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.

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More than two-thirds of family members visiting patients in the intensive care unit suffer from symptoms of anxiety or depression. Involvement of anxious or depressed family members in end-of-life decisions should be carefully discussed.