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ethanol and benzalkonium chloride. Opportunities for product substitution were defined as EOI-containing formulations for which an EOI-free product was reported in the survey with identical active pharmaceutical ingredient (API), galenic form and strength. Results Of 31 invited European countries 20 with 115 NICUs responded. A total of 564 trade names (TN) with 53 APIs were used in more than 10% of units. EOI containing formulations (n = 151) were used for 31 APIs, found overall in 363 TNs. Compared to parenteral forms (50/199; 25%), enteral (83/130; 64%) and topical TNs (18/34; 53%) contained EOI more frequently (OR; 95% CI 5.3; 3.3-8.5 and 3.4; 1.6-7.1, respectively). An EOI free substitution was available for 31/50 parenteral (63%), 17/83 enteral (21%) and 3/18 topical (17%) TNs. Overall, 51/ 151 (34%) TNs with EOI could be replaced; substitution was possible in 92/151 (61%) of cases if the requirement for identical API strength was ignored. Conclusions EOI-free formulations available on the European market could be used to reduce the number of TNs with EOI by at least a third. Background and aims In light of the current epidemic in the abuse of opioids, a major increase in neonates with neonatal abstinence syndrome (NAS) is likely. Incorporation of breastfeeding as a first pillar of treatment of NAS seems appropriate. We aimed to quantify the impact of breastfeeding on the incidence and severity of NAS. Methods Pooling of published NAS cohorts, with specific emphasis on the impact of breastfeeding on the incidence (yes/no opioid administration) and duration (duration opioids, duration hospitalisation) of NAS. O-099Results Three studies [1][2][3] were retrieved and resulted in a pooled dataset of 400 neonates (218 breastfed, 54.5%). There is a significant reduction in NAS (54 vs 77%, number needed to treat 5-6). The same trends are observed when the duration of opioid treatment (difference -18 to -23 days) or the length of hospital stay (difference -4 to -10 days) are considered.Conclusions Breastfeeding is associated with a clinical significant reduction on both the incidence and the duration of NAS in opioid exposure newborns. Incorporation of breastfeeding as a first pillar of treatment for relieving the NAS symptoms seems to be a very natural, and effective way of addressing this. REFERENCESAbdel-Lalif ME et al. Pediatrics

To describe the frequency and nature of premedication practices for neonatal tracheal intubation (TI) in 2011; to identify independent risk factors for the absence of premedication; to compare data with those from 2005 and to confront observed practices with current recommendations. Data concerning TI performed in neonates during the first 14 days of their admission to participating neonatal/pediatric intensive care units were prospectively collected at the bedside. This study was part of the Epidemiology of Procedural Pain in Neonates study (EPIPPAIN 2) conducted in 16 tertiary care units in the region of Paris, France, in 2011. Multivariate analysis was used to identify factors associated with premedication use and multilevel analysis to identify center effect. Results were compared with those of the EPIPPAIN 1 study, conducted in 2005 with a similar design, and to a current guidance for the clinician for this procedure. One hundred and twenty-one intubations carried out in 121 patients were analyzed. The specific premedication rate was 47% and drugs used included mainly propofol (26%), sufentanil (24%), and ketamine (12%). Three factors were associated with the use of a specific premedication: nonemergent TI (Odds ratio (OR) [95% CI]: 5.3 [1.49-20.80]), existence of a specific written protocol in the ward (OR [95% CI]:4.80 [2.12-11.57]), and the absence of a nonspecific concurrent analgesia infusion before TI (OR [95% CI]: 3.41 [1.46-8.45]). No center effect was observed. The specific premedication rate was lower than the 56% rate observed in 2005. The drugs used were more homogenous and consistent with the current recommendations than in 2005, especially in centers with a specific written protocol.Premedication use prior to neonatal TI was low, even for nonemergent procedures.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Background Heelstick is the most frequently performed skin-breaking procedure in the NICU. There are no large multicenter studies describing the frequency and analgesic approaches used for heelsticks performed in NICUs. Objective To describe the frequency and analgesic therapy used for heelsticks in neonates. To determine the factors associated with the use of specific analgesia prior to heelsticks. Methods EPIPPAIN2 is a descriptive epidemiological study prospectively collecting data on all heelsticks and corresponding analgesic therapies during the first 14 days of admission for all neonates admitted to 16 NICUs within the Parisian region in France. Results From May to October 2011, 562 neonates who underwent heelsticks were included. The mean (SD) gestational age was 33.3(4.4) weeks. Each neonate experienced a mean (SD) of 16.0(14.4) heelsticks during the study period (range 1–86 heelsticks). Of the 8995 heelsticks studied, 2487 (27.6%) were performed while the newborn was receiving continuous analgesia and 5236 (58.2%) were performed with specific analgesia given prior to the heelstick. Overall, 6764 (75.2%) heelsticks were performed with analgesia (continuous and/or specific analgesia). Table 1 shows the main pre-procedural analgesic regimens used. Table 2 shows a multivariate multilevel model (GEE) of factors associated with the use of pre-procedural analgesia. Abstract O-147 Table 1 The main pre-procedural analgesic regimens used for 5236 heel-sticks Abstract O-147 Table 2 GEE model of factor associated with the use of specific analgesia during 8995 in heel sticks in neonates, adjusted for centres Conclusions Heelstick is a painful procedure performed routinely and frequently in NICUs. Most heelsticks (75.2%) were carried out with some form of analgesia. Given the availability of non-invasive methods for measuring clinical variables and less painful methods for obtaining blood, the necessity of performing this procedure so frequently is questionable.

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