title: [Clinical assessment of pain in Spanish Neonatal Intensive Care Units].
abstract: BACKGROUND
  Clinical scales are currently the best method to assess pain in the neonate, given the impossibility of self-report in this age group. A study is designed with the aim of determining the current practices as regards the clinical assessment of pain in Spanish Neonatal Units and the factors associated with the use of clinical scales.
  
  
  METHODS
  A prospective longitudinal observational study was conducted. A total of 30 Units participated and 468 neonates were included.
  
  
  RESULTS
  Only 13 Units (43.3%) had pain assessment protocols. Pain was evaluated with a scale in 78 neonates (16.7%, 95% CI; 13.1-20.1) and the mean number of pain assessments per patient and per day was 2.3 (Standard Deviation; 4.8), with a median of 0.75. Of the total number of 7,189 patient-days studied, there was at least one pain assessment in 654 (9.1%). No pain assessment was performed with a clinical scale on any patient in 20 (66.7%) Units. Among those that did, a wide variation was observed in the percentage of patients in whom pain was assessed, as well as in the scales used. The CRIES (C-Crying; R-Requires increased oxygen administration; I-Increased vital signs; E-Expression; S-Sleeplessness) scale was that used in most Units. In the multivariate analysis, only invasive mechanical ventilation was associated with receiving a pain assessment with a scale (OR 1.46, P=.042).
  
  
  CONCLUSIONS
  The majority of neonates admitted into Intensive Care in Spain do not receive a pain assessment. Many units still do not routinely use clinical scales, and there is a wide variation between those that do use them. These results could serve as a basis for preparing national guidelines as regards pain in the neonate.
authors.affiliation: Unidad de Neonatología, Servicio de Pediatría, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade de A Coruña (UDC), A Coruña, España. Electronic address: alejandro.avila.neonatologia@gmail.com.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Avila-Alvarez
authors.affiliation: Service d'Urgences Pédiatriques. Hôpital d'enfants Armand Trousseau, Inserm UMR 1153 Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Université Pierre et Marie Curie, París, Francia.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
authors.affiliation: Service d'Urgences Pédiatriques. Hôpital d'enfants Armand Trousseau, Inserm UMR 1153 Equipe de recherche en Epidémiologie Obstétricale, Périnatale et Pédiatrique (EPOPé), Université Pierre et Marie Curie, París, Francia.
authors.forename: Emilie
authors.initials: E
authors.lastname: Courtois
authors.affiliation: Grupo de Investigación de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), SERGAS, Universidade de A Coruña (UDC), A Coruña, España.
authors.forename: Sonia
authors.initials: S
authors.lastname: Pertega-Diaz
authors.affiliation: University of Tennessee Health Science Center, Memphis, Estados Unidos.
authors.forename: Kanwaljeet J S
authors.initials: KJ
authors.lastname: Anand
authors.affiliation: Instituto Universitario de Ciencias de la Salud e Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade de A Coruña (UDC), A Coruña, España.
authors.forename: Javier
authors.initials: J
authors.lastname: Muñiz-Garcia
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008137:Longitudinal Studies; D008297:Male; D059408:Pain Management; D010147:Pain Measurement; D011446:Prospective Studies; D013030:Spain
chemical_list: D000700:Analgesics
keywords: Analgesia; Dolor; Neonate; Neonato; Pain; Sedación; Sedation