EPEATED INVASIVE PROCEdures occur routinely in neonates who require intensive care, causing pain at a time when it is developmentally unexpected. 1 Neonates are more sensitive to pain than older infants, children, and adults, 2 and this hypersensitivity is exacerbated in preterm neonates. 3 Multiple lines of evidence suggest that repeated and prolonged pain exposure alters their subsequent pain processing, long-term development, and behavior. 4,5 It is essential, therefore, to prevent or treat pain in neonates. Numerous pharmacological and nonpharmacological treatments can alleviate procedural pain in neonates. 6 As a consequence, national 7 and international 6 evidence-based guidelines have been issued for preventing or treating neonatal pain and its adverse consequences. The burden of procedural pain in the neonatal intensive care unit (NICU) has been reported in previous singlecenter studies 8-11 and a multicenter study. 12 The latter study was based on chart review and was not directly observational. Effective strategies to improve pain management in neonates require a better understanding of the epidemiology and management of procedural pain. We report epidemiological data on neonatal pain collected Context Effective strategies to improve pain management in neonates require a clear understanding of the epidemiology and management of procedural pain. Objective To report epidemiological data on neonatal pain collected from a geographically defined region, based on direct bedside observation of neonates.

BackgroundIntubation and extubation of ventilated patients are not risk-free procedures in the intensive care unit (ICU) and can be associated with morbidity and mortality. Intubation in the ICU is frequently required in emergency situations for patients with an unstable cardiovascular or respiratory system. Under these circumstances, it is a high-risk procedure with life-threatening complications (20–50%). Moreover, technical problems can also give rise to complications and several new techniques, such as videolaryngoscopy, have been developed recently. Another risk period is extubation, which fails in approximately 10% of cases and is associated with a poor prognosis. A better understanding of the cause of failure is essential to improve success procedure.Results and conclusionIn constructing these guidelines, the SFAR/SRLF experts have made use of new data on intubation and extubation in the ICU from the last decade to update existing procedures, incorporate more recent advances and propose algorithms.

The data suggest that gestational age, requirement of neonatal oxygen supplementation, bronchopulmonary dysplasia and tracheal colonisation with Haemophilus influenzae are correlated with prolonged mechanical ventilation in children with bronchiolitis. Only bronchopulmonary dysplasia was associated with a need for extracorporeal membrane oxygenation that may provide lifesaving support in infants refractory to conventional management.

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