title: Epidemiology and treatment of painful procedures in neonates in intensive care units.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Between September 2005 and January 2006, data on all painful and stressful procedures and corresponding analgesic therapy from the first 14 days of admission were prospectively collected within a 6-week period from 430 neonates admitted to tertiary care centers in the Paris region of France (11.3 millions inhabitants) for the Epidemiology of Procedural Pain in Neonates (EPIPPAIN) study.
  
  
  METHODS
  Number of procedures considered painful or stressful by health personnel and corresponding analgesic therapy.
  
  
  RESULTS
  The mean (SD) gestational age and intensive care unit stay were 33.0 (4.6) weeks and 8.4 (4.6) calendar days, respectively. Neonates experienced 60,969 first-attempt procedures, with 42,413 (69.6%) painful and 18,556 (30.4%) stressful procedures; 11,546 supplemental attempts were performed during procedures including 10,366 (89.8%) for painful and 1180 (10.2%) for stressful procedures. Each neonate experienced a median of 115 (range, 4-613) procedures during the study period and 16 (range, 0-62) procedures per day of hospitalization. Of these, each neonate experienced a median of 75 (range, 3-364) painful procedures during the study period and 10 (range, 0-51) painful procedures per day of hospitalization. Of the 42,413 painful procedures, 2.1% were performed with pharmacological-only therapy; 18.2% with nonpharmacological-only interventions, 20.8% with pharmacological, nonpharmacological, or both types of therapy; and 79.2% without specific analgesia, and 34.2% were performed while the neonate was receiving concurrent analgesic or anesthetic infusions for other reasons. Prematurity, category of procedure, parental presence, surgery, daytime, and day of procedure after the first day of admission were associated with greater use of specific preprocedural analgesia, whereas mechanical ventilation, noninvasive ventilation and administration of nonspecific concurrent analgesia were associated with lower use of specific preprocedural analgesia.
  
  
  CONCLUSIONS
  During neonatal intensive care in the Paris region, large numbers of painful and stressful procedures were performed, the majority of which were not accompanied by analgesia.
authors.affiliation: Centre National de Ressources de lutte contre la Douleur, Hôpital d'enfants Armand Trousseau, 26, av du Dr Netter, 75012 Paris, France. ricardo.carbajal@trs.aphp.fr
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
authors.forename: André
authors.initials: A
authors.lastname: Rousset
authors.forename: Claude
authors.initials: C
authors.lastname: Danan
authors.forename: Sarah
authors.initials: S
authors.lastname: Coquery
authors.forename: Paul
authors.initials: P
authors.lastname: Nolent
authors.forename: Sarah
authors.initials: S
authors.lastname: Ducrocq
authors.forename: Carole
authors.initials: C
authors.lastname: Saizou
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lapillonne
authors.forename: Michèle
authors.initials: M
authors.lastname: Granier
authors.forename: Philippe
authors.initials: P
authors.lastname: Durand
authors.forename: Richard
authors.initials: R
authors.lastname: Lenclen
authors.forename: Anne
authors.initials: A
authors.lastname: Coursol
authors.forename: Philippe
authors.initials: P
authors.lastname: Hubert
authors.forename: Laure
authors.initials: L
authors.lastname: de Saint Blanquat
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Boëlle
authors.forename: Daniel
authors.initials: D
authors.lastname: Annequin
authors.forename: Patricia
authors.initials: P
authors.lastname: Cimerman
authors.forename: K J S
authors.initials: KJ
authors.lastname: Anand
authors.forename: Gérard
authors.initials: G
authors.lastname: Bréart
mesh_terms: D000698:Analgesia / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data / Q000639:trends; D015931:Intensive Care, Neonatal / Q000379:methods / Q000706:statistics & numerical data; D016015:Logistic Models; D008297:Male; D010146:Pain / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D010147:Pain Measurement; D010297:Paris / Q000453:epidemiology; D011446:Prospective Studies; D013312:Stress, Physiological / Q000209:etiology / Q000503:physiopathology