Factors influencing the occurrence of neonatal procedural pain

Abstract

Objectives The objective of this study was to describe the occurrence of neonatal procedural pain and explore the factors that influence the frequency of painful procedures. Design A descriptive prospective epidemiologic study. Setting NICU at a general hospital in China. Methods A demographic and diagnosis or illness information questionnaire and an occurrence of procedural pain questionnaire specifically designed for this study were used to record the current status of neonatal procedural pain. The neonatal infant pain scale (NIPS) was used to measure pain intensity. A multiple linear regression model was used to explore the factors influencing the frequency of painful procedures. Results One hundred and twenty neonates experienced a total of 16,840 painful procedures. Each neonate was exposed to a median (IQR) of 66.5(27,154.75) painful procedures during hospitalization and a median (IQR) of 13(11, 19) painful procedures. All 27 different procedures were considered painful, and 70.37% (19/27) of these procedures caused severe pain. Overall, the mean NIPS score of the 27 procedures was 5.04 ± 1.52 with a range from 0 to 7. Respiratory support, age, and length of hospital stay were factors influencing the frequency of painful procedures. Conclusions NICU neonates experience pain at a high frequency and intensity during hospitalization. Respiratory support, age, and length of hospital stay were factors influencing the frequency of painful procedures. Strategies are needed to bridge the gap between practice and the evidence‐based guidelines.

The practice of procedural pain assessment and management in neonatal intensive care unit in Ethiopia: Cross‐sectional study

“…Three hundred twenty‐five neonates experienced a total of 1325 skin breaking and non‐skin breaking painful procedures, corresponding to an average of 4.2 per day in each neonate in the first 24 hours of NICU admission, which is similar to four procedures per day, studies done in Kenya 3 . Inconsistent with our findings, previous studies conducted in different countries reported that each neonate experienced an average of 7 to 13 painful procedures per day 2,4,6,9 . Another systemic review of observational study 1 also reported an average of 7.5 to 17.3 per neonate per day.…”

“…[1][2][3][4] The most frequently performed painful procedures were heel lance, suctioning, venipuncture, and peripheral IV insertion. [5][6][7][8][9] Despite the misconception regards to neonatal pain in the past years, scientific evidence indicates that pain pathways are active and functional as early as 25 weeks of gestation. 10 Under-treated pain experienced in the early life of the neonatal period can cause physiological and behavioral changes, which may lead to detrimental long-term consequences of altered pain sensation, neuro-behavioral changes, and learning disabilities in later life.…”

“…The most frequently performed painful procedures were heel lance, suctioning, venipuncture, and peripheral IV insertion 5‐9 …”

The trajectories of physical growth in 4 months postnatal corrected age among preterm infants discharged from neonatal intensive care units and associated factors: A prospective study

“…In this study, each preterm infant experienced 20 skin punctures as painful operations during the mean 14.2-day NICU stay, which translates to 1.4 skin punctures per day. Compared with the frequencies, 5 [ 30 ] and 10 [ 31 ] painful operations, for each infant per day in previous studies, we found that the average frequency of painful operations in this cohort was lower due to the lack of records of repeated punctures. We found that infants with a shorter LOS were likely to perform better in the weight status at 40 weeks corrected age.…”

Effects of routine procedures on salivary cortisol in mechanically ventilated neonates

“…Experts in neonatal pain management agree that endotracheal intubation can be classified as moderate to severely painful 3 . Repeated painful stimuli cause several short and long-term adverse effects on newborns 4 . The hypothalamic–pituitary–adrenal axis (HPA axis) is an essential endocrine axis of the human body, with cortisol being its primary end product.…”