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Influence of risk of neurological impairment and procedure invasiveness on health professionals’ management of procedural pain in neonates
Author(s) -
Stevens Bonnie,
McGrath Patrick,
Ballantyne Marilyn,
Yamada Janet,
Dupuis Annie,
Gibbins Sharyn,
Franck Linda,
Finley G. Allen,
Howlett Alexandra,
Johnston Celeste,
O'Brien Karel,
Ohlsson Arne
Publication year - 2010
Publication title -
european journal of pain
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.305
H-Index - 109
eISSN - 1532-2149
pISSN - 1090-3801
DOI - 10.1016/j.ejpain.2009.11.016
Subject(s) - psychological intervention , medicine , cohort , cohort study , observational study , physical therapy , neonatal intensive care unit , prospective cohort study , pain assessment , pediatrics , pain management , nursing
Objectives: To describe how (i) risk of neurological impairment (NI) and (ii) procedure invasiveness influence health professionals’ assessment and management of procedural pain in neonates in the Neonatal Intensive Care Unit (NICU). Design: Prospective observational study. Setting: Three tertiary level NICUs in Canada. Participants: 114 neonates, 25–40 weeks gestational age (GA) undergoing painful procedures. Main Outcome Measures: Physical and behavioural pain indicators and pharmacological and nonpharmacological pain interventions. Results: 114 neonates at high (Cohort A, n = 35), moderate (Cohort B, n = 25) and low (Cohort C, n = 54) risk of NI were observed during 254 painful procedures performed by 147 health professionals. Physical pain indicators were used more frequently by health professionals to assess pain with Cohorts A and B than C ( p < .05). Behavioural pain indicators were used similarly across Cohorts. Nonpharmacological interventions were implemented most frequently for pain management. Physical interventions were used with 84% of procedures across Cohorts; particularly for the most invasive procedures. Infants with the highest NI risk (Cohort A) received the most behavioural interventions ( p < .05) irrespective of procedural invasiveness. Pharmacological interventions were implemented with 23.2% of procedures; Cohort B received pharmacological interventions most frequently (Cohort B > A, B > C, p < .05) and for increasingly invasive procedures ( p < .05). Conclusions: Health professionals use multidimensional indicators to assess neonatal pain. Nonpharmacological interventions dominate pain management. NI risk status and procedure invasiveness are important contextual factors in neonatal pain assessment and management.