title: Does neonatal pain management in intensive care units differ between night and day? An observational study.
abstract: OBJECTIVE
  To determine whether analgesic use for painful procedures performed in neonates in the neonatal intensive care unit (NICU) differs during nights and days and during each of the 6 h period of the day.
  
  
  METHODS
  Conducted as part of the prospective observational Epidemiology of Painful Procedures in Neonates study which was designed to collect in real time and around-the-clock bedside data on all painful or stressful procedures.
  
  
  METHODS
  13 NICUs and paediatric intensive care units in the Paris Region, France.
  
  
  METHODS
  All 430 neonates admitted to the participating units during a 6-week period between September 2005 and January 2006.
  
  
  METHODS
  During the first 14 days of admission, data were collected on all painful procedures and analgesic therapy. The five most frequent procedures representing 38 012 of all 42 413 (90%) painful procedures were analysed.
  
  
  METHODS
  Observational study.
  We compared the use of specific analgesic for procedures performed during each of the 6 h period of a day: morning (7:00 to 12:59), afternoon, early night and late night and during daytime (morning+afternoon) and night-time (early night+late night).
  
  
  RESULTS
  7724 of 38 012 (20.3%) painful procedures were carried out with a specific analgesic treatment. For morning, afternoon, early night and late night, respectively, the use of analgesic was 25.8%, 18.9%, 18.3% and 18%. The relative reduction of analgesia was 18.3%, p<0.01, between daytime and night-time and 28.8%, p<0.001, between morning and the rest of the day. Parental presence, nurses on 8 h shifts and written protocols for analgesia were associated with a decrease in this difference.
  
  
  CONCLUSIONS
  The substantial differences in the use of analgesics around-the-clock may be questioned on quality of care grounds.
authors.affiliation: INSERM U1153 - Equipe Epopé, Paris Cedex, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Guedj
authors.forename: Claude
authors.initials: C
authors.lastname: Danan
authors.forename: Patrick
authors.initials: P
authors.lastname: Daoud
authors.forename: Véronique
authors.initials: V
authors.lastname: Zupan
authors.forename: Sylvain
authors.initials: S
authors.lastname: Renolleau
authors.forename: Elodie
authors.initials: E
authors.lastname: Zana
authors.forename: Sophie
authors.initials: S
authors.lastname: Aizenfisz
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lapillonne
authors.forename: Laure
authors.initials: L
authors.lastname: de Saint Blanquat
authors.forename: Michèle
authors.initials: M
authors.lastname: Granier
authors.forename: Philippe
authors.initials: P
authors.lastname: Durand
authors.forename: Florence
authors.initials: F
authors.lastname: Castela
authors.forename: Anne
authors.initials: A
authors.lastname: Coursol
authors.forename: Philippe
authors.initials: P
authors.lastname: Hubert
authors.forename: Patricia
authors.initials: P
authors.lastname: Cimerman
authors.forename: K J S
authors.initials: KJ
authors.lastname: Anand
authors.forename: Babak
authors.initials: B
authors.lastname: Khoshnood
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D009551:Night Care; D059408:Pain Management; D010297:Paris; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies
chemical_list: D000700:Analgesics
keywords: After-hours care; Neonate; Neonatology and infant care; Pain; pain; painful procedures