title: Assessment of continuous pain in newborns admitted to NICUs in 18 European countries.
abstract: OBJECTIVE
  Continuous pain occurs routinely, even after invasive procedures, or inflammation and surgery, but clinical practices associated with assessments of continuous pain remain unknown.
  
  
  METHODS
  A prospective cohort study in 243 neonatal intensive care units (NICUs) from 18 European countries recorded the frequency of pain assessments, use of mechanical ventilation, sedation, analgesia or neuromuscular blockade for each neonate for up to 28 days after NICU admission.
  
  
  RESULTS
  Only 2113 of 6648 (31.8%) of neonates received assessments of continuous pain, occurring variably among tracheal ventilation (TrV, 46.0%), noninvasive ventilation (NiV, 35.0%) and no ventilation (NoV, 20.1%) groups (p < 0.001). Daily assessments for continuous pain occurred in only 10.4% of all neonates (TrV: 14.0%, NiV: 10.7%, NoV: 7.6%; p < 0.001). More frequent assessments of continuous pain occurred in NICUs with pain guidelines, nursing champions and surgical admissions (all p < 0.01), and for newborns <32 weeks gestational age, those requiring ventilation, or opioids, sedatives-hypnotics, general anaesthetics (O-SH-GA) (all p < 0.001), or surgery (p = 0.028). Use of O-SH-GA drugs increased the odds for pain assessment in the TrV (OR:1.60, p < 0.001) and NiV groups (OR:1.40, p < 0.001).
  
  
  CONCLUSIONS
  Assessments of continuous pain occurred in less than one-third of NICU admissions and daily in only 10% of neonates. NICU clinical practices should consider including routine assessments of continuous pain in newborns.
authors.affiliation: Departments of Pediatrics, Anesthesiology, Perioperative & Pain Medicine, Stanford University School of Medicine, Stanford, CA, USA.
authors.forename: Kanwaljeet J S
authors.initials: KJS
authors.lastname: Anand
authors.affiliation: School of Health Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
authors.forename: Mats
authors.initials: M
authors.lastname: Eriksson
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Boyle
authors.affiliation: Department of Neonatology, Complexo Hospitalario Universitario de A Coruña, Coruña, Spain.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Avila-Alvarez
authors.affiliation: Department of Child & Adolescent Health Services, Telemark Hospital, Skien, Norway.
authors.forename: Randi Dovland
authors.identifier: http://orcid.org/0000-0001-6857-7058
authors.initials: RD
authors.lastname: Andersen
authors.affiliation: 1st Department of Neonatology, 'Hippokrateion' General Hospital, Aristotle University of Thessaloniki, Thessalokiki, Greece.
authors.forename: Kosmas
authors.initials: K
authors.lastname: Sarafidis
authors.affiliation: Children and Women Department, Oulu University Hospital, Oulu, Finland.
authors.forename: Tarja
authors.initials: T
authors.lastname: Polkki
authors.affiliation: Maternidade Dr. Alfredo da Costa, Lisboa, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Matos
authors.affiliation: Department of Woman's and Child's Health, University of Padua, Padua, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Lago
authors.affiliation: Department of Paediatrics, Arch. Makarios III Hospital, Nicosia, Cyprus.
authors.forename: Thalia
authors.initials: T
authors.lastname: Papadouri
authors.affiliation: Department of Paediatrics, Mater Dei Hospital, Msida, Malta.
authors.forename: Simon
authors.initials: S
authors.lastname: Attard-Montalto
authors.affiliation: Department of Paediatrics, Tallinn Children's Hospital, Tallinn, Estonia.
authors.forename: Mari-Liis
authors.initials: ML
authors.lastname: Ilmoja
authors.affiliation: Department of Pediatrics, Erasmus MC-Sophia Kinderziekenhuis, Rotterdam, The Netherlands.
authors.forename: Sinno
authors.initials: S
authors.lastname: Simons
authors.affiliation: Department of Neonatology, Kaunas Perinatal Center, Lithuanian University of Health Sciences, Kaunas, Lithuania.
authors.forename: Rasa
authors.initials: R
authors.lastname: Tameliene
authors.affiliation: Cliniques Universitaires de Bruxelles, Erasme Hospital, Bruxelles, Belgium.
authors.forename: Bart
authors.initials: B
authors.lastname: van Overmeire
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
authors.forename: Angelika
authors.initials: A
authors.lastname: Berger
authors.affiliation: Department of Neonatology, Children's Memorial Health Institute Warsaw, Warszawa, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Dobrzanska
authors.affiliation: Department of Paediatrics, Cnopf'sche Kinderklinik, Nürnberg Children's Hospital, Nürenberg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schroth
authors.affiliation: Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Solna, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Bergqvist
authors.affiliation: Urgences Pédiatriques, Hôpital Armand Trousseau, INSERM U1153, Université Pierre et Marie Curie Paris VI, Paris VI, Paris, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Courtois
authors.affiliation: Urgences Pédiatriques, Hôpital Armand Trousseau, INSERM U1153, Université Pierre et Marie Curie Paris VI, Paris VI, Paris, France.
authors.forename: Jessica
authors.initials: J
authors.lastname: Rousseau
authors.affiliation: Urgences Pédiatriques, Hôpital Armand Trousseau, INSERM U1153, Université Pierre et Marie Curie Paris VI, Paris VI, Paris, France.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Carbajal
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis*; D005060:Europe; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D008297:Male; D010147:Pain Measurement / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012121:Respiration, Artificial
keywords: Clinical practices; Infant-newborn; Infant-premature; Neonatal intensive care units; Suffering