Background Neonates admitted to NICUs are frequently subjected to invasive procedures, often with sub-optimal analgesic treatment.
Objective To determine the number of invasive procedures and analgesic practices in NICUs.
Methods Invasive procedures and corresponding analgesic therapies on days 1–14 of NICU admission were prospectively studied over a 2-month period in all neonates admitted to the 16 NICUs in the Paris region.
Results For 589 neonates included, mean (SD) gestational age, birth weight, CRIB scores, and number of days of participation were 33.3 (4.5) wks, 1983 (943) gm, 1.5 (2.5), and 7.4 (4.5) days, respectively. 103239 procedures were performed in all neonates, 40927 were classified as painful and 62312 were stressful. The median (range) number of all procedures, painful procedures (PP) and stressful procedures (SP) per infant were, respectively, 124 (0–699), 44 (0–353), and 78 (0–406). Table 1 shows most frequent PP.
Analgesic therapy before PP varied widely among procedures. Analgesic therapy was given before 28.1% of PP. Continuous infusions of sedatives and/or analgesics were given during 38.8% of PP. Overall, 61.8% of PP were performed with an analgesic given before the procedures and/or while the neonate was receiving continuous sedation/analgesia. Fig. shows factors associated with preprocedural analgesia use.
Conclusions There is an urgent need to reduce the number of procedures and the pain produced by routine NICU procedures in neonates. Analgesic therapy should be matched with the intensity and duration of acute pain caused by invasive procedures.