The online version of this article (doi:10.1186/s13052-017-0343-2) contains supplementary material, which is available to authorized users.
We aimed to examine current bedside analgesia/sedation (A/S) and pain assessment (PA) practices in Italian neonatal intensive care units (NICUs) in relation to the findings of an epidemiological European study and recently-introduced national guidelines.
We analyzed the Italian data from the EUROPAIN (EUROpean-Pain-Audit-In-Neonates) prospective observational study on A/S practices that involved 6680 newborns admitted to tertiary-level NICUs in 18 European countries. Demographics, type of assisted ventilation, type and mode of A/S administration and PA were analyzed. Multivariate linear regression models were used to identify factors predicting A/S and PA practices.
From October 1st, 2012 to June 30th, 2013, thirty Italian NICUs gathered data on 422 newborn: 131 on invasive ventilation (IV); 150 on noninvasive ventilation (NIV); and 141 on spontaneous ventilation (SV). A/S was documented for 35.3% of all infants admitted (86.3% IV; 17.3% NIV; 7.1% SV [p = 0.0001]), and varied considerably between NICUs (as reported in other European countries). Strong analgesics were used in 32.5% of cases, sedatives in 10.2%, mild analgesics in 3.8%. Fentanyl was used in 78.6% of cases, morphine in 8.4%, neuromuscular blockers in 5.3%, midazolam in 22.1%. The performance of PA was documented in 67.5% of all newborn (85.5% IV; 67.3% NIV; 51.1% SV [p = 0.001]). Illness severity, type of ventilation, bedside PA, and number of NICU beds were all factors associated with A/S use on multivariate analysis, while gestational age ≤ 32 weeks, and type of ventilation and presence of a pain team were associated with PA.
We documented a generally widespread, but still highly variable use of A/S and PA at Italian NICUs, despite the diffusion of national guidelines. There is an urgent need to improve routine PA to enable customized pain and stress control (and prevention) in all infants.
Clinical Trials.gov # NCT01694745.
Additional file 1: Table S1. Demographics of the study population < 33 weeks gestational age. (DOC 55 kb)13052_2017_343_MOESM1_ESM.doc
Lago P, Merazzi D, Garetti E, Pieragostini L, et al. Guidelines for procedural pain in the newborn. Acta Pediatrica. 2009;98:932–9. CrossRef
Lago P, Garetti E, Ancora G, Merazzi D, for the Pain Study Group of the Italian Society of Neonatology, et al. Procedural pain in neonates: the state of the art in the implementation of national guidelines in Italy. Pediatr Anesth. 2013;23(5):407–14. CrossRef
Lund GC, Green D, Browne R, Ackerman N. New CRIB Score: one score for all NICU admissions. Pediatr Res. 1997;41:162. CrossRef
Ng E, Taddio A, Ohlsson A. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Cochrane Database Syst Rev. 2012;6, CD002052.
Lago P, Garetti E, Pirelli A, Merazzi D, et al. Linee Guida per la prevenzione ed il trattamento del dolore nel neonato. Edizioni Biomedia giugno. 2016.
Demsey EM, Hazzani Al F, Faucher D, Barrington KJ. Facilitation endotracheal intubation with mivacurium and fentanyl in the neonatal intensive care unit. Arch Dis Child Fetal Neonatal Ed. 2006;91:F279–282. CrossRef
Alexander SM, Todres ID. The use of sedation and muscle relaxation in the ventilated infants. Clin Perinatol. 1998;25(1):63–78. PubMed
Bellù R, de Waal WK, Zanini R. Opioids for neonates receiving mechanical ventilation. Cochrane Database Syst Rev. 2008;23(1):CD004212.
- Sedation and analgesia practices at Italian neonatal intensive care units: results from the EUROPAIN study
Anna Chiara Frigo
Kanwaljeet J. S. Anand
- BioMed Central
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