title: Epidemiology and neonatal pain management of heelsticks in intensive care units: EPIPPAIN 2, a prospective observational study.
abstract: BACKGROUND
  Heelstick is the most frequently performed skin-breaking procedure in the neonatal intensive care units (NICUs). There are no large multicenter studies describing the frequency and analgesic approaches used for heelsticks performed in NICUs.
  
  
  OBJECTIVE
  To describe the frequency of heelsticks and their analgesic management in newborns in the NICU. To determine the factors associated with the lack of specific preprocedural analgesia for this procedure.
  
  
  METHODS
  EPIPPAIN 2 (Epidemiology of Procedural PAin In Neonates) is a descriptive prospective epidemiologic study.
  
  
  METHODS
  All 16 NICUs in the Paris region in France.
  
  
  METHODS
  All newborns in the NICU with a maximum corrected age of 44 weeks +6 days of gestation on admission who had at least one heelstick during the study period were eligible for the study. The study included 562 newborns.
  
  
  METHODS
  Data on all heelsticks 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 NICU stay or discharge, whichever occurred first.
  
  
  RESULTS
  The mean (SD) gestational age was 33.3 (4.4) weeks and duration of participation was 7.5 (4.4) days. The mean (SD; range) of heelsticks per neonate was 16.0 (14.4; 1-86) during the study period. Of the 8995 heelsticks studied, 2379 (26.4%) were performed with continuous analgesia, 5236 (58.2%) with specific preprocedural analgesia. Overall, 6764 (75.2%) heelsticks were performed with analgesia (continuous and/or specific). In a multivariate model, the increased lack of preprocedural analgesia was associated with female sex, term birth, high illness severity, tracheal or noninvasive ventilation, parental absence and use of continuous sedation/analgesia.
  
  
  CONCLUSIONS
  Heelstick was very frequently performed in NICUs. Although, most heelsticks were performed with analgesia, this was not systematic. The high frequency of this procedure and the known adverse effects of repetitive pain in neonates should encourage the search of safe and effective strategies to reduce their number.
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@trs.aphp.fr.
authors.forename: Emilie
authors.initials: E
authors.lastname: Courtois
authors.affiliation: NICU, Hôpital André Grégoire, Montreuil, France.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Droutman
authors.affiliation: NICU, Institut de puériculture et de périnatalogie, Paris, France.
authors.forename: Jean-François
authors.initials: JF
authors.lastname: Magny
authors.affiliation: PICU, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Zied
authors.initials: Z
authors.lastname: Merchaoui
authors.affiliation: 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; NICU, Centre Hospitalier Intercommunal de Créteil, Créteil, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Durrmeyer
authors.affiliation: NICU, Hôpital Antoine Béclère, Clamart, France.
authors.forename: Camille
authors.initials: C
authors.lastname: Roussel
authors.affiliation: NICU, Hôpital Robert Debré, Paris, France.
authors.forename: Valérie
authors.initials: V
authors.lastname: Biran
authors.affiliation: NICU, Hôpital Louise Michel, Evry, France.
authors.forename: Sergio
authors.initials: S
authors.lastname: Eleni
authors.affiliation: NICU, Hôpital Cochin Port Royal, Paris, France.
authors.forename: Gaëlle
authors.initials: G
authors.lastname: Vottier
authors.affiliation: PICU, Hôpital Armand-Trousseau, Paris, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Renolleau
authors.affiliation: NICU, Hôpital Louis Mourier, Colombes, France.
authors.forename: Luc
authors.initials: L
authors.lastname: Desfrere
authors.affiliation: NICU, Intercommunal de Poissy, Poissy, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Castela
authors.affiliation: PICU, Hôpital Necker, Paris, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Boimond
authors.affiliation: NICU, Centre hospitalier de Meaux, Meaux, France.
authors.forename: Djamel
authors.initials: D
authors.lastname: Mellah
authors.affiliation: NICU, Centre hospitalier Delafontaine, Saint-Denis, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Bolot
authors.affiliation: NICU, Centre hospitalier René Dubos, Cergy Pontoise, France.
authors.forename: Anne
authors.initials: A
authors.lastname: Coursol
authors.affiliation: NICU, Centre hospitalier Victor Dupouy, Argenteuil, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Brault
authors.affiliation: Emergency Department, Hôpital Armand-Trousseau, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Chappuy
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: Department of Pediatrics, Critical Care Medicine Division, University of Tennessee Health Science Center, Memphis, USA.
authors.forename: Kanwaljeet J S
authors.initials: KJ
authors.lastname: Anand
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: D006365:Heel; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D059408:Pain Management / Q000379:methods*; D018962:Phlebotomy / Q000379:methods; D011446:Prospective Studies
keywords: Epidemiology; Heel lance; Heelstick; Neonatal intensive care unit; Neonate; Nursing care; Pain management; Procedural pain