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O-147 Frequency Of Heelsticks And Analgesic Management In Neonates Admitted To Neonatal Intensive Care Units (nicus): Epippain 2 Study (epidemiology Of Procedural Pain In Neonates)
  1. E Courtois1,
  2. S Droutman2,
  3. JF Magny3,
  4. Z Merchaoui4,
  5. X Durrmeyer5,
  6. C Roussel6,
  7. V Biran7,
  8. S Eleni8,
  9. G Vottier9,
  10. S Renolleau10,
  11. L Desfrere11,
  12. F Castela12,
  13. N Boimond13,
  14. D Mellah14,
  15. P Bolot15,
  16. A Coursol16,
  17. D Brault17,
  18. P Cimerman18,
  19. KJS Anand19,
  20. R Carbajal1
  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 Louise Michel, Evry, France
  9. 9NICU, Hôpital Cochin Port Royal, Paris, France
  10. 10NICU, Hôpital Armand-Trousseau, Paris, France
  11. 11NICU, Hôpital Louis Mourier, Colombes, France
  12. 12NICU, Intercommunal de Poissy, Poissy, France
  13. 13NICU, Hôpital Necker, Paris, France
  14. 14NICU, Centre Hospitalier de Meaux, Meaux, France
  15. 15NICU, Centre Hospitalier de Saint-Denis, Saint-Denis, France
  16. 16NICU, Centre Hospitalier René Dubos, Cergy Pontoise, France
  17. 17NICU, Centre Hospitalier Victor Dupouy, Argenteuil, France
  18. 18Centre National de Ressources de Lutte Contre La Douleur, Hôpital Armand-Trousseau, Paris, France
  19. 19Department of Pediatrics Critical Care Medecine Division, University of Tennessee Health Science Center, Memphis, USA


Background Heelstick is the most frequently performed skin-breaking procedure in the NICU. There are no large multicenter studies describing the frequency and analgesic approaches used for heelsticks performed in NICUs.

Objective To describe the frequency and analgesic therapy used for heelsticks in neonates. To determine the factors associated with the use of specific analgesia prior to heelsticks.

Methods EPIPPAIN2 is a descriptive epidemiological study prospectively collecting data on all heelsticks and corresponding analgesic therapies during the first 14 days of admission for all neonates admitted to 16 NICUs within the Parisian region in France.

Results From May to October 2011, 562 neonates who underwent heelsticks were included. The mean (SD) gestational age was 33.3(4.4) weeks. Each neonate experienced a mean (SD) of 16.0(14.4) heelsticks during the study period (range 1–86 heelsticks). Of the 8995 heelsticks studied, 2487 (27.6%) were performed while the newborn was receiving continuous analgesia and 5236 (58.2%) were performed with specific analgesia given prior to the heelstick. Overall, 6764 (75.2%) heelsticks were performed with analgesia (continuous and/or specific analgesia). Table 1 shows the main pre-procedural analgesic regimens used. Table 2 shows a multivariate multilevel model (GEE) of factors associated with the use of pre-procedural analgesia.

Abstract O-147 Table 1

The main pre-procedural analgesic regimens used for 5236 heel-sticks

Abstract O-147 Table 2

GEE model of factor associated with the use of specific analgesia during 8995 in heel sticks in neonates, adjusted for centres

Conclusions Heelstick is a painful procedure performed routinely and frequently in NICUs. Most heelsticks (75.2%) were carried out with some form of analgesia. Given the availability of non-invasive methods for measuring clinical variables and less painful methods for obtaining blood, the necessity of performing this procedure so frequently is questionable.

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