title: Influence of risk of neurological impairment and procedure invasiveness on health professionals' management of procedural pain in neonates.
abstract: OBJECTIVE
  To describe how (i) risk of neurological impairment (NI) and (ii) procedure invasiveness influence health professionals' assessment and management of procedural pain in neonates in the Neonatal Intensive Care Unit (NICU).
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Three tertiary level NICUs in Canada.
  
  
  METHODS
  114 neonates, 25-40 weeks gestational age (GA) undergoing painful procedures.
  
  
  METHODS
  Physical and behavioural pain indicators and pharmacological and nonpharmacological pain interventions.
  
  
  RESULTS
  114 neonates at high (Cohort A, n=35), moderate (Cohort B, n=25) and low (Cohort C, n=54) risk of NI were observed during 254 painful procedures performed by 147 health professionals. Physical pain indicators were used more frequently by health professionals to assess pain with Cohorts A and B than C (p<.05). Behavioural pain indicators were used similarly across Cohorts. Nonpharmacological interventions were implemented most frequently for pain management. Physical interventions were used with 84% of procedures across Cohorts; particularly for the most invasive procedures. Infants with the highest NI risk (Cohort A) received the most behavioural interventions (p<.05) irrespective of procedural invasiveness. Pharmacological interventions were implemented with 23.2% of procedures; Cohort B received pharmacological interventions most frequently (Cohort B>A, B>C, p<.05) and for increasingly invasive procedures (p<.05).
  
  
  CONCLUSIONS
  Health professionals use multidimensional indicators to assess neonatal pain. Nonpharmacological interventions dominate pain management. NI risk status and procedure invasiveness are important contextual factors in neonatal pain assessment and management.
authors.affiliation: The Hospital for Sick Children, Toronto, Canada. b.stevens@utoronto.ca
authors.forename: Bonnie
authors.initials: B
authors.lastname: Stevens
authors.forename: Patrick
authors.initials: P
authors.lastname: McGrath
authors.forename: Marilyn
authors.initials: M
authors.lastname: Ballantyne
authors.forename: Janet
authors.initials: J
authors.lastname: Yamada
authors.forename: Annie
authors.initials: A
authors.lastname: Dupuis
authors.forename: Sharyn
authors.initials: S
authors.lastname: Gibbins
authors.forename: Linda
authors.initials: L
authors.lastname: Franck
authors.forename: G
authors.initials: G
authors.lastname: Allen Finley
authors.forename: Alexandra
authors.initials: A
authors.lastname: Howlett
authors.forename: Celeste
authors.initials: C
authors.lastname: Johnston
authors.forename: Karel
authors.initials: K
authors.lastname: O'Brien
authors.forename: Arne
authors.initials: A
authors.lastname: Ohlsson
mesh_terms: D000328:Adult; D000698:Analgesia / Q000379:methods*; D002170:Canada; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D010146:Pain / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement / Q000379:methods*; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D018570:Risk Assessment