title: Painful procedures and analgesia in the NICU: what has changed in the medical perception and practice in a ten-year period?
abstract: OBJECTIVE
  To compare the use of analgesia versus neonatologists' perception regarding analgesic use in painful procedures in the years 2001, 2006, and 2011.
  
  
  METHODS
  This was a prospective cohort study of all newborns admitted to four university neonatal intensive care units during one month in 2001, 2006, and 2011. The frequency of analgesic prescription for painful procedures was evaluated. Of the 202 neonatologists, 188 answered a questionnaire giving their opinion on the intensity of pain during lumbar puncture, tracheal intubation, mechanical ventilation, and postoperative period using a 10-cm visual analogic scale (VAS; pain >3cm).
  
  
  RESULTS
  For lumbar puncture, 12% (2001), 43% (2006), and 36% (2011) were performed using analgesia. Among the neonatologists, 40-50% reported VAS >3 for lumbar puncture in all study periods. For intubation, 30% received analgesia in the study periods, and 35% (2001), 55% (2006), and 73% (2011) of the neonatologists reported VAS >3 and would prescribe analgesia for this procedure. As for mechanical ventilation, 45% (2001), 64% (2006), and 48% (2011) of patient-days were under analgesia; 56% (2001), 57% (2006), and 26% (2011) of neonatologists reported VAS >3 and said they would use analgesia during mechanical ventilation. For the first three post-operative days, 37% (2001), 78% (2006), and 89% (2011) of the patients received analgesia and more than 90% of neonatologists reported VAS >3 for major surgeries.
  
  
  CONCLUSIONS
  Despite an increase in the medical perception of neonatal pain and in analgesic use during painful procedures, the gap between clinical practice and neonatologist perception of analgesia need did not change during the ten-year period.
authors.affiliation: Division of Neonatal Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Ana Claudia Yoshikumi
authors.initials: AC
authors.lastname: Prestes
authors.affiliation: Division of Neonatal Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Rita de Cássia Xavier
authors.initials: Rde C
authors.lastname: Balda
authors.affiliation: Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil.
authors.forename: Gianni Mara Silva dos
authors.initials: GM
authors.lastname: Santos
authors.affiliation: Department of Pediatrics, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, SP, Brazil.
authors.forename: Ligia Maria Suppo de Souza
authors.initials: LM
authors.lastname: Rugolo
authors.affiliation: Department of Pediatrics, Faculdade de Medicina de Botucatu (FMB), Universidade Estadual Paulista Júlio de Mesquita Filho (UNESP), Botucatu, SP, Brazil.
authors.forename: Maria Regina
authors.initials: MR
authors.lastname: Bentlin
authors.affiliation: Department of Pediatrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil; Service of Neonatology, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Magalhães
authors.affiliation: Department of Pediatrics, Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil.
authors.forename: Paulo Roberto
authors.initials: PR
authors.lastname: Pachi
authors.affiliation: Department of Pediatrics, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Sergio Tadeu Martins
authors.initials: ST
authors.lastname: Marba
authors.affiliation: Division of Neonatology, Hospital da Mulher Prof. Dr. José Aristodemo Pinotti, Centro de Atenção Integral à Saúde da Mulher (CAISM), Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brazil.
authors.forename: Jamil Pedro de Siqueira
authors.initials: JP
authors.lastname: Caldas
authors.affiliation: Division of Neonatal Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, Brazil. Electronic address: ruthgbr@netpoint.com.br.
authors.forename: Ruth
authors.initials: R
authors.lastname: Guinsburg
mesh_terms: D000328:Adult; D000368:Aged; D000698:Analgesia / Q000592:standards / Q000639:trends*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D015931:Intensive Care, Neonatal / Q000379:methods / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D059408:Pain Management / Q000592:standards / Q000639:trends*; D010147:Pain Measurement; D010465:Perception; D011364:Professional Practice / Q000706:statistics & numerical data / Q000639:trends*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors
keywords: Manejo da dor; Medição da dor; Neonatal intensive care units; Newborn; Pain management; Pain measurement; Pain perception; Percepção da dor; Recém-nascido; Unidades de terapia intensiva neonatal