SummaryBackground Neonates who are in pain or are stressed during care in the intensive care unit (ICU) are often given sedation or analgesia. We investigated the current use of sedation or analgesia in neonatal ICUs (NICUs) in European countries.

Aim: Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown.Methods: A prospective cohort study in 243 neonatal intensive care units (NICUs) from 18 European countries recorded the frequency of pain assessments, use of mechanical ventilation, sedation, analgesia or neuromuscular blockade for each neonate for up to 28 days after NICU admission.

Introduction: Intellectual and developmental disabilities (IDD) include conditions associated with physical, learning, language, behavioural, and/or intellectual impairment. Pain is a common and debilitating secondary condition compromising functional abilities and quality of life. Objectives: This article addresses scientific and clinical challenges in pain assessment and management in individuals with severe IDD. Methods: This Clinical Update aligns with the 2019 IASP Global Year Against Pain in the Vulnerable and selectively reviews recurring issues as well as the best available evidence and practice. Results: The past decade of pain research has involved the development of standardized assessment tools appropriate for individuals with severe IDD; however, there is little empirical evidence that pain is being better assessed or managed clinically. There is limited evidence available to inform effective pain management practices; therefore, treatment approaches are largely empiric and highly variable. This is problematic because individuals with IDD are at risk of developing drug-related side effects, and treatment approaches effective for other populations may exacerbate pain in IDD populations. Scientifically, we are especially challenged by biases in self-reported and proxy-reported pain scores, identifying valid outcome measures for treatment trials, being able to adequately power studies due to small sample sizes, and our inability to easily explore the underlying pain mechanisms due to compromised ability to self-report. Conclusion: Despite the critical challenges, new developments in research and knowledge translation activities in pain and IDD continue to emerge, and there are ongoing international collaborations.

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Skin-to-skin care is implemented in all Nordic neonatal units, but offered to various degrees, to various populations and to varying extents. Danish, Norwegian and Swedish units are offering SSC more extensively than units in Finland and Iceland.

The persisting difference between Swedish and Norwegian units in pain assessment and the use of pain measurement scales are not easily explained. However, the reported increased availability and reported use of pain measurement scales in neonatal care units in both countries may be seen as a contribution towards better awareness and recognition of pain, better pain management and potentially less suffering for vulnerable neonates.

Andersen RD. Greve-Isdahl M. Jylli L. The opinions of clinical staff regarding neonatal procedural pain in two Norwegian neonatal intensive care units. Aim:Neonates are subjected to numerous painful procedures without sufficient pain management. The aim of this study was to describe the opinions of Norwegian physicians, nurses and nurse assistants who care for neonates, regarding procedural pain in neonates.Methods: A replication of a previous questionnaire study (Porter FL et al) was conducted in two Norwegian neonatal intensive care units (NICU's). The questionnaire aimed at evaluating procedure painfulness, the current use of pharmacological agents and comfort measures and the optimal use of both.Results: Ninety members of the clinical staff participated, which is a response rate of 87%. Opinions on how procedural pain is currently and optimally managed differed significantly. Although most respondents rated a majority of the listed procedures as being more than moderately painful, pharmacological agents were rarely used, except for the insertion of a chest tube and endotracheal intubation. Comfort measures were also believed to be underutilized, but not to the same degree as pharmacological agents. Conclusion Methods Subjects and settingOne hundred and three of 111 clinical staff members were invited to participate (N=103). InstrumentThe survey is based on a questionnaire [10] which consists of a series of questions on pain and pain management in reference to twelve frequently performed procedures.In our study, ten of the procedures were included (table I). Circumcision and arterial or venous cutdown were excluded as they are never performed in the units being studied. The responses are in a Likert scale format, ranging from zero to four and the participants were asked to grade the painfulness of the 10 different procedures, the frequency of the actual use of pharmacological agents and comfort measures, and the optimal use of such (table I).The internal consistency was examined by computing Chronbach's α for each series of questions. The observed alphas ranged from .74 to .93, which demonstrates that the survey has a good reliability. ProcedureApproval was obtained from the Regional Ethics Committee. The survey was conducted in 2003 during three staff meetings at each hospital and after the attendants had received oral information about the study. Participants were encouraged not to discuss the questionnaire between meetings. A comparison of the answers showed no significant differences. 5 Statistical analysesRespondents were divided into groups based on profession. Differences between groups for the different procedures and for a sum score of each question have been calculated by the use of the Kruskal Wallis test. In cases where a significant difference between groups was found, a post hoc Mann Whitney U-test with Bonferroni correction was performed. Answers to the questions regarding current and optimal treatment of procedural pain were compared using the Wilcoxon paired groups test. P ≤ 0.05 wa...

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