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A Prospective Study of Procedural Pain and Analgesia in Neonates

Sinno H. P. Simons, MSc; Monique van Dijk, PhD; Kanwaljeet S. Anand, MBBS, DPhil; Daniella Roofthooft, MD; Richard A. van Lingen, MD, PhD; Dick Tibboel, MD, PhD

Arch Pediatr Adolesc Med. 2003;157:1058-1064.

Background  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.

Objective  To assess the frequency of use of analgesics in invasive procedures in neonates and the associated pain burden in this population.

Methods  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.

Results  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 be painful (pain scores >4 on a 10-point scale). Preemptive analgesic therapy was provided to fewer than 35% of neonates per study day, while 39.7% of the neonates did not receive any analgesic therapy in the neonatal intensive care unit.

Conclusions  Clinicians estimated that most neonatal intensive care unit procedures are painful, but only a third of the neonates received appropriate analgesic therapy. Despite the accumulating evidence that neonatal procedural pain is harmful, analgesic treatment for painful procedures is limited. Systematic approaches are required to reduce the occurrence of pain and to improve the analgesic treatment of repetitive pain in neonates.

From the Department of Pediatric Surgery (Mr Simons and Drs van Dijk and Tibboel) and Division of Neonatology, Department of Pediatrics (Mr Simons and Dr Roofthooft), Erasmus MC–Sophia Children's Hospital, Rotterdam, and Division of Neonatology, Department of Pediatrics, Isala Clinics, Zwolle (Dr van Lingen), the Netherlands; and the Department of Pediatrics, University of Arkansas for Medical Sciences, and Arkansas Children's Hospital, Little Rock (Dr Anand).

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