The Journal of Pain
Volume 10, Issue 7 , Pages 715-722 , July 2009

Analgesics Administered During Minor Painful Procedures in a Cohort of Hospitalized Infants: A Prospective Clinical Audit

  • Denise Harrison

      Affiliations

    • Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
    • School of Nursing and Social work, The University of Melbourne, Melbourne, Australia
    • Department of Paediatrics, The University of Melbourne, Melbourne, Australia
    • Critical Care & Neurosciences, Murdoch Childrens Research Institute, Melbourne, Australia
    • Corresponding Author InformationAddress reprint requests to Dr Denise Harrison, Centre for Nursing and the Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, 555 University Avenue, Toronto, Ontario, Canada, M5G 1X8.
    • ,
  • Peter Loughnan

      Affiliations

    • Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
    • ,
  • Elizabeth Manias

      Affiliations

    • School of Nursing and Social work, The University of Melbourne, Melbourne, Australia
    • ,
  • Linda Johnston

      Affiliations

    • Department of Neonatology, Royal Children's Hospital, Melbourne, Australia
    • School of Nursing and Social work, The University of Melbourne, Melbourne, Australia
    • Critical Care & Neurosciences, Murdoch Childrens Research Institute, Melbourne, Australia

Received 21 October 2008 ,Revised 5 December 2008 ,Accepted 17 December 2008.

References 

  1. American Academy of Pediatrics. Canadian Paediatric Society: Prevention and management of pain and stress in the neonate. Pediatrics. 2000;105:454–461
  2. Anand KJ. Effects of perinatal pain and stress. Brain Res. 2000;122:117–129
  3. Anand KJ, Barton BA, McIntosh N, Lagercrantz H, Pelausa E, Young TE, et al. Analgesia and sedation in preterm neonates who require ventilatory support: Results from the NOPAIN trial: Neonatal Outcome and Prolonged Analgesia in Neonates. Arch Pediatr Adolesc Med. 1999;153:331–338
  4. Anand KJ, Hall RW, Desai N, Shephard B, Bergqvist LL, Young TE, et al. Neopain Trial Investigators Group. Effects of morphine analgesia in ventilated preterm neonates: Primary outcomes from the NEOPAIN randomised trial. Lancet. 2004;363:1673–1682
  5. Anand KJ. International Evidence-Based Group for Neonatal Pain: Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med. 2001;155:173–180
  6. Australian College of Neonatal Nurses. Position Statement Number 2003/2, Management of pain in sick hospitalised infants. 2004. Available at: www.acnn.org.au. Accessed October 13, 2008.
  7. Barker DP, Rutter N. Exposure to invasive procedures in neonatal intensive care unit admissions. Arch Dis Child. 1995;72:F47–F48
  8. Blass E, Ciaramitaro V. A new look at some old mechanisms in human newborns. Monogr Soc Res Child Dev. 1994;59:
  9. Boyle EM, Freer Y, Khan-Orakzai Z, Watkinson M, Wright E, Ainsworth JR, et al. Sucrose and non-nutritive sucking for the relief of pain in screening for retinopathy of prematurity: A randomised controlled trial. Arch Dis Child Fetal Neonatal Ed. 2006;91:F166–F168
  10. Bremerich DH, Neidhart G, Heimann K, Kessler P, Behne M. Prophylactically-administered rectal acetaminophen does not reduce postoperative opioid requirements in infants and small children undergoing elective cleft palate repair. Anesth Analg. 2001;92:907–912
  11. Buskila D, Neumann L, Zmora E, Feldman M, Bolotin A, Press J. Pain sensitivity in prematurely born adolescents. Arch Pediatr Adolesc Med. 2003;157:1079–1082
  12. Carbajal R, Lenclen R, Jugie M, Paupe A, Barton BA, Anand KJS. Morphine does not provide adequate analgesia for acute procedural pain among preterm neonates. Pediatrics. 2005;115:1494–1500
  13. Carbajal R, Rousset A, Danan C, Coquery S, Nolent P, Ducrocq S, et al. Epidemiology and treatment of painful procedures in neonates in intensive care units. JAMA. 2008;300:60–70
  14. Carbajal R, Veerapen S, Couderc S, Jugie M, Ville Y. Analgesic effect of breast feeding in term neonates: Randomised controlled trial. BMJ. 2003;326:13
  15. Evans JC, McCartney EM, Lawhon G, Galloway J. Practice applications of research: Longitudinal comparison of preterm pain responses to repeated heelsticks. Pediatr Nurs. 2005;31:216–221
  16. Franck LS. Some pain, some gain: Reflections on the past two decades of neonatal pain research and treatment. Neonatal Netw. 2002;21:37–41
  17. Gal P, Kissling GE, Young WO, Dunaway KK, Marsh VA, Jones SM, et al. Efficacy of sucrose to reduce pain in premature infants during eye examinations for retinopathy of prematurity. Ann Pharmacother. 2005;39:1029–1033
  18. Grabska J, Walden P, Lerer T, Kelly C, Hussain N, Donovan T, et al. Can oral sucrose reduce the pain and distress associated with screening for retinopathy of prematurity?. J Perinatol. 2005;25:33–35
  19. Gradin M, Schollin J. The role of endogenous opioids in mediating pain reduction by orally administered glucose among newborns. Pediatrics. 2005;115:1004–1007
  20. Gray L, Miller LW, Philipp BL, Blass EM. Breastfeeding is analgesic in healthy newborns. Pediatrics. 2002;109:590–593
  21. Gray L, Watt L, Blass EM. Skin-to-skin contact is analgesic in healthy newborns. Pediatrics. 2000;105:e14
  22. Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. 2004;8:iii–iv
  23. Grunau RE, Weinberg J, Whitfield MF. Neonatal procedural pain and preterm infant cortisol response to novelty at 8 months. Pediatrics. 2004;114:e77–e84
  24. Harrison D: Oral sucrose for procedural pain management in infants. 2001, updated 2006. Melbourne, Australia, Royal Children's Hospital
  25. Harrison D, Johnston L, Loughnan P. Oral sucrose for procedural pain in sick hospitalized infants: A randomized-controlled trial. J Paediatr Child Health. 2003;39:591–597
  26. Harrison D, Johnston L, Loughnan P, Manias E. Erratum, re: oral sucrose for procedural pain in sick hospitalized infants: A randomized-controlled trial (J Paediatr Child Health 2003;39:5917). J Paediatr Child Health. 2005;41:535
  27. Harrison D, Loughnan P, Manias E, Johnston L. The effectiveness of repeated doses of oral sucrose in reducing procedural pain during the course of an infant's prolonged hospitalisation. J Paediatr Child Health. 2007;43:A20
  28. Henderson-Smart D. Australian and New Zealand Neonatal Network: Evidence Uptake Using Networks: Newborn Pain project. Sydney: National Institute of Clinical Studies, National Health and Medical Research Council; 2007;
  29. Howard CR, Howard FM, Weitzman ML. Acetaminophen analgesia in neonatal circumcision: The effect on pain. Pediatrics. 1994;93:641–646
  30. Johnston CC, Collinge JM, Henderson SJ, Anand KJ. A cross-sectional survey of pain and pharmacological analgesia in Canadian neonatal intensive care units. Clin J Pain. 1997;13:308–312
  31. Johnston CC, Filion F, Snider L, Majnemer A, Limperopoulos C, Walker CD, et al. Routine sucrose analgesia during the first week of life in neonates younger than 31 weeks' postconceptional age. Pediatrics. 2002;110:523–528
  32. Johnston CC, Stevens B, Pinelli J, Gibbins S, Filion F, Jack A, et al. Kangaroo care is effective in diminishing pain response in preterm neonates. Arch Pediatr Adolesc Med. 2003;157:1084–1088
  33. Ludington-Hoe SM, Hosseini R, Torowicz DL. Skin-to-skin contact (Kangaroo Care) analgesia for preterm infant heel stick. AACN Clin Issues. 2005;16:373–387
  34. Mitchell A, Stevens B, Mungan N, Johnson W, Lobert S, Boss B. Analgesic effects of oral sucrose and pacifier during eye examinations for retinopathy of prematurity. Pain Manag Nurs. 2004;5:160–168
  35. Moustogiannis AN, Raju TN, Roohey T, McCulloch KM. Intravenous morphine attenuates pain induced changes in skin blood flow in newborn infants. Neurol Res. 1996;18:440–444
  36. Mucignat V, Ducrocq S, Lebas F, Mochel F, Baudon JJ, Gold F. Analgesic effects of EMLA cream and saccharose solution for subcutaneous injections in preterm newborns: A prospective study of 265 injections. Archives de Pediatrie. 2004;11:921–925
  37. Pokela ML. Pain relief can reduce hypoxemia in distressed neonates during routine treatment procedures. Pediatrics. 1994;93:379–383
  38. Porter FL, Anand KJ. Epidemiology of pain in neonates. Res Clin Forum. 1998;20:9–16
  39. Porter FL, Wolf CM, Gold J, Lotsoff D, Miller JP. Pain and pain management in newborn infants: A survey of physicians and nurses. Pediatrics. 1997;100:626–632
  40. Porter FL, Wolf CM, Miller JP. Procedural pain in newborn infants: The influence of intensity and development. Pediatrics. 1999;104:e13
  41. Ramenghi LA, Griffith GC, Wood CM, Levene MI. Effect of non-sucrose sweet tasting solution on neonatal heel prick responses. Arch Dis Child. 1996;74:F129–F131
  42. Rennix C, Manjunatha CM, Ibhanesebhor SE. Pain relief during common neonatal procedures: A survey. Arch Dis Child Fetal Neonatal Ed. 2004;89:F563
  43. Rohrmeister K, Kretzer V, Berger A, Haiden N, Kohlhauser C, Pollak A. Pain and stress management in the Neonatal Intensive Care Unit: A national survey in Austria. Wien Klin Wochenschr. 2003;115:715–719
  44. Royal Australasian College of Physicians: Guideline Statement: Management of Procedure-related Pain in Neonates. Sydney: Paediatrics and Child Health Division, The Royal Australasian College of Physicians; 2005;
  45. Rush R, Rush S, Ighani F, Anderson B, Irwin M, Naqvi M. The effects of comfort care on the pain response in preterm infants undergoing screening for retinopathy of prematurity. Retina. 2005;25:59–62
  46. Sabrine N, Sinha S. Pain in neonates. Lancet. 2000;355:932–933
  47. Schechter N. Neonatal pain. J Paediatr Child Health. 2006;42:2–3
  48. Shah V, Ohlsson A. The effectiveness of premedication for endotracheal intubation in mechanically ventilated neonates: A systematic review. Clin Perinatol. 2002;29:535–554
  49. Shah V, Ohlsson A: Venepuncture versus heel lance for blood sampling in term neonates. The Cochrane Database of Systematic Reviews; Article No: CD001452.pub2.DOI:10.1002/14651858.CD001452.pub2., 2004
  50. Simons SH, van Dijk M, van Lingen RA, Roofthooft D, Duivenvoorden HJ, Jongeneel N, et al. Routine morphine infusion in preterm newborns who received ventilatory support: A randomized controlled trial. JAMA. 2003;290:2419–2427
  51. Simons SHP, Van Dijk M, Anand KS, Roofthooft D, van Lingen RA, Tibboel D. Do we still hurt newborn babies? A prospective study of procedural pain and analgesia in neonates. Arch Pediatr Adolesc Med. 2003;157:1058–1064
  52. Spence K, Gillies D, Johnston L, Harrison D, Nagy S. A reliable pain assessment tool for clinical assessment in the neonatal intensive care. J Obstet Gynecol Neonatal Nurs. 2005;34:80–86
  53. StataCorp . Stata Statistical Software. College Station, TX: Stata Press; 2005;
  54. Stevens B, McGrath P, Gibbins S, Beyene J, Breau L, Camfield C, et al. Procedural pain in newborns at risk for neurologic impairment. Pain. 2003;105:27–35
  55. Stevens B, Yamada J, Beyene J, Gibbins S, Petryshen P, Stinson J, et al. Consistent management of repeated procedural pain with sucrose in preterm neonates: Is it effective and safe for repeated use over time?. Clin J Pain. 2005;21:543–548
  56. Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures (Cochrane Review). The Cochrane Library, Issue 1. Chichester, UK: John Wiley & Sons, Ltd; 2004;
  57. Taddio A, Shah V, Shah P, Katz J. Beta-endorphin concentration after administration of sucrose in preterm infants. Arch Pediatr Adolesc Med. 2003;157:1071–1074

 Supported by an Australian Postgraduate Award and a Murdoch Childrens Research Institute trainee award for the duration of this study (Dr Harrison).

 There are no conflicts of interest to declare. There were no sponsors and no financial gain occurred for any authors at any stage throughout this study.

PII: S1526-5900(09)00009-1

doi: 10.1016/j.jpain.2008.12.011

The Journal of Pain
Volume 10, Issue 7 , Pages 715-722 , July 2009

Article Tools

* Image Usage & Resolution