title: The burden of venipuncture pain in neonatal intensive care units: EPIPPAIN 2, a prospective observational study.
abstract: BACKGROUND
  Newborns in intensive care units (ICUs) undergo numerous painful procedures including venipunctures. Skin-breaking procedures have been associated with adverse neurodevelopment long-term effects in very preterm neonates. The venipuncture frequency and its real bedside pain management treatment are not well known in this setting.
  
  
  OBJECTIVE
  To describe venipuncture frequency, its pain intensity, and the analgesic approach in ICU newborns; to determine the factors associated with the lack of preprocedural analgesia and with a high pain score during venipuncture.
  
  
  METHODS
  Further analysis of EPIPPAIN 2 (Epidemiology of Procedural Pain In Neonates), which is a descriptive prospective epidemiologic study.
  
  
  METHODS
  All 16 neonatal and pediatric ICUs in the Paris region in France.
  
  
  METHODS
  All newborns in the ICU with a maximum corrected age under 45 weeks of gestation on admission who had at least one venipuncture during the study period.
  
  
  METHODS
  Data on all venipunctures, their pain score assessed with the DAN scale and their corresponding analgesic therapies were prospectively collected. The inclusion period lasted six weeks, from June 2, 2011, to July 12, 2011. Newborns were followed from their admission to the 14th day of their ICU stay or discharge, whichever occurred first.
  
  
  RESULTS
  495 newborns who underwent venipunctures were included. The mean (SD) gestational age was 33.0 (4.4) weeks and duration of participation was 8.0 (4.5) days. A total of 257 (51.9%) neonates were very preterm (<33 weeks). The mean (SD; range) number of venipunctures per neonate during the study period was 3.8 (2.8; 1-19) for all neonates and 4.1 (2.9; 1-17) for neonates <33 weeks. Of the 1887 venipunctures, 1164 (61.7%) were performed successfully in one attempt, 437 (23.2%) with continuous analgesia, 1434 (76.0%) with specific preprocedural analgesia. In multivariate models, lack of preprocedural analgesia was associated with higher disease-severity score, intrauterine growth retardation, invasive or noninvasive ventilation, venipuncture performed on the first day of hospitalization or at nighttime, and the use of continuous sedation/analgesia. High pain scores were significantly associated with absence of parents during procedures, surgery during the study period, and higher number of attempts.
  
  
  CONCLUSIONS
  Venipuncture is very frequent in preterm and term neonates in the ICUs. 76% were performed with preprocedural analgesia. Strategies to reduce the number of attempts and to promote parental presence seem necessary.
authors.affiliation: Emergency Department, Hôpital Armand-Trousseau, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, France. Electronic address: emilie.courtois@aphp.fr.
authors.forename: Emilie
authors.initials: E
authors.lastname: Courtois
authors.affiliation: Centre National de Ressources de lutte contre la Douleur, Hôpital Armand-Trousseau, Paris, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Cimerman
authors.affiliation: NICU, Hôpital André Grégoire, Montreuil, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Dubuche
authors.affiliation: NICU, Institut de puériculture et de périnatalogie, Paris, France.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Goiset
authors.affiliation: PICU, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Orfèvre
authors.affiliation: NICU, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Lagarde
authors.affiliation: NICU, Hôpital Antoine Béclère, Clamart, France.
authors.forename: Betty
authors.initials: B
authors.lastname: Sgaggero
authors.affiliation: NICU, Hôpital Robert Debré, Paris, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Guiot
authors.affiliation: NICU, Hôpital Louise Michel, Evry, France.
authors.forename: Mélanie
authors.initials: M
authors.lastname: Goussot
authors.affiliation: NICU, Hôpital Cochin Port Royal, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Huraux
authors.affiliation: PICU, Hôpital Armand-Trousseau, Paris, France.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Nanquette
authors.affiliation: NICU, Hôpital Louis Mourier, Colombes, France.
authors.forename: Céline
authors.initials: C
authors.lastname: Butel
authors.affiliation: NICU, Intercommunal de Poissy, Poissy, France.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Ferreira
authors.affiliation: PICU, Hôpital Necker, Paris, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Lacoste
authors.affiliation: NICU, Centre Hospitalier de Meaux, Meaux, France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Séjourné
authors.affiliation: NICU, Centre Hospitalier Delafontaine, Saint-Denis, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Jolly
authors.affiliation: NICU, Centre Hospitalier René Dubos, Cergy Pontoise, France.
authors.forename: Gladys
authors.initials: G
authors.lastname: Lajoie
authors.affiliation: NICU, Centre Hospitalier Victor Dupouy, Argenteuil, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Maillard
authors.affiliation: Emergency Department, Hôpital Armand-Trousseau, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Guedj
authors.affiliation: Emergency Department, Hôpital Armand-Trousseau, Paris, France; UPMC, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Chappuy
authors.affiliation: Emergency Department, Hôpital Armand-Trousseau, Paris, France; Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, France; UPMC, Paris, France.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D010146:Pain / Q000209:etiology*; D010297:Paris; D018962:Phlebotomy / Q000009:adverse effects*; D011446:Prospective Studies
keywords: Epidemiology; Intensive care unit; Neonate; Nursing care; Pain; Pain management; Procedural pain; Venipuncture