Painful procedures and analgesia in hospitalized newborns: A prospective longitudinal study (original) (raw)
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Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates
Archives of pediatrics & adolescent medicine, 2003
Despite an increasing awareness regarding pain management in neonates and the availability of published guidelines for the treatment of procedural pain, preterm neonates experience pain leading to short- and long-term detrimental effects. To assess the frequency of use of analgesics in invasive procedures in neonates and the associated pain burden in this population. For 151 neonates, we prospectively recorded all painful procedures, including the number of attempts required, and analgesic therapy used during the first 14 days of neonatal intensive care unit admission. These data were linked to estimates of the pain of each procedure, obtained from the opinions of experienced clinicians. On average, each neonate was subjected to a mean +/- SD of 14 +/- 4 procedures per day. The highest exposure to painful procedures occurred during the first day of admission, and most procedures (63.6%) consisted of suctioning. Many procedures (26 of 31 listed on a questionnaire) were estimated to b...
Texto & Contexto - Enfermagem, 2019
Objective: to describe potentially painful procedures performed in neonates and their relation with pain relief strategies. Method: a longitudinal correlational study, conducted from October to December 2014, with 50 neonates admitted to neonatal units of a public maternity hospital in Belo Horizonte, Minas Gerais (Brazil). Procedures were analyzed in the first two weeks of life of neonates admitted with up to three hours of life and born at the maternity hospital in which the study was conducted. Data was submitted to descriptive, comparative and correlational analyses using the Statistical Package for the Social Sciences software, adopting a significance level of 5%. Results: most newborns were male (n=32; 64%), premature (n=34; 69.4%) and hospitalized for having respiratory disorders (n=45; 91.8%). A total of 894 painful and of 2883 potentially painful procedures related to daily care were recorded. Non-pharmacological pain relief strategies were used in 49 (98%) neonates, while ...
Pain Management Nursing, 2019
Background: Despite strong evidence that repeated pain exposure in neonates is associated with adverse outcomes, pain assessment and management continues to be less than optimal in most neonatal intensive care units (NICUs). Aims: To evaluate current pain assessment and management practices, and identify factors associated with optimal treatment throughout a cohort of preterm neonates over the entire hospital stay. Design: A secondary analysis of study data collected from 2012 to 2016 as part of a larger clinical trial and supplemental chart review. Settings: Tertiary level neonatal intensive care unit. Participants/Subjects: 242 stable preterm neonates born at less than 37 weeks gestational age. Methods: Data were analyzed quantitatively using R for statistics. Results: The 242 neonates underwent a total of 10,469 painful procedures (4,801 tissue breaking and 5,667 nonetissue breaking, with only 56.6% and 12.2% having a documented pain score using the Premature Infant Pain Profile, respectively). Average pain exposure was 43 with a median of 32(10-576) per entire hospital stay. Documented pain score and greater postnatal age were associated with higher use of a pain reducing intervention and lower gestational age, first day, first week, higher illness severity, non tissue breaking and night time procedures were associated with lower. Use of a pain relieving intervention was documented in 58.5% of procedures. Sucrose was most commonly used pharmacologic and non nutritive sucking the most common non pharmacologic interventions. Conclusions: Increased efforts are needed to promote consistent pain assessment and management to ensure optimal outcomes for vulnerable at risk neonates.
Painful and stressful procedures and analgesia in newborns from the viewpoint of professionals
Revista Brasileira de Enfermagem
Objective: To identify the procedures considered painful and stressful by health professionals from a neonatal intensive care unit and check the measures of analgesia. Method: Descriptive exploratory quantitative study with 65 health professionals, from November 2016 to February 2017. Results: The procedures considered painful were removal of adhesives, vein, arterial and lumbar puncture, phlebotomy, and thoracic drainage. Oral suctioning, intravenous catheter removal and tracheal extubation were considered stressful. Fentanyl was the most cited pharmacological measure, and restraint and nonnutritive suction were the most used nonpharmacological measures. Conclusion: Professionals were able to classify the painful and stressful procedures; however, low use of measures for analgesia was evidenced.
Journal of Family Medicine and Primary Care, 2020
Background: Premature neonates receive a large number of painful procedures during their stay in the neonatal intensive care unit (NICU). However, there are many other processes that happen in the NICU, which may not be considered painful but can cause discomfort and/or stress to the neonate. Method: Pain profile during routine procedures in NICU was assessed using the premature infant pain profile (PIPP) score. Neonates of gestational age >26 weeks, less than 7 days old and admitted for less than 7 days in the NICU were included. Results: A total of 662 procedures were observed in 132 (78 M, 54 F) neonates. The mean (SD) age of the neonates was 2.4 (1.8) days and the mean (SD) birth weight was 2.3 (0.6) kg. 63 (54.5%) were of low birth weight (LBW), 85 (64.39%) were full term. High PIPP score was noted in blood sampling, heel prick, suction, and weight measurement. Significant differences were observed in the PIPP score during blood sampling and suction across gender. Some ordinary and non-stressful procedures also scored very high on the PIPP scale. Conclusions: The validity of PIPP needs to be reexamined. Our understanding of pain during routine procedures may need to be revisited.
A study of pain management practices during the prolonged hospitalisation of infants
Purpose: The purpose of this study was threefold ; to investigate the use of pain assessment tools and pain reduction strategies during minor painful procedures in neonatal units in Australia; to map the history of an infant's prolonged hospitalisation in a tertiary neonatal intensive care unit with respect to painful procedures and pain management practices, and to describe the effectiveness of oral sucrose in reducing procedural pain during the course of an infant's prolonged hospitalisation (≥ 28 days).
Pain perception in NICU: a pilot questionnaire
The Journal of Maternal-Fetal & Neonatal Medicine, 2017
Pain perception in NICU: a pilot questionnaire Purpose: Neonatal pain management has made a great step forward over the last several years. Despite the drafting of International guidelines, an under-treatment of neonatal pain is still reported. Materials and methods: Medical and paramedical personnel working in 5 Italian NICUs were asked to complete a questionnaire about pain management. The questionnaire was comprised of three sections: (i) brief explanation of the purpose; (ii) demographic information, including age, profession, religious beliefs, and hospital level; (iii) questionnaire about pain management and prevention. Results: One-hundred and forty caregivers participated in this study. Non-pharmacological analgesia during heel prick or venipuncture was used by 64% and 60% of them, respectively; topical analgesia was performed in 13% of venipunctures; no analgesia was used in 30% of cases for both heel prick and venipuncture. In the case of lumbar puncture, 35% of participants used topical analgesia, 15% non-pharmacological approach, 10% opioids and 6% intravenuous paracetamol. While 65% of participants gave a score of 4 out of 5 about the importance of pain treatment, 39% of them reported that in their department no pain scales were used. Conclusions: Pain treatment in these NICUs is still far to be optimal. This nonetheless reflects a worldwide trend, which requires more attention on pain prevention, assessment and treatment.