Assessment and Management of Procedural Pain During the Entire Neonatal Intensive Care Unit Hospitalization

Abstract

Background: Despite strong evidence that repeated pain exposure in neonates is associated with adverse outcomes, pain assessment and management continues to be less than optimal in most neonatal intensive care units (NICUs).

Aims: To evaluate current pain assessment and management practices, and identify factors associated with optimal treatment throughout a cohort of preterm neonates over the entire hospital stay.

Design: A secondary analysis of study data collected from 2012 to 2016 as part of a larger clinical trial and supplemental chart review.

Settings: Tertiary level neonatal intensive care unit.

Participants/subjects: 242 stable preterm neonates born at less than 37 weeks gestational age.

Methods: Data were analyzed quantitatively using R for statistics.

Results: The 242 neonates underwent a total of 10,469 painful procedures (4,801 tissue breaking and 5,667 non-tissue breaking, with only 56.6% and 12.2% having a documented pain score using the Premature Infant Pain Profile, respectively). Average pain exposure was 43 with a median of 32(10-576) per entire hospital stay. Documented pain score and greater postnatal age were associated with higher use of a pain reducing intervention and lower gestational age, first day, first week, higher illness severity, non tissue breaking and night time procedures were associated with lower. Use of a pain relieving intervention was documented in 58.5% of procedures. Sucrose was most commonly used pharmacologic and non nutritive sucking the most common non pharmacologic interventions.

Conclusions: Increased efforts are needed to promote consistent pain assessment and management to ensure optimal outcomes for vulnerable at risk neonates.