Epidemiology and Treatment of Painful Procedures in Neonates in Intensive Care Units

Abstract

EPEATED INVASIVE PROCEdures occur routinely in neonates who require intensive care, causing pain at a time when it is developmentally unexpected. 1 Neonates are more sensitive to pain than older infants, children, and adults, 2 and this hypersensitivity is exacerbated in preterm neonates. 3 Multiple lines of evidence suggest that repeated and prolonged pain exposure alters their subsequent pain processing, long-term development, and behavior. 4,5 It is essential, therefore, to prevent or treat pain in neonates. Numerous pharmacological and nonpharmacological treatments can alleviate procedural pain in neonates. 6 As a consequence, national 7 and international 6 evidence-based guidelines have been issued for preventing or treating neonatal pain and its adverse consequences. The burden of procedural pain in the neonatal intensive care unit (NICU) has been reported in previous singlecenter studies 8-11 and a multicenter study. 12 The latter study was based on chart review and was not directly observational. Effective strategies to improve pain management in neonates require a better understanding of the epidemiology and management of procedural pain. We report epidemiological data on neonatal pain collected Context Effective strategies to improve pain management in neonates require a clear understanding of the epidemiology and management of procedural pain. Objective To report epidemiological data on neonatal pain collected from a geographically defined region, based on direct bedside observation of neonates.

Sedation and analgesia practices in neonatal intensive care units (EUROPAIN): results from a prospective cohort study

“…The epidemiology of invasive procedures in the NICU has already been reported. 55 Fourth, our models of the factors associated with the use of sedation and analgesia might be subject to bias because neonates were classifi ed on the basis of ever or never use of sedation and analgesia. This dichotomy gives neonates who were given occasional sedation and analgesia the same weighting as those who were given frequent and longlasting sedation and analgesia.…”

Knowledge, attitudes and practices of neonatal staff concerning neonatal pain management

“…• Neonatal procedural pain: Includes acute and chronic pain induced and experienced as a result of named procedures (Porter et al 1997;Simons et al 2003;Dodds 2003;Carbajal et al 2008 (Porter et al 1997;Andersen et al 2007;Bellini & Damato 2009). …”

“…To bridge the gap between knowledge and practice, national and international collaborations formed to develop research-based best practice clinical guidelines to inform effective neonatal pain management (Anand & International Evidence-Based Group for Neonatal Pain 2001;Anand et al 2004;Carbajal et al 2008;Gradin & Eriksson 2010). Designed to support decisionmaking in patient care, these guidelines enable neonatal staff to advocate for and provide scientifically approved interventions to assess, diagnose, prevent, alleviate and treat neonatal pain.…”

Analgesia e sedação durante a instalação do cateter central de inserção periférica em neonatos

“…For minor procedures, the combination of sweet solutions and non-nutritive sucking should be sufficient. For major procedures, although the non-pharmacological strategies are still applicable, systemic opioid analgesia is usually required (3) .…”

“…On average, they are subjected to 16 painful procedures per day, the majority of which occur without analgesia (3) , which highlights the need for changes in the practice of care to reduce stress and pain and to promote improved clinical and adequate neurobehavioral development for the neonates.…”