Influence of risk of neurological impairment and procedure invasiveness on health professionals' management of procedural pain in neonates.

OBJECTIVES

To describe how (i) risk of neurological impairment (NI) and (ii) procedure invasiveness influence health professionals' assessment and management of procedural pain in neonates in the Neonatal Intensive Care Unit (NICU).

DESIGN

Prospective observational study.

SETTING

Three tertiary level NICUs in Canada.

PARTICIPANTS

114 neonates, 25-40 weeks gestational age (GA) undergoing painful procedures.

MAIN OUTCOME MEASURES

Physical and behavioural pain indicators and pharmacological and nonpharmacological pain interventions.

RESULTS

114 neonates at high (Cohort A, n=35), moderate (Cohort B, n=25) and low (Cohort C, n=54) risk of NI were observed during 254 painful procedures performed by 147 health professionals. Physical pain indicators were used more frequently by health professionals to assess pain with Cohorts A and B than C (p<.05). Behavioural pain indicators were used similarly across Cohorts. Nonpharmacological interventions were implemented most frequently for pain management. Physical interventions were used with 84% of procedures across Cohorts; particularly for the most invasive procedures. Infants with the highest NI risk (Cohort A) received the most behavioural interventions (p<.05) irrespective of procedural invasiveness. Pharmacological interventions were implemented with 23.2% of procedures; Cohort B received pharmacological interventions most frequently (Cohort B>A, B>C, p<.05) and for increasingly invasive procedures (p<.05).

CONCLUSIONS

Health professionals use multidimensional indicators to assess neonatal pain. Nonpharmacological interventions dominate pain management. NI risk status and procedure invasiveness are important contextual factors in neonatal pain assessment and management.