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01.12.2017 | Research | Ausgabe 1/2017 Open Access

Italian Journal of Pediatrics 1/2017

Sedation and analgesia practices at Italian neonatal intensive care units: results from the EUROPAIN study

Zeitschrift:
Italian Journal of Pediatrics > Ausgabe 1/2017
Autoren:
Paola Lago, Anna Chiara Frigo, Eugenio Baraldi, Roberta Pozzato, Emilie Courtois, Jérôme Rambaud, Kanwaljeet J. S. Anand, Ricardo Carbajal
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​s13052-017-0343-2) contains supplementary material, which is available to authorized users.

Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

Trial registration

Clinical Trials.gov # NCT01694745.
Zusatzmaterial
Additional file 1: Table S1. Demographics of the study population < 33 weeks gestational age. (DOC 55 kb)
13052_2017_343_MOESM1_ESM.doc
Literatur
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