International Journal of Nursing Studies
Volume 46, Issue 5 , Pages 624-632 , May 2009

Utilization of analgesics, sedatives, and pain scores in infants with a prolonged hospitalization: A prospective descriptive cohort study

  • Denise Harrison

      Affiliations

    • School of Nursing, The University of Melbourne, Australia
    • Department of Neonatology, Royal Children’s Hospital, Melbourne, Australia
    • Department of Paediatrics, The University of Melbourne, Australia
    • Critical Care & Neurosciences, Murdoch Childrens Research Institute, Australia
    • Corresponding Author InformationCorresponding author at: Centre for Nursing and the Child Health Evaluative Sciences, Hospital for Sick Children, Toronto, 555 University Avenue Toronto, Ontario, Canada M5G 1X8. Tel.: +1 416 946 0674; fax: +1 416 978 8222.
  • ,
  • Peter Loughnan

      Affiliations

    • Department of Neonatology, Royal Children’s Hospital, Melbourne, Australia
    • Department of Paediatrics, The University of Melbourne, Australia
  • ,
  • Elizabeth Manias

      Affiliations

    • School of Nursing, The University of Melbourne, Australia
  • ,
  • Linda Johnston

      Affiliations

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

Received 25 August 2008 ,Revised 24 October 2008 ,Accepted 4 November 2008.

References 

  1. Alexander J, Manno M. Underuse of analgesia in very young pediatric patients with isolated painful injuries. Annals of Emergency Medicine. 2003;41(5):617–622
  2. American Academy of Pediatrics, Committee on Psychosocial Aspects of Child and Family Health, & Task Force on Pain in Infants Children and Adolescents . The assessment and management of acute pain in infants, children, and adolescents. Pediatrics. 2001;108(3):793–797
  3. Anand KJ, Aranda JV, Berde CB, Buckman S, Capparelli EV, Carlo W, et al. Summary proceedings from the neonatal pain-control group. Pediatrics. 2006;117(3 Pt 2):S9–S22
  4. Anand KJ, Aranda JV, Berde CB, Buckman S, Capparelli EV, Carlo WA, et al. Analgesia and anesthesia for neonates: study design and ethical issues. Clinical Therapeutics. 2005;27(6):814–843
  5. 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. Archives of Pediatrics & Adolescent Medicine. 1999;153(4):331–338
  6. Anand KJ, Hall RW, Desai N, Shephard B, Bergqvist LL, Young TE, et al. Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet. 2004;363(9422):1673–1682
  7. Anand KJ, International Evidence-Based Group for Neonatal Pain . Consensus statement for the prevention and management of pain in the newborn. Archives of Pediatrics & Adolescent Medicine. 2001;155(2):173–180
  8. Anand KJS, Soriano SG. Anesthetic agents and the immature brain: are these toxic or therapeutic?. Anesthesiology. 2004;101(2):527–530
  9. Anderson B, Anderson M, Hastie B. Paracetamol prescribing habits in a children’s hospital. New Zealand Medical Journal. 1996;109(1031):376–378
  10. Anderson BJ, Lin YC, Sussman H, Benitz WE. Paracetamol pharmacokinetics in the premature neonate; the problem with limited data. Paediatric Anaesthesia. 1998;8(5):442–444
  11. Anderson BJ, Palmer GM. Recent developments in the pharmacological management of pain in children. Current Opinion in Anaesthesiology. 2006;19(3):285–292
  12. Arana A, Morton NS, Hansen TG. Treatment with paracetamol in infants. Acta Anaesthesiologica Scandinavica. 2001;45(1):20–29
  13. Bellu R, de Waal KA, Zanini R. Opioids for neonates receiving mechanical ventilation. The Cochrane Library, Issue 1. Chichester, UK: John Wiley & Sons, Ltd.; 2005;
  14. Bergman I, Steeves M, Burckart G, Thompson A. Reversible neurologic abnormalities associated with prolonged intravenous midazolam and fentanyl administration. Journal of Pediatrics. 1991;119(4):644–649
  15. Blass E, Ciaramitaro V. A new look at some old mechanisms in human newborns. Monographs of the Society for Research in Child Development. 1994;59(1):
  16. 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. Anesthesia & Analgesia. 2001;92(4):907–912
  17. 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(6):1494–1500
  18. 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(1):60–70
  19. Conroy S, Peden V. Unlicensed and off label analgesic use in paediatric pain management. Paediatric Anaesthesia. 2001;11(4):431–436
  20. Cunliffe M. Codeine phosphate in children: time for re-evaluation?. British Journal of Anaesthesia. 2001;86(3):329–331
  21. Dawson KP, McIlvenny S, Quinn S, Harron DW. Paracetamol prescribing—an epidemic?. Family Practice. 1996;13(2):179–181
  22. Debillon T, Bureau V, Savagner C, Zupan-Simunek V, Carbajal R. French National Federation of Neonatologists. Pain management in French neonatal intensive care units. Acta Paediatrica. 2002;91(7):822–826
  23. Duhn LJ, Medves JM. A systematic integrative review of infant pain assessment tools. Advances in Neonatal Care. 2004;4(3):126–140
  24. Fidler P, Kalman BA, Ziemer HE, Green KF. Early onset of reduced morphine analgesia by ingestion of sweet solutions. Physiology & Behavior. 1993;53(1):167–171
  25. Franck LS. A national survey of the assessment and treatment of pain and agitation in the neonatal intensive care unit. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 1987;16(6):387–393
  26. Franck LS. Some pain, some gain: reflections on the past two decades of neonatal pain research and treatment. Neonatal Network. 2002;21(5):37–41
  27. Gharavi B, Schott C, Nelle M, Reiter G, Linderkamp O, Gharavi B, et al. Pain management and the effect of guidelines in neonatal units in Austria. Germany and Switzerland. Pediatrics International. 2007;49(5):652–658
  28. Gray PH, Trotter JA, Langbridge P, Doherty CV. Pain relief for neonates in Australian hospitals: a need to improve evidence-based practice. Journal of Paediatrics and Child Health. 2006;42(1–2):10–13
  29. Hansen TG, O’Brien K, Morton NS, Rasmussen SN. Plasma paracetamol concentrations and pharmacokinetics following rectal administration in neonates and young infants. Acta Anaesthesiologica Scandinavica. 1999;43(8):855–859
  30. Harrison D. Oral Sucrose for Procedural Pain Management in Infants. Melbourne, Australia: Royal Children’s Hospital; 2001;(updated 2006)
  31. Harrison D. Assessment of pain in sick hospitalised infants. Neonatal, Paediatric & Child Health Nursing. 2006;9(2):25–29(Position Statement)
  32. Harrison D, Johnston L, Loughnan P. Oral sucrose for procedural pain in sick hospitalized infants: a randomized-controlled trial. Journal of Paediatrics & Child Health. 2003;39(8):591–597
  33. Harrison D, Loughnan P, Johnston L. Pain assessment and procedural pain management practices in neonatal units in Australia. Journal of Paediatrics and Child Health. 2006;42(1–2):6–9
  34. 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. Journal of Paediatrics & Child Health. 2007;43(Supplement 1):A20
  35. Heaton P, Herd D, Fernando A, Heaton P, Herd D, Fernando A. Pain relief for simple procedures in New Zealand neonatal units: practice change over 6 years. Journal of Paediatrics & Child Health. 2007;43(5):394–397
  36. Hodgkinson K, Bear M, Thorn J, van Blaricum S. Measuring pain in neonates: evaluating an instrument and developing a common language. Australian Journal of Advanced Nursing. 1994;12(1):17–22
  37. Holder MD, Bolger GT. Chronic sweet intake lowers pain thresholds without changing brain mu- or delta-opiate receptors. Behavioral & Neural Biology. 1988;50(3):335–343
  38. Howard CR, Howard FM, Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics. 1994;93(4):641–646
  39. Hummel P, van Dijk M. Pain assessment: current status and challenges. Seminars in Fetal and Neonatal Medicine. 2006;11(4):237–245
  40. Johnston CC, Collinge JM, Henderson SJ, Anand KJ. A cross-sectional survey of pain and pharmacological analgesia in Canadian neonatal intensive care units. Clinical Journal of Pain. 1997;13(4):308–312
  41. Johnston CC, Filion F, Snider L, Limperopoulos C, Majnemer A, Pelausa E, et al. How much sucrose is too much sucrose?. Pediatrics. 2007;119(1):
  42. 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(3):523–528
  43. Lago P, Guadagni A, Merazzi D, Ancora G, Bellieni CV, Cavazza A, et al. Pain management in the neonatal intensive care unit: a national survey in Italy. Paediatric Anaesthesia. 2005;15(11):925–931
  44. Lamb SA, Henry RL. Paracetamol pro re nata orders: an audit. Journal of Paediatrics & Child Health. 2004;40(4):213–216
  45. Larsson BA. Pain management in neonates. Acta Paediatrica. 1999;88(12):1301–1310
  46. Lieblich I, Cohen E, Ganchrow JR, Blass EM, Bergmann F. Morphine tolerance in genetically selected rats induced by chronically elevated saccharin intake. Science. 1983;221(4613):871–873
  47. Lin YC, Sussman HH, Benitz WE. Plasma concentrations after rectal administration of acetaminophen in preterm neonates. Paediatric Anaesthesia. 1997;7(6):457–459
  48. Menon G, Anand KJ, McIntosh N. Practical approach to analgesia and sedation in the neonatal intensive care unit. Seminars in Perinatology. 1998;22(5):417–424
  49. Ng E, Klinger G, Shah V, Taddio A. Safety of benzodiazepines in newborns. The Annals of Pharmacotherapy. 2002;36(7–8):1150–1155
  50. Ng E, Taddio A, Ohlsson A. Intravenous midazolam infusion for sedation of infants in the neonatal intensive care unit. Cochrane Database of Systematic Reviews. 2005;1:CD002052
  51. Penna AC, Dawson KP, Penna CM. Is prescribing paracetamol ‘pro re nata’ acceptable?. Journal of Paediatrics & Child Health. 1993;29(2):104–106
  52. Reyes S. Nursing assessment of infant pain. Journal of Perinatal & Neonatal Nursing. 2003;17(4):291–303
  53. 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. Wiener Klinische Wochenschrift. 2003;115(19–20):715–719
  54. Schechter N. Neonatal pain. Journal of Paediatrics and Child Health. 2006;42(1–2):2–3
  55. Shah V, Taddio A, Ohlsson A. Randomised controlled trial of paracetamol for heel prick pain in neonates. Archives of Disease in Childhood: Fetal & Neonatal Edition. 1998;79(3):F209–211
  56. Simons SHP, Anand KJS. Pain control: opioid dosing, population kinetics and side-effects. Seminars in Fetal and Neonatal Medicine. 2006;11(4):260–267
  57. Simons SHP, Van Dijk M, Anand KS, Roofthooft D, van Lingen R, Tibboel D. Do We Still Hurt Newborn Babies?: a prospective study of procedural pain and analgesia in neonates. Archives of Pediatrics & Adolescent Medicine. 2003;157(11):1058–1064
  58. Spence K, Gillies D, Johnston L, Harrison D, Nagy S. A reliable pain assessment tool for clinical assessment in the neonatal intensive care. Journal of Obstetric, Gynecologic & Neonatal Nursing. 2005;34(1):80–86
  59. StataCorp . Stata Statistical Software (Version 9.0). College Station, Texas: Stata Press; 2005;
  60. 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?. Clinical Journal of Pain. 2005;21(6):543–548
  61. 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;
  62. Taddio A. Opioid analgesia for infants in the neonatal intensive care unit. Clinics in Perinatology. 2002;29(3):493–509
  63. Tan E, Cranswick NE, Rayner CR, Chapman CB. Dosing information for paediatric patients: are they really “therapeutic orphans”?. Medical Journal of Australia. 2003;179(4):195–198
  64. Tibboel D, Anand KJ, van den Anker JN. The pharmacological treatment of neonatal pain. Seminars In Fetal & Neonatal Medicine. 2005;10(2):195–205
  65. van Dijk M, Peters JWB, van Deventer P, Tibboel D. Pain control. The COMFORT Behavior Scale: a tool for assessing pain and sedation in infants. American Journal of Nursing. 2005;105(1):33–35
  66. van Lingen RA, Deinum JT, Quak JM, Kuizenga AJ, van Dam JG, Anand KJ, et al. Pharmacokinetics and metabolism of rectally administered paracetamol in preterm neonates. Archives of Disease In Childhood: Fetal & Neonatal Edition. 1999;80(1):F59–F63
  67. van Lingen RA, Quak CM, Deinum HT, van de Logt F, van Eyck J, Okken A, et al. Effects of rectally administered paracetamol on infants delivered by vacuum extraction. European Journal of Obstetrics, Gynecology, & Reproductive Biology. 2001;94(1):73–78
  68. Walden M, Carrier CT. Sleeping beauties: the impact of sedation on neonatal development. Journal of Obstetric, Gynecologic, & Neonatal Nursing. 2003;32(3):393–401
  69. Williams DG, Patel A, Howard RF. Pharmacogenetics of codeine metabolism in an urban population of children and its implications for analgesic reliability. British Journal of Anaesthesia. 2002;89(6):839–845
  70. Zuppa AF, Adamson PC, Mondick JT, Davis LA, Maka DA, Narayan M, et al. Drug utilization in the pediatric intensive care unit: monitoring prescribing trends and establishing prioritization of pharmacotherapeutic evaluation of critically ill children. Journal of Clinical Pharmacology. 2005;45(11):1305–1312

PII: S0020-7489(08)00313-1

doi: 10.1016/j.ijnurstu.2008.11.001

International Journal of Nursing Studies
Volume 46, Issue 5 , Pages 624-632 , May 2009