Maria Dulce Damas da Cruz1, Ananda Fernandes1, Catarina Resende de Oliveira1
1) Portugal
Background and aims: Procedures with expected high scores of pain are the less performed in neonatal intensive care units (NICU) but require effective analgesic approaches to minimize the neonate experience of pain and short and long term adverse effects. The aim of this study was to assess the use of analgesia in painful procedures with high tissue invasiveness or with an expected severe pain.
Methods: Data on severely painful procedures performed in neonates during the first seven days of admission to the NICU were selected from a total of 6705 painful procedures recorded in a prospective Portuguese epidemiological study. Fifteen units and 375 neonates were included from April 2013 to October 2014.
Results: Eighty-six severe painful procedures were performed in 56 neonates. The mean (SD; Range) gestational age was 33.3 (5.2; 24.2-41) weeks. Each neonate experienced a mean of one procedure, during the study period (range 1-5), most of them performed on day 1 (51.8%) and day 1 to 3 (81.2%). The procedures recorded were: traqueal intubation, 61 (71.8%); lumbar puncture, 16 (18.8%); insertion of chest tube, 5 (5.9%); and 3 others (3.6%). Most of the procedures were successful with one attempt, but 29 (34.1%) needed more (2-4). Overall, 71 (83.5%) procedures were performed with some analgesia: pharmacological (37.6%), nonpharmacological (32.9%), and/or sweet solutions (12.9%). No interventions at all were applied in 12 traqueal intubations and 2 lumbar punctures. Analgesia according to guidelines was observed in only 32 (37.6%) procedures.
Conclusions: Neonates need more protection in the first three days of admission to the NICU, although procedures that cause severe pain are comparatively rare. Optimal pain management, according to recommendations and clinical guidelines, needs to be observed, especially for this type of procedures and considered as a clinical or a quality of care outcome.
Acknowledgments: Pain in Child Health (PICH), Strategic Training Initiative in Health Research.
