breastfeeding. One of the difficulties in clinical settings is that we try to avoid the word ‘pain’ in everyday language. So, we try to shift that conversation by putting the word ‘pain’ into the poster. 

I guess it is quite a stigmatised word. Were there any challenges you found with convincing your target audience to be more accepting of using the word ‘pain’?

Initially, we were worried about including the word ‘pain’ in the infographic. We decided to bring together a group of parents with lived experience, our ‘pain champions’, and ask them for their thoughts. Surprisingly, parents were happy with the wording, preferring the infographic to be upfront about the procedures being painful.

Our next step was to ask where parents would like to see the infographic. And they said they would like it by the cot side, which, even though I’m all for open communication, it was still somewhat unexpected for me: “You really want this right by the cot?”. And that was one of the biggest messages that we were able to deliver to neonatal staff because, if parents say they want it by the cot, it means they don’t want their baby’s pain to be minimised. They want open, transparent communication, and that’s the first step in real collaboration and working with parents so they can also help reduce their baby’s pain.

Was there anything in particular that really shaped how you developed the communication tool?

It’s about making it easy. That’s one of the things I really learned. How can you make your messaging as easy as possible? Our message is really simple: Prepare, Support, Protect. It’s very visual, very easy to remember, and we’ve created a tool where we use plain language to get our message across. 

 It can be quite difficult for parents to get a hold of doctors, for example, to learn a little bit more about what their baby is going through. It is overwhelming because there’s so much information and navigating that is really hard. There’s always something new that they are being told about and pain management is only one aspect of it. There are ward rounds and you’re constantly trying to benchmark that, to make it more equitable for everyone. How do you train staff who are new to the neonatal unit? And with the number of parents who come in every single day, how can you keep track of everyone being able to access that information? You need something that’s really accessible and easy.

 Our vision is that if this tool was in all neonatal units, then it makes it easier for staff and parents because it’s the same information across the NHS. Some parents would move neonatal units two or three times, and this tool would help them navigate their journey. Even if they felt like they already knew the tool, some procedures have to happen suddenly, but parents would have been able to find where the procedure was on the scale and get information that helps them ask informed questions.

 So, having the tool at the point of care, with all the research evidence distilled into a very easy poster, is one of the biggest steps in creating equity. We know staff are so busy, so it gives parents that time to think about it, ask informed questions and help them to be equal partners in managing neonatal care.

Implementing a new tool

Can you tell us a bit about how the tool is beginning to be used in the NHS and how you’ve found the process of implementing a new tool?

We are in the middle of starting the evaluation now. We have two hospitals that will be starting the parent-delivered pain management audit to look at the impact of the knowledge tool. We need to see if it gets parents involved in using strategies like skin-to-skin, which is really effective for reducing pain of everyday procedures (White-Traut, 2004; Zengin et al., 2023). This audit will target staff and parents so that we can also hear the parents’ views.

Implementing a new tool takes time and needs to be gradual. When you’re trying to introduce something new, you don’t want to raise feelings that there is a threat to their autonomy. And one of the things you get a lot in pain management research is that staff have said they feel their autonomy is being threatened in terms of their decision making. Those are real issues that we shouldn’t put aside. Instead, we should accept and work around it. We’ve taken the approach of a very slow, gradual process, giving staff time to look at it, accept it, and not feel like they are being made to do it. If you want to create change, it needs to be sustainable and it needs to be accepted. If it’s accepted, then you’re more likely to have it implemented. And so, we envisage this as something that will take time and we are nurturing it to truly make this change sustainable and acceptable. One thing we’ve done is create a pain support network, to give parents and neonatal staff a chance to ask questions and to be motivated when they hear staff who have piloted it in their own unit and survey the acceptability of it.

You mentioned a pain support network. Could I ask who is part of that group and how you’ve integrated different groups of people to develop and disseminate the communication tool?

We engaged with the London Operational Delivery Network, targeting organisations that could help influence the dissemination of the knowledge tool. We also engaged with the Neonatal Nurses Association, because with that endorsement there is more credibility, and so, it will be more accepted. We also worked with the British Association of Perinatal Medicine (BAPM) and partnered with their working group so that our knowledge tool would be in the framework and be more likely to be accepted across neonatal units.

We were hoping to approach different neonatal units directly. It was through the early adopters, the people who heard our message, and the allied health professionals, that we were given a gateway into the different neonatal units. This is probably because they also understand long-term development and that’s part of their work, so they were able to take us into their local units.

We engaged with neonatal staff by going to each unit, doing team presentations, and answering any questions they had. So, this one-on-one contact was very important and is probably part of the success of our dissemination strategy.

And then it snowballed. So, once it began to spread, we were able to reach team leads like family-centered care, developmental care, nurses, and doctors. We created the pain support network, and we had meetings every 3 to 4 months which allowed us to ask questions about what they thought about it: Are there any barriers they found? And through engaging with neonatal units and the working group in BAPM, we were able to improve the infographic and that’s really helped to shape it to the final product. 

One final question: If you wanted people to take one thing away from this interview, what would you like that to be?

We need to protect babies’ developing brains, and consistent pain management is one of the things that we could do to help. There’s a lot of other things that can impact brain development, but we know that pain management needs to be improved and is preventative. So, that’s what I would like to leave as the message: neuroprotection.

Find out more about the communication tool for neonatal pain management:

• BAPM: Management of Neonatal Pain Framework

• Register your interest for disseminating the communication tool

Resources for knowledge mobilisation and dissemination

• The Guide to Disseminating Research (GuiDiR) framework developed by Professor Debi Bhattacharya (Scott et al., 2024)

• National Institute for Health and Care Research: Plan Knowledge Mobilisation

References: 

• Laudiano-Dray, M.P. et al. (2020) ‘Quantification of neonatal procedural pain severity: A platform for estimating total pain burden in individual infants’, Pain, 161(6), pp. 1270–1277. doi:10.1097/j.pain.0000000000001814. 

• Management of neonatal pain (2025) British Association of Perinatal Medicine. Available at: https://www.bapm.org/resources/management-of-neonatal-pain.

• Prematurity statistics in the UK (2024) Bliss. Available at: https://www.bliss.org.uk/research-campaigns/neonatal-care-statistics/prematurity-statistics-in-the-uk (Accessed: 24 January 2026). 

• Scott, S. et al. (2024) ‘Development of the guide to disseminating research (guidir): A Consolidated Framework’, Research in Social and Administrative Pharmacy, 20(11), pp. 1047–1057. doi:10.1016/j.sapharm.2024.08.001. 

• Siva, N., Nayak, R. and Ghosh, D. (2025) ‘Pain and pain-related stress in high-risk neonates at NICU – A narrative review’, Journal of Neonatal Nursing, 31(3), p. 101675. doi:10.1016/j.jnn.2025.101675. 

• Walker S.M. (2019). Long-term effects of neonatal pain. Seminars in Fetal and Neonatal Medicine, 24(4), p.101005. https://doi.org/10.1016/j.siny.2019.04.005

• White‐Traut, R. (2004) ‘Providing a nurturing environment for infants in adverse situations: Multisensory strategies for Newborn Care’, Journal of Midwifery & Women’s Health, 49(S1), pp. 36–41. doi:10.1016/j.jmwh.2004.05.004. 

• World Prematurity Day 2025 (2025) World Health Organization. Available at: https://www.who.int/campaigns/world-prematurity-day/2025.

• Zengin, H. et al. (2023) ‘The effects of kangaroo mother care on physiological parameters of premature neonates in Neonatal Intensive Care Unit: A systematic review’, Journal of Pediatric Nursing, 71. doi:10.1016/j.pedn.2023.04.010.

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This interview was conducted by Alyssa Khoo and edited by Rebecca Pope and Clarise Castleman, with graphics produced by Lilly Green and Rebecca Pope. If you enjoyed this article, be the first to be notified about new posts by signing up to become a WiNUK member (top right of this page)! Interested in writing for WiNUK yourself? Contact us through the blog page and the editors will be in touch.