title: Heel blood sampling in European neonatal intensive care units: compliance with pain management guidelines.
abstract: OBJECTIVE
  To describe the use of heel blood sampling and non-pharmacological analgesia in a large representative sample of neonatal intensive care units (NICUs) in eight European countries, and compare their self-reported practices with evidence-based recommendations.
  
  
  METHODS
  Information on use of heel blood sampling and associated procedures (oral sweet solutions, non-nutritive sucking, swaddling or positioning, topical anaesthetics and heel warming) were collected through a structured mail questionnaire. 284 NICUs (78% response rate) participated, but only 175 with ≥50 very low birth weight admissions per year were included in this analysis.
  
  
  RESULTS
  Use of heel blood sampling appeared widespread. Most units in the Netherlands, UK, Denmark, Sweden and France predominantly adopted mechanical devices, while manual lance was still in use in the other countries. The two Scandinavian countries and France were the most likely, and Belgium and Spain the least likely to employ recommended combinations of evidence-based pain management measures.
  
  
  CONCLUSIONS
  Heel puncture is a common procedure in preterm neonates, but pain appears inadequately treated in many units and countries. Better compliance with published guidelines is needed for clinical and ethical reasons.
authors.affiliation: Unit of Epidemiology, Ospedale Pediatrico Bambino Gesù, Piazza S. Onofrio 4, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Losacco
authors.forename: Marina
authors.initials: M
authors.lastname: Cuttini
authors.forename: Gorm
authors.initials: G
authors.lastname: Greisen
authors.forename: Dominique
authors.initials: D
authors.lastname: Haumont
authors.forename: Carmen R
authors.initials: CR
authors.lastname: Pallás-Alonso
authors.forename: Veronique
authors.initials: V
authors.lastname: Pierrat
authors.forename: Inga
authors.initials: I
authors.lastname: Warren
authors.forename: Bert J
authors.initials: BJ
authors.lastname: Smit
authors.forename: Björn
authors.initials: B
authors.lastname: Westrup
authors.forename: Jacques
authors.initials: J
authors.lastname: Sizun
mesh_terms: D000698:Analgesia / Q000379:methods / Q000592:standards*; D005060:Europe; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006365:Heel / Q000098:blood supply*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D019102:Infant, Very Low Birth Weight; D007363:Intensive Care Units, Neonatal / Q000592:standards*; D010146:Pain / Q000209:etiology / Q000517:prevention & control*; D018962:Phlebotomy / Q000009:adverse effects / Q000592:standards*; D017410:Practice Guidelines as Topic; D011364:Professional Practice / Q000706:statistics & numerical data