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Pharmacology I
O-101 Number Of Procedures And Analgesic Therapy In Neonates Admitted To Nicus: Epippain 2 Study
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  1. R Carbajal1,
  2. E Courtois1,
  3. S Droutman2,
  4. JF Magny3,
  5. Z Merchaoui4,
  6. X Durrmeyer5,
  7. C Roussel6,
  8. V Biran7,
  9. S Renolleau8,
  10. L Desfrere9,
  11. F Castela10,
  12. N Boimond11,
  13. D Mellah12,
  14. P Bolot13,
  15. A Coursol14,
  16. M El Ayoubi15,
  17. S Eleni16,
  18. D Brault17,
  19. Epippain E18 2 Study Group,
  20. P Cimerman19,
  21. KJS Anand20
  1. 1Emergency Department, Hôpital Armand-Trousseau, Paris, France
  2. 2NICU, Hôpital André Grégoire, Montreuil, France
  3. 3NICU, Institut de Puériculture Et de Périnatalogie, Paris, France
  4. 4NICU, Hôpital Bicêtre, Le Kremlin Bicêtre, France
  5. 5NICU, Intercommunal de Créteil, Créteil, France
  6. 6NICU, Hôpital Antoine Béclère, Clamart, France
  7. 7NICU, Hôpital Robert Debré, Paris, France
  8. 8NICU, Hôpital Armand-Trousseau, Paris, France
  9. 9NICU, Hôpital Louis Mourier, Colombes, France
  10. 10NICU, Intercommunal de Poissy, Poissy, France
  11. 11NICU, Hôpital Necker, Paris, France
  12. 12NICU, Centre Hospitalier de Meaux, Meaux, France
  13. 13NICU, Centre Hospitalier de Saint-Denis, Saint-Denis, France
  14. 14NICU, Centre Hospitalier René Dubos, Cergy Pontoise, France
  15. 15NICU, Hôpital Cochin Port Royal, Paris, France
  16. 16NICU, Hôpital Louise Michel, Evry, France
  17. 17NICU, Centre Hospitalier Victor Dupouy, Argenteuil, France
  18. 18Epippain 2 Study Group, Epippain 2 Study Group, Paris, France
  19. 19Centre National de Ressources de Lutte Contre La Douleur, Hôpital Armand-Trousseau, Paris, France
  20. 20Department of Pediatrics Critical Care Medecine Division, University of Tennessee Health Science Center, Memphis, USA

Abstract

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.

Abstract O-101 Table 1
Abstract O-101 Table 1

Five more frequent painful procedures

Abstract O-101 Table 2
Abstract O-101 Table 2

Logistic regression models factor association with the use of analgesia during 40927 painful procedures in neonates, adjusted for centres

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.

https://doi.org/10.1136/archdischild-2014-307384.168

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