title: Epidemiology of painful procedures performed in neonates: A systematic review of observational studies.
abstract: OBJECTIVE
  Procedural pain in neonates has been a concern in the last two decades. The purpose of this review was to provide a critical appraisal and a synthesis of the published epidemiological studies about procedural pain in neonates admitted to intensive care units. The aims were to determine the frequency of painful procedures and pain management interventions as well as to identify their predictors.
  
  
  METHODS
  Academic Search, CINAHL, LILACS, Medic Latina, MEDLINE and SciELO databases were searched for observational studies on procedural pain in neonates admitted to intensive care units. Studies in which neonatal data could not be extracted from the paediatric population were excluded.
  
  
  RESULTS
  Eighteen studies were included in the review. Six studies with the same study duration, the first 14 days of the neonate life or admission in the unit of care, identified 6832 to 42,413 invasive procedures, with an average of 7.5-17.3 per neonate per day. The most frequent procedures were heel lance, suctioning, venepuncture and insertion of peripheral venous catheter. Pharmacological and nonpharmacological approaches were inconsistently applied. Predictors of the frequency of procedures and analgesic use included the neonate's clinical condition, day of unit stay, type of procedure, parental presence and pain assessment. The existence of pain protocols was not a predictor of analgesia.
  
  
  CONCLUSIONS
  Painful procedures were performed frequently and often with inadequate pain management. Unlike neonate clinical factors, organizational factors may be modified to promote a context of care more favourable to pain management.
authors.affiliation: Nursing School of the University of Évora, Portugal.|Health Sciences Research Unit, Nursing hosted by the Nursing School of Coimbra, Portugal.
authors.forename: M D
authors.initials: MD
authors.lastname: Cruz
authors.affiliation: Nursing School of Coimbra, Portugal.|Health Sciences Research Unit, Nursing hosted by the Nursing School of Coimbra, Portugal.
authors.forename: A M
authors.initials: AM
authors.lastname: Fernandes
authors.affiliation: Faculty of Medicine of the University of Coimbra, Portugal.|CNC-Center for Neuroscience and Cell Biology, University of Coimbra, Portugal.
authors.forename: C R
authors.initials: CR
authors.lastname: Oliveira
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D003422:Critical Care; D006801:Humans; D007231:Infant, Newborn; D064887:Observational Studies as Topic; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D059408:Pain Management; D010147:Pain Measurement; D011677:Punctures / Q000009:adverse effects*
chemical_list: D000700:Analgesics