Parents in Neonatal Pain Management-An International Survey of Parent-Delivered Interventions and Parental Pain Assessment

Abstract

Background: While parent-delivered pain management has been demonstrated to effectively reduce neonatal procedural pain responses, little is known about to what extent it is utilized. Our aim was to explore the utilization of parents in neonatal pain management and investigate whether local guidelines promote parent-delivered interventions.

Methods: A web-based survey was distributed to neonatal units worldwide.

Results: The majority of the 303 responding neonatal intensive care units (NICUs) from 44 countries were situated in high-income countries from Europe and Central Asia. Of the responding units, 67% had local guidelines about neonatal pain management, and of these, 40% answered that parental involvement was recommended, 27% answered that the role of parents in pain management was mentioned as optional, and 32% responded that it was not mentioned in the guidelines. According to the free-text responses, parent-delivered interventions of skin-to-skin contact, breastfeeding, and parental live singing were the most frequently performed in the NICUs. Of the responding units, 65% answered that parents performed some form of pain management regularly or always.

Conclusions: There appears to be some practice uptake of parent-delivered pain management to reduce neonatal pain in high-income countries. Additional incorporation of these interventions into NICU pain guidelines is needed, as well as a better understanding of the use of parent-delivered pain management in low- and middle-income countries.

Keywords: breastfeeding; infant-directed singing; neonatal pain; newborn infants; pain; parent-delivered pain management; parents; skin-to-skin contact.

Figure 1

Responding units per country.

Figure 2

Radar diagram showing three levels of parental pain management: units with low, moderate, or high participation, where 1 is never and 5 is always.

Figure 3

The most frequently combined parent-delivered pain-relieving interventions performed in the NICUs according to the free-text responses in the survey. Overlapping circles indicate units that reported more than one of these combinations.

Figure 4

The perceived opinion of nurse assistants, physicians, and registered nurses and their perception and attitude towards parental-delivered pain-relieving interventions, from very negative (left, light peach color) to very positive (right, dark brown color).

Figure 5

Health care professionals generally transfer knowledge about parent-delivered pain-relieving interventions to parents orally.