title: Sedation and analgesia practices at Italian neonatal intensive care units: results from the EUROPAIN study.
abstract: BACKGROUND
  We aimed to examine current bedside analgesia/sedation (A/S) and pain assessment (PA) practices in Italian neonatal intensive care units (NICUs) in relation to the findings of an epidemiological European study and recently-introduced national guidelines.
  
  
  METHODS
  We analyzed the Italian data from the EUROPAIN (EUROpean-Pain-Audit-In-Neonates) prospective observational study on A/S practices that involved 6680 newborns admitted to tertiary-level NICUs in 18 European countries. Demographics, type of assisted ventilation, type and mode of A/S administration and PA were analyzed. Multivariate linear regression models were used to identify factors predicting A/S and PA practices.
  
  
  RESULTS
  From October 1st, 2012 to June 30th, 2013, thirty Italian NICUs gathered data on 422 newborn: 131 on invasive ventilation (IV); 150 on noninvasive ventilation (NIV); and 141 on spontaneous ventilation (SV). A/S was documented for 35.3% of all infants admitted (86.3% IV; 17.3% NIV; 7.1% SV [p = 0.0001]), and varied considerably between NICUs (as reported in other European countries). Strong analgesics were used in 32.5% of cases, sedatives in 10.2%, mild analgesics in 3.8%. Fentanyl was used in 78.6% of cases, morphine in 8.4%, neuromuscular blockers in 5.3%, midazolam in 22.1%. The performance of PA was documented in 67.5% of all newborn (85.5% IV; 67.3% NIV; 51.1% SV [p = 0.001]). Illness severity, type of ventilation, bedside PA, and number of NICU beds were all factors associated with A/S use on multivariate analysis, while gestational age ≤ 32 weeks, and type of ventilation and presence of a pain team were associated with PA.
  
  
  CONCLUSIONS
  We documented a generally widespread, but still highly variable use of A/S and PA at Italian NICUs, despite the diffusion of national guidelines. There is an urgent need to improve routine PA to enable customized pain and stress control (and prevention) in all infants.
  
  
  BACKGROUND
  Clinical Trials.gov # NCT01694745 .
authors.affiliation: Neonatal Intensive Care Unit, Women's and Children's Health Department, Azienda Ospedaliera-University of Padova, Via Giustiniani 3, Padua, 35128, Italy. paola.lago@aopd.veneto.it.
authors.forename: Paola
authors.initials: P
authors.lastname: Lago
authors.affiliation: Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy.
authors.forename: Anna Chiara
authors.initials: AC
authors.lastname: Frigo
authors.affiliation: Neonatal Intensive Care Unit, Women's and Children's Health Department, Azienda Ospedaliera-University of Padova, Via Giustiniani 3, Padua, 35128, Italy.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Baraldi
authors.affiliation: Neonatal Intensive Care Unit, Women's and Children's Health Department, Azienda Ospedaliera-University of Padova, Via Giustiniani 3, Padua, 35128, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Pozzato
authors.affiliation: Hôpital Amand Trousseau, Service des Urgences Pédiatrique, Paris, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Courtois
authors.affiliation: Hôpital Amand Trousseau, Service de Réanimation Pédiatrique et Néonatale, Paris, France.
authors.forename: Jérôme
authors.initials: J
authors.lastname: Rambaud
authors.affiliation: Departments of Pediatrics, Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Kanwaljeet J S
authors.initials: KJ
authors.lastname: Anand
authors.affiliation: Hôpital Amand Trousseau, Service des Urgences Pédiatrique, Paris, France.|Université Pierre at Marie Curie, Faculté de Médecine, Paris, France.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
mesh_terms: D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage*; D016292:Procedural Sedation / Q000379:methods*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage*; D015994:Incidence; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D010146:Pain / Q000453:epidemiology*; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement / Q000379:methods*; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000379:methods; D011795:Surveys and Questionnaires
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives
keywords: Analgesic; Newborn and preterm; Opioids; Pain; Pain assessment; Sedative