To Örebro University

Introduction & Aims

International evidence-based guidelines for preventing or treating neonatal pain were published in 2001(1). They describe sources of acute pain and recommend approaches for pain assessment, and pharmacological and non-pharmacological management. We investigated the occurance and content of national guidelines for neonatal pain management and their compliance with international recommendations. A secondary aim was to study how intubation premedication recommendations were followed in clinical practice.

Methods

A questionnaire was distributed to neonatal societies worldwide and to members of the e-mail-lists International Pediatric pain-list, NICU-net and Council of International Neonatal Nurses-network. Additionally a search in Pubmed was done, using pain, neonatal, newborn, guideline, government publication and pain management as searchwords. A web-based survey about premedication prior to intubation of newborn infants was sent to members of the same e-mail-lists.

Results

National guidelines from 14 countries were obtained, mostly issued by professional societies from 1995 to 2011. Guidelines from 13 countries contained suggestions concerning procedural pain. Other issues were pain assessment (14 countries), postoperative pain (12) and ongoing/prolonged pain (9). Pharmacological and non-pharmacological treatment recommendations were found in 13 national guidelines. Six countries had recommendations for premedication prior to intubation. Seventy-six individuals from 27 different countries responded to the web-based survey. Seventy-one percent used premedications routinely prior to intubation. The most commonly used drug was fentanyl followed by morphine and midazolam. Thirty-four percent reported using muscle relaxant routinely, with suxamethonium as the most commonly used drug. Thirty-six percent used atropine prior to intubation.

Discussion & Conclusions

Many countries have still not developed national guidelines for management of neonatal pain. The guidelines obtained in this study comply with the international guidelines concerning their recommendations for pain assessment, actions at procedural pain, and pharmacological and non-pharmacological pain treatment. Many national guidelines do not have specific suggestions concerning dosages of drugs, management of ongoing/prolonged pain, and premedications for intubation. The web-based survey indicates that the use of premedication is still not widely adopted and there is wide variability in the drugs and doses used. The lack of evidence-based recommendations for intubation premedication in many countries also implies that the international guidelines should be revised and updated.

Reference

1. Anand, K. J. S. & the International Evidence-Based Group for Neonatal Pain (2001). Consensus statement for the prevention and management of pain in the newborn. Archives of Pediatrics and Adolescent Medicine, 155(2), 173-180.

The authors have no conflict of interest to declare.