Losacco et al's1 review of practice across European neonatal units regarding the use of non-pharmacological analgesia (NPA) for painful procedures in neonatal units has highlighted the relatively infrequent use of these techniques. This is despite good evidence confirming the effectiveness of NPA2 and evidence of deleterious effects of pain in babies, both short term3 (decreased oxygenation, haemodynamic instability and raised intracranial pressure) and long term4 (neurodevelopmental delay and altered perceptions of pain in later life).

We have recently conducted an audit on the use of NPA for neonates, comparing our current practice at Good Hope Hospital, Birmingham, UK, against our hospital guidelines. As a part of this process, we have also carried out a review of literature on the use of NPA and assessed whether the current hospital guidance meets evidence-based recommendations.

Clinical staff in various neonatal and paediatric clinical areas at Good Hope Hospital were requested to fill in questionnaires every time they carried out a painful procedure in an infant. Forty-six questionnaires were filled in total; 8 from the postnatal wards, 11 from the children's assessment unit or paediatric ward and 27 from the neonatal unit.

For postnatal wards, the ages for which the procedures were carried out ranged from day 1 to 4. Five of the eight babies were given sucrose (0.6 ml …