Painful procedures and analgesia in hospitalized newborns: A prospective longitudinal study

Abstract

Objective

To identify the type and frequency of stressful and painful procedures, the use of pharmacological and non-pharmacological strategies; to identify relationships between demographic and clinical variables with frequency of procedures and pain management.

Design

A prospective longitudinal study was conducted in neonatal intensive care units (NICU) of two hospitals in the city of Belo Horizonte, Brazil. 140 newborns admitted to the NICU between June 2014 and January 2015 were included.

Results

A total of 21,291 procedures were documented, 18,131 (85.2%) stressful procedures and 3,160 (14.8%) invasive skin-breaking painful procedures. Each day of hospitalization increased by 10.9 the number of stressful procedures and by 2.2 the number of painful procedures. Furthermore, for each day of hospitalization, non-pharmacological strategies registered increased by 3.4% and pharmacological strategies, increased by 9.3%.

Conclusion

Neonates underwent a high number of stressful and painful procedures and with infrequent use of pharmacological and non-pharmacological strategies during the entire hospitalization.

Introduction

Newborns admitted to neonatal intensive care units (NICU) are exposed to a high numbers of painful skin breaking procedures such as heel lance and venipuncture, and stressful interventions such as handling. Early life exposure to untreated pain can negatively impact on postnatal growth and brain development, and may affect attention, cognitive, emotional and motor progress (Valeri et al., 2015). Furthermore, a cohort study demonstrated painful procedures were associated with decreased weight gain and head circumference gain in 78 very preterm newborns (<32 weeks of gestational age) hospitalized in an NICU (Vinall et al., 2012).

However a systematic review of studies conducted worldwide demonstrate that procedural pain prevention and management in newborns is suboptimal (Cruz et al., 2016), and studies published more recently continue to demonstrate similar results (Courtois et al., 2016a, 2016b). However there is little known about the epidemiology of neonatal pain in the Brazilian context (Bonutti et al., 2017; Linhares et al., 2012; Nóbrega et al., 2007; Sposito et al., 2017).

Although the length of hospitalization in NICU may vary from days to months according to newborns' clinical conditions, the majority of prior studies conducted in developed and developing countries have evaluate pain exposure and pain management practices during the first days of life only (Cruz et al., 2016). Therefore, examining the epidemiology of procedural pain and pain management and exploring the relation between painful procedures and neonatal demographic and clinical variables can contribute to the knowledge base concerning the true burden of pain for sick infants, and inform the creation and implementation of strategies to improve neonatal pain outcomes throughout the hospitalization.

The aims of this study were to identify the type and frequency of stressful and painful procedures, the use of analgesic and comforting strategies for newborn comfort and pain relief, and to identify relationships between demographic and clinical variables with frequency of procedures and pain management during the course of newborns' hospitalization.