title: Procedural pain in neonatal units in Kenya.
abstract: OBJECTIVE
  To determine the nature and frequency of painful procedures and procedural pain management practices in neonatal units in Kenya.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Level I and level II neonatal units in Kenya.
  
  
  METHODS
  Ninety-five term and preterm neonates from seven neonatal units.
  
  
  METHODS
  Medical records of neonates admitted for at least 24 h were reviewed to determine the nature and frequency of painful procedures performed in the 24 h period preceding data collection (6:00 to 6:00) as well as the pain management interventions (eg, morphine, breastfeeding, skin-to-skin contact, containment, non-nutritive sucking) that accompanied each procedure.
  
  
  RESULTS
  Neonates experienced a total of 404 painful procedures over a 24 h period (mean=4.3, SD 2.0; range 1-12); 270 tissue-damaging (mean=2.85, SD 1.1; range 1-6) and 134 non-tissue-damaging procedures (mean=1.41, SD 1.2; range 0-6). Peripheral cannula insertion (27%) and intramuscular injections (22%) were the most common painful procedures. Ventilated neonates and neonates admitted in level II neonatal units had a higher number of painful procedures than those admitted in level I units (mean 4.76 vs 2.96). Only one procedure had a pain intensity score documented; and none had been performed with any form of analgesia.
  
  
  CONCLUSIONS
  Neonates in Kenya were exposed to numerous tissue-damaging and non-tissue-damaging procedures without any form of analgesia. Our findings suggest that education is needed on how to assess and manage procedural pain in neonatal units in Kenya.
authors.affiliation: School of Nursing, Moi University, Eldoret, Kenya Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: O'Brien Munyao
authors.initials: OM
authors.lastname: Kyololo
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada The Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Bonnie
authors.initials: B
authors.lastname: Stevens
authors.affiliation: Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Denise
authors.initials: D
authors.lastname: Gastaldo
authors.affiliation: Department of Paediatrics and Child Health, Moi University, Eldoret, Kenya.
authors.forename: Peter
authors.initials: P
authors.lastname: Gisore
mesh_terms: D000698:Analgesia / Q000379:methods / Q000706:statistics & numerical data; D002406:Catheterization, Peripheral / Q000009:adverse effects; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D006801:Humans; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D007234:Infant, Premature; D007273:Injections, Intramuscular / Q000009:adverse effects; D007630:Kenya / Q000453:epidemiology; D008297:Male; D009725:Nurseries, Hospital; D010146:Pain / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods
keywords: Analgesia; Neonatal units; Procedural Pain; Procedures