Published online October 2, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. e992-e1000 (doi:10.1542/peds.2005-3203)
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ARTICLE

Assessing Postoperative Pain in Neonates: A Multicenter Observational Study

Bonnie J. Taylor, MDa, James M. Robbins, PhDa,b, Jeffrey I. Gold, PhDc, Tina R. Logsdon, MSd, T. M. Bird, MAPa,b and K. J. S. Anand, DPhil, MBBSa,e,f,g

a Departments of Pediatrics
e Anesthesiology
f Pharmacology
g Neurobiology and Developmental Sciences
b Center for Applied Research and Evaluation, University of Arkansas for Medical Sciences College of Medicine and Arkansas Children's Hospital Research Institute, Little Rock, Arkansas
c Departments of Anesthesiology and Pediatrics, Keck School of Medicine, University of Southern California, Childrens Hospital Los Angeles, Los Angeles, California
d Performance Improvement Division, Child Health Corporation of America, Shawnee Mission, Kansas

OBJECTIVE. A multicenter observational study was conducted to evaluate the practices of postoperative pain assessment and management in neonates to identify specific targets for improvement in clinical practice.

METHODS. Ten participating NICUs collected data for the 72 hours after a surgical operation on 25 consecutive neonates (N = 250), including demographics, principal diagnoses, operative procedure, other painful procedures, pain assessments, interventions (pharmacologic and nonpharmacologic), and adverse events in neonates who underwent minor and major surgery. Descriptive and logistic-regression analyses were performed by using SPSS and Stata.

RESULTS. The neonates studied had a birth weight of 2.4 ± 1.0 kg (mean ± SD) and gestational age of 36 ± 4.3 weeks; 57% were male, and length of hospital stay was 23.5 ± 30.0 days. Participating hospitals used 7 different numeric pain scales, with nursing pain assessments documented for 88% (n = 220) of the patients and physician pain assessments documented for 9% (n = 23) of the patients. Opioids (84% vs 60%) and benzodiazepines (24% vs 11%) were used more commonly after major surgery than minor surgery, and a small proportion (7% major surgery, 12% minor surgery) received no analgesia. Logistic-regression analyses showed that physician pain assessment was the only significant predictor of postsurgical analgesic use, whereas major surgery and postnatal age in days did not seem to contribute. Physician pain assessment was documented for 23 patients; 22 of these received postoperative analgesia.

CONCLUSIONS. Documentation of postoperative pain assessment and management in neonates was extremely variable among the participating hospitals. Pain assessment by physicians must be emphasized, in addition to developing evidence-based guidelines for postoperative care and educating professional staff to improve postoperative pain control in neonates.

Key Words: pain • newborn infant • surgery • premature infant • quality improvement • clinical audit • medical effectiveness • analgesia • stress

Abbreviations: CHCA—Child Health Corporation of America • ADE—adverse drug event • NNP—neonatal nurse practitioner • OR—odds ratio

Accepted Apr 20, 2006.