Pain and stress management in the Neonatal Intensive Care Unit--a national survey in Austria.
Neonates are sensitive to pain and vulnerable to both its short-term and long-term effects. Management of analgesia is thought to be hampered by lack of awareness that newborns are capable of experiencing pain and by fears about adverse effects associated with analgesics. The purpose of this study was to assess current medical practice in preventive analgesia and sedation in the neonate throughout Austria. This report details the results of a survey in 28 neonatal intensive care units (NICUs) in Austria. Data collection took place from October to December 2001. All NICUs reported the capability of newborns to experience and express pain and nearly all stated the possibility of pain affecting morbidity. Validated scores for pain assessment were used by 11% of NICUs, standardized protocols for analgesia existed in 75%, and 100% practiced non-pharmacological treatment strategies. The use of preventive measures in routinely performed painful procedures ranged from 8% to 96%. For example, only 8% of NICUs prevent distress and pain prior to umbilical vessel catheterization, 29% prior to subcutaneous injections and 46% prior to heel lancing. Nearly all NICUs apply analgesia before lumbar puncture and thoracic-drain placement, and all use analgesic and/or sedative medication in elective intubation.


CONCLUSIONS
There is widespread awareness among neonatologists of the importance and effects of distress caused by pain in newborns. However, the necessity of providing sufficient analgesia is underestimated. Further information on the safety of analgesic drugs in neonatology is imperative.
Rohrmeister
Klaudia
K
Division of Neonatology, Department of Pediatrics, University Hospital of Vienna, Vienna, Austria. klaudia.rohrmeister@akh-wien.ac.at
Kretzer
Veronika
V
Berger
Angelika
A
Haiden
Nadja
N
Kohlhauser
Christina
C
Pollak
Arnold
A
D000700:Analgesics / Q000627:therapeutic use*; D001317:Austria; D003625:Data Collection; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D013312:Stress, Physiological / Q000188:drug therapy*
D000700:Analgesics; D006993:Hypnotics and Sedatives