Does neonatal pain management in intensive care units differ between night and day? An observational study

Abstract

ObjectiveTo determine whether analgesic use for painful procedures performed in neonates in the neonatal intensive care unit (NICU) differs during nights and days and during each of the 6 h period of the day.DesignConducted as part of the prospective observational Epidemiology of Painful Procedures in Neonates study which was designed to collect in real time and around-the-clock bedside data on all painful or stressful procedures.Setting13 NICUs and paediatric intensive care units in the Paris Region, France.ParticipantsAll 430 neonates admitted to the participating units during a 6-week period between September 2005 and January 2006.Data collectionDuring the first 14 days of admission, data were collected on all painful procedures and analgesic therapy. The five most frequent procedures representing 38 012 of all 42 413 (90%) painful procedures were analysed.InterventionObservational study.Main outcome assessmentWe compared the use of specific analgesic for procedures performed during each of the 6 h period of a day: morning (7:00 to 12:59), afternoon, early night and late night and during daytime (morning+afternoon) and night-time (early night+late night).Results7724 of 38 012 (20.3%) painful procedures were carried out with a specific analgesic treatment. For morning, afternoon, early night and late night, respectively, the use of analgesic was 25.8%, 18.9%, 18.3% and 18%. The relative reduction of analgesia was 18.3%, p<0.01, between daytime and night-time and 28.8%, p<0.001, between morning and the rest of the day. Parental presence, nurses on 8 h shifts and written protocols for analgesia were associated with a decrease in this difference.ConclusionsThe substantial differences in the use of analgesics around-the-clock may be questioned on quality of care grounds.

Neonatal Intensive Care Nurses' Perceptions of Parental Participation in Infant Pain Management

“…32 The reasoning for this approach was the improvements in infant pain management resulted by parental involvement. 1,4,5 Nurses in this study also identified the positive connection between learning to parent and parental involvement in pain management. 1,3 These subjective experiences further validate the earlier quantitative findings.…”

Systematic review and meta‐analysis suggest that varying prevalence of non‐acute pain in critically ill infants may be due to different definitions

“…We were unable to determine the impact of pain management practices on prevalence estimates due to inadequate reporting. Because previous studies have noted variability in pain management practices between NICUs, and within the same NICU, unit and hospital based differences in pain management practices may have contributed to the variable prevalence estimates in this review.…”

The case for quality improvement in the Neonatal Intensive Care Unit

“…This is a move towards neonate centred care within the highly technological environment of the NICU and the move is to have reliable pain control at all times [43].…”