Nature and frequency of painful procedures and procedural pain management practices in neonatal units in Kenya

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“Our findings suggest that education is needed on how to assess and manage procedural pain in neonatal units in Kenya.” Kyololo et al (2014).

Reference:

Kyololo, O.M., Stevens, B., Gastaldo, D. and Gisore, P. (2014) Procedural pain in neonatal units in Kenya. Archives of Disease in Childhood. Fetal and Neonatal Edition. July 4th. [epub ahead of print].

Abstract:

OBJECTIVES: To determine the nature and frequency of painful procedures and procedural pain management practices in neonatal units in Kenya.

DESIGN: Cross-sectional survey.

SETTING: Level I and level II neonatal units in Kenya.

PATIENTS: Ninety-five term and preterm neonates from seven neonatal units.

METHODS: Medical records of neonates admitted for at least 24 h were reviewed to determine the nature and frequency of painful procedures performed in the 24 h period preceding data collection (6:00 to 6:00) as well as the pain management interventions (eg, morphine, breastfeeding, skin-to-skin contact, containment, non-nutritive sucking) that accompanied each procedure.

RESULTS: Neonates experienced a total of 404 painful procedures over a 24 h period (mean=4.3, SD 2.0; range 1-12); 270 tissue-damaging (mean=2.85, SD 1.1; range 1-6) and 134 non-tissue-damaging procedures (mean=1.41, SD 1.2; range 0-6). Peripheral cannula insertion (27%) and intramuscular injections (22%) were the most common painful procedures. Ventilated neonates and neonates admitted in level II neonatal units had a higher number of painful procedures than those admitted in level I units (mean 4.76 vs 2.96). Only one procedure had a pain intensity score documented; and none had been performed with any form of analgesia.

CONCLUSIONS: Neonates in Kenya were exposed to numerous tissue-damaging and non-tissue-damaging procedures without any form of analgesia. Our findings suggest that education is needed on how to assess and manage procedural pain in neonatal units in Kenya.

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