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Procedural pain in neonates: the state of the art in the implementation of national guidelines in I taly
Author(s) -
Lago Paola,
Garetti Elisabetta,
Boccuzzo Giovanna,
Merazzi Daniele,
Pirelli Anna,
Pieragostini Luisa,
Piga Simone,
Cuttini Marina,
Ancora Gina
Publication year - 2013
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12107
Subject(s) - medicine , sedation , venipuncture , tracheal intubation , retinopathy of prematurity , intensive care , lumbar puncture , pain assessment , anesthesia , sufentanil , psychological intervention , intubation , intensive care medicine , gestational age , pain management , pregnancy , psychiatry , cerebrospinal fluid , pathology , biology , genetics
Summary Background National and international guidelines have been published on pain control and prevention in the newborn, but data on compliance with these guidelines are lacking. Aim To document current hospital practices for analgesia at neonatal intensive care units ( NICU s) 5 years after national guidelines were published in Italy. Methods A computer‐based questionnaire was sent to all registered Italian level II and level III NICU s to investigate their routine pain control practices. Main outcome measures The analgesia and sedation currently used for invasive procedures as compared with best practices. Results The questionnaire was returned by 103 of the 118 NICU s (87.3%), most of which (85.4%) knew of the national guidelines on procedural pain control and prevention, and used some analgesic measures during invasive procedures. One or more nonpharmacological interventions were only used routinely by 64.1% of the NICU s for heel pricks and venipuncture, 56.0% for percutaneous insertion of central catheters, 69.7% for nasal CPAP , and 62.4% for eye tests to screen for retinopathy of prematurity. Pain medication was routinely administered at 34.3% NICU s for tracheal intubation, 46.6% for mechanical ventilation ( MV ), 12.9% for tracheal aspiration, 71.4% for chest tube insertion, 33.0% for lumbar puncture, and 64.0% for postoperative pain. Pain was routinely monitored at only 22.7% of the units during MV , 12.1% for nCPAP , and 21.8% postoperatively. Conclusion This survey showed that most Italian NICU s provide some form of analgesia and sedation for invasive procedures in accordance with national guidelines, but their routine adherence to best practices for pain control and monitoring is still suboptimal.