Department of Pediatrics, Pramukhswami Medical College , Karamsad-Anand , India.
Department of Pediatrics, Pramukhswami Medical College, Karamsad-Anand, India; Central Research Services, Charutar Arogya Mandal, Karamsad-Anand, India.
Front Pediatr. 2016 Feb 23;4:7. doi: 10.3389/fped.2016.00007. eCollection 2016.
Neonates in the neonatal intensive care unit (NICU) undergo a multitude of painful and stressful procedures during the first days of life. Stress from this pain can lead to neurodevelopmental problems that manifest in later childhood and should be prevented.
To determine the number of painful procedures performed per day for each neonate, to verify documentation of painful procedures performed, and to, subsequently, note missed opportunities for providing pain relief to neonates.
We conducted a cross-sectional study at a level III NICU located in a rural part of western India. A total of 69 neonates admitted for more than 24 h were included. Twenty-nine neonates were directly observed for a total of 24 h each, and another 40 neonatal records were retrospectively reviewed for the neonate's first 7 days of admission. All stressful and painful procedures performed on the neonate were recorded. Also recorded were any pharmaceutical pain relief agents or central nervous system depressants administered to the neonate before or at the time of the procedures. Average nurse-patient ratio was also calculated. Data were analyzed using descriptive statistics.
A documentation deficit of 2.2% was observed. The average nurse-patient ratio was 1.53:1. A total of 13711 procedures were recorded, yielding 44.1 (38.1 stressful, 3.8 mildly painful, and 2.2 moderately painful) procedures per patient day. Common stressful procedures were position changing (2501) and temperature recording (2208). Common mildly and moderately painful procedures were heel prick (757) and endotracheal suctioning (526), respectively. Use of pharmacological agents coincided with 33.48% of the procedures. The choice of drug and time of administration were inappropriate, indicating that the pharmacological agents were intended not for pain relief but rather for a coexisting pathology or as sedation from ventilation with no analgesia.
Stressful procedures are common in the NICU; mildly and moderately painful procedures fairly common. Almost two-thirds of the times, no pharmaceutical pain relief methods were used, and when administered, the pharmaceutical agents were seldom intended for pain relief; this implies poor pain management practices and emphasizes the imperative need for educating NICU nurses, residents, fellows, and attendings.
新生儿重症监护病房（NICU）中的新生儿在生命的头几天会经历许多痛苦和有压力的程序。这种疼痛带来的压力会导致神经发育问题，这些问题会在以后的儿童时期表现出来，因此应该加以预防。
确定每天对每个新生儿进行的有痛程序的数量，验证已执行的有痛程序的记录，随后记录对新生儿提供疼痛缓解的错失机会。
我们在印度西部农村地区的三级 NICU 进行了一项横断面研究。共纳入了 69 名住院时间超过 24 小时的新生儿。对 29 名新生儿进行了总共 24 小时的直接观察，对另外 40 名新生儿的住院前 7 天的记录进行了回顾性审查。记录了对新生儿进行的所有有压力和有痛的程序。还记录了在程序前或程序进行时给予新生儿的任何药物性疼痛缓解剂或中枢神经系统抑制剂。还计算了平均护士与患者的比例。使用描述性统计数据对数据进行分析。
观察到有 2.2%的记录缺失。平均护士与患者的比例为 1.53:1。共记录了 13711 次程序，得出每个患者日有 44.1 次（38.1 次有压力，3.8 次轻度疼痛，2.2 次中度疼痛）程序。常见的有压力的程序是改变体位（2501 次）和体温记录（2208 次）。常见的轻度和中度疼痛的程序分别是足跟采血（757 次）和经气管吸引（526 次）。药物治疗与 33.48%的程序同时发生。药物的选择和给药时间不合适，表明药物不是用于缓解疼痛，而是用于治疗共存的病理，或者作为没有镇痛作用的通气镇静剂。
在 NICU 中，有压力的程序很常见；轻度和中度疼痛的程序也很常见。几乎三分之二的情况下，没有使用药物性疼痛缓解方法，而在使用时，药物也很少是用于缓解疼痛；这意味着疼痛管理实践不佳，并强调了对 NICU 护士、住院医师、研究员和主治医生进行教育的必要性。
