The Road to No Pain: An Audit םn Reducing Procedural Pain in the Neonatal Unit

Background: Infants admitted to the neonatal unit experience frequent invasive and painful procedures. Research has proven that neonates are hypersensitive to pain due to an immature central nervous system. (1) Long term data suggests that repeated painful procedures in this period can lead to negative neurodevelopmental outcomes, including motor and sensory disturbances, attention deficits and cognitive impairment (2).

Objective: The primary outcome of this audit was to improve practice within the neonatal unit to reduce pain during bloodletting procedures, with the aim of having 90% of neonates expressing minimum or no pain.

Methods: Practice within the neonatal unit at the time of bloodletting procedures was assessed using a modified Evaluation of Intervention (mEVIN) tool. Standardised pain scores (modified Premature Infant Pain Profile (mPIPP)) were used to monitor neonatal pain and to assess the effectiveness of our practice. Several interventions were introduced in a step wise fashion over a one month period and data recorded in real time. Interventions included an educational programme based on the Family and Infant Neurodevelopmental Education (FINE), nest audit, promotion of expressed breast milk and oral sucrose, and promotion of increased nursing presence.

Results: The most significant change in practice included a 44.85% increase in the availability of a second person to provide support during procedures, Figure 1. Minimum or no pain, defined as an mPIPP score less than 6, observed in 100% of bloodletting procedures following interventions, up from a baseline of 54.30%, figure 2.

Conclusion: Invasive procedures in the neonatal unit are often unavoidable so appropriate steps should be taken to minimise pain, with the long-term goal of improving neurodevelopmental outcomes. This audit has shown that the implementation of an education and promotion programme (‘Road to No pain’) has shown to significantly improve practice and as a result neonatal exposure to pain can be reduced.

References

1. Williams MD, Lascelles BDX. Early Neonatal Pain-A Review of Clinical and Experimental Implications on Painful Conditions Later in Life. Front Pediatr. 2020;8:30.

2. Grunau RE. Neonatal pain in very preterm infants: long-term effects on brain, neurodevelopment and pain reactivity. Rambam Maimonides Med J. 2013;4(4):e0025.